压/径比储备——评估甲状腺功能亢进患者心脏储备功能的新指标

目的 探讨超声检测甲状腺功能亢进(甲亢)患者心脏储备功能的一种新指标.方法 对比检测甲亢组和对照组两组受试者运动前后的左室收缩末期短径及舒张压和收缩压,计算平均动脉压/左室收缩末期短径储备值(压/径比储备),并进行统计分析.结果 甲亢病人组的压/径比储备值明显低于对照组,P＜0.01.结论 压/径比储备值能够反映患者的心脏储备功能的强弱.     

甲状腺功能亢进性心脏病62例临床分析

目的 探讨甲状腺功能亢进性心脏病患者的临床特点和治疗效果.方法 选择2005年11月至2010年11月甲状腺功能亢进性心脏病患者62例,分析患者临床表现、心电图和心脏彩超检查结果,分析患者误诊情况.本组患者确诊为甲状腺功能亢进心脏病后,均给予他巴唑或者丙基硫氧嘧啶治疗,根据患者合并的心脏病,可给予盐酸普奈洛尔、利尿剂、血管扩张药、强心药物等治疗.结果 经过1～6个月治疗后,甲状腺功能亢进症状得到有效控制,血清游离三碘甲腺原氨酸和血清游离甲状腺素逐渐降到正常水平;4例心绞痛患者在治疗1周后心绞痛症状消失;27例心力衰竭患者在治疗1个月内心衰症状均得到纠正;心房颤动和心房扑动患者在治疗3个月内均转为窦性心律,早搏和房室传导阻滞患者心电图均转为正常;18例心脏扩大患者复查心脏彩超,15例患者均恢复正常,其余3例患者有不同程度较治疗前缩小.结论 掌握甲状腺功能亢进性心脏病临床特点,避免误诊,及早确诊及早治疗,有助于改善患者预后,提高临床治疗效果.     

普萘洛尔对甲状腺功能亢进患者激素水平及心脏功能的影响

目的观察普萘洛尔对甲状腺功能亢进患者激素水平及心脏功能的影响。方法选取2018年3月至12月接收的106例甲状腺功能亢进患者进行研究,根据双色球法分为观察组和对照组,各53例。对照组患者给予常规治疗,观察组患者在对照组基础上给予普萘洛尔进行治疗。对比两组患者甲状腺功能指标、心脏功能及临床疗效。结果治疗前,两组患者的血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)指标差异无统计学意义(P0.05)。治疗后,两组患者的血清FT3及FT4水平均有效降低,TSH水平均显著升高,并且观察组明显优于对照组,差异具有统计学意义(P0.05)。两组患者心脏功能各指标水平均明显降低,并且观察组显著优于对照组,差异具有统计学意义(P0.05)。观察组总有效率(96.23%)明显高于对照组(81.13%),差异有统计学意义(P0.05)。结论普萘洛尔用于甲状腺功能亢进患者,能够明显改善患者的甲状腺相关激素水平及心脏功能,临床效果显著。     

老年甲状腺功能亢进性心脏病误诊为冠心病临床分析

目的 分析老年甲状腺功能亢进性心脏病误诊为冠心痛的原因.方法 对17例患者的临床表现、检查结果、治疗转归进行综合分析.结果 17例患者均为老年人,仅有轻度或缺乏典型的甲状腺功能亢进症症状、体征,均有心脏疾病的表现,甲状腺功能测定均有促甲状腺激素降低,游离三碘甲状腺原氨酸、游离甲状腺激素升高.单纯针对心脏疾病治疗效果差,确诊后同时予以抗甲状腺功能亢进治疗,心脏疾病得到有效控制.结论 老年甲状腺功能亢进性心脏病易误诊为冠心病,对原因不明的老年心脏病患者经常规治疗效果不明显应进行甲状腺功能检查,以免误诊.     

血清胰岛素原含量与甲状腺功能亢进的相关性观察

目的：临床观察甲状腺功能亢进患者血清胰岛素原水平,探讨甲状腺功能亢进症对血糖的影响。方法：选择确诊甲状腺功能亢进症患者56例为甲亢组,同期入选甲状腺功能正常对照者53例为正常对照组。采用放射免疫法测定所有入选人群血清胰岛素原含量。结果：甲状腺功能亢进组血清胰岛素原含量（21.33±3.76）pmol/L,显著高于正常对照组（9.72±2.11）pmol/L,P〈0.05。结论：甲状腺功能亢进人群血清胰岛素原水平升高,甲亢人群可能存在胰岛B细胞功能受损,可能与甲状腺激素对胰岛B细胞刺激有关。     

甲巯咪唑联合美托洛尔对甲亢并冠心病患者甲状腺相关激素及心脏功能指标的影响

目的 探讨甲巯咪唑联合美托洛尔对甲状腺功能亢进并冠心病患者心脏功能指标及甲状腺相关激素的影响。方法 选取2017年6月～2020年6月我院收治的80例甲状腺功能亢进并冠心病患者,将其随机分为研究组和对照组各40例。对照组患者给予美托洛尔与丙基硫氧嘧啶片治疗,研究组给予美托洛尔与甲巯咪唑治疗,比较两组心脏功能指标、甲状腺相关激素及治疗效果。结果 治疗前,两组心脏功能指标比较,差异无统计学意义(P0.05);治疗后,两组左心室射血分数、左心室收缩末期内径、血浆NT-proBNP浓度、心率、左心室舒张末期内径均改善,且研究组改善幅度显著优于对照组(P0.05)。治疗后,两组的血清FT4、TSH、FT3浓度均降低,且研究组降低幅度显著优于对照组(P0.05)。研究组治疗总有效率显著高于对照组,差异有统计学意义(P0.05)。结论 甲巯咪唑联合美托洛尔治疗甲状腺功能亢进并冠心病,能有效改善患者心脏功能和甲状腺相关激素,临床疗效显著。     

妊娠合并甲状腺功能亢进病人的护理

妊娠合并甲状腺功能亢进是产科常见的妊娠合并症,须引起产科工作者的重视.妊娠合并甲状腺功能亢进的孕妇,轻症或经过适当治疗病情得到控制者一般不影响妊娠,重症或不易控制病情的甲状腺功能亢进病人怀孕后母体和胎儿的合并症则较多.由于孕妇心脏负荷加大,重症甲状腺功能亢进病人易发生心力衰竭和甲状腺功能亢进危象.为此,对我院近10年妊娠合并甲状腺功能亢进病人的护理总结如下.     

彩色多普勒超声在甲状腺功能亢进与亚临床甲状腺功能低下诊断与鉴别诊断中的应用

目的:探讨彩色多普勒超声在甲状腺功能亢进与亚临床甲状腺功能低下诊断与鉴别诊断中的应用。方法:选取2017年1月-2018年12月我院收治的甲状腺功能亢进患者42例,亚临床甲状腺功能低下患者42例,并选取同期我院健康体检者20名作为健康对照组,对入组人员进行彩色多普勒超声检查,分析其成像特点。结果:经检查显示,甲状腺功能亢进组患者V、PSV以及HR均高于亚临床甲状腺功能低下以及健康对照组(P<0.05),甲状腺功能亢进组患者T低于亚临床甲状腺功能低下以及健康对照组(P<0.05),亚临床甲状腺功能低下患者V、PSV、T均高于健康对照组(P<0.05),亚临床甲状腺功能低下HR与健康对照组无明显差异(P>0.05);经检查显示,甲状腺功能亢进组患者Vmax以及Vmin均高于亚临床甲状腺功能低下以及健康对照组(P<0.05),亚临床甲状腺功能低下患者Vmax以及Vmin均高于健康对照组(P<0.05)。结论:采用彩色多普勒超声对甲状腺功能亢进与亚临床甲状腺功能低下患者进行鉴别,可将STA血流动力学量化指标作为诊断依据,可以在临床中进行进一步推广应用。     

甲状腺功能亢进性心脏病76例临床分析

目的 分析甲状腺功能亢进性心脏病患者的临床特点.方法 选择2001年2月至2008年2月间内分泌科诊治的甲状腺功能亢进性心脏病患者76例为观察组,另选择98例单纯甲状腺功能亢进患者为对照组,分析甲状腺功能亢进性心脏病危险因素.应用碘剂治疗,根据患者病情不同辅以β-受体阻滞剂(如普萘洛尔)、利尿剂及洋地黄类药物,治疗周期为6个月.结果 观察组患者年龄大于对照组,病程长于对照组,其差异均有统计学意义(P＜0.01).观察组患者血FT4平均为(63.85±13.76)pmol/L,明显高于对照组,差异有统计学意义(P＜0.05).两组患者性别构成比、血FT3及TSH水平间无统计学差异(P＞0.05).经6个月规范治疗,76例甲状腺功能亢进性心脏病患者痊愈54例(71.1%),缓解15例(19.7%),无效7例(9.2%).其中5例无效患者经二次治疗后获得缓解,2例治愈.结论 甲状腺功能亢进性心脏病发病与患者年龄、病程及FT4水平有关,碘剂(I131)对甲状腺功能亢进性心脏病具有较好的疗效.     

甲状腺功能失调对血清胱抑素C及肌酐水平的影响

目的 分析甲状腺功能失调及甲状腺激素对血清胱抑素C(CysC)及肌酐(Cr)水平的影响.方法 检测并比较甲状腺功能亢进患者(甲亢组)、甲状腺功能减退患者(甲减组)及健康者(对照组)血清CysC及Cr水平,比较患者治疗前后血清CysC及Cr水平.结果 甲亢组、甲减组与对照组血清CysC以及Cr水平比较有统计学差异(P＜0.05).甲减患者治疗至游离甲状腺素(FT4)达正常水平后,血清CysC水平升高,而血清Cr水平下降(P＜0.05).甲亢患者治疗至FT4达正常水平后,血清CysC水平降低,而血清Cr水平升高(P＜0.05).结论 甲状腺功能的变化对血清CysC及Cr水平产生不同影响;在应用CysC评价患者肾功能时,应同时考虑患者甲状腺功能状态.     

甲状腺功能亢进性心脏病左心结构与功能临床研究

目的探讨甲状腺功能亢进（甲亢）性心脏病（HHD）病人左心功能与结构的改变和早期诊断。方法应用彩色多普勒超声显像仪检测31例单纯甲亢和65例HHD病人左、右心室舒张末期内径（LV、RV）,舒张末期左心室后壁及室间隔的厚度（IVS、LVPW）,收缩末期左、右心房横径（LA、RA）;测量左心室舒张早期（E峰）及舒张晚期（A峰）二尖瓣最大血流速度,左心室射血分数（EF）。计算左心室质量（LVM）、左心室质量指数（LVMI）及舒张早晚期的最大血流速度比值（E/A）,并与30例正常对照组比较。结果HHD病人早期LVMI明显高于对照组和单纯甲亢组,二尖瓣血流频谱E/A比值明显低于对照组和单纯甲亢组（F=5.47、20.32,q=4.93～5.10,P〈0.01）,而早期EF与对照组比较差异无显著性（P〉0.05）。HHD病人早期左心房、左心室大于单纯甲亢组和对照组,右心房、右心室无明显的变化,晚期右心房、右心室大于HHD早期和单纯甲亢病人。HHD晚期EF低于对照组,差异有显著性（F=5.03,q=4.87,P〈0.01）,单纯甲亢病人EF高于对照组,差异有显著性（q=5.02,P〈0.01）。结论甲亢病人左心室收缩功能增强。HHD病人早期出现左心舒张功能不全,收缩功能正常,晚期出现收缩功能不全。HHD病人先左心扩大,晚期全心扩大。LVMI结合E/A可早期诊断HHD。     

左旋甲状腺素对充血性心力衰竭的心功能及β受体反应性的影响

目的　探讨左旋甲状腺素对充血性心力衰竭(CHF)的心功能及β受体反应性的影响。方法　23例CHF患者,男13例,女10例,平均年龄63岁,随机分为对照组进行心力衰竭的一般治疗;治疗组另外加用左旋甲状腺素(L-T     

The nature and prognosis of thyrotoxic heart disease

Thirty-two patients with uncomplicated hyperthyroidism were compared to 17 patients deemed to be suffering from pure thyrotoxic cardiac failure, other heart disease having been excluded. The thyrotoxic failure group were older and had clinically and biochemically milder endocrinal abnormalities for a longer time. Haemodynamic studies at rest and exercise showed that the thyrotoxic failure patients had no functional cardiac reserve. Their response to propranolol indicated that myocardial function was dependent on beta-adrenergic activity. Following specific anti-thyroid medication cardiac function returned to normal in the majority of cases with cardiac failure. This study shows that hyperthyroidism by itself can cause a reversible cardiomyopathy.     

APATHETIC THYROTOXICOSIS

A previously fit 37-year-old woman was admitted with acute left ventricular failure, atrial fibrillation and a left-sided thromboembolic stroke. Her ventricular rate progressively increased despite full digitalisation. She had a cardiac arrest and was successfully resuscitated. Investigations revealed evidence of hyperthyroidism and she was treated for thyrotoxic crisis. She has made a complete recovery from the hemiparesis and is now in sinus rhythm. She denied any symptoms of hyperthyroidism. This patient had apathetic thyroid crisis, which is exceedingly rare in the young.     

Is there an optimal hemoglobin value in the cardiac intensive care unit?

Anemia is common in patients admitted to the cardiac intensive care unit. Many unique issues must be considered in the treatment of the anemic cardiac patient. Coronary artery disease and left ventricular dysfunction may significantly increase the risk of anemia. These patients have limited reserve because of a high extraction ratio of oxygen in the cardiac circulation. Left ventricular dysfunction increases the risk of complications from transfusion. Recent observational studies suggest that cardiac patients may benefit from a higher transfusion threshold. However, very few patients with cardiovascular disease have been included in clinical trials comparing high and low transfusion triggers. Experimental data and recent studies in humans suggest that cardiac patients may be intolerant of anemia. Pending definitive clinical trials in cardiac patients, we suggest a more aggressive transfusion trigger (9-10 g/dL) in patients with active cardiac disease. Pulmonary edema may be precipitated by transfusion in patients with left ventricular dysfunction. Large clinical trials are urgently needed to determine optimal transfusion thresholds in patients with cardiovascular disease.     

Abnorme Verkürzung der linksventrikul?ren Diastolendauer unter k?rperlicher Belastung bei Patienten mit dilatativer Kardiomyopathie

BACKGROUND AND PURPOSE: Cardiac performance can be characterized in terms of the relative duration of systole and diastole. In pediatric patients with dilated cardiomyopathy (DCM), a disproportionate shortening of left ventricular diastole was observed. The present study was intended to reproduce these findings in an adult patient group and to evaluate exercise-related changes of both time intervals. PATIENTS AND METHODS: Exercise radionuclide angiography was used in 61 patients with DCM NYHA (New York Heart Association) stage II-III. The phases of the cardiac cycle were derived from a radionuclide time-activity curve with high temporal resolution. The control group consisted of 26 patients referred for ventricular function assessment with radionuclide angiography before cardiotoxic cancer treatment. RESULTS: When the duration of systole was expressed as the product of systolic time and heart rate, DCM patients exhibited a significant increase in left ventricular systolic time at rest (23.9 vs. 21.5 s/min; p = 0.006) and during peak exercise (29.2 vs. 26.7 s/min; p = 0.01). The prolongation of left ventricular systole at peak exercise was evident, although the peak heart rate was significantly lower in the patient group than in the control group (118 vs. 127/min; p = 0.04). In DCM patients the diastolic time loss per beat was further quantified using a regression equation obtained from the healthy control group. A significant shortening of left ventricular diastolic time was confirmed during peak exercise. Furthermore, a progressive loss in diastolic time per beat from rest to peak exercise was noted. CONCLUSION: Cardiac cycle abnormalities of patients with DCM are characterized by a prolongation of left ventricular systole and an abnormal shortening of left ventricular diastole. The systolic-diastolic mismatch is accentuated during exercise and has the potential to impair the cardiac reserve in these patients by restricting ventricular filling and perfusion.     

二维斑点追踪技术评估妊娠期甲状腺功能亢进患者胎儿的心功能

目的  探究二维斑点追踪技术评估妊娠期甲状腺功能亢进患者胎儿心功能。方法  选取2021年8月~2022年6月于我院就诊的妊娠期甲亢患者作为研究组（n=63）,另选同期进行产前健康检查的孕妇作为对照组（n=55）。使用二维斑点追踪技术对两组患者胎儿的心功能进行检测,比较舒张末期的右心室面积（LVDA）、右心室周长（RVDC）、左心室周长（LVDC）及收缩末期的右心室面积（RVSA）、左心室面积（LVSA）、右心室周长（RVSC）、左心室周长（LVSC）;比较胎儿三尖瓣流速（TV）、二尖瓣流速（MV）、左右心室舒张早期与晚期血流速度（E峰值流速、A峰值流速）及其比值（E/A）、左心室收缩分数1（LVSF1）左心室收缩分数2（LVSF2）、右心室收缩分数1（RVSF1）、右心室收缩分数2（RVSF1）,比较胎儿心脏结构异常情况。结果  研究组患者胎儿收缩末期的LVSA、RVSA、RVSC、LVSC均高于对照组（P < 0.05）,而舒张末期的LVDA、RVDA、RVDC、LVDC均高于对照组（P < 0.05）;研究组患者胎儿舒张期的心功能指标MVA、MVE、MV-E/A、TVA、TVE、TV-E/A均高于对照组（P < 0.05）,而收缩末期的心功能指标LVSF1、RVSF1、LVSF2、RVSF2也均高于对照组（P < 0.05）;研究组患者胎儿出现9例（14.29%）心脏结构异常,总发生率高于对照组（P < 0.05）。结论  妊娠期甲状腺功能亢进患者胎儿心功能异常,心脏结构也可能存在异常,二维斑点追踪技术可在早期对胎儿的心功能及结构进行准确监测。     

实时三维联合斑点追踪技术定量评估甲亢患者右心功能

目的  探讨实时三维（RT-3DE）联合二维斑点追踪技术（2D-STI）定量评估甲状腺功能亢进患者的右心功能。方法  在我院就诊患者中选取80例甲状腺功能亢进患者,其中30例肺动脉收缩压>35 mmHg的患者被纳入甲亢肺高压组,余下的50例被纳入甲亢无肺高压组,选取同期40例健康体检人群作为对照组。经常规超声技术获得参数：右室基底段、右室中间段、右室长轴、右房上下径、右房左右径、右房收缩期面积、右心室面积变化率、三尖瓣环收缩期位移、三尖瓣瓣环的收缩期侧壁峰值速度、右室心肌做功指数、毛细血管楔形压,经RT-3DE技术获得参数：右室舒张末期容积（RVEDV）、右室舒张末期容积指数（RVEDVi）、右室收缩末期容积（RVESV）、右室收缩末期容积指数（RVESVi）、右室输出量（RVSV）、右室射血分数（RVEF）,应用2D-STI技术获得参数：右心室游离壁纵向应变（GLS-FW）、右心室整体纵向应变（GLS）,比较上述结果的组间差异;采用Pearson分析各参数之间的相关性。结果  对照组、甲亢无肺高压组、甲亢肺高压组右室基底段、右室中间段、右室长轴、右房上下径、右房左右径、右房收缩期面积、毛细血管楔形压、三尖瓣环收缩期位移、三尖瓣瓣环的收缩期侧壁峰值速度、右室心肌做功指数依次增加,右心室面积变化率依次减小,且两两比较差异均有统计学意义（P < 0.05）;3组RVEDV、RVESV、RVEDVi、RVESVi、RVSV依次增加,两两比较差异均有统计学意义（P < 0.05）,但三者RVEF的差异无统计学意义（P>0.05）;3组GLS-FW、GLS依次减小,两两比较差异均有统计学意义（P < 0.05）;相关性检验分析结果显示RVEDV与RVESV、SV呈正相关关系(r=0.534、0.760,P < 0.01),RVEDV与GLS-FW、GLS呈负相关关系(r=-0.915、-0.886,P < 0.01)。结论  RT-3DE、2D-STI参数结果显示,甲亢患者较对照组容量负荷增加,右心功能下降,同时合并肺高压和甲亢两种病理状态会使患者容量负荷进一步增加,右心功能进一步下降。RT-3DE联合2D-STI技术可以准确评估右心功能的状态,为临床评估患者病情提供技术支撑,也为进一步制定诊疗方案提供重要的理论支持。     

Short‐term overt hypothyroidism induces discrete diastolic dysfunction in patients treated for differentiated thyroid carcinoma

Background Thyroid hormone has important effects on the cardiovascular system. The consequences of episodes of acute hypothyroidism on cardiac function have been investigated in only a few studies, and their results are inconclusive. Our objective was to investigate the effects of acute hypothyroidism on cardiac function in patients with iatrogenically induced subclinical hyperthyroidism after treatment for differentiated thyroid carcinoma. Material and methods Fourteen patients with a history of differentiated thyroid carcinoma on thyroid‐stimulating hormone (TSH)‐suppressive thyroxine replacement therapy were studied. We assessed cardiac function before, and 1 and 4 weeks after withdrawal of thyroxine substitution. We measured serum levels of free thyroxine, triiodothyronine and TSH and used a new sophisticated Doppler echocardiography technique, tissue Doppler imaging (TDI), to assess detailed and quantitative assessment of systolic and diastolic cardiac function. Echocardiographic parameters in patients were compared to controls. Results Compared to controls, patients had higher left ventricular mass and wall thickness and decreased diastolic function during TSH‐suppressive l ‐thyroxine substitution therapy. Thyroxine withdrawal resulted in a decrease in both early (E) and late (A) diastolic mitral inflow velocities, without impact on E/A ratio. Using TDI, late diastolic velocity (A′) decreased without impact on E′/A′ ratio. Left ventricular dimensions, wall thickness and mass did not change during thyroxine withdrawal. Conclusions Subclinical hyperthyroidism is accompanied by diastolic dysfunction. Subsequent acute hypothyroidism induces only subtle changes in diastolic function.     

Electrocardiographic voltage changes during hyperthyroidism.

Electrocardiograms of 67 thyrotoxic patients were studied. Subsequent electrocardiograms during euthyroidism in 16 patients permitted an analysis of voltage changes. Decreases in voltages after radioiodine therapy were significant (P less than 0.01) for the P wave in lead, V1, R wave in leads II, AVF, V4, V5, and V6, maximal RS wave, and maximal R wave and were present in all but one patient. Criteria for left ventricular hypertrophy (sum of S wave in V1 plus R wave in V5 or V6 greater than 35 mm), present in 21% of patients, regressed in all five patients who had later electrocardiograms during euthyroidism. Left ventricular hypertrophy or high-voltage R waves in the absence of usual causes may suggest the presence of hyperthyroidism. The concept that cardiac voltage is determined in part by thyroid hormone is reviewed; this relationship may be the basis for increased voltage in hyperthyroidism as well as decreased voltage in hypothyroidism.