充血性心力衰竭患者治疗前后甲状腺激素的变化

目的:探讨甲状腺激素与充血性心力衰竭的关系。方法:运用放射免疫法测定心力衰竭患者(68例)及健康者(39例)血浆三碘甲状腺原氨酸(T_3)、四碘甲状腺原氨酸(T_4)及促甲状腺素(TSH),并进行对比分析。结果:充血性心力衰竭组血浆T_3明显低于健康对照组(P<0.05),心力衰竭程度越重,变化越明显。结论:T_3可作为估计充血性心力衰竭严重程度、治疗效果及预后的一项指标。     

Remotely monitored death of a patient with implanted ICD

Remote monitoring is useful for management of implantable cardioverter defibrillator (ICD) patients regarding detection of arrhythmias and probable device or lead failure. We report the case of a patient who died suddenly while being on remote monitoring. The ICD was not retrieved postmortem. Even though clinical circumstances were suspicious of an arrhythmic death, this was excluded due to a distinctive manufacturer feature of the system.     

可溶性肿瘤坏死因子受体Ⅱ在慢性心功能不全患者中的变化

目的:观察慢性充血性心力衰竭患者血清可溶性坏死因子受体II(sTNFR II)的改变与临床意义。方法:sTNFR II采用酶联免疫双抗体夹心法测定。结果:对照组(n=30)sTNFR II为2.59±0.58μg/L,实验组(n=30)sTNFR II为8.62±5.32μg/L,两组间有极显著差异(P<0.01)。实验组的轻度组(n=12)sTNFR II为5.3l±1.54μg/L,重度组(n=18)sTN-FR II为10.87±5.78μg/L,两组间有极显著差异(P<0.01)。对照组与实验组的心力衰竭轻、重组间有极显著差异(P<0.01),TNF的变化与病情呈正相关,相关程度较高(r=0.5,P<0.01)。结论:心力衰竭患者血清sTNFR II值升高,并与心力衰竭的严重程度相关。sTNFR II可以作为判断心力衰竭严重程度的指标之一。     

The Role of the Selective Serotonin Re‐Uptake Inhibitor Sertraline in Nondepressive Patients with Chronic Ischemic Heart Failure: A Preliminary Study

Background: Selective serotonin re‐uptake inhibitors (SSRIs) have been associated with better psychiatric status, functional capacity, and fewer arrhythmias in depressive patients with heart failure (HF). In this study, we tested the impact of sertraline (an SSRI) on patients with HF, but not clinical depression. Methods: We studied 62 clinically stable, nondepressive patients with ischemic HF (New York Heart Association class: I‐II), and implantable cardioverter‐defibrillator (ICD). Following psychiatric evaluation and quality of life (QoL) assessment, 24‐hour electrocardiogram recordings including heart rate variability (HRV) and ICD interrogation were performed every 4 months for 1 year. Ventricular effective refractory period (ERP) at 600‐, 500‐, and 400‐ms cycle length and the inducibility of ventricular tachycardia (VT) were assessed via the ICD. After that, sertraline 50 mg/day was administered for 12 months and the whole evaluation was repeated. Results: Sertraline was associated with fewer ventricular extrasystoles per 24 hours and a significant change in HRV (increase in mean R‐R, 5‐minute standard deviation of RR intervals, and root mean‐square difference of successive RR intervals, and reduction in ultra and very low frequency). It was also followed by an improvement in patients’ QoL. A trend toward a decrease was observed in the number of recalled nonsustained VTs. The episodes of sustained VT were not significantly reduced. Ventricular ERPs and VT inducibility remained unaltered. Conclusion: In clinically stable, nondepressive patients with ischemic HF and ICD, sertraline is associated with reduced ventricular extrasystoles, better QoL, and a possible improvement in some HRV indexes. This suggests that SSRIs may have a favorable clinical impact on these patients, independent of the improvement in depressive symptoms. (PACE 2010; 33:1217–1223)     

充血性心力衰竭住院死亡患者的性别差异

目的:了解各种病因充血性心力衰竭住院死亡患者的性别差异。方法:对我科1997年12月到2007年9月的全部心功能为NYHA2~4级的死亡患者进行回顾性分析,比较不同心脏病心衰患者死亡的两性间差异。结果:冠心病死亡者、风心病死亡者有明显的性别差异。结论:两性比较,男性死于冠心病者较女性多,死亡年龄较女性小;女性死于风心病者较男性多。     

B型脑钠肽与慢性充血性心力衰竭预后的研究

目的探讨B型脑钠肽（BNP）与慢性充血性心力衰竭预后的关系。方法2008年1月-10月收治的慢性充血性心力衰竭患者100例,均符合美国心脏病协会分级标准（NYHA）Ⅲ～Ⅳ级,快速检测BNP,观察心血管事件发生组与未发生组患者血浆BNP浓度差异。结果发生心血管事件患者血浆BNP浓度显著升高,未发生心血管事件患者血浆BNP浓度下降。血浆BNP浓度与心血管事件发生有密切关系。结论BNP水平可以指导心力衰竭患者的治疗,并可以预测失代偿期充血性心力衰竭患者的预后。     

舒张性心力衰竭患者心功能分级与左房重构的变化及意义

【目的】探讨舒张性心力衰竭病人不同心功能分级状态下左房重构的变化趋势、规律及临床意义。【方法】选择2008～2009年住院,符合舒张性心力衰竭诊断标准,基础疾病为高血压病、冠心病、糖尿病、肥厚性心肌病病人98例,心功能按NYHA分级分为I～Ⅳ级;应用多普勒超声心动图检测左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、左房内径（LAD）、室间隔厚度（（IVSD）、左室后壁厚度（LVPWD）、E峰、A峰、E／A值多项指标,并同时测定患者血浆脑钠肽（BNP）浓度。【结果】心功能Ⅲ～Ⅳ级组LAD、血浆BNP浓度、房颤发生率显著高于心功能I级组和心功能Ⅱ级组;左房内径（≥40mm）组房颤发生率、血浆BNP浓度高于左房内径（30～39mm）组及左房内径（≤29mm）组;房颤组血浆脑钠肽浓度高于窦律组。【结论】舒张性心力衰竭病人随着心功能进展、恶化,LAD扩大,房颤发生率增加;左房扩大致房颤发生率增加;左房重构（LAD扩大,房颤）亦引起心衰加剧。     

104例伴或不伴休克的心功能不全患者B型脑钠肽与心功能关系的分析

【目的】探讨伴或不伴休克的心功能不全患者血浆B型脑钠肽（BNP）与心功能的关系。【方法】选取3年住院心力衰竭患者104例,分为休克组、非休克组和死亡组、非死亡组。测定血清BNP水平;同时均行心脏超声测定其左室舒张末内径（LVDd）、左室射血分数（LVEF）。比较各组BNP水平以及BNP与LVEF、LVDd的相关性。【结果】休克组较非休克组BNP水平显著升高,有统计学差异（P〈0．05）,BNP与年龄呈正相关性（r=0．392,P〈0．05）;与LvDd呈正相关（r=0．349,P〈0．05）;与LvEF呈负相关（r=-0．586,P〈0．05）。死亡组与非死亡组相比,BNP显著升高,差别有统计学意义（P〈0．05）,LVDd、LvEF差别亦有统计学意义（P〈0．05）。【结论]BNP水平可作为判断心力衰竭患者的心功能不全程度及预后的指标。     

Heart Failure Guidelines and Implications for Surgically Treating Heart Failure

In 2005, the American College of Cardiology and the American Heart Association released updated guidelines for the diagnosis and management of chronic heart failure in the adult, yielding new insights into the progression and treatment of this disease. Perioperative nurses need a working knowledge of these guidelines to provide optimal care when patients require surgical interventions for heart failure. This article provides an overview of the pathophysiology, classifications, and treatments for heart failure. AORN J 90 (December 2009) 874–888. © AORN, Inc, 2009.     

β1肾上腺素能受体基因多态性与青年缺血性卒中的关联性研究

目的:探讨陕西地区汉族人群中中青年缺血性卒中与β1肾上腺素能受体(ADRB1)基因多态性的关系。方法:选择136例中青年缺血性卒中患者为卒中组,同期另选择青年健康体检者150例为对照组,采用聚合酶链反应结合DNA直接测序法检测ADRB1基因型,比较各组基因型和等位基因分布频率的差异。结果:多因素Logistics回归分析结果显示ADRB1基因Ser49Gly位点等位基因模型(Ser v.s.Gly)和显性基因模型(Ser/Ser v.s.Ser/Gly+Gly/Gly)与青年缺血性卒中的相关性具有统计学意义(OR=2.5,95%CI 1.2~5.2,P=0.009;OR=1.8,95%CI 1.2~3.3,P=0.011);Arg389Gly位点各基因模型与青年缺血性卒中相关性均无统计学意义(P0.05)。结论:对于陕西地区汉族中青年人群缺血性卒中患者,ADRB1基因Ser49Gly位点多态性与缺血性卒中相关。     

老年慢性心力衰竭患者NT—proBNP检测及其临床意义

【目的】探讨检测N端脑利钠肽前体（NT-proBNP）水平在老年慢性心力衰竭患者的临床应用价值。【方法】采用电化学发光法测定80例治疗前后老年慢性心力衰竭患者（心衰组）和60例健康对照者血清（对照组）NT-proBNP水平,心力衰竭患者心功能按NYHA心功能分级,以6分钟步行试验评价运动耐量。【结果】心衰组NT-proBNP水平较对照组明显升高E（5052．6土1860．4）pg／mLvs（220．4士99．2）,pg／mL,P〈0．O11;心衰组治疗后NT-proBNP水平较治疗前明显降低[（5052．6±4-1860．4）pg／mLVS（3203±1453．4）pg／mL,Pd0．01）]。NT-proBNP水平与左室射血分数（LVEF）（r=-O．174,Pd0．05）和6分钟步行距离成显著负相关（r=-0．187,Pd0．05）。【结论】老年慢性心力衰竭患者NT—proBNP水平明显增高,其检测水平可反映老年心力衰竭患者心功能状态、运动耐量,并可作为疗效判断指标。     

充血性心力衰竭患者B型尿钠肽与肝功能异常的临床意义

【目的】探讨充血性心力衰竭患者B型尿钠肽(BNP)水平和肝功能异常的变化规律及其临床意 义。【方法】130例心功能为Ⅱ～Ⅳ级充血性心力衰竭患者(其中Ⅱ级30例,Ⅲ级50例,Ⅳ级50例),分别于 入院d1及治疗一周后进行肝功能检测。部分病人根据需要随时检测。58例病人做了BNP检测,其中40例 在心衰治疗前后(平均治疗7d)检测了BNP水平。【结果】随着充血性心力衰竭程度的加重,肝功能指标中异 常率较高的有总胆红素、直接胆红素及血清白蛋白水平,在心功能Ⅳ级组分别达40%、80%及78%;同时患者 BNP水平随病情严重程度逐渐升高。经抗心衰治疗后,患者总胆红素及直接胆红素水平有明显降低,与治疗 前相比差异有显著性(P<0.01)。BNP水平较治疗前有明显下降。【结论】对心衰患者应注意肝功能的异常 变化,必要时应做BNP检测,动态观察肝功能及BNP水平有助于判断治疗效果及估计预后。