曲美他嗪联合瑞舒伐他汀治疗缺血性心肌病心力衰竭的疗效

目的观察曲美他嗪联合瑞舒伐他汀治疗缺血性心肌病(ICM)心力衰竭的临床疗效。方法 74例ICM患者随机分为常规治疗组(对照组,37例)和曲美他嗪联合瑞舒伐他汀组(治疗组,37例)。对照组给予地高辛、利尿剂、血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂以及β受体阻滞剂治疗,治疗组在此基础上加用盐酸曲美他嗪联合瑞舒伐他汀,共6个月。观察两组患者治疗前后心功能分级、心脏收缩功能及6 min步行距离的改变。结果治疗组的显效率及总有效率均明显高于对照组(P﹤0.05)。治疗组的心功能、LVESV、LVEDV、LVEF、6 min步行试验均明显优于对照组(P<0.05),且无肝肾功能异常。结论常规治疗ICM心力衰竭基础上加用曲美他嗪联合瑞舒伐他汀,可以进一步改善患者心脏功能,且无明显不良反应。     

曲美他嗪对缺血性心肌病伴心力衰竭患者心功能的影响

目的观察曲美他嗪对缺血性心肌病伴心力衰竭患者心功能的影响。方法选取84例β-受体阻滞剂和血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体拮抗(ARB)使用禁忌的缺血性心肌病伴心力衰竭患者,随机分为曲美他嗪组和对照组各42例。曲美他嗪组在常规治疗基础上加用曲美他嗪20 mg,3次/d;对照组给予常规药物治疗,不加用曲美他嗪。随访12个月,分析治疗前、治疗后6个月和治疗后12个月时两组心率、脑利钠肽前体(proBNP)、6 min步行距离、左室射血分数(LVEF)和左室舒张末期内径(LVEDD)变化情况。结果曲美他嗪组治疗后12个月与治疗前及对照组相比,心率、proBNP明显降低,6 min步行距离明显增加,LVEF明显升高,LVEDD明显减小(均P0.05)。结论不能使用β-受体阻滞剂和ACEI/ARB的缺血性心肌病伴心力衰竭患者加用曲美他嗪治疗,可显著改善心功能。     

曲美他嗪治疗心力衰竭合并心绞痛的疗效观察

目的观察曲美他嗪片治疗心力衰竭合并心绞痛的临床疗效。方法将179例心力衰竭合并心绞痛的患者随机分为两组,对照组予常规治疗,异山梨酯(消心痛)、血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)、β受体阻滞剂(βRB)、阿司匹林、他汀类药物,间断服利尿剂。治疗组在对照组的基础上加用曲美他嗪片20mg,3次/日,坚持服3个月。结果治疗组心绞痛症状改善总有效率86.67%,优于对照组70.79%;心电图疗效有效率83.33%,优于对照组69.66%。两组治疗前后心功能左室射血分数(LVEF)、6min步行距离均得到改善,但治疗组明显优于对照组(P0.01)。结论曲美他嗪片可缓解心绞痛,并改善心功能,对缺血的心肌细胞有明显的保护作用。     

曲美他嗪治疗缺血性心肌病慢性心力衰竭合并糖尿病患者的疗效观察

目的探讨曲美他嗪治疗缺血性心肌病慢性心力衰竭合并糖尿病患者的疗效。方法选择2013-01~2014-06在驻马店市中心医院心内科住院的,诊断为缺血性心肌病慢性心力衰竭合并糖尿病患者,按纽约心脏病协会(NYHA)心功能分级标准在Ⅲ~Ⅳ级患者共60例(男42例,女18例),随机分为治疗组和对照组各30例。在给予血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)、β受体阻滞剂、洋地黄、利尿剂等常规抗心衰药物治疗的同时,治疗组加用曲美他嗪,对照组给予谷维素治疗。随访6个月,比较两组患者心脏彩色超声各指标改善情况及运动耐量情况。结果治疗组心脏超声指标左室收缩末径(LVESD)、左室舒张末径(LVEDD)、左室射血分数(LVEF)、6 min步行试验改善均明显好于对照组(P0.05),服药期间无明显不良反应发生。结论曲美他嗪可明显改善缺血性心肌病慢性心力衰竭合并糖尿病患者心功能,提高生活质量。     

曲美他嗪对老年冠心病心力衰竭患者左室功能的影响

目的 观察曲美他嗪(TMZ)对老年冠心病心力衰竭患者左室功能的影响.方法 将42例老年冠心病心力衰竭患者随机分成两组,对照组采用常规治疗,治疗组在常规治疗的基础上加用曲美他嗪口服.观察两组治疗前后NYHA心功能分级、左室收缩和舒张功能的变化情况.结果 治疗组治疗3个月后NYHA心功能分级较治疗前及对照组均无明显变化(P＞0.05),治疗6个月后较治疗前显著提高,且较对照组明显改善(P＜0.05,或＜0.01);治疗3个月和6个月后治疗组LVEF均较前显著升高,且较对照组均明显升高(P＜0.05,或＜0.01);治疗3个月后治疗组E/A较治疗前无明显变化(P＞0.05),6个月后较治疗前显著增加(P＜0.01),且较对照组明显改善(P＜0.05).结论 老年冠心病心力衰竭患者在常规抗心衰治疗基础上加用曲美他嗪能有效改善左室功能.     

增强型体外反搏联合曲美他嗪对冠心病慢性心力衰竭病人心功能的影响

目的探讨增强型体外反搏联合曲美他嗪治疗对冠心病慢性心力衰竭病人心功能的影响。方法 120例病人按随机数字表法分为对照组及治疗组。对照组给予常规抗心力衰竭治疗;治疗组在对照组基础上给予增强型体外反搏及曲美他嗪治疗,疗程均为3个月。比较两组治疗前后的左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、6 min步行试验(6MWT)、N末端脑钠肽前体(NT-proBNP)、美国纽约心脏病协会(NYHA)心功能分级等。结果治疗后两组的LVEDD、LVESD及NT-proBNP较治疗前明显下降(P0.05),LVEF、6WMT及NYHA心功能分级较治疗前明显改善(P0.05),且与对照组相比,治疗组的LVEDD、LVESD及NT-proBNP显著下降(P0.05),LVEF、6WMT明显升高(P0.05),治疗有效率明显升高(P0.05)。结论增强型体外反搏联合曲美他嗪治疗冠心病慢性心力衰竭,可显著提高LVEF,改善心功能。     

麝香保心丸联合曲美他嗪对冠心病心力衰竭患者血管内皮功能及血浆BNP的影响

目的观察麝香保心丸联合曲美他嗪治疗冠心病心力衰竭的临床疗效及对血管内皮功能、血浆脑钠肽(BNP)的影响。方法将188例冠心病心力衰竭患者随机分为两组,两组均予常规药物治疗,曲美他嗪组在常规治疗基础上加用曲美他嗪20mg,每日3次口服;联合治疗组在曲美他嗪组治疗基础上加用麝香保心丸2粒,每日3次口服,治疗3个月后对比观察两组临床症状、左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、6min步行距离及治疗前后内皮素-1(ET-1)、一氧化氮(NO)、C反应蛋白(CRP)、P-选择素及BNP浓度的变化。结果联合治疗组心功能改善更明显,总有效率90.63%,治疗后LVEF明显提高,LVEDd、CRP、ET-1、P-选择素及血浆BNP水平较治疗前均明显降低(P0.05或P0.01)。且与曲美他嗪组治疗后比较差异有统计学意义(P0.05)。结论麝香保心丸联合曲美他嗪治疗冠心病心力衰竭安全有效,可明显改善冠心病病人的血管内皮功能,降低血浆BNP浓度,减少心脏事件,可作为冠心病心力衰竭的长期治疗药物。     

曲美他嗪对心肌病伴心力衰竭患者疗效观察

目的 探讨曲美他嗪对心肌病伴心力衰竭患者的临床治疗效果.方法 50例心肌病伴重度心力衰竭患者,随机分为对照组和曲美他嗪治疗组,观察应用曲美他嗪治疗前后,患者心功能分级、左室射血分数(LVEF)、左室舒张末期内径(LVDd)及步行试验的影响.结果 与对照组相比,曲美他嗪治疗组患者临床心功能分级明显改善.治疗组总有效率88%,对照组64为%.治疗组LVEF治疗后为0.58±0.03、LVDd显著减小治疗后为49.1 mm±1.2 mm,且差异有统计学意义.进一步观察发现,治疗组治疗后步行试验结果409.4 m±11.5m有明显改善(P＜0.01).结论 曲美他嗪能明显改善心肌病伴心力衰竭患者的心功能.     

常规药物与联合曲美他嗪治疗充血性心力衰竭的临床观察

目的观察曲美他嗪对充血性心力衰竭(CHF)患者心功能影响。方法 80例病情稳定的CHF患者(NYHAⅡ～Ⅳ级),随机分为两组:对照组(40例,采用心力衰竭常规药物治疗)和治疗组(40例,常规药物治疗+曲美他嗪20mg,3次/d),治疗6个月。治疗前后观察心力衰竭症状和体征,测定左心室射血分数(LVEF)、左心室质量指数(LVMI)和左心室舒张末期内径(LVEDD),记录NYHA分级和心功能等指标的变化。结果入选前两组基线资料有可比性,治疗后曲美他嗪组的心功能改善的总有效率为95.0%,对照组为52.5%;曲美他嗪组LVMI[(106.7±13.6)g/m~2]低于对照组[(136.7±14.8)g/m~2],曲美他嗪组LVEF(51.4%±6.9%)高于对照组(43.6%±7.7%)(均为P0.05)。末见明显不良反应。结论在常规心力衰竭治疗基础上加用曲美他嗪,能改善CHF患者的心脏收缩功能,安全性好。     

美托洛尔联合曲美他嗪对老年冠心病心力衰竭病人心功能、心肌重塑和炎症因子的影响

目的探讨美托洛尔、曲美他嗪对老年冠心病心力衰竭病人心功能、心肌重塑及炎症因子的影响。方法选取2015年6月—2016年8月我院老年冠心病心力衰竭病人182例,随机分为观察组与对照组,各91例。两组均给予常规治疗,观察组加用美托洛尔、曲美他嗪,连续治疗6个月。采用左室射血分数(LVEF)及6分钟步行距离(6MWT)评价心功能,利用左室收缩末期内径(LVESD)和舒张末期内径(LVEDD)评价病人心肌重塑能力,并比较两组炎症因子水平。结果观察组治疗总有效率明显高于对照组(94.51%与84.62%,P0.05)。治疗6个月后两组LVEF、6MWT较治疗前均改善,且观察组改善情况优于对照组(P0.05)。两组LVESD、LVEDD较治疗前降低,且观察组降低更明显(P0.05)。治疗后两组炎症因子水平均降低,且观察组降低更明显(P0.05)。结论美托洛尔联合曲美他嗪能够有效改善老年冠心病心力衰竭病人的心功能,防止病人心肌重塑,减少炎症因子分泌。     

心率对心力衰竭患者预后的影响

心力衰竭作为很多心血管疾病的最终恶化趋势,对于其相关的临床诊疗近年来有了很大进步.近年的临床研究也显示,快速心率对于心力衰竭患者的病情发生、发展及预后有着重要的影响,当心率控制在适当范围内可明显改善心功能不全的预后.对心率的严密监控能够有效地指导临床诊疗,并且通过指数差异预测心力衰竭的预后,从而有效地判断治疗效果.心率...     

Assessment of right heart function in the athlete's heart

 It is known that the heart of an athlete has been physiologically adapted by prolonged training. There are a large number of echocardiographic studies which have focused on left ventricular wall thickness and dilatation, but there are few studies concerning right heart function in the athlete's heart. The aim of this study was to assess right heart function in elite athletes by conventional and new echocardiographic methods. The study population consisted of 36 elite highly-trained male athletes and 16 age-matched healthy sedentary controls. Right atrial, right ventricular, and inferior vena cava dimensions, and pulsed Doppler measurements of tricuspid inflow and right ventricular outflow were obtained, and systolic (preejection period, ejection time, preejection time/ejection time, QV peak, isovolumic contraction time) and diastolic (E peak, A peak, E/A ratio, decelaration time, isovolumic relexation time) function parameters were measured. The myocardial performance index was calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. In addition, right ventricular systolic and diastolic functions were determined by Pulsed wave tissue Doppler imaging (S, E, and A velocities) at the lateral corners of the tricuspid annulus. The left ventricular mass index (P < 0.005), and right atrial (P < 0.001), right ventricular (P < 0.001), and inferior vena cava dimensions (P < 0.001) were significantly greater in athletes than in controls. Tricuspid E peak, A peak, E/A ratio, deceleration time, isovolumic relaxation time, preejection period, right ventricular ejection time, preejection time/ejection time, isovolumic contraction time, QV peak, and myocardial performance index were found to be similar in athletes and in controls (P > 0.05). Systolic, early diastolic, and late diastolic tissue Doppler imaging velocities were not significantly different in athletes and controls (P > 0.05). Left ventricular hypertrophy (LV mass index >134 g/m²) was found in 15 of the athletes. Right atrial dimension was greater in the athletes with left ventricular hypertrophy than in those without hypertrophy (P < 0.05). All right ventricular systolic and diastolic echocardiographic parameters were similar in athletes with and without left ventricular hypertrophy (P > 0.05). The results of this study indicate that right ventricular systolic and diastolic functions do not deteriorate in the athlete's heart despite significant chamber dilatation. They suggest that these changes are a normal physiologic adaptation to prolonged training. Received: November 28, 2001 / Accepted: March 8, 2002     

The microvasculature of heart valves in rheumatic heart disease

The process of vascularization of the valves of 18 hearts with features of rheumatic heart disease, which were part of a larger series of 147 hearts from patients who died at the Mulago Hospital, Kampala, Uganda, has been studied using injection, microradiographic, and histological techniques. In mildly diseased atrioventricular valves, small vessels were first seen at the valve ring and along the inflamed endothelial surface of the valve leaflets, but vessels also passed up the chordae tendineae to the lower part of the leaflets. The density of vessels increased with more florid disease and sometimes the capillary-like vessels became thick-walled, but the vascularity diminished as the valves became fibrotic and calcified. In the aortic and pulmonary valves, vessels passed into the cusps mainly from the commissures. These appearances were of value in distinguishing rheumatic heart valves from avascular normal valves and those affected by endomyocardial fibrosis.     

Spatiotemporal control of heart rate in a rabbit heart

Sinoatrial node is responsible for the origin of the wave of excitation, which spreads throughout the heart and orchestrates cardiac contraction via calcium-mediated excitation-contraction coupling. P wave represents the spread of excitation in the atria. It is well known that the autonomic nervous system controls the heart rate by dynamically altering both cellular ionic fluxes and the anatomical location of the leading pacemaker. In this study, we used isolated rabbit right atria and mathematical model of the pacemaker region of the rabbit heart. Application of isoproterenol resulted in dose-dependent acceleration of the heart rate and superior shift of the leading pacemaker. In the mathematical model, such behavior could be reproduced by a gradient of expression in β1-adrenergic receptors along the superior-inferior axis. Application of acetylcholine resulted in preferentially inferior shift of pacemaker and slowing of the heart rate. The mathematical model reproduced this behavior with imposing a gradient of expression of acetylcholine-sensitive potassium channel. We conclude that anatomical shift of the leading pacemaker in the rabbit heart could be achieved through gradient of expression of β1-adrenergic receptors and I_K,ACh.     

冠心病窦性心率振荡的变化

目的观察不同类型冠心病患者窦性心率振荡(HRT)的变化。方法90冠心病患者分为急性心肌梗死(AMI)组、陈旧性心肌梗死(OMI)组和冠心病非心肌梗死(CHD)组(各组均为30例),记录24h动态心电图,计算振荡起始(TO)及振荡斜率(TS)。结果AMI组TO和TS皆异常,分别为(0.018±0.013)ms/RR和(1.73±0.54)ms/RR);CHD组[分别为(-0.042±-0.012)ms/RR和(20.30±2.84)ms/RR]与OMI组[分别为(-0.018±-0.008)ms/RR和(8.70±2.16)ms/RR]皆在正常范围;三组TO及TS值比较以及三组间两两比较,差异有统计学意义(P<0.01)。结论冠心病非心肌梗死、陈旧性心肌梗死及急性心肌梗死患者HRT趋于异常。     

心率震荡现象与心力衰竭

恶性心律失常和心源性猝死是心力衰竭患者死亡的重要原因.心率震荡(HRT)是对心脏室性早搏内源性刺激的反应,不仅反映自主神经功能的变化,也反映在一次室性早搏后心室压力变化所导致的主动脉弓颈动脉窦压力反射调节机制的变化.HRT有望成为预测心力衰竭高危患者的有效预测指标.     

冠心病患者冠脉动脉病变严重程度与心率震荡斜率相关

目的评价冠心病与心率震荡、心率变异的关系。方法对20例经冠脉造影术确诊的冠心病患者,20例高血压患者（经冠脉造影术排除冠心病）与20例正常体检者进行心率变异指标和心率震荡参数比较。并对冠脉病变与各项指标进行线性回归分析,进一步评价心率变异、心率震荡指标与冠脉病变程度的相关性。结果冠心病患者组心率变异指标SDNN（100±7）ms、SDNNI（39±3）ms和心率震荡参数TS（3.0±2.3）均低于正常体检组的SDNN（131±6）ms、SDNNI（53±3）ms、TS（6.7±1.3）（P<0.01）,而高血压患者组仅SDNN（109±6）ms、SDNNI（44±3）ms低于正常体检组（P<0.05）;研究还发现冠心病组TS（3.0±2.3）低于高血压组TS（6.0±1.6）（P<0.01）。对冠脉病变与各项检测指标进行线性回归分析后发现,TS与冠脉的狭窄程度呈负相关（r=-0.61,P<0.01）,与冠脉病变评分呈负相关（r=-0.462,P<0.05）。将冠脉按照病变程度进行分组发现,冠状动脉病变狭窄程度≥50%的TS值显著变小（P<0.01）,多支病变的TS明显变小（P<0.05）,冠脉病变评分高于10分组TS值显著变小（P<0.05）。结论冠心病患者的心率震荡参数TS显著减小,并且TS与冠状动脉粥样硬化严重程度有一定相关性。     

心率变异性评价心力衰竭及其等级的临床应用

目的 :评价心率变异性在充血性心力衰竭患者的临床应用价值。方法 :用 2 4h动态心电图研究充血性心力衰竭患者和对照组的心率变异性 ,并与其它心脏结构及功能参数比较。结果 :充血性心力衰竭组的 SDNN,SDANN,L F,HF和 L F/HF均较对照组显著降低 （P<0 .0 5或 P<0 .0 1）。随心力衰竭严重程度的增加 ,心率变异性呈递进性降低 ,且与左室射血分数、左室短轴缩短率及左室舒张末内径的改变相关 （P<0 .0 5或 P<0 .0 1）。结论 :心率变异性测定可以作为心力衰竭的诊断及其严重程度判断的客观指标。