缬沙坦/氨氯地平和依贝沙坦/双氢克尿噻联合治疗老龄高血压疗效的研究

Objective To compare the clinical effect of valsartan/amlodipine combination or irbesartan/hydrochlorothiazide(HCTZ)combination in very elderly hypertensives.Methods After a 4-week placebo period,94 hypertensives,aged 75-89 years were random given valsartan 160 mg/amlodipine 5 mg or irbesartan 300 mg/HCTZ 12.5 mg for 24 weeks according to a rospective study.After 4 weeks,amlodipine or HCTZ was doubled in non-responders.Patients were checked every 4 weeks.At each visit,sitting,lying and standing blood pressure(BP),systolic BP(SBP)and diastolic BP(DBP)were measured. At the end of placebo period and treatment period,electrolytes and uric acid were evaluated.Results Blood pressure was significantly decreased in both treatment groups,however,there was no statistical significance between two groups.BP changes from lying to standing position were significantly greater in the irbosartan/HCTZ group(-17.2/-9.1 mmHg)than that in the valsartan/amlodipine group(-10.1/-1.9 mmHg,t=2.14,P＜0.05 for SBP and t=3.11,P＜0.01 for DBP vs.irbesartan/HCTZ).Potassium significantly decreased and uric acid significantly increased(-0.4 mmol/L,t = 2.33,P＜ 0.05 and+29.7μ mol/L,t =2.54,P＜0.05 vs.baseline,respectively)only in the irbesartan/HCTZ group.Conclusions Both combinations had similarly effective in reducing clinical BP in very elderly hypertensives.However,valsartan/amlodipine offered some advantage and less pronounced BP orthostatic changes and absence of metabolic adverse effects.     

急性乙型肝炎临床特征和病毒标志物动态变化分析

Objective To explore the dynamic change of viral marker and clinical features in acute hepatitis B (AHB)and distinguish AHB from chronic hepatitis B(CHB) in acute onset. Methods Viral marker, HBV DNA in serum and clinical features were analyzed in 105 patients with AHB (AHB group) and 102 patients with CHB in acute onset (CHB group) between 2005 and 2009. Results There was no statistical difference in the mean levels of ALT, TBil, HBsAg, HBeAg and HBV DNA between AHB and CHB group on admission. However, the titer of auti-HBc-IgM in AHB group was(26.34 ±3.74)S/CO, which was obviously higher than that in CHB group, which was( 14.46 ± 3.10)S/CO, there was a statistical difference between the two groups( P < 0.05). After 2 weeks treatment, the levels of ALT and TBil in AHB patients decreased (1540.50±225.54)IU/L and (103.60± 46.48) μmol/L respectively, the decreased levels in AHB group were high compared to CHB group; the levels of HBsAg, HBeAg and HBV DNA in AHB group decreased (2558.46 ±644.26) IU/mL, (420.20± 63.20) S/CO and (4.53± 1.42) log10copies/mL respectively, and the levels decreased obviously compared to CHB group (P < 0.05). The decreased level of anti-HBc-IgM in AHB group was no statistical difference to CHB group after 2 weeks treatment (P > 0.05). 19.04% of the AHB patients were HBV DNA negative seroconversion before they were hospitalized. The level of HBsAg and HBeAg in AHB group declined quickly. Separately, 90.47% and 94.24% of the AHB patients had HBsAg and HBeAg seroconversion at the end of follow-up in AHB group. The level of ALT in AHB decreased quickly but its normalization was slower than the clearance of HBV. Conclusions There is no difference in viral marker, HBV DNA and clinical features between AHB and CHB in acute onset patients on admission, but the recovery of liver function in AHB is obviously after treatment. Anti-HBc-IgM (≥20 S/CO), dynamic change and seroconversion viral marker, ALT ≥20×ULN and recovery can be used to differentiate AHB from CHB in acute onset.     

急性乙型肝炎临床特征和病毒标志物动态变化分析

Objective To explore the dynamic change of viral marker and clinical features in acute hepatitis B (AHB)and distinguish AHB from chronic hepatitis B(CHB) in acute onset. Methods Viral marker, HBV DNA in serum and clinical features were analyzed in 105 patients with AHB (AHB group) and 102 patients with CHB in acute onset (CHB group) between 2005 and 2009. Results There was no statistical difference in the mean levels of ALT, TBil, HBsAg, HBeAg and HBV DNA between AHB and CHB group on admission. However, the titer of auti-HBc-IgM in AHB group was(26.34 ±3.74)S/CO, which was obviously higher than that in CHB group, which was( 14.46 ± 3.10)S/CO, there was a statistical difference between the two groups( P < 0.05). After 2 weeks treatment, the levels of ALT and TBil in AHB patients decreased (1540.50±225.54)IU/L and (103.60± 46.48) μmol/L respectively, the decreased levels in AHB group were high compared to CHB group; the levels of HBsAg, HBeAg and HBV DNA in AHB group decreased (2558.46 ±644.26) IU/mL, (420.20± 63.20) S/CO and (4.53± 1.42) log10copies/mL respectively, and the levels decreased obviously compared to CHB group (P < 0.05). The decreased level of anti-HBc-IgM in AHB group was no statistical difference to CHB group after 2 weeks treatment (P > 0.05). 19.04% of the AHB patients were HBV DNA negative seroconversion before they were hospitalized. The level of HBsAg and HBeAg in AHB group declined quickly. Separately, 90.47% and 94.24% of the AHB patients had HBsAg and HBeAg seroconversion at the end of follow-up in AHB group. The level of ALT in AHB decreased quickly but its normalization was slower than the clearance of HBV. Conclusions There is no difference in viral marker, HBV DNA and clinical features between AHB and CHB in acute onset patients on admission, but the recovery of liver function in AHB is obviously after treatment. Anti-HBc-IgM (≥20 S/CO), dynamic change and seroconversion viral marker, ALT ≥20×ULN and recovery can be used to differentiate AHB from CHB in acute onset.     

PPAR-γ在COPD所致的肺动脉高压患者中的表达变化

Objective To investigate the relationship among peroxisome proliferators - activated receptor gamma (PPAR-γ), pul-monary arterial systolic pressure(PASP) ,and insulin resistance in Chronic Obstructive Pulmonary Disease (COPD) patients. Methods A-mong 63 COPD patients, 30 patients with level of PASP above 40mmHg were enrolled in PAH group and other 33 patients were enrolled in COPD group. Twenty healthy medical examination subjects were enrolled in control group. The expression of PPAR-γ, mRNA was detected by real time fluorescent quantitative RT- PCR. Radioimmunoassay was used to measure the level of fasting plasma insulin (FIN). Fasting plas-ma glucose (FPG) was detected by glucose oxidase method. Results The expression of PPAR-γ mRNA was significantly decreased in PAH and COPD group, while FPG, FIN and IRI increased significantly. PAH group had more increased PASP, decreased expression of PPAR-γ and higher IRI than COPD group. Expression of PPAR-γ was negatively related to PASP and IRI. Conclusions The significantly down reg-ulated expression of PPAR-γ maybe explain the higher FPG and PASP.     

低温与振动联合作用对周围循环功能及神经功能的影响

Objective To study the combined effect of low temperature and vibration on function of peripheral circulation and nerve.Methods 64 rabbits were divided into control group,low temperature group,vibration group and combined effect group randomly,16 each group.The changes of concentration of ET,Ang Ⅱ,NO in plasma and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were measured before and after experiment.Results After experiment,the concentration of ET,Ang Ⅱ,NO and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were (68.84±14.81) pg/ml,(544.01±70.20) pg/ml,(123.73±9.58) nmol/ml,(25.36±6.96) m/s,(1.84±0.65) μV,(4.05±1.04) m/s,(27.40±6.05) m/s,(1.60±0.52) μV,(3.51±1.30) m/s respectively in low temperature group;(70.22±15.02) pg/ml,(540.77±68.25) pg/ml,(129.46±11.99) nmol/ml,(27.69±6.16) m/s,(2.19±0.53)μV,(3.86±0.89) m/s,(30.03±5.21) m/s,(1.65±0.49)μV,(3.36±1.11)m/s respectively in vibration group;(88.47±13.20) pg/ml,(687.38±101.44) pg/ml,(70.66±4.99) nmol/ml,(20.82±3.65)m/s,(1.21±0.64)μV,(5.05±0.94) m/s,(19.97±4.37) m/s,(1.09±0.49)μV,(4.49±1.26) m/s respectively in eombined effect group;compared with pre-experiment,the concentration of ET and Ang Ⅱ in low temperature group,vibration group and combined effect group were increased after experiment,and the NO was decreased (P＜0.05);the nerve conduct velocity and amplitude was decreased and the latency was delayed (P＜0.05).After experiment,the concentrations of ET and Ang Ⅱ in combined effect group were higher than low temperature group and vibration group,and the concentration of NO in combined effect group was lower than low temperature group and vibration group(P＜0.05).After experiment,the SCV and MCV in combined effect group were slower than low temperature group and vibration group;the amplitude of sensory nerve action potential and distal amplitude of moor nerve were less than low temperature group and vibration group;the latency of sensory nerve action potential and distal latency of motor nerve in combined effect group was longer than low temperature group and vibration group.The factorial analysis results indicated the synergistic effect between low temperature and vibration(P＜0.05).Conclusion Vibration-induced peripheral vascular impairment and nerve impairment would be intensified by low temperature.     

低温与振动联合作用对周围循环功能及神经功能的影响

Objective To study the combined effect of low temperature and vibration on function of peripheral circulation and nerve.Methods 64 rabbits were divided into control group,low temperature group,vibration group and combined effect group randomly,16 each group.The changes of concentration of ET,Ang Ⅱ,NO in plasma and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were measured before and after experiment.Results After experiment,the concentration of ET,Ang Ⅱ,NO and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were (68.84±14.81) pg/ml,(544.01±70.20) pg/ml,(123.73±9.58) nmol/ml,(25.36±6.96) m/s,(1.84±0.65) μV,(4.05±1.04) m/s,(27.40±6.05) m/s,(1.60±0.52) μV,(3.51±1.30) m/s respectively in low temperature group;(70.22±15.02) pg/ml,(540.77±68.25) pg/ml,(129.46±11.99) nmol/ml,(27.69±6.16) m/s,(2.19±0.53)μV,(3.86±0.89) m/s,(30.03±5.21) m/s,(1.65±0.49)μV,(3.36±1.11)m/s respectively in vibration group;(88.47±13.20) pg/ml,(687.38±101.44) pg/ml,(70.66±4.99) nmol/ml,(20.82±3.65)m/s,(1.21±0.64)μV,(5.05±0.94) m/s,(19.97±4.37) m/s,(1.09±0.49)μV,(4.49±1.26) m/s respectively in eombined effect group;compared with pre-experiment,the concentration of ET and Ang Ⅱ in low temperature group,vibration group and combined effect group were increased after experiment,and the NO was decreased (P＜0.05);the nerve conduct velocity and amplitude was decreased and the latency was delayed (P＜0.05).After experiment,the concentrations of ET and Ang Ⅱ in combined effect group were higher than low temperature group and vibration group,and the concentration of NO in combined effect group was lower than low temperature group and vibration group(P＜0.05).After experiment,the SCV and MCV in combined effect group were slower than low temperature group and vibration group;the amplitude of sensory nerve action potential and distal amplitude of moor nerve were less than low temperature group and vibration group;the latency of sensory nerve action potential and distal latency of motor nerve in combined effect group was longer than low temperature group and vibration group.The factorial analysis results indicated the synergistic effect between low temperature and vibration(P＜0.05).Conclusion Vibration-induced peripheral vascular impairment and nerve impairment would be intensified by low temperature.     

低温与振动联合作用对周围循环功能及神经功能的影响

Objective To study the combined effect of low temperature and vibration on function of peripheral circulation and nerve.Methods 64 rabbits were divided into control group,low temperature group,vibration group and combined effect group randomly,16 each group.The changes of concentration of ET,Ang Ⅱ,NO in plasma and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were measured before and after experiment.Results After experiment,the concentration of ET,Ang Ⅱ,NO and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were (68.84±14.81) pg/ml,(544.01±70.20) pg/ml,(123.73±9.58) nmol/ml,(25.36±6.96) m/s,(1.84±0.65) μV,(4.05±1.04) m/s,(27.40±6.05) m/s,(1.60±0.52) μV,(3.51±1.30) m/s respectively in low temperature group;(70.22±15.02) pg/ml,(540.77±68.25) pg/ml,(129.46±11.99) nmol/ml,(27.69±6.16) m/s,(2.19±0.53)μV,(3.86±0.89) m/s,(30.03±5.21) m/s,(1.65±0.49)μV,(3.36±1.11)m/s respectively in vibration group;(88.47±13.20) pg/ml,(687.38±101.44) pg/ml,(70.66±4.99) nmol/ml,(20.82±3.65)m/s,(1.21±0.64)μV,(5.05±0.94) m/s,(19.97±4.37) m/s,(1.09±0.49)μV,(4.49±1.26) m/s respectively in eombined effect group;compared with pre-experiment,the concentration of ET and Ang Ⅱ in low temperature group,vibration group and combined effect group were increased after experiment,and the NO was decreased (P＜0.05);the nerve conduct velocity and amplitude was decreased and the latency was delayed (P＜0.05).After experiment,the concentrations of ET and Ang Ⅱ in combined effect group were higher than low temperature group and vibration group,and the concentration of NO in combined effect group was lower than low temperature group and vibration group(P＜0.05).After experiment,the SCV and MCV in combined effect group were slower than low temperature group and vibration group;the amplitude of sensory nerve action potential and distal amplitude of moor nerve were less than low temperature group and vibration group;the latency of sensory nerve action potential and distal latency of motor nerve in combined effect group was longer than low temperature group and vibration group.The factorial analysis results indicated the synergistic effect between low temperature and vibration(P＜0.05).Conclusion Vibration-induced peripheral vascular impairment and nerve impairment would be intensified by low temperature.     

低温与振动联合作用对周围循环功能及神经功能的影响

Objective To study the combined effect of low temperature and vibration on function of peripheral circulation and nerve.Methods 64 rabbits were divided into control group,low temperature group,vibration group and combined effect group randomly,16 each group.The changes of concentration of ET,Ang Ⅱ,NO in plasma and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were measured before and after experiment.Results After experiment,the concentration of ET,Ang Ⅱ,NO and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were (68.84±14.81) pg/ml,(544.01±70.20) pg/ml,(123.73±9.58) nmol/ml,(25.36±6.96) m/s,(1.84±0.65) μV,(4.05±1.04) m/s,(27.40±6.05) m/s,(1.60±0.52) μV,(3.51±1.30) m/s respectively in low temperature group;(70.22±15.02) pg/ml,(540.77±68.25) pg/ml,(129.46±11.99) nmol/ml,(27.69±6.16) m/s,(2.19±0.53)μV,(3.86±0.89) m/s,(30.03±5.21) m/s,(1.65±0.49)μV,(3.36±1.11)m/s respectively in vibration group;(88.47±13.20) pg/ml,(687.38±101.44) pg/ml,(70.66±4.99) nmol/ml,(20.82±3.65)m/s,(1.21±0.64)μV,(5.05±0.94) m/s,(19.97±4.37) m/s,(1.09±0.49)μV,(4.49±1.26) m/s respectively in eombined effect group;compared with pre-experiment,the concentration of ET and Ang Ⅱ in low temperature group,vibration group and combined effect group were increased after experiment,and the NO was decreased (P＜0.05);the nerve conduct velocity and amplitude was decreased and the latency was delayed (P＜0.05).After experiment,the concentrations of ET and Ang Ⅱ in combined effect group were higher than low temperature group and vibration group,and the concentration of NO in combined effect group was lower than low temperature group and vibration group(P＜0.05).After experiment,the SCV and MCV in combined effect group were slower than low temperature group and vibration group;the amplitude of sensory nerve action potential and distal amplitude of moor nerve were less than low temperature group and vibration group;the latency of sensory nerve action potential and distal latency of motor nerve in combined effect group was longer than low temperature group and vibration group.The factorial analysis results indicated the synergistic effect between low temperature and vibration(P＜0.05).Conclusion Vibration-induced peripheral vascular impairment and nerve impairment would be intensified by low temperature.     

低温与振动联合作用对周围循环功能及神经功能的影响

Objective To study the combined effect of low temperature and vibration on function of peripheral circulation and nerve.Methods 64 rabbits were divided into control group,low temperature group,vibration group and combined effect group randomly,16 each group.The changes of concentration of ET,Ang Ⅱ,NO in plasma and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were measured before and after experiment.Results After experiment,the concentration of ET,Ang Ⅱ,NO and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were (68.84±14.81) pg/ml,(544.01±70.20) pg/ml,(123.73±9.58) nmol/ml,(25.36±6.96) m/s,(1.84±0.65) μV,(4.05±1.04) m/s,(27.40±6.05) m/s,(1.60±0.52) μV,(3.51±1.30) m/s respectively in low temperature group;(70.22±15.02) pg/ml,(540.77±68.25) pg/ml,(129.46±11.99) nmol/ml,(27.69±6.16) m/s,(2.19±0.53)μV,(3.86±0.89) m/s,(30.03±5.21) m/s,(1.65±0.49)μV,(3.36±1.11)m/s respectively in vibration group;(88.47±13.20) pg/ml,(687.38±101.44) pg/ml,(70.66±4.99) nmol/ml,(20.82±3.65)m/s,(1.21±0.64)μV,(5.05±0.94) m/s,(19.97±4.37) m/s,(1.09±0.49)μV,(4.49±1.26) m/s respectively in eombined effect group;compared with pre-experiment,the concentration of ET and Ang Ⅱ in low temperature group,vibration group and combined effect group were increased after experiment,and the NO was decreased (P＜0.05);the nerve conduct velocity and amplitude was decreased and the latency was delayed (P＜0.05).After experiment,the concentrations of ET and Ang Ⅱ in combined effect group were higher than low temperature group and vibration group,and the concentration of NO in combined effect group was lower than low temperature group and vibration group(P＜0.05).After experiment,the SCV and MCV in combined effect group were slower than low temperature group and vibration group;the amplitude of sensory nerve action potential and distal amplitude of moor nerve were less than low temperature group and vibration group;the latency of sensory nerve action potential and distal latency of motor nerve in combined effect group was longer than low temperature group and vibration group.The factorial analysis results indicated the synergistic effect between low temperature and vibration(P＜0.05).Conclusion Vibration-induced peripheral vascular impairment and nerve impairment would be intensified by low temperature.     

低温与振动联合作用对周围循环功能及神经功能的影响

Objective To study the combined effect of low temperature and vibration on function of peripheral circulation and nerve.Methods 64 rabbits were divided into control group,low temperature group,vibration group and combined effect group randomly,16 each group.The changes of concentration of ET,Ang Ⅱ,NO in plasma and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were measured before and after experiment.Results After experiment,the concentration of ET,Ang Ⅱ,NO and SCV,amplitude of sensory nerve action potential,latency of sensory nerve action potential,MCV,distal amplitude of motor nerve,and distal latency of motor nerve were (68.84±14.81) pg/ml,(544.01±70.20) pg/ml,(123.73±9.58) nmol/ml,(25.36±6.96) m/s,(1.84±0.65) μV,(4.05±1.04) m/s,(27.40±6.05) m/s,(1.60±0.52) μV,(3.51±1.30) m/s respectively in low temperature group;(70.22±15.02) pg/ml,(540.77±68.25) pg/ml,(129.46±11.99) nmol/ml,(27.69±6.16) m/s,(2.19±0.53)μV,(3.86±0.89) m/s,(30.03±5.21) m/s,(1.65±0.49)μV,(3.36±1.11)m/s respectively in vibration group;(88.47±13.20) pg/ml,(687.38±101.44) pg/ml,(70.66±4.99) nmol/ml,(20.82±3.65)m/s,(1.21±0.64)μV,(5.05±0.94) m/s,(19.97±4.37) m/s,(1.09±0.49)μV,(4.49±1.26) m/s respectively in eombined effect group;compared with pre-experiment,the concentration of ET and Ang Ⅱ in low temperature group,vibration group and combined effect group were increased after experiment,and the NO was decreased (P＜0.05);the nerve conduct velocity and amplitude was decreased and the latency was delayed (P＜0.05).After experiment,the concentrations of ET and Ang Ⅱ in combined effect group were higher than low temperature group and vibration group,and the concentration of NO in combined effect group was lower than low temperature group and vibration group(P＜0.05).After experiment,the SCV and MCV in combined effect group were slower than low temperature group and vibration group;the amplitude of sensory nerve action potential and distal amplitude of moor nerve were less than low temperature group and vibration group;the latency of sensory nerve action potential and distal latency of motor nerve in combined effect group was longer than low temperature group and vibration group.The factorial analysis results indicated the synergistic effect between low temperature and vibration(P＜0.05).Conclusion Vibration-induced peripheral vascular impairment and nerve impairment would be intensified by low temperature.     

胺碘酮联用缬沙坦治疗阵发性房颤临床疗效观察

目的：观察口服胺碘酮联合应用血管紧张素II受体拮抗剂（ARB）缬沙坦在阵发性心房颤动复律后维持窦律的疗效。方法：将145例阵发性房颤分为胺碘酮组（I组，n=72），胺碘酮加缬沙坦组（Ⅱ组，n=73），疗效观察24个月。结果：治疗6个月后两组左心房内径无显著差异，但12个月后两组有显著差异（p〈0．05），窦性心律维持12个月后有显著差异（p〈0．05）。结论：胺碘酮与缬沙坦联合治疗阵发性房颤维持，窦性心律的疗效优于单用胺碘酮，并能延缓左心房扩大。     

Atrial fibrillation

The aim of transesophageal echocardiography (TOE) in atrial fibrillation milieu is to search a cardiac chamber thrombus. In order to establish the indications of TOE and to raise new issues for the echographic prognosis of maintain of sinus rhythm, 40 patients with atrial fibrillation who underwent cardioversion were prospectively screened. All patients had transthoracic and transesophageal echocardiography before procedure to control the absence or disappearing of atrial thrombus (N = 7). All 40 patients underwent a successful cardioversion. Follow-up was done after one, three and six months for both success group (N = 28) and refibrillation group (N = 12). Our study provides evidence that the only predictive echographic factor of maintain of a good result (sinus rhythm) after cardioversion was a systolic velocity peak > 0.25 metir/sec.     

电复律治疗心脏瓣膜手术后心房颤动或心房扑动的疗效及影响因素

目的分析电复律治疗心脏瓣膜手术后患者发生心房颤动或心房扑动的疗效及影响因素。 方法选取南京鼓楼医院心胸外科2011年1月至2014年6月收治的心脏瓣膜病术后发生心房颤动或心房扑动并行电复律治疗的91例患者进行回顾性分析。在重症监护病房(ICU)心电(ECG)监测下，全身麻醉后以双向波100～150 J能量对患者行同步电复律，复律成功的患者辅以口服胺碘酮3个月。统计患者接受电复律治疗的即时成功率以及随访6个月的窦性心律稳定率，以电复律即时成功与否将患者分成两组，电复律成功组和电复律不成功组，并分析可能影响电复律即时成功的影响因素。91例患者中，男性39例，女性52例；年龄26 ～ 76岁，平均(54.3±11.1)岁。有75例(82.4%)即时转为窦性心律；随访1～6个月，64例(85.3%)维持窦性心律。 结果术前纽约心脏病协会(NYHA)心功能分级低、血清B型脑钠肽(BNP)水平低、左房内径较小、心房扑动、外科术前心房颤动病程较短患者的电复律成功率高，而手术方式以及电复律时间距离外科手术的时间对电复律成功率无明显影响。左心房内径是心脏外科术后患者心房颤动或心房扑动电复律治疗成功的独立预测因素。 结论电复律是心脏瓣膜术后心房颤动或心房扑动的有效的治疗方法，电复律的即时成功率是82.4%，随访1～6个月的窦性心律维持率是85.3%。电复律前左心房内径是电复律成功的独立预测因素。     

福辛普利联合胺碘酮和非洛地平对高血压合并房颤患者复律后的临床观察

目的探讨福辛普利联合胺碘酮和非洛地平对高血压合并房颤者复律后窦律维持情况的作用。方法选择武汉大学人民医院2006年1月—2009年1月收治的阵发性房颤患者97例,经药物或者电复律后,随即分为观察组和对照组。观察组给予胺碘酮、非洛地平和福辛普利,对照组给予胺碘酮和非洛地平。治疗随访时间为1a,终点事件是房颤复发,观察2组复律后2、4、6、8、10、12个月内窦性心律的维持人数,同时观察血压的维持水平,心脏结构和功能的变化。结果在房颤复律后第6、8、10、12个月,观察组的窦律维持人数高于对照组,且差异具有统计学意义(P0.05)。2组血压稳定下降,差异无统计学意义。观察组治疗1a后心脏结构和功能明显优于对照组(P0.05)。结论使用福辛普利联合胺碘酮和非洛地平比单用胺碘酮和非洛地平更有利于高血压合并房颤患者复律后窦律的维持。     

老年持续性心房颤动控制节律的临床研究

目的对比老年持续性心房颤动(AF)的患者,控制房颤的心室率(频率控制)与恢复并维持窦性心律(节律控制)两种方法的治疗效果。方法频率控制组使用阿替洛尔和地高辛控制AF的心室率;节律控制组用胺碘酮或直流电转复并用胺碘酮维持窦性心律,比较3年后两组患者的病死率、致残率、生活质量及住院率。结果两组病人的病死率、生活质量相比较无统计学意义(P>0.05),频率控制组的致残率、住院率低于节律控制组(P<0.05)。结论控制AF心室率应列为持续性AF的首选治疗措施。     

胺碘酮联合氯沙坦治疗房颤的临床研究

目的观察胺碘酮联合氯沙坦治疗心房颤动及维持窦性心律的疗效。方法将66例具有转复窦性心律指征的心房颤动患者随机分为两组,单用胺碘酮治疗组（n=32）和胺碘酮＋氯沙坦治疗组（n=34）,12个月后停用胺碘酮,共随访18个月,观察药物对两组患者窦性心律的维持率及心房重构的影响。结果随访第12月和第18月,窦性心律维持率：胺碘酮＋氯沙坦组均显著高于胺碘酮组（P〈0．05）。胺碘酮＋氯沙坦组转变为永久性心房颤动患者（7例）显著低于单用胺碘酮治疗组（13例）（P〈0．05）。结论胺碘酮联合氯沙坦能提高心房颤动复律后维持窦性心律的疗效。     

奎尼丁联合胺碘酮治疗持续性心房颤动的临床研究

目的 探讨奎尼丁联合胺碘酮治疗持续性心房颤动的安全性及临床疗效.方法 房颤患者65例,随机分为胺碘酮组31例和联合用药组34例进入胺碘酮组每次给胺碘酮0.2 g,每天3次,持续10 d,奎尼丁联合胺碘酮组第1天奎尼丁每2 h 0.2 g,共5次,如未转复窦律,第2天剂量不变,第3天每2 h 0.3 g,共5次 转复窦性心律后奎尼丁改每8 h 0.5 g,重叠应用胺碘酮3 d.药物负荷量期间未转复者应用同步直流电复律.观察复律率、复律时间、Q-T间期.结果 奎尼丁联合胺碘酮组较胺碘酮组转复时间短、转复律高,无严重不良反应.结论 奎尼丁联合胺碘酮是治疗房颤的一种安全、有效的方法.     

血浆脑钠肽水平在心房纤颤患者中的临床价值

目的：分析血浆脑钠肽（BNP）水平在心房纤颤患者复律前、后中的变化,评价其临床应用价值。方法：选取2010年12月-2013年12月本院确诊为心房纤颤且成功复律的57例患者作为观察组,依据发作时间分为两亚组：阵发性房颤（发作时间〈2 d）31例,持续性房颤（持续发作2 d-12个月）26例;选取同期在本院行健康检查正常者33例作为对照组,分析观察组复律前后的血浆BNP水平变化。结果：观察组复律前的血浆BNP比对照组高,比较差异有统计学意义（P〈0.05）;观察组两亚组的3项指标水平组间比较,差异差异有统计学意义（P〈0.05）;观察组患者的BNP水平与LEVF呈负相关性,与LVEDD呈正相关性,比较差异有统计学意义（P〈0.05）;观察组复律后、房颤复发患者的血浆BNP水平比对照组高,差异有统计学意义（P〈0.05）;窦律维持患者的血浆BNP水平与对照组比较,差异无统计学意义（P〉0.05）。结论：心房纤颤患者复律前血浆脑钠肽水平明显升高,复律后其显著下降,可用于评价房颤患者的发作时间和治疗预后效果。     

最低剂量胺碘酮防止老年患者心房颤动复发的长期疗效

目的前瞻性研究最低剂量胺碘酮防止老年患者心房颤动(房颤)复发的长期疗效和安全性.方法共65例老年房颤患者口服最低剂量胺碘酮(84±34)mg/d以维持窦性心律(窦律).其中39例患者为慢性房颤,经胺碘酮药物复律或电击除颤后再服药维持窦律,另26例为阵发性房颤病例直接服药防止房颤复发.平均年龄(70±7)岁,平均随访(24±13)个月(31d～46个月).结果随访满1、2和3a的窦律维持率分别是87%、80%和76%.33例患者房颤复发,但增加药物剂量后30例(91%)又转复窦律,其中27例随访期超过1a,85%维持窦律.因副作用而停药的发生率1、2、和3a分别为0、2.5%和4.8%.副作用有甲状腺毒性2例(3.1%)和干咳1例(1.5%).随访期中未发现有胺碘酮致死亡的病例.结论最低剂量胺碘酮防止老年患者房颤的复发疗效高,副作用小.     

普罗帕酮与洋地黄转复慢性心房颤动的临床观察

目的观察普岁帕酮与洋地黄转复慢性心房颤动的作用。方法将心房颤动发作时间大于3周的患者随机分为普罗帕酮组和洋地黄组,普罗帕酮组先静脉椎注2mg／kg,再以5mg/kg维持24h,后改口服每天450mg治疗4周。洋地黄组先静脉推注毛花甙C0．4mg,然后每6h静脉推注0．2mg,24h后改口服地高辛每日0.25mg。结果普罗帕酬组17例（48．6％）转复为窦性心律,洋地黄组仅2例转复成功。普岁帕酮组转复成功者与未转复者卡甘比,左房内径明旺较小（P〈0．001）,心房颤动持续时间显著较短（P〈0．001）。结论普罗帕酮可有效地转复慢性心房颤动,洋地黄转复慢性心房颤动疗效不佳;左房内径、心房颤动持续时间是影响转复成功的重要因素。