超声心动图评价高血压病患者左心功能

目的运用超声心动图技术综合评价高血压病患者左室收缩功能和舒张功能。方法高血压病组56例和对照组36例,M-型和二维(2D)超声心动图检测:左房内径(LAd),舒张期室间隔厚度(IVST)和左室后壁厚度(PWT),左室舒张末期内径(LVDd),二尖瓣EF斜率,室间隔及左室后壁运动幅度,左室射血分数(EF),左室短轴缩短率(FS),每搏量(SV);脉冲多普勒(PW)检测二尖瓣口舒张早期充盈峰速度(VE),舒张晚期充盈峰速度(VA),E/A比值,等容舒张时间(IVRT)。结果高血压病患者左室壁与室间隔收缩期运动幅度普遍增强,与对照组比较P<0.01;左室收缩功能各项参数(EF、FS、SV)高于对照组(P<0.05),高血压病组左室舒张功能各参数异常,表现为VE减低,VA升高,E/A<1,IVRT延长,MV-EF斜率减慢,与对照组比较P<0.001;左房扩大(P<0.001)。结论超声心动图技术可反映高血压病患者左心结构和功能变化,为临床诊治提供客观依据。     

超声心动图评价高血压患者心脏结构及功能的改变

目的 应用超声心动图探讨高血压患者左室结构与功能的改变。方法 取正常对照组26例，并按1999年WHO／ISH标准把357例高血压患者分为1、2、3级。分别应用超声心动图测量各组心脏结构、收缩功能、舒张功能各项指标。对各项指标应用单因素方差分析。结果 高血压患者与正常人心房收缩期峰值流速(APFV)与E／A有差异，但高血压各组间无差异。高血压患者室间隔、左室后壁、左室质量及左室质量指数较正常人增加，中、重度高血压患者左房及主动脉内径增大。心脏收缩功能及舒张早期血流峰值流速(EPFV)各组间无差异。结论 室间隔及左室后壁厚度是反映血压升高的敏感指标。心房收缩期峰值流速(APFV)反映收缩功能正常的高血压患者左室舒张功能减低。     

超声心动图评价平静呼吸对正常人左心室收缩功能的影响

目的观察平静呼吸时胸压变化对左、右心室前后径及左室收缩功能的影响,进一步证实呼吸影响血流动力学机制新假说。方法20名健康志愿者,用Sequoia512彩色超声同步记录呼吸曲线。启动二维及M-型超声心动图记录右室前壁、室间隔及左室后壁活动曲线,测量舒张末期室间隔左室面随呼吸摆动幅度,分别测量呼气和吸气时右室前壁、室间隔、左室后壁的收缩幅度及左、右心室舒张期和收缩期内径,计算左室短轴缩短率、每搏输出量及射血分数,并计算上述指标随呼吸的变化率。结果平静呼吸时,室间隔吸气时摆向左室侧,呼气时摆向右室侧,室间隔随呼吸左右摆动幅度为(1.76±0.50)cm;右室舒张期前后径吸气时较呼气时明显增大,左室变化相反;室间隔及左室后壁收缩期运动幅度及左室每搏输出量呼气时较吸气明显增加,而射血分数及短轴缩短率在呼气和吸气间无明显差别。结论呼吸性胸压变化最终作用到了室间隔上,使左、右室内径及收缩功能发生交替性变化。     

急性心肌梗死后室壁瘤形成与左室附壁血栓的关系

目的:探讨急性心肌梗死后室壁瘤形成与左室附壁血栓关系.方法:回顾性分析66例急性心肌梗死后左室附壁血栓形成患者的临床资料,根据是否并发左室附壁血栓分为血栓组与非血栓组,血栓组30例,非血栓组36例,比较两组左房直径、左室舒张末期直径、左室收缩末期直径、左室舒张期室间隔厚度、左室舒张期后壁厚度、室壁瘤基底直径、膨出直径及左室射血分数.结果:(1)左房直径、左室舒张末期直径、左室收缩末期直径、左室舒张期后壁厚度、室壁瘤基底直径、室壁瘤膨出直径、左室射血分数两组比较无统计学差异(均P>0.05).(2)左室舒张期室间隔厚度血栓组显著大于非血栓组[(1.17±0.26)cm比(1.04±0.19)cm,P<0.05].结论:急性心肌梗死后室壁瘤形成易发生附壁血栓,但左室附壁血栓与瘤体大小无明显关系.     

脉压与冠心病患者左室功能及左室肥厚的关系

目的:比较分析合并与未合并糖尿病、高血压冠心病患者脉压与心功能指标及左室肥厚的关系。方法:①选择2001-01/12上海交通大学附属第一人民医院心内科住院冠心病患者105例,男70例,女35例。其中仅合并高血压者29例(合并高血压组),同时合并高血压及糖尿病者27例(合并高血压及糖尿病组),合并糖尿病者32例(合并糖尿病组),无高血压及糖尿病者(无高血压及糖尿病组)17例。患者均知情同意。②在行冠状动脉造影术过程中测定主动脉内收缩压、舒张压,计算脉压值。超声心动描记法为M型模式下测定舒张末期左室腔直径、左室后壁厚度及室间隔厚度及左室射血分数。根据公式:左室质量=1.04[(室间隔厚度+舒张末期左室腔直径+左室后壁厚度)3-舒张末期左室腔直径3]-13.6计算左室质量。根据公式:相对室壁厚度=(室间隔厚度+左室后壁厚度)/舒张末期左室腔直径计算相对室壁厚度。③分别以脉压、左室质量、左室射血分数及相对室壁厚度为变量,以年龄、性别、伴有高血压、伴有糖尿病、同时伴有高血压及糖尿病为控制变量,进行偏相关分析。组间分析采用方差分析。结果:冠心病105例均进入结果分析。①各组脉压无明显差别。合并高血压及糖尿病组左室质量、相对室壁厚度大于其他3组(P<0.05),心功能指标左室射血分数明显低于其他3组(P<0.05)。②各组脉压均与左室质量呈显著正相关(r=0.35～0.47,P<0.05～0.01)。合并高血压组、合并高血压及糖尿病组脉压与左室射血分数呈显著正相关(r=0.33,0.41P<0.05)。合并高血压及糖尿病组脉压与相对室壁厚度呈显著正相关(r=0.51,P<0.01)。结论:脉压是一独立于高血压之外的,与左室肥厚有关的独立指标;同时合并高血压及糖尿病,为影响冠心病患者左室肥厚,左室收缩功能的重要因素。     

超声诊断妊娠高血压综合征孕妇的胎儿心脏功能变化及意义

0的;研究高血压及妊娠高血压综合征(PIH),简称妊高征孕妇的胎儿心脏形态和功能的变化。方法:应用超声诊断仪测定32例妊娠高血压孕妇的胎儿(研究组)和120例正常孕妇妊娠的胎儿(对照组)的心脏室间隔厚度,心室收缩期及舒张期周长及面积,心室收缩分数1(心室舒张末期面积-心室收缩末期面积)/心室舒张末期面积,心室收缩分数2(心室舒张末期周长-心室收缩末期周长)/心室舒张末期周长。并随访两组新生儿体重。结果:研究组室间隔厚度为(5.8±0.7mm,X±S,下同),明显高于对照组(4.0±0.7)mm,研究组左心室舒张,收缩末期面积分别为(3.40±0.8)cm2,(2.3±0.60)cm2,明显高于对照组(2.5±0.7)cm2,(2.0±0.5)cm2。研究组右心室舒张末期面积、收缩末期面积(3.50±0.7)cm2、(2.6±0.7)cm2,明显高于对照组(3.2±0.5)cm2、(2.4±0.7)cm2,研究组左心室收缩分数1为(0.21±0.07),明显高于对照组(0.12±0.04)。研究组右心室收缩分数2为(0.37±0.11),明显高于对照组2(0.23±0.10)。研究组右心室收缩分数1为(0.20±0.05),明显高于对照组(0.14±0.11)。研究组右心室收缩分数2为(0.33±0.09),明显高于对照组2(0.24±0.14)。妊高症孕妇新生儿体重为(3040±750)g,明显低于对照组(3440±580)g。结论:高血压孕妇的胎儿心脏相对较大,心率增     

组织多普勒评价经皮室间隔化学消融术对肥厚梗阻型心肌病左心室收缩舒张功能的影响

目的 应用多普勒组织成像测量室间隔、后壁和二尖瓣环各点速度.以评价肥厚梗阻型心肌病患者在经皮室间隔化学消融术(PTSMA)前后左室收缩舒张功能的改变.方法 在PTSMA术前、术后急性期对肥厚梗阻型心肌病患者分别测量室间隔、左室后壁和二尖瓣环各点收缩期、舒张期早期和舒张晚期峰值速度.结果 肥厚型心肌病患者术后急性期室间隔、左室后壁和二尖瓣环各点收缩期、舒张期早期峰值速度均较术前减低,差异有统计学意义(P＜0.05).舒张晚期峰值也较术前减低,大部分差异有统计学意义(P＜0.05).结论 肥厚型心肌病患者PTSMA术后急性期左室长轴收缩功能及主动松弛功能较术前减低.     

替米沙坦对老年收缩性高血压左心室舒张功能的影响

目的研究血管紧张素Ⅱ受体拈抗剂替米沙坦对老年收缩期高血压左心室舒张功能的影响。方法采用自身对照开放试验方法,56例原发性收缩期高血压伴左心室舒张功能不全的老年患者口服替米沙坦80～160mg,1次／d,治疗12个月后,对治疗前后进行超声多普勒左心舒张功能测量与对照分析。结果与治疗前相比,56例高血压患者治疗12个月后,血压显著下降（P〈0．01）;超声多普勒对照检查显示,左室后壁舒张末期厚度（LVPWT）、室间隔舒张末期厚度（IVST）、峰值充盈速度A、峰值速度A／峰值速度E比值均明显下降（P〈0．01）。结论替米沙坦在降压的同时,能有效地改善左心室舒张功能。     

二维超声心动图对原位心脏移植的术后观察

目的 :二维超声心动图观察同种异体原位心脏移植术后心脏的变化 ,确定超声所测指标对临床治疗的意义。方法 :5例接受同种异体原位心脏移植的患者 ,自术后第 3天起至第 30天 ,行常规超声心动图检查 ,术后第 30天心内膜活检。结果 :左室收缩末期、右室舒张末期、右房收缩末期大小 ,均与术后时间 (天数 )显著正相关 (r=0 .50 0 4 ,P<0 .0 5;r=0 .564 6,P<0 .0 1 ;r=0 .545 7,P<0 .0 5)。左室舒张末期、左房收缩末期大小、左室后壁及室间隔厚度和搏幅、左室心肌重量、 EF、 ΔD与术后时间之间无显著相关性。各数据在术后第 3天和第 30天的比较中仅左室收缩末期大小有显著变化 [(37.2 6± 8.2 5) cm3 vs (43.91± 1 3.51 ) cm3 ,P<0 .0 5] ,其余指标无显著差异。心内膜活检均为 级排斥反应。结论 :超声心动图检查可提供重要的心脏形态和功能指标 ,对于观察患者、指导治疗有重要意义     

超声观察高血压患者左心系统结构和功能

目的利用超声心动图观察高血压患者左心结构及功能变化。方法检测高血压患者65例及正常对照者70例。分别检测左心室内径,室间隔及左室后壁厚度,二尖瓣口血流舒张早期最大流速(E)及舒张晚期最大流速(A),左房内径及反映收缩功能的四项指标。结果高血压患者左室壁(室间隔、左室后壁)厚度增加,平均为0.41cm(P<0.001),左室内径扩大或不扩大,二尖瓣口血流频谱A/E>1(P<0.001),左房内径普遍扩大(P<0.001),左室收缩功能参数高于正常对照(P<0.05)。结论超声心动图可以准确评价高血压患者左心系统结构变化及心功能改变,为治疗和控制疾病发展的不可缺少的检查手段。     

超声多普勒监测移植心脏心肌排斥反应研究

应用超声多普勒技术，对两例原位心脏移植术患者心肌排斥反应进行监测。经与心肌活检、临床观察及诊断性治疗结果对比，认为超声监测指标可用于移植心脏急件排斥反应诊断，并提出了相应的超声诊断分度标准。采用超声监测为主、辅以临床观察和超声引导下心内膜心肌活检的综合监测方法，可使心肌活检次数较常规减少２／３，认为此项技术有较高实用价值。     

43例心脏肿瘤临床分析

目的：总结心脏肿瘤的临床特征，提高对心脏肿瘤的认识。方法：回顾性分析了43例心脏肿瘤的临床表现、肿瘤发生部位及肿瘤性质等。结果：心脏肿瘤最常见临床表现是心悸和气短。心脏肿瘤可发生于心脏任何部位，左心房最常见，且多为粘液瘤，其次是右心房。右心肿瘤除粘液瘤外，多为恶性肿瘤。43例肿瘤中粘液瘤35例（81．39％），非粘液良性肿瘤6例（13．95％），恶性肿瘤2例（4．65％）。结论：原发心脏肿瘤中左心房粘液瘤最多见，良性心脏肿瘤手术治疗效果好，恶性心脏肿瘤仅能解除机械梗阻，缓解症状，预后差。     

Impaired venous return causes circulatory failure in experimental pancreatitic shock in dogs

The haemodynamic effects in the early phase of canine acute experimental pancreatitis (AP) were studied using a cardiac catheterization technique. AP was induced in anaesthetized dogs with an infusion of trypsin-sodium-taurocholate into the pancreatic duct. The initial haemodynamic measurements were performed after the preparation of the animal and 5 min after the induction of AP. Thereafter, pressure and volume parameters were measured at 10 min intervals. AP induced significant increases in heart rate, dP/dt_max and mean arterial pressure, but a decrease in V_max 5 min after the induction of AP. After the initial phase, the heart rate remained significantly increased, while constant and significant decreases of stroke volume, cardiac output, enddiastolic volume and end-diastolic pressure developed. The parameters of the contractility of the left ventricle were not affected to the same extent. It is suggested that the circulatory failure observed in AP, characterised by a prompt reduction of cardiac output, was primarily due to a heavy reduction in preload. This supports the theory that cardiac output is primarily affected by impaired venous return with consequently decreased preload rather than by a loss of ventricular contractility. Hence, the existence of a myocardial depressant factor in the early phase of experimental AP does not gain support from the present results.     

在线血液透析滤过对维持性血液透析患者心脏结构和功能的影响

目的探讨规律性在线高通量血液透析滤过对维持性血液透析(maintain hemodialysis,MHD)患者左心室结构和功能的维护作用和机理。方法按一定的纳入标准选择湖北医药学院附属人民医院血液净化中心MHD患者53例,随机分为单纯透析组(HD组)和透析+透析滤过组(HD+HDF组),于治疗前及6个月后用超声心动图分别测定各患者心脏结构和功能指标(LVDd、LVVd、E/A、EF和LVMI);在以上两时间点进行体检并抽取患者血标本分别检测患者基础状态指标(MAP、Hb、BMI、SCr)和透析相关慢性损害指标(CRP、IL-1a、a2-MG、PTH)。结果入选时两组患者在基础状态指标、透析相关慢性损害指标和心功能指标方面无显著差异;经不同治疗模式治疗6个月后,HD组在基础状态指标方面变化不明显,但在CRP、IL-1a、a2-MG、PTH等指标上有轻度升高;HD+HDF组患者在基础指标的血压和血红蛋白上和透析相关慢性损害指标上较前均有好转;治疗6个月后,HD组和HD+HDF组在E/A、EF、LVMI等心功能指标上均有所减退,但HD+HDF组较HD组的减退幅度明显较小。结论在维持性血液透析患者中采用HD+HDF模式更有助于减轻患者心脏结构和功能损害。     

Resuscitation quality assurance for out-of-hospital cardiac arrest--setting-up an ambulance defibrillator telemetry network

Background

Out-of-hospital cardiac arrest (OHCA) is a leading cause of pre-hospital mortality. Chest compressions performed during cardiopulmonary resuscitation aim to provide adequate perfusion to the vital organs during cardiac arrest. Poor resuscitation technique and the quality of pre-hospital CPR influences outcome from OHCA. Transthoracic impedance (TTI) measurement is a useful tool in the assessment of the quality of pre-hospital resuscitation by ambulance crews but TTI telemetry has not yet been performed in the United Kingdom. We describe a pilot study to implement a data network to collect defibrillator TTI data via telemetry from ambulances.

Methods

Prospective, observational pilot study over a 5-month period. Modems were fitted to 40 defibrillators on ambulances based in Edinburgh. TTI data was sent to a receiving computer after resuscitation attempts for OHCA.

Results

58 TTI traces were transmitted during the pilot period. Compliance with the telemetry system was high. The mean ratio of chest compressions was 73% (95% CI 69-77%), the mean chest compression rate was 128 (95% CI 122-134). The mean time interval from chest compression interruption to shock delivery was 27 s (95% CI 22-32 s).

Conclusion

Trans-thoracic impedance analysis is an effective means of recording important measures of resuscitation quality including the hands-on-the-chest time, compression rate and defibrillation interval time. TTI data transmission via telemetry is straightforward, efficient and allows resuscitation data to be captured and analysed from a large geographical area. Further research is warranted on the impact of post-resuscitation reporting on the quality of resuscitation delivered by ambulance crews.     

经食道心脏超声检查对射频消融围术期患者的心脏监测

目的监测射频消融快速心律失常术对患者心瓣结构和心功能的影响。方法以经食道心脏超声技术在９２例患者于射频消融术前及术后３、１０天分别检测左心室功能及心瓣膜结构。结果射频消融术对心功能没有影响,但可致８．３３％～２０．４５％心瓣膜功能不全,射频消融术导致的心瓣膜功能不全多可在数日内消失,仅不到１／３患者遗留有轻度心瓣膜返流,有待长期随访观察。结论射频消融术对心脏结构的损伤轻微,对心脏射血功能没有影响     

Emergency department factors associated with survival after sudden cardiac arrest

Background

Sudden cardiac arrest (SCA) is a leading cause of death in the US. Recent innovations in post-arrest care have been demonstrated to increase survival. However, little is known about the impact of emergency department (ED) and hospital characteristics on survival to hospital admission and ultimate outcome.

Objective

We sought to describe the incidence of SCA presenting to the ED and to identify ED and hospital characteristics associated with survival to hospital admission.

Methods

We identified patients with diagnoses of atraumatic cardiac arrest or ventricular fibrillation (ICD-9 427.5 or 427.41) in the 2007 Nationwide Emergency Department Sample (NEDS), a nationally representative estimate of all ED admissions in the United States. We defined SCA as cardiac arrest in the out-of-hospital or ED settings. We used the NEDS sample design to generate nationally representative estimates of the incidence of SCA that presents to EDs. We performed unadjusted and adjusted analyses to examine the relation between patient, ED, and hospital characteristics and outcome using logistic regression. Our primary outcome was survival to hospital admission. Survival to hospital discharge was a secondary outcome. Data are presented as odds ratios (OR) with 95% confidence intervals (CI).

Results

Of the 966 hospitals in the NEDS, 933 (96.6%) reported at least one SCA and were included in the analysis. We identified 38,593 cases of cardiac arrest representing an estimated 174,982 cases nationally. Overall ED SCA survival to hospital admission was 26.2% and survival to discharge was 15.7%. Greater survival to admission was seen in teaching hospitals (OR 1.3 95% CI 1.1–1.5, p = 0.001), hospitals with ≥20,000 annual ED visits (OR 1.3 95% CI 1.1–1.6, p = 0.003), and hospitals with percutaneous coronary intervention capability (OR 1.6 95% CI 1.4–1.8, p < 0.001). Higher SCA volume (>40 annually) was associated with lower survival overall (OR 0.7 95% 0.6–0.9, p = 0.010), but not when transferred patients were excluded from the analysis (OR 0.8 95% CI 0.6–1.1, p = 0.116).

Conclusions

An estimated 175,000 cases of SCA present to or occur in US EDs each year. Percutaneous coronary intervention capability, ED volume, and teaching status were associated with higher survival to hospital admission. Emergency departments with higher annual SCA volume had lower survival rates, possibly because they transfer fewer patients. An improved understanding of the contribution of ED care to survival following SCA may be useful in advancing our understanding of how best to organize a system of care to ensure optimal outcomes for patients with SCA.     

Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI

Aim

To determine if early cardiac catheterization (CC) is associated with improved survival in comatose patients who are resuscitated after cardiac arrest when electrocardiographic evidence of ST-elevation myocardial infarction (STEMI) is absent.

Methods

We conducted a retrospective observational study of a prospective cohort of 754 consecutive comatose patients treated with therapeutic hypothermia (TH) following cardiac arrest.

Results

A total of 269 (35.7%) patients had cardiac arrest due to a ventricular arrhythmia without STEMI and were treated with TH. Of these, 122 (45.4%) received CC while comatose (early CC). Acute coronary occlusion was discovered in 26.6% of patients treated with early CC compared to 29.3% of patients treated with late CC (p = 0.381). Patients treated with early CC were more likely to survive to hospital discharge compared to those not treated with CC (65.6% vs. 48.6%; p = 0.017). In a multivariate regression model that included study site, age, bystander CPR, shock on admission, comorbid medical conditions, witnessed arrest, and time to return of spontaneous circulation, early CC was independently associated with a significant reduction in the risk of death (OR 0.35, 95% CI 0.18–0.70, p = 0.003).

Conclusions

In comatose survivors of cardiac arrest without STEMI who are treated with TH, early CC is associated with significantly decreased mortality. The incidence of acute coronary occlusion is high, even when STEMI is not present on the postresuscitation electrocardiogram.     

超声心动图在心脏移植中的应用进展

心脏移植是治疗终末期严重心脏病最有效的方法,但排异反应(主要为心脏移植体的血管病)仍是影响患者长期生存的主要因素.心内膜心肌活检、冠状动脉造影与血管内超声等有创方法不但费时,而且不适合长期监测.超声心动图技术具有无创、方便等优点,在临床应用中具独特的优势.组织多普勒、三维超声心动图、斑点追踪技术、负荷及造影超声心动图等新技术及相互融合比较被证实在心脏排异反应的筛查中具有重要价值.