射频消融联合索拉非尼治疗进展期肝细胞癌的临床观察

原发性肝癌在全球发病率已超过62.6万/年,居于恶性肿瘤发病率的第5位;病死率也接近60万/年,位居肿瘤相关死亡的第3位[1]。我国发病人数约占全球的55%,其中85%～90%为肝细胞癌,     

老年心房颤动应用导管射频消融治疗进展

心房颤动（房颤）是临床上常见的快速心律失常,有较高的致残率和致死率.随着年龄的增长,心房颤动的发病率呈显著上升趋势,据临床统计,＞60岁的老年人群房颤的发病率＞1％,＞70岁人群发病率＞5％,＞80岁时可增加到10％[1].对于老年人,心房颤动多发生在自身患有心血管疾病的基础上（高血压、冠心病、心力衰竭及瓣膜病等）,并且具有持续时间长、并发症较多、生活质量差的特点.     

微创射频消融治疗心房颤动

心房颤动（简称房颤）是最常见的快速型心律失常之一,可增加心血管疾病死亡率和发病率,我国流行病学研究显示房颤发病率为0.73％[1].房颤治疗原则包括：控制心室率、抗凝治疗、缓解症状、治疗基础心脏病和诱发因素、恢复并维持窦性心律.房颤的药物疗效差,不能预防血栓栓塞和心力衰竭,抗凝药物的应用虽然减少血栓栓塞风险但同时也增加了出血风险.导管及外科的射频消融治疗房颤效果明显好于单纯药物治疗12-4].内、外科微创射频消融治疗房颤各有优缺点,可结合其优点联合治疗房颤.     

射频消融治疗阵发性房颤46例护理体会

心房颤动（房颤）是非常常见的一种心律失常,轻者影响生活质量,重者可致残、致死。房颤是脑卒中和心衰最强烈的独立危险因素。然而,药物治疗房颤用于转复和维持窦性心律疗效差,副作用明显,长期以来房颤缺乏安全有效的节律控制方法。近来,房颤导管消融取得了长足进展,     

肝癌局部消融治疗规范的专家共识

局部消融治疗是在影像技术的引导对肿瘤靶向定位,用物理或化学的方法杀死肿瘤组织;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种。局部消融治疗的特点：一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,可以反复应用。     

肾交感神经消融术治疗顽固性高血压的现状与未来

目前,经导管肾交感神经射频消融术（catheter．basedrenalsympatheticdenervation,RDN）在欧美国家已逐渐被认可用于治疗顽固性高血压。     

较大肝癌局部消融的关键问题

近年来,超声、CT、MRI 引导下射频消融（RFA）和微波消融（MCT）作为微创热消融技术迅速发展,已证实热消融治疗肝癌安全、廉价、有效,且极具前景。对于小肝癌（〈3 cm）的疗效确切[1],目前被临床列为一线治疗方法[2]。对大于3 cm 的肝癌进行消融,虽有较高的坏死率[3],但由于受消融热场区限制,存在完全灭活困难,局部复发率高的问题[4]。鉴于在临床实际工作中,小肝癌比例较少,而3 cm 以上较大肝癌最常见,因此提高较大肝癌局部消融的疗效成为改善肝癌患者预后的关键。如何能做到穿刺次数少,又完全灭活肿瘤、减少消融治疗后肝癌的局部复发已成为重要的研究热点。     

梗阻性肥厚型心肌病室间隔化学消融术后合并二尖瓣腱索断裂一例

1临床资料 患者,男性,50岁,以“活动后胸闷气短10余年,再发加重1个月”为主诉,于2010年11月25日入我院。该患者10余年前无明显诱因开始出现活动后胸闷气短,偶有胸痛。9年前于我院行心脏彩超示左室后壁17mm,室间隔29mm,     

肥厚型梗阻性心肌病室间隔心肌消融术中国专家共识

型梗阻性心肌病（hypertrophic obstructive cardiomyopathy,HOCM）是肥厚型心肌病的一种,因肥厚室间隔造成心室梗阻而得名.目前尚无理想的治疗措施,药物治疗为首选.但部分ＨＯＣＭ患者药物治疗效果不佳或不能耐受,这部分患者需要借助非药物治疗方法.     

肝癌射频消融治疗规范的专家共识

以射频消融为代表局部消融治疗是借助影像技术的引导对肿瘤靶向定位,用物理或化学的方法杀死肿瘤组织;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种。     

New Perspectives on Pharmacological Treatment of Atrial Fibrillation

Despite the huge development of radiofrequency catheter ablation, surgical operation, pacemaker implantation, and drug therapy remains the first line treatment of atrial fibrillation. Several new anti-arrhythmic drugs and anticoagulation drugs have come out recently, and have made the drug therapy of atrial fibrillation a more promising choice. This article provides a contemporary highlight on the new anti-arrhythmic agents of atrial fibrillation. （ S Chin J Cardiol 2009 ; 10 （4） ： 244 - 249 ）     

Plasma N-terminal pro-Brain natriuretic peptide levels after hybrid therapy with pulmonary vein isolation and amiodarone for atrial fibrillation

Background The purpose of this study was to investigate the effect of hybrid therapy and the relationship between the plasma N-terminal pro-Brain natriuretic peptide (NT-pro BNP) levels and the recurrence rate of the atrial fibrillation (AF) patients underwent pulmonary vein isolation (PVI) with or without amiodarone. Methods There were two groups in this study: control group and hybrid group. In the control group, 54 patients (36 males, 54±13 years) including paroxysmal (PAF) 22, persistent (Pers-AF) 15, and permanent AF (perm-AF) 17, respectively, underwent the PVI procedure only; In the hybrid, 63 AF patients (41 males, 53±12 years) including PAF 24, Pers-AF 18, and perm-AF 21, respectively,underwent the PVI procedure and used amiodarone to enhance the effect of PVI. Blood samples were collected before and 3 months after PVI. NT-pro BNP concentrations were determined by immunoassays. Results In the control group, AF recurred in 29 patients (PAF 5 in 22, Pers-AF 11 in 15, and perm-AF 13 in 17) after the initial PVI procedure; And in the hybrid group, AF recurrred in 20 patiens (PAF 3 in 24, Pers-AF 7 in 18, and perm-Af 11 in 21 ). The average recurrent rate decreased significantly in the hybrid group (53.7% vs 31.7%, P0.01). While the NT pro- BNP level (pg/mL) was significantly different between the 2 groups (PAF 294.34±54.4 versus 241.69±17.6 pg/mL, P=0.047; Pers-AF 487.51±47.9 versus 248.76±19.4, P=0.001; Perm-AF 490.91±38.3 versus 300.86±31.8, P=0.032), While the NT pro- BNP level was also much lower in hybird group than control group in total (263.43±26.1 versus 409.88±49.7, P=0.02). Conclusions Sinus rhythm(SR)following AF ablation is associated with a dramatic decrease in NT-pro BNP. The hybrid group which had the administration of amiodarone after PVI would significantly decrease the plama NT pro-BNP levels and the recurrent rate of AF.     

经导管射频消融治疗室性心动过速的疗效观察

室性心动过速是临床上较常见的心律失常,可发生于健康人群和各种心脏病患者。由于其可造成严重的症状甚至危及生命,因而需要积极处理,目前导管射频消融已逐渐成为首选治疗。我院近2年经导管射频消融治疗室性心律失常患者11例,现报道如下,以评价其临床疗效及安全性。     

心房纤维化及重构与房颤发展的新视点

房颤的发生源于心脏电生理改变和心房结构重塑的共同作用。心房纤维化是一个有害的过程,会引起细胞外基质沉积与降解失衡及成纤维细胞的过度增值等。早期研究显示,心室纤维化会引起心室壁进行性硬化,进而引起心室功能不全和充血性心力衰竭。但随后的研究突出显示了心房纤维化与房颤的关系,与瓣膜病、高血压和老龄化的关系。     

应用完全胸腔镜射频消融技术治疗心房颤动的初步结果

微创外科射频消融治疗心房颤动（房颤）是当今心血管外科领域倍受关注的热点之一。我院在采用双侧胸部小切口和胸腔镜辅助下双侧肺静脉射频消融隔离术的基础上,自2010年4月至2011年3月在国内率先开展了完全电视胸腔镜下双侧肺静脉射频消融并左心耳切除术治疗单纯性房颤,现对其技术方法和9例随访结果报道如下。     

Ebstein畸形合并预激综合征伴阵发性房颤(外科治疗一例)

2009年5月我院收治了一例Ebstein畸形合并预激综合征伴阵发性心房颤动的患者，予Ebstein畸形矫治，术中同期行心内电生理标测后予异常的房室传导束切断术，获得满意的效果，现报道如下。     

交感风暴的研究

交感风暴是由于心室电活动极度不稳定所导致的最危重的恶性心律失常,是心源性猝死的重要机制,本文对此作一综述。     

左心耳封堵术在心房颤动患者中的应用价值

心房颤动是临床最常见的快速性心律失常。而血栓栓塞是心房颤动的主要危害之一,长期口服抗凝药物是预防栓塞的主要方法。但由于其存在较大的局限性,严重限制了其临床应用。     

Situation of antithrombotic therapy in elderly patients with atrial fibrillation and acute coronary syndrome

Background Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. The study examines the situation of antithrombotic therapy in elderly patients(more than 60 years old) with non-valvular atrial fibrillation(NVAF) and acute coronary syndrome(ACS) / percutaneous coronary intervention(PCI).Methods This study enrolled 381 elderly patients [mean age(69.95 ± 8.41) years; 289 males, 92 females]with NVAF and ACS / PCI between January 2006 and September 2013. According to clinical data, these patients were categorized into 4 groups: triple therapy(TT) group, dual antiplatelet therapy(DAT) group,vitamin K antagonist(VKA) plus single antiplatelet therapy(SAT) group and VKA group. According to score of CHA2DS2-VASc and HAS-BLED, all the patients were divided into 4 combinations. Statistical methods were used to analyze the situation of antithrombotic therapy and potential associations between the different combinations. Results 38 patients(9.97%) received TT and 300 patients(78.74%) received DAT. TT was received in 20 patients with CHA2DS2-VASc ≥2 and HAS-BLED ≥3, and 16 patients with CHA2DS2-VASc≥2 and HAS-BLED 3. Conclusions Elderly patients who suffered NVAF and ACS / PCI were with high risk of stroke and low risk of bleeding. Majority of these patients received DAT instead of TT.     

心房颤动研究新进展:微小RNA调控心房重构相关基因

<正>心房颤动(atrial fibrillation,AF)是心血管疾病以及致死性疾病中最常见的持续性心律失常,其发生和维持的机制非常复杂。目前的研究表明,心房电重构和结构重构是AF发生和持续的核心环节,它们相互结合,共同构成了AF的电生理-解剖学基础。最近,与AF相关的离子通道蛋白质表达的变化吸引了很多研究者的关注,特别是伴随着微小RNA(microRNA,miRNA)研究的快速发展,研究者已经开始关注不编码蛋白质的miRNA在AF中的作用。有些实验依据也