老年慢性肺源性心脏病血浆内皮素测定及其临床意义

内素素（ET）是日本学者Yanagisawa等1988年首次从猪主动脉内皮细胞中分离纯化的一种新的生物活性肽。ET有广泛的生物活性，但其主要作用是收缩血管平滑肌，是目前所知最强的缩血管物质，ET由ET-1，ET-2，ET-3和血管活性肠收缩肽（VIC）4种异形肽组成。     

慢性肺源性心脏病患者血浆环氧化酶2改变的意义

目的了解慢性肺心病患者血浆环氧化酶2（COX-2）活性变化的临床意义。方法采用ELISA方法动态观察了65例慢性肺心病患者及30例健康对照者血浆COX-2活性。结果慢性肺心病患者血浆COX．2活性急性加重期（45．23±4．16）IU／L及缓解期（21．40±5．19）IU／L明显高于对照组（7．13±3．26）IU／L（P均〈0．01）；在急性加重期，患者心功能越差，血浆COX-2活性越高，心功能Ⅳ级者（62．98±8．15）IU／L〉心功能Ⅲ级者（39．00±6．73）IU／L〉心功能Ⅱ级者（12．84±5．20）IU／L及对照组（P均〈0．01）；另外，在急性加重期，患者COX．2活性与Pa02（5．08±2．65）kPa和pH值（7．29±0．31）均呈显著负相关（r分别为-0．65和-0．61，均为P〈0．01），而与PaCO2（7．92±2．69）kPa呈显著正相关（r=0．71，P〈0．01）。结论提示COX-2可能参与了慢性肺心病的发病过程．测定血浆COX-2活性，对评估慢性肺心病患者的病情变化及严重程度可能有一定的意义，拮抗COX-2的治疗可能有助于缓解患者的病情。     

慢性肺源性心脏病并发心律失常118临床分析

心律失常是慢性肺心病常见的并发症之一.自2000年至2004年我科共收治慢性肺心病246例,其中并发心律失常118例,经采用各种药物治疗,除5例死亡外,其余均被治愈.现结合文献学习分析讨论如下.     

慢性肺源性心脏病合并冠心病临床治疗分析

目的：探讨分析临床治疗慢性肺源性心脏病合并冠心病的特点,为临床治疗提供更多的理论参考依据。方法回顾分析来我院治疗的84例慢性肺源性心脏病患者的临床资料,分为观察组和对照组,每组42例,其中观察组合并冠心病,对照组单纯慢性肺源性心脏病。比较两组患者的临床表现并分析数据。结果在心悸、心绞痛、呼吸困难、心肌梗死及心界扩大发生率方面,对照组明显低于观察组,差异具有显著性(<0.05)。结论由于慢性肺源性心脏病合并冠心病患者的病情复杂,其症状由于受到体征影响,不易被发现,在临床上很容易漏诊、误诊,所以,大力加强对该病的诊断和治疗具有十分重要的意义。     

慢性肺源性心脏病并发心律失常78例临床分析

目的探讨慢性肺源性心脏病并发心律失常的临床特点。方法对本院2006年1月-2008年12月间121例慢性肺心病患者的临床资料进行回顾性分析。结果经心电图和心电监护时检查发现121例患者中并发心律失常者78例,占64．46％。心律失常表现为窦性心动过速、窦性心动过缓、房性早搏、室性早搏、心房颤动、心房扑动、阵发性房性心动过速（包括紊乱性房性心动过速）、阵发性室性心动过速、一度或二度房室传导阻滞、右束支传导阻滞（完全性或不完全性）、左柬支传导阻滞（完全性或不完全性）、左前分支传导阻滞。I&#176;心衰22例,心律失常9例（40．90石）;II&#176;心衰41例,心律失常25例（60．97％）;III&#176;心衰58例,心律失常44例（75．86％）。三组之间有非常显著差异（P均〈0．01）,提示心衰程度越重,并发心律失常率越高。结论心律失常是慢性肺心病最常见的并发症之一,肺心病并发心律失常是多种多样的、可变的。了解其心电图特点对慢性肺心病的诊断和治疗具有重要的临床意义。     

慢性肺源性心脏病并发心律失常78例临床分析

目的 探讨慢性肺源性心脏病并发心律失常的临床特点.方法 对本院2006年1月～2008年12月间121例慢性肺心病患者的临床资料进行回顾性分析.结果 经心电图和心电监护时检查发现121例患者中并发心律失常者78例,占64.46%.心律失常表现为窦性心动过速、窦性心动过缓、房性早搏、室性早搏、心房颤动、心房扑动、阵发性房性心动过速(包括紊乱性房性心动过速)、阵发性室性心动过速、一度或二度房室传导阻滞、右束支传导阻滞(完全性或不完全性)、左束支传导阻滞(完全性或不完全性)、左前分支传导阻滞.Ⅰ°心衰22例,心律失常9例(40.9%);Ⅱ°心衰 41例,心律失常25例(60.97%);Ⅲ°心衰58例,心律失常44例(75.86%).三组之间有非常显著差异(P均＜0.01),提示心衰程度越重,并发心律失常率越高.结论 心律失常是慢性肺心病最常见的并发症之一,肺心病并发心律失常是多种多样的、可变的,了解其心电图特点对慢性肺心病的诊断和治疗具有重要的临床意义.     

慢性肺源性心脏病患者血浆晚期氧化蛋白改变的意义

目的了解慢性肺心病患者血浆晚期氧化蛋白（AOPP）变化的临床意义。方法采用ELISA方法动态观察65例慢性肺心病患者及30例健康对照者血浆AOPP的含量。结果慢性肺心病患者急性加重期及缓解期血浆AOPP的含量为（143．51±32．83）μmol／L和（56．55±14．48）μmol／L，明显高于对照组（23．14±8．24）μmol／L，P均〈0．01；在急性加重期，患者心功能越差，血浆AOPP的含量越高，心功能Ⅳ级者（157．03±41．09）μmol／L〉心功能Ⅲ级者（104．25±24．47）μmol／L〉心功能Ⅱ级者（33．93±12．91）μmol／L及对照组（P均〈0．01）；另外，在急性加重期患者AOPP含量与PaO2（5．08±2．65）kPa和pH值（7．29±0．31）均呈显著负相关（r分别为-0．55和-0．58。P均〈0．01），而与PaCO2（7．92±2．69）kPa呈显著正相关（r=0．65，P〈0．01）。结论AOPP可能参与了慢性肺心病的发病过程，测定血浆AOPP的含量对评估慢性肺心病患者的病情变化及严重程度有一定的意义，拮抗AOPP的治疗有助于缓解患者的病情。     

慢性肺源性心脏病与慢性左心衰竭患者血浆BNP浓度的差异

目的 探索血浆BNP(B型利钠肽)浓度对慢性肺源性心脏病或慢性左心衰竭所致呼吸困难的鉴别诊断价值.方法 比较慢性肺源性心脏病和慢性左心衰竭患者血浆BNP浓度的差异.结果 慢性左心衰竭的患者血浆BNP浓度明显高于慢性肺源性心脏病患者.结论 BNP> 400ng/L可作为鉴别慢性肺源性心脏病和慢性左心衰竭的指标,如结合心血管病危险因素可进一步提高慢性左心衰竭所致呼吸困难的诊断的特异性.     

血浆B型利钠肽联合D-二聚体在慢性心力衰竭患者中的检测及临床意义

目的 研究血浆B型利钠肽(brain natriuretic peptide,BNP)联合D-二聚体检测在慢性心力衰竭患者中的诊断价值.方法 将2013年1月至6月来我院就诊和体检的人群分为3组:慢性心力衰竭患者组60例、有器质性心脏病但心功能正常的患者组20例和健康对照组30例,对三组患者的血浆B型利钠肽和D-二聚体进行比较并判断其与慢性心力衰竭的相关性.结果 血浆B型利钠肽联合D-二聚体检测能反映慢性心力衰竭的程度.结论 血浆B型利钠肽联合D-二聚体检测在慢性心力衰竭患者中具有很高的诊断价值,可以作为诊断慢性心力衰竭的辅助诊断检测.     

血浆D-二聚体检测对急性缺血性脑卒中的临床意义

目的:分析血浆D-二聚体对急性缺血性脑卒中患者的诊断价值。方法:对113例住院急性缺血性脑卒中患者(卒中组),应用颗粒增强型免疫浊度法检测血浆D-二聚体水平,并与100例正常体检者(对照组)比较。通过绘制ROC曲线确定D-二聚体最佳临界值,并计算其对急性缺血性脑卒中诊断的敏感度和特异度。结果:卒中组血浆D-二聚体水平(1.97±0.13mg/L)明显高于对照组(0.34±0.09mg/L),差异有统计学意义(P0.05)。血浆D-二聚体诊断急性缺血性脑卒中最佳临界值为1.53mg/L,此时的敏感度为83.26%,特异度为66.32%。结论:血浆D-二聚体水平检测对诊断急性缺血性脑卒中有一定临床意义。     

Potential drug-drug interactions in hospitalized patients with chronic heart failure and chronic obstructive pulmonary disease

Introduction

Polypharmacy is common in patients with chronic heart failure (HF) and/or chronic obstructive pulmonary disease (COPD), but little is known about the prevalence and significance of drug-drug interactions (DDIs). This study evaluates DDIs in hospitalized patients.

Material and methods

We retrospectively screened medical charts over a 6-month period for diagnosis of chronic HF and/or COPD. Potential DDIs were evaluated using Lexi-Interact software.

Results

Seven hundred and seventy-eight patients were included in the study (median age 75 years, 61% men). The median number of drugs on admission and discharge was 6 (interquartile range (IQR) 4–9) and 7 (IQR 5–), respectively (p = 0.10). We recorded 6.5 ±5.7 potential DDIs per patient on admission and 7.2 ±5.6 on discharge (p = 0.2). From admission to discharge, type-C and type-X potential DDIs increased (p < 0.05 for both). Type X interactions were rare (< 1%), with the combination of a β-blocker and a β₂ agonist being the most common (64%). There were significantly more type-C and type-D potential DDIs in patients with chronic HF as compared to patients with COPD (p < 0.001). Patients with concomitant chronic HF and COPD had more type-C and type-X potential DDIs when compared to those with individual disease (p < 0.005). An aldosterone antagonist and ACE inhibitor/ARB were prescribed to 3% of chronic HF patients with estimated glomerular filtration rate < 30 ml/(min × 1.73 m²).

Conclusions

The DDIs are common in patients with chronic HF and/or COPD, but only a few appear to be of clinical significance. The increase in potential DDIs from admission to discharge may reflect better guideline implementation rather than poor clinical practice.     

深吸气训练在COPD患者开胸术后的临床应用

目的探讨应用深吸气训练降低慢性阻塞性肺病(COPD)患者开胸术后肺部并发症发生率的可行性。方法将62例合并COPD行开胸手术的患者随机分为对照组和观察组,对照组予以常规雾化吸入、物理排痰等治疗;观察组在对照组的基础上术后应用呼吸训练器进行深吸气训练。对比观察2组术后肺部并发症发生率、预后,以及术前、术后1~5 d深吸气量的变化。结果观察组肺部并发症发生率及ICU停留时间显著低于对照组,其术后3~5 d的深吸气量显著高于对照组。结论术后进行深吸气训练可显著降低COPD患者围手术期肺部并发症发生率,并促进肺功能的恢复。     

疏血通对慢性肺心病急性加重患者红细胞膜黏弹特性的影响

探讨疏血通对慢性肺心病急性加重期患者红细胞膜黏弹特性的影响。采用微管吸吮技术,定量测定了慢性肺源性心脏病患者体外使用疏血通前后红细胞膜的黏弹特性的变化情况。结果表明:一定浓度疏血通可降低红细胞膜的弹性模量、黏性系数。这为临床上在肺心病的综合治疗中包括改善红细胞变形性的药物或措施提供了实验依据。     

慢性阻塞性肺病患者心理状况及影响因素

调查慢性阻塞性肺疾病（COPD）患者心理状况和影响因素，对60例患者和60例健康者对照，应用焦虑和抑郁情绪表（HAO）对两组进行问卷调查，结果显示，患者评分显著差于健康者，年龄、病程和通气功能与患者抑郁症状和总分呈显著性相关，提示患者伴有心理障碍，重视和兼顾心理症状诊治颇有必要。     

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case control study from China

Patients with severe chronic obstructive pulmonary disease (COPD) are at higher risk of developing invasive pulmonary aspergillosis (IPA). However, there are limited data for this disease. To evaluate risk factors and the clinical characteristics of IPA in COPD patients, we conducted a hospital-based, retrospective case-control study of 30 COPD patients with IPA and 60 COPD control patients without IPA. Patients in the case group were significantly more likely to have concurrent co-morbidities than controls. Of the IPA patients, 65.4% had worsening radiological findings vs. 11.4% in the control group (p<0.001). IPA in COPD was associated with a higher proportion of mechanical ventilation (43.3% vs. 5%; p<0.001), a longer hospital stay duration (45.8±39.1 days vs. 18.4±11.8 days; p<0.001), and higher mortality (43.3% vs. 11.4%; p<0.001). Systemic use of steroids in the stable phase, treatment with three or more antibiotics during hospitalization and antibiotic treatment longer than 10 days were independent risk factors associated with IPA. COPD patients with obvious dyspnoea, antibiotic-resistant lower respiratory tract infection and repeated detection of Aspergillus in sputum should be considered for the possibility of IPA.     

Efficiency of refracterin in patients with chronic cardiac insufficiency caused by coronary heart disease

Composite preparation refracterin administered in a dose of 300 mg/day for 3 days in addition to routine therapy significantly improved the results of treatment of severe cardiac insufficiency of ischemic genesis compared to placebo. Improvement of clinical status of patients is determined by positive dynamics of systolic and diastolic functions of the left ventricle. Translated fromByulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 138, No. 7, pp. 79–82, July, 2004     

Nonlinear analysis of heart rate variability of healthy subjects and patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is one of the causes of mortality worldwide with an increasing prevalence. Heart rate variability (HRV) reflects the regulation mechanism of the cardiac activity by the autonomic nervous system. The assessment of HRV by using nonlinear methods is more sensitive for the detection of complexity when compared to linear methods. This study aims to get information about the autonomic dysfunction occurred in patients with COPD by analysing the complexity of HRV. Electrocardiogram signals recorded from healthy subjects, patients with moderate COPD and severe COPD (eight subjects per group) were analysed. The HRV signals were acquired from ECG signals. Signals were reconstructed in the phase space and largest Lyapunov exponent (LLE), correlation dimension, Hurst exponent and approximate entropy (ApEn) values were calculated. It has seen that for the patients with COPD LLE, correlation dimension, Hurst exponent and ApEn values were less than control group. According to this, HRV complexity decreases in the presence of COPD. However, there is no significant difference between COPD groups and the severity of COPD has no effect on the chaoticity of the system. The results revealed that autonomic dysfunction occurred in patients with COPD is associated with reduced HRV complexity.     

运动锻炼对慢性阻塞性肺疾病患者肺康复的干预效果

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是一种具有气流受限特征,可以预防和治疗的慢性疾病。该疾病患病率和病死率较高,且严重影响患者的生命质量,给患者家庭和社会带来沉重的经济负担。运动锻炼可以改善COPD患者的呼吸困难和疲劳状况,提高运动能力、肌肉力量和生活质量,还能减少住院率。研究表明,不同类型的运动锻炼对COPD的干预效果存在差异,如步行锻炼可以改善COPD患者的身体功能和运动耐受性,传统抗阻运动锻炼可以改善COPD患者的上下肢肌肉强度和运动能力。本文综述了不同类型的有氧运动和抗阻运动对不同病程COPD患者的干预效果,强调了运动处方个性化的重要性,并讨论了运动风险和规避方法,为慢阻肺患者的运动康复提供指导性建议。     

老年慢性阻塞性肺疾病患者血浆N-端脑钠肽前体与肺动脉高压的关系

目的:探讨老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者中血浆N-端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)与肺动脉高压的关系.方法:将99例老年COPD患者,根据心脏彩超分为单纯...     

The significance of mitral and tricuspid valve systolic lateral annular velocities in the diagnosis of acute pulmonary embolism in patients with chronic heart failure

Introduction

The diagnosis of acute pulmonary embolism (APE) in patients with chronic heart failure (CHF) remains a difficult task, despite the refinement of imaging techniques. The goal of this study was to assess the value of measuring tricuspid and mitral valve systolic annular velocities in CHF patients with suspected PE by tissue Doppler imaging (TDI).

Material and methods

The study included 75 patients with previously diagnosed CHF, admitted due to resting dyspnea, with a maximum tricuspid regurgitation pressure gradient (TRPG) of ≥ 35 mm Hg and positive D-dimer assay. Spiral computed tomography (sCT) was performed on all subjects to confirm APE. Acute pulmonary embolism was diagnosed in 35 patients (PE+), and excluded in 40 others (PE–). Tissue Doppler imaging was performed to measure maximum systolic lateral annular velocities in the mitral (SmLV) and tricuspid (SmRV) valves, as well as the SmRV/SmLV ratio.

Results

PE+ subjects were found to have higher SmLV than PE– subjects (6.0 cm/s (2.0–13.8 cm/s) vs. 4.2 cm/s (1.3–9.1 cm/s), p = 0.003). SmRV/SmLV ratios were 1.05 (0.50–2.50) and 1.56 (0.62–4.30), respectively (p < 0.0001). Areas under ROC curves for diagnosis of APE were 0.700 for SmLV and 0.789 for SmRV/SmLV. In multivariate logistic regression analysis, only SmRV/SmLV was statistically significant, with an odds ratio for APE of 6.26 (95% CI: 1.53–25.59; p = 0.009).

Conclusions

Tissue Doppler imaging of the lateral tricuspid and mitral annuli is a useful clinical tool that can help identify PE in CHF patients. Those patients who fulfill these criteria should be considered for further diagnostic studies to confirm PE.