扩张性心肌病的诊断和治疗

扩张型心肌病（DCM）是指因原发性心肌疾病导致一侧或双侧心腔扩大，继以心室收缩功能减退的原因不明心肌病。DCM以左心室或双心室扩张并伴心室收缩功能受损为特征，临床表现为进行性的心力衰竭，常有心律失常、血栓栓塞及猝死，且可发生于疾病的任何阶段。本病预后不良，一般认为症状出现后5年生存率为40．0％，10年生存率为22．0％。由于DCM无特异性治疗方法，因而早诊断、早治疗，防止DCM发展成为终末期心脏病，对提高生存率、降低死亡率有重要意义。     

扩张型心肌病行心脏再同步化治疗术后的护理

扩张型心肌病（dilatedcardiomyopathy,DCM）以心脏扩大、心力衰竭、心律失常、栓塞为基本特征。终末期心力衰竭和恶性心律失常是导致DCM患者死亡的主要原因。在没有抗心室重构的治疗策略之前,DCM患者在出现心力衰竭症状后5年存活率仅40％-50％。虽然抗心肌重构药物能延缓部分患者的病程,但大部分患者的病情仍呈进行性发展。DCM后期往往存在左右心室收缩不同步,     

扩张型心肌病患者心肌显像肺摄取的临床意义

近年来,扩张型心肌病（DCM）发病率逐年升高。对于其病因的研究及疾病预后的判断不断引起人们的关注。本研究旨在通过观察不同时间DCM患者^99Tc^m-甲氧基异丁基异腈（MIBI）心肌显像中肺心放射性比值（LHR）的变化及其与左心室功能之间的关系,以期为疗效及预后评价提供有用信息,现报道如下。     

儿童原发性心肌病的临床特点及影响预后的相关因素

 目的 回顾性分析医院诊治的原发性心肌病,探讨其临床特点及影响预后的相关因素。方法 对1997-01至2016-12我院收治的125例原发性心肌病患儿的临床表现、辅助检查(实验室检查、胸片、心电图、超声心动图等)等资料进行回顾性分析,同时对2007—2016年收治的扩张型心肌病(dilated cardiomyopathy, DCM)患儿进行随访,分析影响DCM预后的相关因素。结果 125例原发性心肌病中, 1岁以内发病73例(58.4%),限制型心肌病(restrictivecardiomyopathy,RCM)见于1岁以上患儿。DCM、左室致密化不全(noncompaction of ventricular myocardium, NVM)、肥厚型心肌病(hypertrophic cardiomyopathy, HCM)患儿多数有心脏、肺部病理性体征,常合并肝大;RCM主要表现为右心力衰竭导致的体循环淤血的系列临床表现。DCM、NVM超声心电图的结果显示LVEDD-Z明显增高,RCM的LAD-Z最大,其次DCM、NVM,而HCM的LAD-Z减小,DCM、NVM、EFE的EF-Z、FS明显降低,HCM、RCM的EF-Z、FS未见明显降低。随访近十年19例DCM,死亡患儿发病年龄、死亡年龄、疾病病程中位数分别是60.3个月、63.8个月和8.0个月,主要死因是顽固性心力衰竭及恶性心律失常。结论 DCM是最常见的心肌病类型;好发年龄是1岁以内,男多于女;cTnI、NT-proBNP、LVEDD-Z增加;顽固性心力衰竭及恶性心律失常是主要死因。     

老年人扩张型心肌病的临床特点

扩张型心肌病(dilated cardiomyopathy.DCM)是原 发性心肌病中最常见的类型,以往认为主要是累及     

扩张型心肌病的影像学研究进展

扩张型心肌病(dilated cardiomyopathy, DCM)是一种常见的原发性心肌疾病，多起病隐匿，容易导致心律失常和猝死，因此，早期DCM的诊断是研究的重点。目前诊断扩张型心肌病的影像学检查有超声心动图、心脏磁共振(cardiovascuar magnetic resonance, CMR)、CT、核医学等。本文介绍了DCM的影像学检查方法，分析并比较每种方法的优劣势，为临床诊疗提供帮助。     

浅谈扩张型心肌病的误诊原因及鉴别要点

扩张型心肌病（DCM）,临床表现多样化,病死率高,早期易误诊,影响治疗及预后。DCM临床表现,酷似冠心病、风心病、心肌炎、克山病等,加之老年男性占多数,如不进行冠脉造影及心内膜心肌活检等心脏介入性检查,很难排除上述诊断,此是本病早期易误诊之主要原因,本文针对DCM鉴别诊断困难,提出几点鉴别要点供同道参考。     

双腔起搏器治疗扩张型心肌病缓慢性心律失常并心功能不全观察与护理

扩张型心肌病（DCM）在出现缓慢性心律失常合并心功能不全时，药物治疗常难奏效。我院自2001年6月-2005年6月，用双腔起搏器治疗DCM缓慢心律失常并心功能不全12例取得较好疗效。现将观察结果及护理体会介绍如下：     

心脏MRI在扩张型心肌病中的应用价值

目的 探讨1.5T心脏磁共振成像(CMRI)在扩张型心肌病(DCM)中的应用价值.方法 选取DCM患者45例及健康对照者25例,均进行CMRI检查,通过LGE序列判断左心室有无心肌纤维化将DCM组患者分为LGE(+)组和LGE(-)组,测如下结构及功能参数:LVEDD、LVESD、LVEDV、LVESV、LVEF、LV...     

地尔硫治疗扩张型心肌病24例

扩张型心肌病(DCM)患者体内存在一种抗心肌线粒体ADP和(或)ATP载体抗体,此抗体可以引起心肌细胞毒性损伤[1,2],而钙拮抗剂可以降低其毒性反应[3]。我院自1992～1997年收治DCM24例,采用钙拮抗剂地尔硫治疗扩张型心肌病24例,疗效较好。1　临床资料1.1　一般情况　本组男17例,女7例;年龄26～62岁,平均46.2岁。病史2～8年,平均5.5年。DCM诊断依据1995年全国心肌炎心肌病诊断参考标准。1.2　给药方法　DCM24例在常规抗心衰治疗基础上加用地尔硫30mg,3次/d,疗程6.4±2.5个月。常规抗心衰治疗包括:地高辛0.125～0.25mg/d,卡托普利12.5…     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.