超声心动图在卧位型心绞痛治疗中的应用

<正> 1材料与方法 本组35例卧位型心绞痛患者,男21例,女14例,年龄42-73岁(62.1±8.1岁)。其中,陈旧性心肌梗死6例,合并高血压16例。所有患者均测治疗前后血压、心率及超声心动图,22例做了选择性冠状动脉造影。所有患者均给予药物治疗.包括口服硝酸异山梨醇酯、肠溶阿斯匹林、阿替洛尔,部分加用地尔硫卓、硝苯地平释控片、苯那普利、小量利尿剂及地戈辛。     

超声心动图检测卧位型心绞痛患者左心室舒张功能的变化

卧位型心绞痛是指平卧位引起的心绞痛发作,发作时患者须坐起甚至站立以减轻胸痛,夜间发作多在平卧后1～3h内。白天尤其是在餐后平卧也可诱发。此类患者常先有或同时有重度劳累性心绞痛,冠状动脉造影常有多支严重的冠状动脉阻塞性病变,且不同程度存在左心室舒张功能障碍。本研究旨在应用超声心动图观察卧位型心绞痛患者左室舒张功能的变化。1　资料与方法1.1.　研究对象　选自2001年1月—2003年10月在我院住院治疗,按照WHO标准确诊为卧位型心绞痛患者并排除有高血压病、糖尿病、高血脂、瓣膜病及心肌肥厚患者。32例为观察组,男23例,女9例,…     

卧位型心绞痛容量负荷试验

目的探讨卧位型心绞痛发生机制．为临床治疗提供理论依据。方法选择卧位型心绞痛20例,混合型心绞痛12例,劳力型心绞痛10例．采用Swan-Ganz导管检查及容量负荷试验．结合无创检查中心脏X线片、超声心动图、心脏放射性核素检查指标,判断心功能状态．并给予相应治疗。结果①卧位型心绞痛者容量负荷前后平均肺动脉压、肺楔嵌压(PWP)均较其他类型心绞痛者高(P<0．01),负荷后卧位型心绞痛者平均肺动脉压、PWP升高,心脏指数下降,与其他组比较有显著性差异(P<0．05)。②6例容量负荷前PWP正常的卧位型心绞痛者,负荷后PWP明显升高≥18mmHg。③与有创检查中PWP相比．无创检查中心脏表面积、左室舒张末径明显增大,射血分数值显著下降,是判定收缩功能障碍的良好指标,而心脏表面指数、左室舒张末径、射血分数值正常而E／A<1,高峰充盈率降低且肺淤血征阳性亦存在舒张功能障碍。结论卧位型心绞痛的发生与心功能不全密切相关,以舒张功能障碍者多见。     

老年卧位性心绞痛的监测护理体会

卧位性心绞痛是冠心病心绞痛的特殊表现类型。在老年人中发生率相对比成年人多。近年来引起临床的重视。现将我们的护理体会总结如下     

β-受体阻滞剂强化治疗变异型心绞痛5例临床探讨

近 1 0年 ,我们诊治变异型心绞痛 5例 ,用硝苯地平、硝酸异山梨醇酯可缓解发作 ,但无法消除再发及减轻疼痛程度 ,经加用 β受体阻滞剂治疗后获显效 ,现报告如下。1 　 临床资料例 1 ,男 ,64岁。原发性高血压史 1 0年余 ,冠心病史 3年。近日每天夜间发作心绞痛 ,白天劳动无发作。于 1 991年 3月 2 9日入院。体检 :BP 1 35 / 90mmHg( 1mmHg =0 .1 33kPa) ,HR 78次 /min ,律齐。眼底动脉硬化Ⅱ级。踏车试验 :阴性 ;双嘧达莫 心电图试验 :静脉推双嘧达莫 2 5mg,心绞痛发作伴S TⅠ、aVL、V4～ 6 上抬达 0 .31～ 1 .5 0mV。含化硝酸异山梨醇…     

β受体阻滞剂对稳定性心绞痛患者心率变异性的影响

目的 :β受体阻滞剂可以预防心源性卒死的发生 ,而心率变异性下降与心源性卒死相关 ,β受体阻滞剂与冠心病心绞痛患者心率变异性的关系尚不清楚。方法 :应用 2 4h动态心电图对 2 5例服用β受体阻滞剂的冠心病稳定性心绞痛患者和 2 5例对照组的患者进行心率变异性分析 ,于检查当日晨起测心率、血压并计算心率×收缩压值。结果 :服用 β受体阻滞剂组患者与对照组相比心率变异性明显增加 (P <0 0 1) ;而心率×收缩压值与对照组相比明显降低 (P <0 0 1)。结论 :β受体阻滞剂可增加冠心病稳定性心绞痛患者的心率变异性 ,同时可降低冠心病稳定性心绞痛患者心率与收缩压的乘积。     

停用β受体阻滞剂致心绞痛频繁发作2例报告分析

β受体阻滞剂是心血管内科常用药物,代表药物有心得安、倍他乐克、比索洛尔等,主要用于治疗心律失常、高血压、慢性心衰,长期服用突然停用可能导致心绞痛发作甚至诱发心梗。临床文献报道不多,现报告2例因停服β受体阻滞剂导致心绞痛频繁发作的病例。     

彩色M型多普勒超声评价高血压病人的左室舒张功能

目的应用彩色M型多普勒超声心动图测量舒张早期左室内血流传播速度(Vp),评价高血压病人的左室舒张功能.方法高血压组195例(50岁以下者23例;50-70岁者101例;70岁以上者71例).正常对照组136例(50岁以下者53例;50-70岁者50例;70岁以上者33例).取心尖四腔或二腔心平面测量左室内血流传播速度(Vp),二尖瓣和肺静脉血流曲线.结果高血压病人的Vp值较正常人降低(P<0.01), 血流形态异常.结论应用彩色M型多普勒超声心动图测量舒张早期左室内血流传播速度,不受心脏负荷及年龄的影响,作为评价高血压病人左室舒张功能的指标有临床意义.     

卧位型心绞痛患者的左心室舒张功能异常

为探讨左心室舒张功能异常与卧位型心绞痛发作的关系，对２４例冠心病卧位型心绞痛患者、２０例冠心病非卧位型心绞痛患者和２０例正常人的左心室造影资料进行分析，发现卧位型心绞痛患者左心室舒张期前１／３充盈率明显低于冠心病对照组（Ｐ＜０．００１）和正常对照组（Ｐ＜０．００１），其左心室造影后的左心室舒张未压（ＬＶＥＤＰ）较之造影前亦显著升高（Ｐ＜０．０１），而冠心病对照组和正常对照组造影前后的ＬＶＥＤＰ差异无显著性。结果表明卧位型心绞痛患者存在明显的左心室舒张功能不全。     

心肌缺血的叠加在心绞痛中的作用

本文依据对冠心病患者心绞痛发作前后的动态心电图的分析,提出心肌缺血的叠加是一种较常见的临床现象,其中由阈下心肌缺血间的叠加诱发心绞痛可分为三种类型:(1)先有劳力诱发的阈下心肌缺血后与冠脉供血减少所致心肌缺血相叠加。(2)先有冠脉供血减少所致阈下心肌缺血后与劳力诱发心肌缺血相叠加。(3)劳力诱发阈下心肌缺血间的叠加。结果提示,阈下心肌缺血及其叠加效应是造成心绞痛阈值多变的主要原因之一。     

急性心肌梗塞后心绞痛危险因素分析

５４例存活的急性心肌梗塞患者中，２３例（４２．６％）有梗塞后早期心绞痛（ＰＩＡ）．经多项危险因素的多元回归分析，发现年龄、性别、梗塞前心绞痛史、梗塞部位、心功能、高血压、糖尿病、高脂血症、肌酸磷酸激酶峰值和左室射血分数等与ＰＩＡ无关，唯有二维超声心动图的室壁运动分数指数（ＷＭＳＩ）与梗塞后心绞痛有关（Ｐ＝０．０００１）．说明室壁运动异常的范围大和严重与梗塞后心肌缺血有关。ＷＭＳＩ≥２者应作冠状动脉造影。     

Left ventricular diastolic function in mitral stenosis

The assessment of left ventricular (LV) function in the setting of mitral stenosis (MS) has been critically examined for decades. Accurate assessment of aberrations in diastolic function is important as these subjects often present with signs and symptoms of heart failure and pulmonary congestion that cannot be solely explained by the severity of mechanical obstruction. Echocardiographic evaluation of diastolic dysfunction includes an evaluation of reduced LV compliance, diminished restoring forces, and enhanced stiffness, which are challenging in the setting of MS owing to altered hemodynamic loading. Conventional echocardiographic and Doppler measures offer limited information. Novel assessments employing speckle tracking echocardiography are relatively less studied. A more comprehensive assessment including clinical evaluation, identification of concomitant disorders, and comorbidities is particularly warranted in older subjects with degenerative MS to suspect diastolic dysfunction and arrive at optimal medical therapy or intervention. This review provides an overview of etiological, pathophysiological, echocardiographic, and invasive assessment of diastolic dysfunction in the setting of MS, with specific focus on strengths and limitations of available echocardiographic and Doppler techniques.     

银杏叶提取物注射液治疗不稳定性心绞痛的临床观察

目的观察银杏叶提取物注射液(金纳多)治疗不稳定性心绞痛(UA)的临床疗效。方法分别观察金纳多组(21例),对照组(18例)治疗前后的心绞痛发作频率,硝酸甘油用量,静息心电图,血压,心率及心肌耗氧量的变化。结果金纳多组在减少心绞痛发作,降低硝酸甘油用量,改善异常心电图方面优于对照组(P<0.01),心肌耗氧量也明显减少(P<0.01)。结论金纳多治疗UA效果肯定,副作用小,值得临床推广应用。     

辛伐他汀对老年不稳定性心绞痛血清胆固醇及超敏C-反应蛋白的影响

目的观察辛伐他汀治疗老年不稳定性心绞痛对患者血清胆固醇及高敏C反应蛋白(high-sensitivityC-reactiveprotein,hs-CRP)的影响。方法将78例(73±7岁)老年不稳定性心绞痛患者,分为辛伐他汀组和对照组。辛伐他汀组(45例)给予辛伐他汀(20mg/天),治疗共4周;对照组(33例),常规(未经调脂)治疗。分别测定治疗前后的血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及hs-CRP,统计学比较两组治疗前后血清TC、LDL-C、HDL-C及hs-CRP水平。结果①治疗前两组血清TC、LDL-C、HDL-C及hs-CRP水平均无显著差异(P>0.05)。②辛伐他汀组治疗后TC、LDL-C显著下降(P<0.001),HDL-C升高(P=0.002)。对照组治疗前后TC、LDL-C、HDL-C均无显著性差异(P>0.05)。③辛伐他汀组与对照组治疗后hs-CRP均有下降,但辛伐他汀组下降值(2.91±2.62mg/L)显著大于对照组下降值(0.91±1.18mg/L)(P<0.001)。④辛伐他汀治疗4周后hs-CRP的降低与血脂改变TC(r=0.004P=0.977)、LDL-C(r=0.173P=0.256)、HDL-C(r=-0.223P=0.141)无相关性。结论辛伐他汀治疗老年不稳定性心绞痛患者4周,能安全有效调节血清胆固醇及降低hs-CRP水平,且降低hs-CRP水平独立于其调脂作用。     

Concordance between Doppler and pulsed-wave Doppler tissue imaging in estimation of the degree of left ventricular dysfunction and correlating it to the degree of chronic obstructive pulmonary disease

Objective

As a consequence of leftward shift of the interventricular septum and of pericardial restraint, related to the degree of right ventricular dilation, alveolar hypoxia and related pulmonary vascular changes, left ventricular function is influenced by chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the prevalence of echocardiographic abnormalities by conventional echocardiography and Doppler tissue imaging (DTI) in COPD patients according to the degree of disease severity.

Methods

We enrolled forty consecutive patients with COPD and twenty matched control. Twenty of the patients were suffering from mild form of COPD, twenty were suffering from severe form of COPD as decided by pulmonary function test and arterial blood gases and twenty apparently healthy non COPD control persons were subjected to echocardiographic assessment to left ventricular diastolic and systolic functions by conventional echocardiography and DTI at the mitral annulus.

Results

There were no significant statistical difference between the three groups as regards the age and the gender. There were significant statistical differences between the patients and the control as regards the diastolic functions of the left ventricle. E and A waves obtained by conventional Doppler and by DTI showed significant statistical difference between mild, severe forms of COPD and control subjects. The degree of diastolic dysfunction increased significantly with increase of the severity of COPD.

Conclusion

Left ventricular diastolic function is significantly affected in patients with COPD and the degree of affection is related to the severity of COPD.     

Diastolic left ventricular dysfunction in ankylosing spondylitis—A systematic review and meta-analysis

Objectives

Ankylosing spondylitis (AS) is associated with increased mortality largely due to cardiovascular disease. Diastolic left ventricular (LV) dysfunction serves as a precursor to chronic heart failure and may cause morbidity and mortality. A systematic literature search was conducted to determine the prevalence of diastolic LV dysfunction in patients with AS.

Methods

We identified all echocardiographic studies investigating diastolic LV function in patients with AS. The initial search yielded 166 studies of which 11 met the inclusion criteria.

Results

Compared to control subjects, AS patients had a worse E/A ratio [mean difference −0.13 m/s (95% CI: −0.19 to −0.07)], a prolonged deceleration time [mean difference 13.90 ms (95% CI: 6.03–21.78)], and a prolonged mean isovolumetric relaxation time [mean difference 8.06 ms (95% CI: 3.23–12.89)], all suggestive of diastolic LV dysfunction. The best way to establish diastolic LV dysfunction, however, is to combine E/A ratio, deceleration time, and isovolumetric relaxation time. The latter has been done in 3 studies, all reaffirming an increased prevalence rate of diastolic LV dysfunction in AS patients as compared with control subjects, i.e., 9% versus 0%, 30% versus 12%, and 45% versus 18%, respectively.

Conclusions

Our observations support the current evidence base for an increased risk of diastolic LV dysfunction in AS. However, larger studies are needed to investigate the exact magnitude of diastolic LV dysfunction and its clinical relevance in patients with AS.     

硝酸异山梨酯(消心痛)皮肤喷雾剂防治心绞痛的效果

硝酸异山梨醋(消心痛)皮肤喷雾剂治疗39例稳定性心绞痛的疗效达79.5%,作HoIler监测减少心肌缺血发作有效率为73.4%,运动耐量在喷药后有改善(占79%)。本药具有使用简便、作用时间持久,副作用小、无皮肤过敏等优点。