Tei指数在选择再血管化治疗急性心肌梗死适应证的价值

目的:用Tei指数的变化评价再血管化治疗急性心肌梗死区心肌功能的恢复情况,探讨Tei指数在选择再血管化治疗适应证的作用。方法:选择再血管化治疗的32例急性心肌梗死患者,按照是否为跨壁心梗及疤痕情况分为两组。在再血管化治疗的术前、术后10d、3个月、6个月分别测定Tei值和左室射血分数(LVEF),比较并分析前后变化。结果:32例患者在术前及术后10d的Tei指数及LVEF无明显变化;24/32例(术前Tei值<0.54,LVEF>46%)术后3个月及6个月时心功能有明显的变化,8/32例(术前Tei>0.66、LVEF<37%)在再血管化术后没有明显的变化。结论:急性心肌梗死患者选择作再血管化治疗适应证时,Tei<0.54的患者是比较合适的,而Tei>0.66的患者再血管化治疗的效价比较低。     

动脉导管未闭介入术对心肌作功指数的影响

目的:研究经皮动脉导管未闭(PDA)介入封堵术对心脏结构和心肌作功(Tei)指数的影响.方法:PDA经导管封堵后的患者16例,并选择年龄相当的16例健康人作为对照组,应用超声心动图测定左、右心室Tei指数、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)和主动脉瓣血流速度峰值(Vp)等指标.结果:①PDA封堵成功率100%,封堵成功的患者均于术前、术后2 d及3个月行经胸超声心动图检查和随访,均无残余分流和并发症,生活质量良好.②PDA患者术前左心室Tei指数较对照组显著升高(P＜0.01),术后2 d左心室Tei指数较术前显著升高(P＜0.01),术后3个月左心室Tei指数恢复到正常范围内,PDA患者封堵术前后右心室Tei指数变化差异无统计学意义(P＞0.05).③PDA封堵前左心房内径、LVEDD、LVESD、LVFS、LVEF、Vp均较对照组明显增大(P＜0.05或P＜0.01),术后2 d均明显减小(P＜0.05或P＜0.01),术后3个月恢复到正常范围内.PDA封堵后右心室舒张末期内径未见明显改变(P＞0.05).④PDA封堵术后Tei指数的变化与LVEDD、LVEF、Vp的变化均呈显著负相关(均P＜0.05),与相应的R-R间期的变化无显著相关性.结论:①介入封堵治疗后PDA患者Tei指数短期内均显著升高,于术后3个月恢复正常.②短期内Tei指数的变化与LVEDD、LVEF、Vp的变化呈负相关,Tei指数可以作为反映心功能变化的可靠的指标.     

再血管化治疗对急性心肌梗死患者血浆激素水平和心功能的影响

目的:评价再血管化治疗对急性心肌梗死(AMI)患者神经内分泌激素水平及心功能的影响.方法:将68例AMI患者按是否行再血管化治疗分为急诊冠状动脉介入治疗(PCI)组20例,延迟PCI组26例,未行再血管化治疗的对照组22例,3组患者基础临床特征无统计学差异.于心肌梗死急性期和心肌梗死术后6个月分别采血检测血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)浓度、血浆醛固酮(Ald)浓度、血浆去甲肾上腺素(NE)和肾上腺素(E)浓度,并测定左心室室壁运动指数(WMI)、左心室射血分数(LVEF)、左心室舒张末期容积指数(LVEDVI)和收缩末期容积指数(LVESVI)变化.结果:①无论急诊PCI组还是延迟PCI组,血浆肾素活性、血管紧张素Ⅱ、血浆醛固酮等激素水平术后6个月均有明显下降,而未行再血管化手术治疗的对照组激素水平无显著变化.②在急诊PCI组和延迟PCI组术后6个月与急性期比较左心室射血分数增加,左心室室壁运动指数减小;延迟PCI组术后6个月时的左心室收缩末期容积指数较急性期减小;急诊PCI组和延迟PCI组6个月的左心室收缩末期容积指数和室壁运动指数明显小于对照组,均有显著性差异(P＜0.05).结论:无论急诊PCI还是延迟PCI均可以降低心肌梗死后神经内分泌激素的过度激活,减缓左心室重塑,改善心功能.     

Tei指数联合B型利钠肽原对起搏器患者术后心功能的评价

目的：探讨Tei指数和血浆N末端B型利钠肽原（NT-proBNP）水平对起搏器患者术后心功能评价的价值。方法：行永久起搏器植入术患者168例,起搏模式均为心室按需起搏（VVI）,术前,术后3个月、12个月行Tei指数、血清NT-proBNP、左室射血分数（LVEF）及E/A峰比值等检测,计算心室累积起搏（CumVP）比例（%）。按心室起搏比例区分为CumVP〈30%组（38例）,CumVP 30%～75%组（56例）,CumVP〉75%组（74例）3组。分析Tei指数与NT-proBNP在不同起搏指数患者之间的变化。结果：与术前比较,术后12个月Cum-VP〉75%组NT-proBNP[（124.88±12.56）ng/L比（168.42±32.46）ng/L]与Tei指数[（0.52±0.04）比（0.68±0.06）]显著升高（P〈0.05～〈0.01）,LVEF[（0.56±0.02）比（0.48±0.05）]显著降低（P〈0.05）;与术前比较,术后CumVP〈30%组上述指标的变化差异无显著性（P〉0.05）,CumVP 30%～75%组,Tei指数明显升高[（0.54±0.14）比（0.66±0.01）,P〈0.05],而BNP、LVEF变化差异无显著性（P〉0.05）。结论：起搏器患者心功能改变与起搏比例有关,N末端B型利钠肽原水平与Tei指数可作为评价术后心功能的指标。     

右心室心尖部起搏下脑钠肽水平及Tei指数与患者预后关系的临床研究

目的 探讨右心室心尖部(RVA)起搏下血浆B型脑钠肽(BNP)水平及Tei指数与患者预后关系.方法 连续选择242例首次植入VVI或DDD起搏器的患者为研究对象,定期行心电图及超声心动图检查,记录左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD),检测BNP水平,计算心室累计起搏比例,记录按照其是否出现心血管事件,分为心血管事件组(A组)及非心血管事件组(B组),并对相关临床因素进行分析.结果 A组58例,B组184例,B组患者与术前比较,术后6个月BNP及Tei指数无变化,术后2年,BNP可增加,LVEF及LVEDD无变化.A组患者术后6个月BNP及Tei指数均有变化,术后2年,BNP及Tei指数明显增加,LVEF值及心功能降低,多因素分析结果显示,BNP、Tei指数是心血管事件独立的危险因素.结论 长期RVA起搏者BNP水平与心功能有关,可早期监测心功能变化,对于持续较高水平BNP、Tei指数的RVA起搏患者心血管不良事件发生率高、预后不良,应干预治疗.     

慢性心力衰竭患者心脏再同步化治疗后多普勒Tei指数的变化

目的评估Tei指数在慢性心力衰竭患者心脏再同步化治疗中的应用价值。方法选取36例慢性心力衰竭患者,采用超声心动图监测,根据左室收缩末期容积(LVESV)在心脏再同步化治疗术后六个月比治疗前下降大于10%分为有反应组和无反应组,分析两组左心室Tei指数的变化情况。结果反应组患者术后一周及术后六个月与术前比较左室舒张末期容积(LVEDV)和LVESV减小差异有统计学意义(P<0.05),而无反应组术后一周及术后六个月与术前比较LVEDV和LVESV的减小差异无统计学意义(P>0.05)。术前Tei指数反应组显著高于无反应组,差异有统计学意义(P<0.05)。术后一周左室Tei指数反应组仍显著高于无反应组,差异有统计学意义(P<0.05)。但在随访六个月后,反应组与无反应组Tei指数比较差异无统计学意义(P>0.05)。Tei指数反应组术后六个月较术前显著下降(P<0.01)。而无反应组中Tei指数术后六个月与术前比较差异无统计学意义(P>0.05)。结论反应组的慢性心力衰竭患者心脏再同步化治疗前左心室Tei指数较高而心脏再同步化治疗后呈现持续改善。     

左西孟旦在急性心肌梗死伴心力衰竭治疗中的应用

目的 探讨左西孟旦对急性心肌梗死并发心力衰竭患者的临床疗效.方法 选择于我院就诊的急性心肌梗死并发心力衰竭的患者76例,随机分为试验组与对照组.其中试验组40例,在基本药物治疗基础上给予左西孟旦治疗;对照组36例,在基本药物治疗基础上给予盐酸多巴酚丁胺治疗.检测治疗前后B型钠尿肽(BNP)的水平,记录超声心动图左心室射血分数(LVEF)的变化,观察心力衰竭的症状体征变化并记录患者住院天数.结果 两组治疗前血BNP及LVEF差异无统计学意义(P均＞0.05),治疗后试验组LVEF高于对照组,血BNP水平低于对照组(P均＜0.05),试验组住院天数较对照组短(P＜0.05).结论 左西孟旦对急性心肌梗死并发心力衰竭患者的心功能改善有益.     

多普勒超声心肌运动指数评价卡维地洛对心力衰竭左心功能的影响

目的 通过多普勒超声测定左心室心肌运动指数评价心力衰竭患者应用卡维地洛治疗前后心功能的变化.方法 收集哈尔滨医科大学第一临床医学院2004-2006年住院和门诊的患者,其中正常对照组50名,慢性心力衰竭组45例,观察治疗前和治疗后1个月、6个月时分别用多普勒超声测量左心室传统Tei指数(c-Tei)和组织多普勒Tei指数(t-Tei)、左室射血分数(LVEF)等指标.结果 慢性心力衰竭组较正常对照组左心室舒张末期内径(LVEDd)、c-Tei和t-Tei明显增高(P＜0.05).LVEF明显降低(P＜0.05);卡维地洛治疗1个月时,c-Tei和t-Tei明显改善(P＜0.05);治疗6个月时,c-Tei、t-Tei、LVEF、LVEDd和美国纽约心脏协会心功能分级较治疗前均明显改善(P＜0.05).结论 应用Tei指数对心力衰竭患者心功能进行评价简便、可行,c-Tei和t-Tei具有同等作用.     

缺血后适应对急性心肌梗死PCI术后再灌注心律失常及心功能的影响

目的探讨缺血后适应对急性心肌梗死经皮冠状动脉介入治疗术（PCI ）后再灌注心律失常及心功能的影响。方法随机抽取58例ST段抬高型急性心肌梗死行急诊PCI的患者,30例为缺血后适应组,其梗死血管再通后1min内应用低压力充盈球囊,持续阻塞30s后球囊抽负压,血流持续再灌注60s ,反复4次;28例为对照组（单纯PCI组）,梗死血管再通后未施加缺血后适应干预。观察两组术中再灌注心律失常的发生情况,检测两组术前及术后3个月血浆氨基酸末端脑钠肽前体（NT-pro-BNP ）水平和测量两组左心室射血分数（LVEF ）。结果术中缺血后适应组发生再灌注心律失常后药物转复或除颤例数明显小于对照组,差异有统计学意义（ P＜0.05）;术后3个月缺血后适应组血浆NT-pro-BNP水平明显低于对照组（ P＜0.05）。结论急性ST段抬高型心肌梗死行急诊PCI时采用缺血后适应治疗有助于终止心律失常的发生,同时能改善患者术后3个月后的心脏功能。     

急性心肌梗死后存活心肌对梗死相关血管晚期血运重建术后左室功能的影响

目的探讨存活心肌对急性心肌梗死(AMI)后梗死相关血管(IRA)晚期血运重建术后远期左室功能以及左室重构的影响.方法69例AMI未接受早期再灌注治疗者,于发病10～21 d行IRA经皮冠状动脉血运重建(PCI)术,术前于AMI发病后5～10 d应用小剂量多巴酚丁胺(5和10μg·min-1·kg-1)超声心动图负荷试验检测存活心肌,并分别测定和计算给药前后左室腔大小、左室射血分数(LVEF)以及室壁运动积分(WMS).按有无存活心肌分为存活心肌组和无存活心肌组,超声心动图随访术后6个月时两组左室腔大小、LVEF和WMS的变化.结果157个运动异常节段中89个节段(57%)有存活心肌,有存活心肌组26例(占38%),无存活心肌组43例(占62%).存活心肌组术后6个月LVEF较术前明显提高(P＜0.05),收缩末期容积指数(LVESVI)和WMS明显降低(P＜0.05和P＜0.01);而无存活心肌组LVEF较术前明显降低(P＜0.01),LVESVI和左室舒张末期容积指数(LVEDVI)较术前明显增加(P＜0.05),WMS无明显变化.存活心肌组多巴酚丁胺负荷时的LVEF和WMS明显改善,且与6个月时的测定值相近;而无存活心肌组PCI前应用多巴酚丁胺LVEF和WMS均无明显变化.结论AMI后有存活心肌者晚期血运重建有利于改善远期左室功能和减少左室重构.心肌梗死后早期小剂量多巴酚丁胺负荷状态下左室收缩功能的提高预示晚期血运重建术后心功能改善.     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.