冠心病充血性心力衰竭治疗的病理生理学基础

冠心病充血性心力衰竭治疗的病理生理学基础北京心肺血管医疗研究中心，首都医学院附属安贞医院（１０００２９）胡旭东近年来冠心病充血性心力衰竭的治疗日新月异，诸多方法，确实挽救了不少病人的生命。但却未能降低其死亡率和提高远期生存率。本文目的在于从冠心病心力...     

冠心病合并糖尿病时的心力衰竭

充血性心力衰竭(CHF)与冠心病和高血压密切相关，近年来尽管冠心病和高血压的病死率与患病率已明显下降，但CHF发生率却逐渐上升，冠心病合并糖尿病患者的病死率并未明显下降。因此，糖尿病合并冠心病在心力衰竭发生中的作用日益引起关注。老年人心力衰竭常常由多种病因引起，而糖尿病合并冠心病是一种常见的病因联合。糖尿病患     

心力衰竭的动物模型

心力衰竭动物模型的建立，对研究心力衰竭的发病机制、病理生理及疾病预防和治疗起重要作用，本文将近年来心力衰竭动物模型制备的相关进展作一综述。     

冠心病慢性心力衰竭患者室性心律失常的临床治疗分析

目的分析研究冠心病慢性心衰病人室性心律失常采用临床治疗的治疗效果。方法抽取2011年6月-2013年8月在我院收治的患有冠心病慢性心衰伴有室性心律失常的病人140例,采用随机抽取模式,随机分为实验组和对照组,每组各70例。对照组对病人单一采取参松养心胶囊治疗,实验组在对照组治疗的基础之上加入盐酸胺碘酮片治疗,对两组临床治疗效果以及不良反应给予对比分析。结果实验组总体有效率为92.9%;对照组总体有效率为74.2%,实验组临床治疗效果明显优于对照组(P0.05);实验组不良反应发生率5.7%,对照组不良反应发生率20%。实验组不良反应发生率明显低于对照组(P0.05)。结论冠心病慢性心衰伴有室性心律失常采用参松养心胶囊联合盐酸胺碘酮片共同治疗,可以获得明显的临床治疗效果,不良反应极少,具有安全稳定性,使病人健康生活质量得到保障。     

老年冠心病慢性心力衰竭的规范治疗

我国老年冠心病心衰的治疗正在成为心血管病领域的重要公共卫生问题,目前中医药治疗心衰虽有一定优势,但临床尚无统一、规范、突出中医特色和优势的一套实用诊疗方案.笔者在临床工作中不断探索,形成了简便、易行、具有自己特色的治疗方案,并进行验证,有肯定的治疗效果.     

老年多器官功能衰竭的临床特征

老年多器官功能衰竭 (ｍｕｌｔｉｐｌｅｏｒｇａｎｆａｉｌｕｒｅｉｎｔｈｅｅｌｄｅｒｌｙ ,ＭＯＦＥ)是老年急救医学领域一个新的临床综合征 ,它病情凶险、病死率高。通辽市医院干部病房共收治ＭＯＦＥ患者 5 3例 ,探讨其临床特征。1　临床资料1998年 1月～ 2 0 0 1年 12月通辽市医院干部病房共收治ＭＯＦＥ患者 5 3例 ,男 5 0例 ,女 3例 ,平均年龄 75岁。诱因 :感染 2 6例 ,脑血管病 13例 ,冠心病 10例 ,高血压病 3例 ,2型糖尿病 1例。慢性基础疾病 :慢性支气管炎 38例 ,冠心病 34例 ,脑血管病 30例 ,老年肺炎 2 8例 ,慢性肾功能不全 2 0…     

老年心力衰竭86例临床分析

老年心力衰竭是内科常见急症之一。本文报道和分析我院近３年收治的８６例６０岁以上心力衰竭患者临床资料，并与同期住院的９８例非老年期心衰病例进行比较，旨在探讨老年人心力衰竭的临床特点。１　临床资料１．１　一般资料　老年组８６例，男５２例，女３４例，年龄６０～８１岁，平均６９－９岁。对照组９８例，男４０例，女５８例，年龄１６～５５岁，平均３７－９岁。１．２　基本病因　见表１，老年组以冠心病、高血压心脏病为多，６６例（７６－８％），对照组以风湿性心脏病为多，５８例（５９－２％）。表１　心力衰竭主要病因（…     

冠心病慢性心力衰竭患者室性心律失常的临床治疗分析

目的探讨研究冠心病慢性心力衰竭患者室性心律失常的临床治疗。方法随机抽取2012年2月~2013年2月本院接诊的100例冠心病慢性心力衰竭患者室性心律失常患者作为研究对象,将其随机分为观察组、对照组,每组50例。对照组采取常规疗法,观察组在常规治疗的基础上,加用胺碘酮,比较分析两组患者的临床疗效。结果观察组治疗的总有效率90.0%显著优于对照组74.0%,二者比较差异显著(P0.05),具有统计学意义,观察组不良反应率4.0%显著优于对照组34.0%,二者比较差异显著(P0.05),具有统计学意义。结论临床治疗冠心病慢性心力衰竭患者室性心律失常时,采用常规疗法加用胺碘酮,不良反应少,医疗效果显著。     

硝酸甘油并小剂量多巴胺治疗冠心病心力衰竭的临床观察

目的:观察硝酸甘油加小剂量多巴胺对冠心病心力衰竭的疗效。方法:对33例冠心病合并心力衰竭患者静点硝酸甘油50-100μg/min,多巴胺2μg/kg·min,疗程10天,观察治疗前后心功能变化。结果:心功能改善总有效率87.9％,治疗前、后有显著差异(P<0.01),心绞痛发作明显减少,不良反应少。结论:只要严格掌握好剂量,硝酸甘油加小剂量多巴胺治疗冠心病心力衰竭是安全、有效的。     

冠心病慢性心力衰竭患者室性心律失常临床治疗

目的：讨论在临床中对冠心病慢性心力衰竭患者存在的室性心律失常进行治疗的临床效果。方法选取我院2012年1月-2014年6月收治治疗的冠心病心力衰竭患者100例,随机的把其分成观察组与对照组,其中观察组患者通过胺碘酮进行治疗,而对照组患者选择常规治疗手段进行治疗,对两组患者的临床治疗效果进行对比分析。结果两组患者经过治疗后,对照组患者的治疗总有效率为76.0％,显效率为48.0％;而观察组患者的治疗总有效率为94.0％,显效率为80.0％;两组患者进行对比,观察组患者的临床疗效明显的高于对照组。100例冠心病衰竭患者中,出现室性心律失常的患者为46例,随着左心室内径的逐渐增大,其出现室性心律失常的概率则越高。结论对于冠心病心力衰竭来说,出现室性心律失常的概率较高,应用胺碘酮对其进行治疗,具备着非常显著的效果,在临床中值得推广与应用。     

小剂量螺内酯辅助治疗高龄冠心病合并慢性心力衰竭临床疗效观察

目的观察小剂量螺内酯辅助治疗高龄冠心病(CAD)合并慢性心力衰竭(CHF)的临床效果。 方法将2016年9月至2017年6月郸城县人民医院收治的84例CAD合并CHF患者纳入研究,按照随机数表法将其分为A、B两组,各42例。A组患者接受常规治疗,B组患者在常规治疗的基础上接受小剂量螺内酯辅助治疗。比较两组患者治疗总有效率,治疗前后LVEF、NT－proBNP水平,不良反应发生率。 结果B组患者治疗总有效率(95.24%)高于A组(78.57%),差异有统计学意义(P<0.05)。B组患者治疗后LVEF水平高于A组(P<0.05),NT－proBNP水平低于A组(P<0.05)。A组不良反应发生率为9.52%,B组不良反应发生率为11.90%,组间差异无统计学意义(P>0.05)。 结论小剂量螺内酯辅助治疗CAD合并CHF临床效果较好,可有效改善患者心功能,且小剂量用药不会增加用药风险,可在临床推广。     

老年慢性肺原性心脏病合并冠心病临床分析

目的：探讨老年慢性肺心病合并冠心病的的临床特点。方法：回顾分析福建省老年医院2002年1月至2006年12月期间82例老年慢性肺心病合并冠心病患者（A组）和195例老年单纯慢性肺心病患者（B组）的临床资料，比较分析两组患者的临床特点。结果：两组比较是易患因素高血压、糖尿病和肥胖比例有显著差别（P〈0．05），临床表现陈旧性心肌梗塞史、完全性左束枝传导阻滞（LBBB）、心界向左或向左下扩大、持续缺血的ST—T改变、Ⅱ～Ⅲ度房室传导阻滞、电轴右偏和重度右心衰竭有显著差别（P〈0．05）。结论：慢性肺心病患者若有陈旧性心肌梗塞史、高血压、糖尿病、肥胖或LBBB、心界向左或左下扩大应考虑合并冠心病。     

老年冠心病患者经皮冠状动脉腔内血管成形术的临床评价

目的评价老年冠心病患者经皮冠状动脉（冠脉）腔内血管成形术（ＰＴＣＡ）的临床疗效。方法将２３６例老年（共２９７支冠脉血管）和３６０例非老年（共４５１支冠脉血管）冠心病患者接受ＰＴＣＡ的结果作对比分析。结果老年患者的冠脉病变特点和发病血管支数与非老年患者差异无显著性;老年组血管扩张病例成功率为９５．４％,随着近年冠脉内支架置入率的增加,主要的ＰＴＣＡ并发症较前降低;以上结果与非老年组比较差异均无显著性。结论对于老年冠心病患者,ＰＴＣＡ是一种有效而安全的冠脉血运重建方法。     

Plasma levels of omentin-1 and visfatin in senile patients with coronary heart disease and heart failure

Objective:To investigate the alteration of plasma levels of omentin-1 and visfatin in elderly patients with coronary heart disease(CHD)and heart failure.Methods:Plasma omentin-1 and visfatin levels were measured in 90 subjects(29 stable angina pectoris(SAP)cases,30 unstable angina pectoris(UAP)cases and 31 age-and sex-matched healthy controls(age≥60 years)by enzyme-linked immunosorbent assay methods.According to the New York Heart Association classification.59 CHDs were divided into three groups:functional I class,11 cases;functional II/III class,36 cases;and functional IV class,12 cases.Results:The plasma level of omentin-1in CHO patients was significantly lower than thai of the control group.Otnenlin-lin SAP group and UAP group were significantly lower compared to the control group(there was no statistical significance between UAP group and SAP group;P0.05).The plasma level of visfatin in CHD patients was significandy higher than that of the control group.Similarly,visfatin in SAP group and UAP group were all significantly higher compared to the control group,while there was no statistical significance between UAP group,and SAP group.The plasma omentin-1 level was negatively correlated with SBP(r=-0.264,P0.05),positively correlated with HDL-c level(r=0.271,P0.05);the plasma visfatin level was positively correlated with TC(r=0.292,P0.05),negatively correlated with HDL-c level(r=-0.266,P0.05).There was a negative correlation between plasma omentin-1 and visfatin levels(r=-0.280,P0.05).Moreover,multiple linear stepwise regression analysis showed that omentin-1 and visfatin levels might be affected by HDL-c level.Logistic regression analysis showed that visfatin could be an independent risk factor of CHD.Conclusions:Decreased levels of omentin-1 and increased levels of visfatin may be involved in the occurrence and development of CHD.Omentin-1 and visfatin,independently,may be protective and pro-inflammatory cytokines.Additionally,both omentin-1 and visfatin may be related to lipid metabolism.Visfatin may be an independent risk factor of CHD.     

伴有糖代谢紊乱冠心病患者的临床特征

为了解冠心病患者伴有或不伴有糖代谢紊乱时临床特点，为此，回顾分析８１０例冠心病患者，其中合并糖尿病占１７．２％，合并应激性高血糖状态占１５．８％。冠心病合并糖尿病患者中伴高血压、脑卒中、高脂血症及阳性家族史率较非糖尿病冠心病患者明显升高，该组患者无胸痛型较多（占４９．２％），病情较重，病死率是非糖尿病冠心病者的２．３６倍，该组病人中近四分之一的糖尿病诊断于冠心病之后，近四分之一是两者同时诊断，无论二者诊断先后，其冠心病的其它危险因素的伴发率、临床特征及病死率无显著差异。这提示糖尿病与冠心病可能为伴发或并发关系，前者是后者的危险因素之一，糖尿病的早期诊治对冠心病的预后非常重要。合并应激性高血糖状态的患者年龄较大，病情较重，病死率高，需予重视。     

左房扩大在冠心病舒张性心力衰竭中的临床意义

目的对冠心病舒张性心力衰竭患者左房内径变化及其临床意义进行研究。方法用彩色多普勒超声心动图仪测定44例冠心病舒张性心力衰竭（DHF组）患者左房内径（LAD）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左心室射血分数（LVEF）、E峰、A峰及E/A比值,并与30例冠心病心功能正常者（对照组）比较。结果DHF组左房内径（34±5）mm较对照组（28±4）mm显著增加（P<0.01）,左房内径扩大者（>30 mm）36例,占80%。DHF组中,E/A>1（假性正常化）患者LAD（36±10）mm较E/A<1患者LAD（33±5）mm增加,但无统计学差异。DHF组E/A值的高低与NYHA心功能分级相关性不明显,左房扩大程度与心功能分级相关性也不明显。结论DHF患者存在左房扩大,左房扩大是舒张性心功能不全病情发展的标志。     

老年冠心病的介入治疗

虽然近年来冠状动脉病变的年轻化趋势明显 ,但是总体统计资料表明 ,老年冠状动脉粥样硬化性心脏病 (以下简称冠心病 )患者仍然占6 4 %～ 87%。在工业化高度发达的西方国家 ,老年患者比例更高 ,而发展中国家尚未见相关报道。老年冠心病患者存在的决定预后的独立相关危险因素较多 (包括高血压、糖尿病和肥胖等 ) ,介入治疗术中风险大 ,因此本文对其相关的问题简述如下。1　老年冠状动脉病变特点及介入治疗策略1 1　病变特点[1] 　与年轻患者相比 ,老年冠心病患者的血管病变特点包括 :①病变弥漫 :长期反复缺血发作和相关危险因素控制不良 ,造…     

老年冠心病的外科治疗

冠心病是老年人常见病和多发病之一。尽管药物治疗和导管技术的发展 ,冠状动脉搭桥术 (ＣＡＢＧ)仍是治疗老年冠心病人心肌缺血十分有效的手段之一 ,其效果已经得到临床 30多年的验证。近 10年 ,行冠状动脉搭桥术病人的构成也在发生变化 ,Ｚａｉｄｉ等报道 ,70岁以上的搭桥病人由 2 0世纪 90年代初期的7 9%上升到 90年代后期的16 5 %[1] ,在我院近 5年完成的 5 0 0多例ＣＡＢＧ中 ,6 0岁以上病人占6 7 2 %,70岁以上占 2 2 6 %。虽然老年冠心病ＣＡＢＧ病人中 ,有急性心肌梗死 (ＡＭＩ)病史、脑卒中史的比例高于年轻病人 ,有不稳定型心…     

Sexuality in patients with coronary disease and heart failure

INTRODUCTION: When a cardiologist is speaking about sexual disorder with a patient with coronary artery disease (CAD) or heart failure (HF) mostly the male sexual disorder is the point. Questions about sexual physical stress and the use of Viagra or MUSE are dominant in the first step. But usually sexual disorders of men and women are a challenge for the cardiologist: is there not another problem behind? Is sexual disorder only a "common symptom"? Is there a need for psychotherapy? There are patients with a "well functioning" of all sexual functions but however feeling unhappy and not satisfied because lacking in sexual fulfilling [32]. The most common questions in my opinion deal with male patients after CABG or valve replacement surgery or after myocardial infarction (MI) or percutaneous transluminal coronary angioplasty (PTCA). Those patients often are concerned about future sexual activity or about a diminished libido. Some fear of failing during intercourse. HOPEFUL PREMISE: The risk of having severe complications during sexual activity is far less than many of the patients and their partners or we the cardiologists would have expected. In only about 0.9% of patients with MI sexual activity was a likely contributor to the onset of MI [27]. Regular exercise reduces the risk of MI by sexual activity. Even in high risk CAD-patients the risk for MI or death are low with 20 chances per million per hour with known CAD [14]. THE PREVALENCE OF ERECTILE DYSFUNCTION (ED) IN POPULATION BASED STUDIES: One of the largest and longest during newer studies is the Massachusetts Male Aging Study (MMAS) asking men with an age of 40-69 years. There was a prevalence of ED (3 levels: mild, moderate, complete) of 39% in the 40 years old and of maximal 67% in men with 69 years of age [16]. Common risks for ED are lower education, diabetes, heart disease, hypertension, cigarette smoking, obesity [22]. As early as possible we should reinforce patients (or even "non-yet-patients") to adopt healthy lifestyles with more physical activity to modify risk for sexual malfunction and for heart disease as well [15]. THE FEMALE SEXUAL DYSFUNCTION (FSD): The prevalence seems to be the same as in men. The most common complaints depending upon their age include decreased libido, vaginal dryness, pain with intercourse, decreased genital sensation and difficulty or inability to achieve orgasm [5]. One of the most important problems for older women are the availability of a sexually active partner and the presence of concurrent illnesses. We should ask for sexual history in older women because the need of love and sexual intimacy does not diminish with age [25]. The risks for FSD are age related as well as para-aging: level of education, history of sexual abuse or sexually transmitted disease, the "integrity" of physical health as well as the overall state general happiness [19]. DEPRESSION AS A RISC FACTOR FOR CAD AND IMPAIRMENT OF SEXUALITY: As cardiologists know sexual dysfunction may be a risk indicator for arteriosclerosis and for heart disease or even a consequence of heart disease. Depression is meanwhile recognized as a independent risk factor for MI. But the connexion of depression and sexual dysfunction is a common problem for psychiatrists', gynaecologists', urologists' and cardiologists' consulting-hours [2, 3, 18, 20, 21, 23]. HEART FAILURE AND SEXUALITY: There is very little data available on this topic. Data are dealing with the need of information for patients and partners on the physical stress during sexual activity [33]. RISK STRATIFICATION FOR SEXUAL ACTIVITY DEPENDING ON THE CLINICAL STATUS OF HEART DISEASE: The examples for clinical status are given in a simple scheme of the Princeton Consensus Panel. Patients with low risk (the large majority of patients) can be safely encouraged to initiate or resume sexual activity or to receive treatment for sexual dysfunction. In group 2 patients with an intermediate risk should undergo cardiologic evaluation before restratification into low- or high-risk category. In the high-risk patients there is a precondition before resuming sexual activity: stabilisation by specific treatment [13]. CONCLUSIONS: Think on the sexual dysfunction when treating female and male cardiologic patients. Work together with other disciplines (gynaecology, psychiatry, sexual medicine, urology) when evaluating a treatment plan. As early as possible try to reinforce lifestyle change for risk factor modification. The absolute risk for death or MI during sexual activity is very low even in patients with known CAD.