扩张型心肌病患者QT离散度与室性心律失常的关系

扩张型心肌病患者ＱＴ离散度与室性心律失常的关系武警广东总队医院一内科杨溢银翠云王敏钟求知唐利①许家俐①（广州５１０５０７）关键词ＱＴ离散度扩张型心肌病室性心律失常随着诊断水平的提高，临床上诊断为扩张型心肌病（ＤＣＭ）的患者明显增多。ＤＣＭ患者易发生心...     

稳心颗粒联合美托洛尔治疗室性心律失常疗效观察

目的:观察稳心颗粒联合美托洛尔治疗室性心律失常的临床疗效及不良反应。方法:选择室性心律失常116例,随机分为观察组和对照组各58例。对照组采用口服美托洛尔治疗,每次12.5～25mg,每天2次。观察组在对照组基础上,增加稳心颗粒治疗,每次9g,每天3次。均4周为1个疗程,观察两组治疗前后临床症状、心电图改善情况及不良反应。结果:观察组临床总有效56例(96.6%),对照组43例(74.1%);两组比较,差异显著(P<0.05)。观察组心电图总改善55例(94.3%),对照组45例(77.6%);两组比较,差异显著(P<0.05)。两组均未发生严重不良反应。结论:稳心颗粒联合美托洛尔治疗室性心律失常较单用美托洛尔疗效好,且安全。     

稳心颗粒与胺碘酮联用治疗冠心病室性心律失常的疗效观察

目的:观察步长稳心颗粒与胺碘酮联用治疗冠心病室性心律失常的疗效。方法:采用随机对照的方法将78例冠心病室性心律失常患者随机分为两组,观察组:胺碘酮600mg/d,分三次口服。1周后改为维持量,200~400mg/d,同时口服稳心颗粒9g/次,3次/日,疗程3~4周,对照组:胺碘酮600mg/d,分三次口服,1周后改为维持量,200~400mg/d,疗程3~4周,治疗前后心电图、动态心电图检查,两组间对照比较。结果:观察组与对照组比较,总有效率有显著性差异。结论:步长稳心颗粒与胺碘酮联用治疗冠心病室性心律失常的疗效优于单用胺碘酮的疗效。     

美托洛尔治疗充血性心力衰竭合并室性心律失常的观察

目的 观察美托洛尔治疗充血性心力衰竭合并室性心律失常患者的临床疗效。方法 40例NYHA心功能分级≥Ⅲ级充血性心衰合并室性心律失常患者,在常规抗心衰药物治疗基础上口服美托洛尔,治疗3个月前后24h动态心电图检查,超声心动图检查心功能,6min步行测试。结果 心功能改善,6min步行增加,室性心律失常的发生减少,而室性心律失常的减少与心功能改善密切相关。结论 美托洛尔用于心衰治疗不仅安全、可以改善心功能,提高患者生活质量,而且对减少室性心律失常的发生率也有较好效果。     

扩张型心肌病心律失常144例

扩张型心肌病 (ＤＣＭ )是一种原因不明的心肌病 ,其主要特征是心脏扩大和心肌收缩功能减低。研究表明 ,心律失常和心肌细胞凋亡是增加ＤＣＭ晚期死亡的重要原因。1992年 5月～ 2 0 0 1年 5月 ,我们收治扩张型心肌病 15 9例 ,检出心律失常 144例 ,分析如下。1　临床资料1 1　一般情况　均为住院病人。男 10 2例 ,女 4 2例 ;年龄 34～ 69岁 ,平均 5 1岁。ＤＣＭ临床诊断符合ＷＨＯ/ＩＳＦＣ国际心脏病学联合学会标准( 1980 ) ,并排除右室心肌病、肥厚性心肌病、心肌炎、缺血性心肌病、高血压病、瓣膜病、肺心病、围产期心肌病等。统计分析项…     

倍他乐克治疗扩张型心肌病心力衰竭34例分析

目的探讨倍他乐克治疗扩张型心肌病心力衰竭的临床疗效。方法34例患者常规给予休息、吸氧、利尿剂、地高辛、血管紧张素转换酶抑制剂（ACEI）类药物常规处理，待病情稳定，无液体潴留后，加用倍他乐克片，起始剂量12．5mg/d，2次／d口服，每2周剂量加倍，至目标量100mg／d，逐步减少传统性抗心力衰竭的药物。结果34例患者均能耐受倍他乐克的治疗。34例患者心功能有明显改善。结论34例患者服用倍他乐克对心功能改善起到了明显的效果。但β受体阻滞剂治疗初期对心功能有明显的抑制作用，仅适用于血流动力学稳定的患者，长期治疗后2—3个月才见效，需要患者有很好的依从性。治疗时应从小剂量开始逐步达到目标剂量，不能突然停药，并严密监测临床情况。     

扩张型心肌病心律失常临床治疗分析

目的：探讨扩张型心肌病心律失常的临床特点。方法采用12导心电图、动态心电图、超声心动图以及心血管X片对68例扩张型心肌病患者进行检查。结果全部扩张型心肌病患者100％检出心律失常,其中76.5％为室性心律失常,58.8％为房性心律失常,55.7％为传导阻滞。结论患者心房颤动和左心房内径在45 mm以上有相关性,恶性室性心律失常同左室射血分数、左室舒张期内径有相关性,严重心律失常的出现率和患者的病变过程没有相关性。     

胺碘酮治疗心力衰竭合并室性心律失常40例临床观察

目的:探讨胺碘酮在心力衰竭合并室性心律失常中的治疗效果。方法:选择我院慢性心力衰竭合并室性心律失常患者共80例,随机分为观察组和对照组。两组均给予常规抗心力衰竭治疗,对照组同时给予利多卡因,观察组同时给予胺碘酮。评定两组疗效。结果:观察组总有效率为95.0%,对照组总有效率为75.0%,观察组总有效率高于对照组,差异有统计学意义(P<0.05)。观察组治疗后左室射血分数和心率分别和对照组治疗后比较,差异有统计学意义(P<0.05)。结论:胺碘酮在心力衰竭合并室性心律失常治疗中疗效显著,有助于改善患者临床症状和体征,值得借鉴。     

稳心颗粒治疗心律失常的临床观察

心律失常是一种心内科常见病,多发病,一些抗心律失常常规用药在治疗的同时又会引起严重的副作用、致心律失常及其它不良反应。现将稳心颗粒治疗心律失常102例的临床观察报告如下。1资料与方法1.1一般资料2002年月—2005年9月共观察102例,均为心内科住院病人。随机分为两组,治疗     

胺碘酮治疗扩张型心肌病伴心律失常18例

胺碘酮近年被广泛用于治疗心律失常 ,且疗效显著[1,2 ] 。我们对扩张型心肌病伴心律失常 18例在综合治疗基础上 ,加服胺碘酮 ,取得了满意的效果。1　临床资料1 1　一般情况　 1995年 9月～ 1997年 11月 ,按ＷＨＯ制定的扩张型心肌病诊断标准 ,超声多普勒检测左室舒张末内径≥ 55ｍｍ及左室心缩功能减弱的扩张型心肌病 4 5例 ,其中经心电图或动态心电图证实有快速心律失常 18例 ,男 11例 ,女 7例 ;年龄 4 5～ 6 7岁 ,平均 55 3岁。有房颤或房扑 6例 ,室上性早搏 2例 ,阵发性室上性心动过速 4例 ,室性早搏 3例 ,短暂室性心动过速 6例。按纽约…     

Molecular imaging to predict ventricular arrhythmia in heart failure

Ventricular tachycardia (VT) is a major cause of sudden cardiac death (SCD) in patients with heart failure (HF). Left ventricular ejection fraction (LVEF) and heart failure class according to the New York Heart association (NYHA) are in most common use to identify patients that may benefit from implantable cardioverter defibrillator (ICD) therapy. But during 3 years of follow up only 35% of patients receive appropriate ICD action. Therefore, there is a continued need for refinement of selection criteria for ICD implantation. In this regard, molecular imaging of the autonomic nervous system, which plays a central role in HF progression and cardiac electro-mechanical regulation, can make a substantial contribution. This article reviews the currently available literature concerning the value of molecular neuronal cardiac imaging for prediction of ventricular arrhythmias in HF patients.     

重组人脑利钠肽治疗急性心力衰竭临床研究

 目的 评价扩张型心肌病(DCM)伴充血性心力衰竭(CHF )患者接受外源性重组人脑利钠肽(新活素)治疗后血浆心房利钠肽(ANP)和脑利钠肽(BNP)水平的动态变化,探讨外源性给予重组人脑利钠肽(新活素)对心脏内分泌的病理生理影响.方法 88例入选,其中新活素组46例,另42例为对照组 .两组治疗前和治疗3个月后分别以放射免疫测定法和固相免疫测定法测定ANP和BNP.结果 新活素治疗后患者近期症状明显改善,同时血浆ANP、BNP水平显著降低.结论 DCM伴CHF患者接受外源性重组人脑利钠肽治疗后,不仅缓解心衰症状,而且显著改善心脏内分泌功能.这种心脏内分泌变化可能有助于心衰预后.     

高剂量曲美他嗪对扩张型心肌病心衰患者预后影响

目的分析高剂量曲美他嗪(120 mg/d)对扩张型心肌病(DCM)心衰患者预后的影响。方法选取西京医院心内科及沈阳军区总医院心内科2014年出院的DCM心衰患者150例,随访1~2年,失访14例,最终纳入136例患者。按曲美他嗪使用剂量将患者分为高剂量组(40 mg,每天3次,n=13)、常规剂量组(20 mg,每天3次,n=99)及对照组(未服用,n=24),比较3组患者用药前后心功能、影像学改变及代谢相关指标的差异。结果高剂量组患者年龄、射血分数(EF)值均偏低(P<0.05);左心室收缩内径(LVESD)、CO、缩短分数(FS)、每搏输出量(SV)值均偏高(P<0.05);主要合并用药包括血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂(100%)、利尿剂(76.92%)及洋地黄(76.92%)。服用药物1~2年后,高剂量组患者脑钠肽、FS值、EF值均较常规剂量组明显减小,LVESD值较常规剂量组明显增大。高剂量与常规剂量的曲美他嗪均可降低CO值,且SV值改变均较对照组大。结论高剂量曲美他嗪常被用于病情偏重患者,但其疗效一般,仍需进一步证实。     

富马酸比索洛尔对扩张型心肌病致心衰的疗效观察

目的：观察富马酸比索洛尔对扩张型心肌病致心衰的疗效。方法：68例病人常规治疗2周后加服小剂量富马酸比索洛尔4周,比较治疗前后心功能参数,24h室性心律失常数总数及临床效果。结果：治疗后心率明显低于治疗前（P＜0．05）,心脏彩超心功能参数显著改善（P＜0．05）,治疗后24h室性心律失常数总数显著下降（P＜0．01）,临床总有效率92．65％,结论：小剂量富马酸比索洛尔能改善扩张型心肌病病人心功能,减少室性心律失常发生,改善心衰症状,小剂量慎用值得临床选择。     

黄芪注射液联用心先安治疗扩张型心肌病心衰50例疗效分析

目的:探讨黄芪注射液联用心先安治疗扩张心肌病心衰的疗效。方法:以2001~2005年住院的扩心病心衰患者99例,随机分为两组即黄芪、心先安治疗组,对照组按常规剂量给予西地兰或地高率静注或口服,其中治疗组50例,对照组49例。结果:两组疗效比较,有显著差异(P<0.05),治疗组平均住院天数明显短于对照组(P<0.05)。结论:黄芪注射液联用心先安治疗扩心病心衰具有较好的效果,且副作用少,值得推广应用。     

Significance of QT dispersion in the onset of ventricular arrhythmia in patients with heart failure

Prolonged QT dispersion which has been proposed as a marker of repolarisation inhomogeneity, may predispose to ventricular arrhythmias in a variety of cardiac disorders. The aim of this study was to compare some indices of QT dispersion in patients with heart failure compared to normal subjects. We have also tested the hypothesis that QT dispersion is a useful method for identifying the patients at high risk for ventricular arrhythmias. METHODS: There were 84 patients, divided into two groups. In the first group there were 62 patients with heart failure, in the sinus rhythm, while in second group there were 22 sex- and age-matched healthy subjects. Simultaneous 12-channel ECGs were recorded at a paper speed 50 mm/sec. Ventricular arrhythmias were quantified by 24-h Holter ECG and classified according to the Lown classification system. Only those patients with a class IVa, IVb, and V arrhythmia were considered to have complex ventricular premature contractions (PVCs). Measurements of QT, JT, and RR intervals were performed manually. Heart rate corrected QT and JT intervals (QTc and JTc) were calculated by Bazett's formula. RESULTS: RR intervals were similar in both groups (862 +/- 120 vs 840 +/- 86; ns). QT dispersion and rate corrected QT dispersion were significantly greater in heart failure patients than in controls (76 +/- 13 ms vs 37 +/- 11 ms and 89 +/- 21 ms vs 40 +/- 17 ms; p < 0.05). When, on the basis of the existing complex PVCs, heart failure patients were divided into two subgroups, QT dispersion and rate corrected QT dispersion were significantly greater in the subgroup with complex PVCs compared to patients without complex PVCs (84 +/- 14 ms vs 61 +/- 18 ms and 98 +/- 26 ms vs 66 +/- 21 ms; p < 0.05). CONCLUSION: All indices of QT dispersion were significantly higher in heart failure patients. QT dispersion is useful, noninvasive method for identifying heart failure patients at high risk for ventricular arrhythmia.     

Measurement of left ventricular dimensions and function in patients with dilated cardiomyopathy

Studies on medical therapy in heart failure are focused on changes of left ventricular (LV) dimensions and function. These changes may be small, requiring a large study group. We measured LV parameters (LV volumes, LV ejection fraction (LV-EF), and left ventricular mass (LVM)) with two-dimensional echocardiography (2D-echo) and magnetic resonance imaging (MRI) in 50 patients. Based on the difference between the measurements, we determined the variance of the results and calculated the sample sizes needed to detect changes of baseline values. For the calculated and measured parameters we found significant differences between the two techniques: LV-EF and LVM were higher in 2D-echo, and LV dimensions were comparable. The sample size to detect relevant changes from baseline with MRI was significantly (P < 0.01) smaller than in 2D-echo. We conclude that MRI is superior in clinical studies on left ventricular dimensional and functional changes, since measurements are more reproducible and the required sample size is substantially smaller, thereby reducing costs.     

Late ventricular potentials in risk assessment of the occurrence of complex ventricular arrhythmia in patients with myocardial infarction and heart failure

AIM: To determine the prognostic significance of late ventricular potentials on signal-averaged electrocardiogram and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmia in patients treated with accelerated tissue-type plasminogen activator, using the rapid protocol, within six months of acute myocardial infarction. METHODS: In this analytic observational prospective study patients were divided into four groups: patients with left ventricular ejection fraction bellow 40% and late ventricular potentials, patients with left ventricular ejection fraction bellow 40% and without late ventricular potentials, patients with left ventricular ejection fraction over 40% and late ventricular potentials, and patients with left ventricular ejection fraction over 40% and without late ventricular potentials. Complex ventricular arrhythmias (Lown grade IVa, IVb, and V) were recorded using standard electrocardiography and 24-hour Holter monitoring 21, 60, and 90 days after acute myocardial infarction, respectively. Serial recordings of signal-averaged electrocardiogram were obtained 30, 90, and 180 days after acute myocardial infarction. Left ventricular ejection fraction was determined by echocardiography between 15 and 21 days after acute myocardial infarction. Multivariant logistic regression analysis was used to evaluate the relation between late ventricular potentials and left ventricular ejection fraction with the occurrence of complex ventricular arrhythmias. Sensitivity, specificity, positive and negative predictive values of late ventricular potentials and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmias were determined. RESULTS: The prospective study included 80 patients (73% men), mean age 64 +/- 3.5 years. Complex ventricular arrhythmias were recorded in 34 (42.5%) of patients, all 17 (50%) of which were from the first group (p < 0.01). Complex ventricular arrhythmias were recorded in 25 (73.5%) patients with late ventricular potentials, and in 23 (67.6%) patients with left ventricular ejection fraction bellow 40%. Left ventricular ejection fraction bellow 40% and late ventricular potentials represented independent predictors for the occurrence of complex ventricular arrhythmias (RR = 14.33, p < 0.01). When combined with left ventricular ejection fraction bellow 40%, late ventricular potentials had sensitivity (0.50), specificity (0.93), and positive predictive accuracy (0.85) higher than late ventricular potentials alone (0.44, 0.67, and 0.37, respectively) for the occurrence of complex ventricular arrhythmias following acute myocardial infarction. CONCLUSION: In this study, late ventricular potentials in patients with left ventricular ejection fraction bellow 40% represented the independent predictor for the occurrence of complex ventricular arrhythmias in the first six months after the first myocardial infarction treated with accelerated tissue-type plasminogen activator, using the rapid protocol.