慢性肺源性心脏病患者心律失常检出情况分析

慢性肺源性心脏病是呼吸系统的常见疾病,是老年人死亡主要原因之一.其发病率高,并发症多,常引起全身多脏器功能衰竭.心律失常可影响慢性肺源性心脏病的治疗及预后.现对144例慢性肺源性心脏病患者常规心电图和动态心电图检查结果进行比较,结果报道如下.     

老年慢性肺源性心脏病诊治分析

慢性肺源性心脏病是由于肺、胸廓或肺动脉血管的慢性病变所致的肺循环阻力增加,肺动脉高压,进而引起右心室心肌肥厚、扩大,甚至发生右心衰竭的心脏病,是老年人的主要死亡原因之一。慢性肺源性心脏病是我国常见的心脏病类型,患病率约为0．48％,     

Tei指数、右心室面积变化分数、右房室瓣环收缩期位移、肺动脉收缩压对慢性肺源性心脏病的诊断价值及其与血浆N末端B型利钠肽前体水平的相关性研究

目的探讨Tei指数、右心室面积变化分数(FAC)、右房室瓣环收缩期位移(TAPSE)、肺动脉收缩压(PASP)对慢性肺源性心脏病的诊断价值及其与血浆N末端B型利钠肽前体(NT-pro BNP)水平的相关性。方法选取2013年6月—2017年1月宜兴市人民医院收治的慢性肺源性心脏病患者337例,根据心肺功能代偿情况分为代偿组(n=64)和失代偿组(n=273),并根据失代偿程度将失代偿组患者分为呼吸困难组(n=118)、右心衰竭组(n=103)、全心衰竭组(n=52);另选取同期体检健康者52例作为对照组。比较对照组、代偿组、失代偿组受试者及代偿组、呼吸困难组、右心衰竭组、全心衰竭组患者Tei指数、FAC、TAPSE、PASP及血浆NT-pro BNP水平,绘制ROC曲线以评价Tei指数、FAC、TAPSE、PASP及血浆NT-pro BNP水平对慢性肺源性心脏病的诊断价值;Tei指数、FAC、TAPSE、PASP与慢性肺源性心脏病患者血浆NT-pro BNP水平的相关性分析采用Pearson相关分析。结果 (1)代偿组、失代偿组患者Tei指数、PASP及血浆NT-pro BNP水平高于对照组,FAC低于对照组,TAPSE小于对照组(P0.05);失代偿组患者Tei指数、PASP及血浆NT-pro BNP水平高于代偿组,FAC低于代偿组,TAPSE小于代偿组(P0.05)。(2)呼吸困难组、右心衰竭组、全心衰竭组患者Tei指数、PASP及血浆NT-pro BNP水平高于代偿组,FAC低于代偿组,TAPSE小于代偿组(P0.05);右心衰竭组、全心衰竭组患者Tei指数、PASP及血浆NT-pro BNP水平高于呼吸困难组,FAC低于呼吸困难组,TAPSE小于呼吸困难组(P0.05);全心衰竭组患者Tei指数、PASP及血浆NT-pro BNP水平高于右心衰竭组,FAC低于右心衰竭组,TAPSE小于右心衰竭组(P0.05)。(3)绘制ROC曲线发现,Tei指数、FAC、TAPSE、PASP及血清NT-pro BNP水平诊断慢性肺源性心脏病的曲线下面积(AUC)分别为0.654[95%CI(0.557,0.751)]、0.960[95%CI(0.929,0.990)]、0.821[95%CI(0.742,0.899)]、0.854[95%CI(0.799,0.929)]、0.906[95%CI(0.853,0.960)];FAC、PASP、血浆NT-pro BNP水平诊断慢性肺源性心脏病的AUC大于Tei指数、TAPSE(P0.05)。(4)Pearson相关分析结果显示,FAC(r=-0.527)、TAPSE(r=-0.361)与慢性肺源性心脏病患者血浆NT-pro BNP水平呈负相关,而PASP(r=0.428)与慢性肺源性心脏病患者血浆NT-pro BNP水平呈正相关(P0.05)。结论 Tei指数、FAC、TAPSE、PASP及血浆NT-pro BNP水平对慢性肺源性心脏病均有一定诊断价值,其中FAC、PASP及血浆NT-pro BNP水平的诊断价值较高;FAC、TAPSE与慢性肺源性心脏病患者血浆NT-pro BNP水平呈负相关,而PASP与慢性肺源性心脏病患者血浆NT-pro BNP水平呈正相关。     

导尿治疗慢性肺源性心脏病急性右心衰竭的对照研究

目的探讨导尿对慢性肺源性心脏病急性右心衰竭的治疗价值。方法慢性肺源性心脏病急性右心衰竭100例,随机分为对照组和治疗组各50例,对照组予积极控制感染、通畅呼吸道、改善呼吸功能、纠正缺氧和二氧化碳潴留、控制呼吸和心力衰竭、积极处理并发症、纠正酸碱失衡,根据病情需要使用呼吸兴奋剂及机械通气辅助通气等治疗;治疗组在对照组基础上行导尿术。观察比较两组的疗效及转归。结果治疗组的有效率90.0%,显著高于对照组76.0%(P<0.05)。结论对慢性肺源性心脏病急性右心衰竭,早期予行导尿术可缩短纠正心功能衰竭时间,缩短住院时间,减少心力衰竭复发,提高患者运动耐量。     

血塞通对慢性肺源性心脏病伴右心衰竭的治疗效果

目的探讨血塞通对慢性肺源性心脏病伴右心衰竭的治疗效果。方法选取我院自2010年1月-2011年1月收治的52例慢性肺源性心脏病伴右心衰竭患者为研究对象,随机分对照组和观察组,每组各26例。对照组给予常规治疗,观察组在此基础上加用血塞通。两组均连续治疗15天后比较治疗效果。结果观察组总有效率达到了88.5%,对照组总有效率为76.9%,两组对比差异显著(P0.05)。结论血塞通在慢性肺源性心脏病伴右心衰竭的治疗中具有较高的应用价值,疗效确切,可以大力推广。     

慢性肺源性心脏病左胸导联ST段改变的临床意义

为探讨慢性肺源性心脏病左胸导联ST段改变的临床意义,分析63例有左胸导联ST段改变的肺源性心脏病患者(Ⅰ组)与63例无ST段改变的肺源性心脏病患者(Ⅱ组)的临床资料和预后。结果显示:Ⅰ组左心室扩大,肥厚的检出率、左心衰竭发生率均明显高于Ⅱ组;两组间疗效、预后差异有非常显著意义(P<0.01)。提示慢性肺源性心脏病左胸导联sT段改变为左心室受损或合并冠心病所致,并预示预后不良。     

柏晋梅教授中西医结合治疗慢性肺源性心脏病经验

探讨柏晋梅教授运用中西医结合治疗慢性肺源性心脏病的经验。分别从中医学对慢性肺源性心脏病的认识、柏晋梅教授关于慢性肺源性心脏病的临床辨证论治、典型病例讨论、临床治疗慢性肺源性心脏病的经验等方面加以阐述,发现柏晋梅教授运用中西医结合治疗慢性肺源性心脏病,尤其是配合中医分阶段辨证施治,能够缩短疗程,改善病情,治疗效果明显。     

肺性脑病的临床护理体会

肺性脑病又称肺心脑综合征，是慢性支气管炎并发肺气肿、肺源性心脏病及肺功能衰竭引起的脑组织损害及脑循环障碍。笔者临床护理45例，报告如下。     

脑钠肽对评估慢性阻塞性肺病和慢性肺源性心脏病严重程度的意义

目的探讨脑钠肽(Nt-pro-BNP)对评估慢性阻塞性肺病和慢性肺源性心脏病严重程度的意义。方法应用酶联免疫吸附法对比慢性阻塞性肺病急性发作期组、慢性肺源性心脏病代偿期组、慢性肺源性心脏病失代偿期组血清中血浆Nt-pro-BNP。结果慢性阻塞性肺病急性发作期组、慢性肺源性心脏病代偿期组、慢性肺源性心脏病失代偿期组血清中Nt-pro-BNP含量分别为185±21 pg/ml,1128±76 pg/ml,7893±248 pg/ml,组间比较,差异显著。结论脑钠肽对评估慢性阻塞性肺病和慢性肺源性心脏病严重程度的有重要意义。     

64例慢性肺源性心脏病的观察与护理

慢性肺源性心脏病简称肺心病,由于肺组织、胸廓或肺动脉血管慢性病变引起肺组织结构和功能异常,产生肺血管阻力增加,肺动脉压力增高,使右心肥大、扩张,甚至发生右心衰竭的一类心脏病。临床上多见于老年患者,往往反复发作,严重影响病人的生活质量。我     

100例老年慢性阻塞性肺疾病急性加重的临床分析

目的 探讨老年慢性阻塞性肺疾病(COPD)急性加重的发生，发展及治疗。方法 2003年9月到2004年2月，我院65岁以上的老年COPD急性加重的住院患者。结果 100例中合并慢性肺源性心脏病59例、冠心病17例、原发性高血压41例、合并高血压性心脏病12例、糖尿病14例、老年瓣膜性心脏病7例；发生心衰52例、呼吸衰竭37例、肾功能不全23例、肝功能不全8例、心律失常7例；其中合并1种其他脏器病变的患者24例，合并2种其他脏器病变的患者33例，合并3种及3种以上其他脏器病变的患者37例；死亡8例。合并1种其他脏器病变(1例)12．5％，合并2种其他脏器的病变(2例)25％，合并3种及3种以上其他脏器的病变(5例)62．5％；死亡组与非死亡组患者入院时的血白细胞，动脉血气等实验室指标比较，统计测定显著性差异。结论 老年呼吸道防御功能下降招致的呼吸道反复感染，可能是老年人COPD发病率增加的原因；老年COPD病患者多合并呼吸，心脏和其他脏器的病变；急性加重患者的处理，应在积极抗感染的同时注意其他脏器合并症和功能衰竭的治疗。     

Assessment of cardiac sympathetic nerve activity in children with chronic heart failure using quantitative iodine-123 metaiodobenzylguanidine imaging

OBJECTIVES: Cardiac sympathetic nerve activity in children with chronic heart failure was examined by quantitative iodine-123 metaiodobenzylguanidine (MIBG) myocardial imaging in 33 patients aged 7.5 +/- 6.1 years (range 0-18 years), including 8 with cardiomyopathy, 15 with congenital heart disease, 3 with anthracycrine cardiotoxicity, 3 with myocarditis, 3 with primary pulmonary hypertension and 1 with Pompe's disease. METHODS: Anterior planar images were obtained 15 min and 3 hr after the injection of iodine-123 MIBG. The cardiac iodine-123 MIBG uptake was assessed as the heart to upper mediastinum uptake activity ratio of the delayed image (H/M) and the cardiac percentage washout rate (%WR). RESULTS: The severity of chronic heart failure was class I (no medication) in 8 patients, class II (no symptom with medication) in 9, class III (symptom even with medication) in 10 and class IV (late cardiac death) in 6. H/M was 2.33 +/- 0.22 in chronic heart failure class I, 2.50 +/- 0.34 in class II, 1.95 +/- 0.61 in class III, and 1.39 +/- 0.29 in class IV (p < 0.05). %WR was 24.8 +/- 12.8% in chronic heart failure class I, 23.3 +/- 10.2% in class II, 49.2 +/- 24.5% in class III, and 66.3 +/- 26.5% in class IV (p < 0.05). The low H/M and high %WR were proportionate to the severity of chronic heart failure. CONCLUSIONS: Cardiac iodine-123 MIBG showed cardiac adrenergic neuronal dysfunction in children with severe chronic heart failure. Quantitative iodine-123 MIBG myocardial imaging is clinically useful as a predictor of therapeutic outcome and mortality in children with chronic heart failure.     

Treatment of chronic systolic heart failure secondary to Chagas heart disease in the current era of heart failure therapy

The treatment of chronic heart failure secondary to Chagas disease has been based on extrapolation of data achieved in the treatment of non-Chagas disease heart failure. Because beta-blockers decrease the incidence of sudden cardiac death in non-Chagas disease heart failure and sudden cardiac death occurs preferentially in patients with mild Chagas disease heart failure, beta-blockers may be administered first to class I/II patients with Chagas disease heart failure. In advanced Chagas disease heart failure, angiotensin-converting enzyme inhibitor and diuretics may be given at first to compensate for congestive symptoms. After clinical status improvement, beta-blockers should be given at targeted doses, if necessary reducing angiotensin-converting enzyme inhibitor doses. Primary and secondary prevention of sudden cardiac death may be accomplished with implantable cardioverter defibrillators because of the high recurrence of life-threatening arrhythmias despite amiodarone administration. In refractory heart failure, heart transplantation is the treatment of choice.     

老年慢性疾病对肺部感染并发老年多器官功能不全综合征的早期预测价值

目的研究老年慢性疾病对肺部感染并发老年多器官功能不全综合征(MODSE)的早期预测价值。方法回顾性地分析2001年1月至2006年12月因肺部感染在白求恩国际和平医院住院或住院期间出现肺部感染的驻石家庄地区60岁以上的师以上军队离退休干部393例的病历资料,根据肺部感染是否诱发MODSE将所有病例分为MODSE组和非MODSE组,调查各组所患老年慢性疾病情况。先做单因素分析,采用四格表χ2检验分析2组病例所患各种老年慢性疾病的差异,再选择单因素分析中差异有统计学意义的老年慢性疾病作自变量,以MODSE为因变量,作二分类逐步Logistic回归分析,筛选对肺部感染并发MODSE有影响的老年慢性疾病。结果单因素分析有统计学意义的老年慢性疾病有:慢性阻塞性肺疾病、慢性呼吸衰竭、肺间质纤维化、肺心病、冠心病、慢性心功能不全、脑血管疾病、颈椎病、慢性肝炎与肝硬化、糖尿病、高尿酸血症、慢性肾功能不全、恶性肿瘤等13种老年慢性疾病。经二分类逐步Logistic回归分析,其中慢性心功能不全、脑血管疾病、慢性阻塞性肺疾病、慢性呼吸衰竭、肺心病、肺间质纤维化、糖尿病、慢性肾功能不全、恶性肿瘤等9种老年慢性疾病为肺部感染并发MODSE的危险因素。结论慢性心功能不全、脑血管疾病、慢性阻塞性肺疾病、慢性呼吸衰竭、肺心病、肺间质纤维化、糖尿病、慢性肾功能不全、恶性肿瘤等老年慢性疾病对肺部感染并发MODSE具有一定的早期预测价值。     

PCI治疗慢性心力衰竭合并冠心病患者的疗效及预后分析

目的 研究经皮冠状动脉介入诊疗术(PCI)治疗慢性心力衰竭(心衰)合并冠状动脉粥样硬化性心脏病(冠心病)患者的疗效及长期预后.方法 入选2016年2月至2018年12月于首都医科大学附属北京胸科医院、解放军总医院第七医学中心因慢性心力衰竭住院的患者180例,入院后给予心衰指南指导下的药物治疗(GDMT).上述患者均经冠...     

The Management of the Older Adult Patient with Anomalous Left Coronary Artery from the Pulmonary Artery Syndrome: A Presentation of Two Cases and Review of the Literature

ALCAPA (anomalous left coronary artery from pulmonary artery) syndrome is a rare congenital abnormality that involves an anomalous insertion of the left coronary artery into the pulmonary artery. Ninety percent of patients present in the first year of life with signs and symptoms of heart failure or sudden cardiac death secondary to chronic myocardial ischemia. There have been an increasing number of reports of ALCAPA patients surviving to adulthood. There seems, however, to be a tendency to die suddenly in the third decade of life. Adult survivors are either asymptomatic or present with mitral regurgitation, cardiomyopathy, myocardial ischemia, or malignant arrhythmias. The management of the older patient presenting with symptoms resulting from ischemia and progressive left ventricular dysfunction remains a challenge. Treatment is largely based on guidelines for adult congenital heart disease management and an extrapolation of evidence from heart failure practice. Currently, surgical reimplantation of the anomalous coronary onto the aorta is the mainstay of treatment. The management of heart failure, sudden cardiac death, and ventricular arrhythmia present problems that are not addressed by reimplantation of the anomalous vessel alone. In this report, we present two cases with different modes of presentation and discuss treatment options.     

Clinical value of pulmonary congestion detection by lung ultrasound in patients with chronic heart failure

Chronic heart failure is one of the common causes of hospitalization and death. Pulmonary congestion is the common disease feature of patients with chronic heart failure, which could be correctly diagnosed by lung ultrasound. Efficacy of lung ultrasound‐guided pulmonary congestion management for patients with acute heart failure is well documented, however, more evidence is needed to establish the clinical value of pulmonary congestion detection by lung ultrasound examination in patients with chronic heart failure. This review summarized current evidence related to the use and clinical value of pulmonary congestion assessment by lung ultrasound in patients with chronic heart failure, aiming to provide new suggestions on promoting the widespread use of lung ultrasound in patients with chronic heart failure to improve the quality of life and outcome of patients with chronic heart failure.     

老年心力衰竭急性加重住院病人临床特点分析

目的探讨老年心力衰竭急性加重病人住院的临床特点,为老年心力衰竭急性加重的防治提供理论依据。方法回顾性分析2017年1月-2017年12月住院急性心力衰竭病人的临床资料,收集65岁及以上病人且以80岁为界,分为高龄组和老年组进行分析。共纳入3914例老年急性心力衰竭住院病人,其中老年组1602例,高龄组2312例。结果两组年龄、男性、住院天数、死亡率、住院费用比较差异均有统计学意义(P<0.05)。老年组前5位住院原因分别是高血压病(18.3%)、慢性阻塞性肺疾病急性发作(13.4%)、冠状动脉粥样硬化性心脏病(12.4%)、脑卒中(7.8%)、其他类型心脏病(6.2%)。高龄组前5位住院原因分别为慢性阻塞性肺疾病急性发作(15.9%)、冠状动脉粥样硬化性心脏病(13.6%)、高血压病(12.2%)、肺炎(7.7%)、脑卒中(6.7%)。结论慢性阻塞性肺疾病急性发作是导致老年特别是高龄病人心力衰竭急性加重入院的重要原因。     

Deaths in risk classes I-III: a measure of quality of care in patients hospitalised with CAP?

All deaths occurring in patients with community-acquired pneumonia in risk classes I-III were reviewed as a quality-of-care measure. The immediate and underlying causes of death were classified according to the World Health Organization protocol. Eleven (1.8%) of the 608 low-risk patients died. Three of the patients did not have pneumonia, one of whom was admitted with atypical pulmonary oedema due to stenosis of a prosthetic heart valve. Failure to include chronic lung disease in the severity-of-illness scoring system resulted in misclassification of seven patients. The most common underlying causes of death were pulmonary fibrosis at 27%, chronic obstructive lung disease at 18% and cancer at 27%. Respiratory failure was the immediate cause of death in 64% of patients, cardiac causes in 27%, and pneumonia in 9%. To conclude, the review of deaths in patients at low risk for mortality is useful for monitoring the quality of care received by patients who require admission for the treatment of community-acquired pneumonia, and that the pneumonia-specific severity-of-illness scoring system results in misclassification of patients with chronic obstructive lung disease and pulmonary fibrosis.     

Pulmonary edema caused by cardiac ischemic attacks in cases with or without minimal myocardial infarction]

We report cases of angina pectoris or minimal acute myocardial infarction accompanied by pulmonary edema, which were retrospectively studied with regard to their clinical characteristics, prognosis and treatment. Sixteen patients, 5 males and 11 females with a mean age of 72.6 years, admitted to the Cardiovascular Center of Sendai between January 1986 and June 1989, were studied. Ten had previous myocardial infarction. Hypertension, chronic renal failure and diabetes mellitus were found in 10, 7 and 7 patients, respectively. Electrocardiograms during cardiac ischemic attacks showed ST elevation in 8 and ST depression in the other 8 patients. Coronary arteriography which was performed in 6 patients revealed three-vessel disease in 5, and two-vessel disease in one. Mechanical ventilation was indicative of 7, and intraaortic balloon counterpulsation in 2 patients. Coronary artery bypass graft surgery was performed for 3 patients. All patients recovered from pulmonary edema and were discharged. During the mean 15-month-follow-up period, 8 patients died. The causes of death were sudden cardiac death in 3, acute myocardial infarction in one, congestive heart failure in one, post-surgical death in one, and non-cardiac death in 2.