心脏介入术中并发急性心脏压塞的抢救与护理

目的研究心脏介入术(CIO)中并发急性心脏压塞(ACT)的抢救与护理。方法将64例患者实施CIO时并发ACT,以数字法随机分成观察组及对照组各32例,2组均实施ACT抢救措施,对照组在此基础上另实施常规护理,而观察组则实施综合护理。对比2组ACT发现率及抢救成功率,2组护理满意情况以及HDL评分情况。结果观察组ACT发现率及抢救成功率均显著高于对照组,差异均有统计学意义(P0.05);观察组的护理满意情况显著优于对照组,差异有统计学意义(P0.05);观察组护理后的焦虑、抑郁评分及总分均显著低于护理前及对照组,差异有统计学意义(P0.05)。结论对CIO并发ACT患者,积极予以抢救措施及综合护理,可明显提升抢救成功率及护理满意率,降低HDL评分,减少医患纠纷。     

心脏直视手术中心脏复苏困难的处理

目的：为提高心脏直视手术中心脏复苏率。方法：总结２０例心脏直视手术中心脏复苏困难的处理经验。结果：胸内心脏挤压和中等剂量心脏兴奋剂有利于心脏手术中的心脏复苏；心肌出现粗颤即应尽早除颤，不宜片面追求较高的心脏自动复跳率。对复苏困难病例，依其不同情况，在常规复苏方法的基础上，可采用一些特殊复苏措施，包括消除导致复苏困难的原因、长时间心脏挤压和长时间体外循环辅助、采用外科手段等。结论：有多种因素影响心脏直视手术中的心脏复苏，正确分析判断复苏困难的特殊原因，恰当地采用综合性措施（包括外科手段）进行复苏可收到良好效果。     

Effect of transvenous cardiac resynchronization therapy device implantation on cardiac troponin I release

BACKGROUND: Pacemaker and implantable cardioverter defibrillator (ICD) implantation increases cardiac troponin I (cTnI) levels which indicates myocardial injury. During implantation of a cardiac resynchronization therapy (CRT) device, balloon inflation for coronary sinus (CS) venogram, cannulation of CS side branch, and electrode advancement may interfere with CS drainage and, hence, may decrease the washout of toxic metabolites from the heart. Thus, CRT implantation may further increase cTnI levels. In this study, we investigated the effects of CRT implantation on cTnI release. METHODS: We included 10 patients (mean age = 57 +/- 15 years) in whom a successful transvenous CRT system was implanted (CRT group). Twenty patients (mean age = 65 +/- 10 years) who underwent a transvenous pacemaker or ICD implantation were included as the control group. Blood samples for cTnI were drawn at baseline and at six, 12, 18, and 24 hours thereafter. RESULTS: Baseline median cTnI levels were similar in CRT and control groups (0.03 ng/mL vs 0.02 ng/mL, respectively; P = 0.1). Postoperative cTnI levels during 24 hours were significantly higher in the CRT group (P < 0.05) by two-way repeated measures of analysis of variance. Post hoc analysis revealed that cTnI levels were higher at the 6th, 12th, 18th, and 24th hours compared to baseline levels (P < 0.001, P < 0.001, P < 0.01, and P < 0.01, respectively). There was a significant difference in the area under the curves (AUCs) of cTnI measurements (1.79 hr.ng/mL in the CRT group and 0.78 hr.ng/mL in the control group, P < 0.05). CONCLUSION: Postoperative cTnI levels were higher after CRT implantation than simple pacemaker/ICD implantation. This may be due to CS manipulation during CRT implantation.     

Factors influencing referral of cardiac patients for cardiac rehabilitation.

This study asked the question: Are there differences in the characteristics and referral rates of men and women who are referred for cardiac rehabilitation? The sample consisted of 203 men (n = 148) and women (n = 55) who were hospitalized with at least one cardiac diagnosis and were eligible for Phase II cardiac rehabilitation. Hospital records were reviewed to obtain information on gender, age, ethnicity, insurance coverage, marital status, employment status, proximity to rehabilitation services, transportation availability, concurrent disease processes, domestic responsibilities, documentation of referral for cardiac rehabilitation, and the attending physician. A survey sent to the patients approximately 3 weeks after their discharge from the hospital also addressed these variables. Logistic regression analysis indicated only one predictor of referral: the gender of the physician. Male physicians were more likely to refer patients for cardiac rehabilitation. This finding must be viewed with caution because of the small number of female patients and female physicians included in the study. The current literature reflects conflicting findings about the proposed relationships; therefore, they merit further investigation.     

In-hospital cardiac arrest

In-hospital sudden cardiac arrest and resuscitation is distinct from out-of-hospital sudden cardiac arrest (OOHSCA) and warrants specific attention. Sudden cardiac arrest (SCA) is a manifestation of an underlying process rather than a disease itself. The complex, multiorgan system dysfunction common among the inpatient population can precipitate SCA by both similar and very different mechanisms than OOHSCA. The diagnostic and treatment algorithms of SCA remain largely the same between the inpatient and outpatient arenas. The application of complex diagnostic and therapeutic interventions is permissible, but such tools must not interrupt or delay the important basics of cardiac arrest management in the inpatient setting, including adequate chest compressions and timely defibrillation when appropriate.     

保留幽门的胃大部切除间置顺蠕动空肠治疗贲门癌

目的 :减少贲门癌行胃次全切除术后并发症 ,提高患者生活质量。方法 :对 2 1例贲门癌 ,行保留幽门的胃次全切除术 ,在食管与残胃之间 ,间置顺蠕动空肠 ,并在食管空肠吻合口下方 3cm左右重叠缝合空肠浆肌层重建人工贲门。结果 :随访患者的胃排空时间为 2 0± 0 5h ,无贫血、倾倒综合征发生 ;食管及吻合口炎症 1例。结论 :本术式术后并发症少 ,反流性食管炎发生率低 ,病人生活质量明显提高     

Doppler echocardiography and cardiac pacing

There is a need for a non-invasive method to evaluate the hemodynamic consequences of pacing. The value of Dop pler echocardiography in assessing relative changes in stroke volume and cardiac output is reviewed. We present preliminary observations illustrating the potential value of Doppler echocardiography in cardiac pacing. (PACE, Vol. 5, July-August, 1982)     

Transthoracic pacing in cardiac asystole

A total of 139 patients had transthoracic pacemakers introduced via a subxiphoid approach for asystole during advanced CPR in the emergency department of a large urban teaching hospital over a calendar year. Two groups were examined retrospectively, A) 34 patients who presented asystolic, and B) 99 patients who presented with ventricular fibrillation that became asystole. Age, sex, and etiologies for cardiac arrest were similar in both groups; there were no survivors. The mean duration of asystole before pacemaker insertion was 4 min (group A) to 7 min (group B). Temporary electrical capture was obtained in six patients from group B, but electrical-mechanical association could not be achieved in any of these patients.     

血清心肌肌钙蛋白I诊断新生儿窒息心肌损害的研究

目的 :探讨血清心肌肌钙蛋白 I(c Tn I)诊断新生儿窒息心肌损害的临床价值。方法 :采用免疫化学发光测定法 (CL IA)检测正常对照组 (2 0例 )、轻度窒息组 (2 0例 )和重度窒息组 (2 0例 )新生儿血清 c Tn I浓度。结果 :1血清 c Tn I浓度在窒息新生儿有明显增高 (F=81 .0 7,P<0 .0 1 ) ;对照组 c Tn I(0 .0 5± 0 .0 4)μg/ L与轻度组 (0 .30± 0 .2 8)μg/ L、重度组 (2 .6 5± 2 .73)μg/ L之间两两比较均存在非常显著性差异 (P均 <0 .0 1 ) ;2 4例重度窒息合并有心力衰竭新生儿血清 c Tn I浓度显著增高分别为 4.1 8、5 .40、7.6 7及 1 0 .43μg/ L ,浓度为1 0 .43μg/ L的患儿死亡。结论 :1 c Tn I可作为新生儿窒息心肌损害新的诊断金标准 ,有助于早期诊断 ;2 c Tn I明显增高或许对新生儿窒息合并心衰的预后有参考价值。     

Effect of cardiac resynchronization therapy on cardiac sympathetic nervous dysfunction and serum C-reactive protein level

Background: Cardiac autonomic dysfunction is associated with a poor prognosis in patients with heart failure (HF). Systemic inflammation is elevated in patients with HF. We hypothesized that cardiac resynchronization therapy (CRT) improves cardiac sympathetic nervous dysfunction and systemic inflammation. To test our hypothesis, we evaluated cardiac sympathetic activity and serum levels of high sensitive C‐reactive protein (hs‐CRP) before and after CRT. Methods: Twenty‐seven patients with chronic HF (19 men, eight women; mean age 67 ± 10 years) with nonischemic cardiomyopathy who underwent CRT were evaluated. Each patient was evaluated before and 6 months after CRT. Responders were defined as patients showing ≥15% absolute decrease in left ventricular end‐systolic volume. Cardiac sympathetic activity was estimated with cardiac ¹²³I‐metaiodobenzylguanidine (MIBG) scintigrams. Results: Patients were categorized as responders (n = 19) and nonresponders (n = 8) according to echocardiographic findings. In responders, the mean heart‐to‐mediastinum (H/M) ratio at the delayed phase in cardiac ¹²³I‐MIBG scintigraphic findings was significantly increased (P < 0.05) and serum levels of hs‐CRP were decreased (P <0.01). Such improvements were not observed in nonresponders. Stepwise multiple regression analysis showed that the reduction in hs‐CRP level was independently associated with the increase in the H/M ratio at delayed phase. Conclusions: Our results demonstrated that cardiac sympathetic nervous dysfunction and systemic inflammation were improved in responder HF patients to CRT. Furthermore, the reduction in systemic inflammation was associated with the improvement in cardiac sympathetic nervous dysfunction. (PACE 2011; 34:1225–1230)     

Optimal cardiac pacing after heart transplantation

The transplanted heart is characterized physiologically by autonomic denervation, chronotropic incompetence, intermittent episodes of allograft rejection, and frequently by diastolic dysfunction. Sinus node dysfunction resulting in bradycardia is common in the early postoperative period following standard orthotopic cardiac transplantation. Bradycardia tends to remit spontaneously but there are no factors that accurately identify patients who will need long-term pacing. Patients in whom bradycardia persists beyond the second postoperative week despite treatment with theophylline require permanent pacemaker implantation. It has been observed that chronotropic incompetence and diastolic dysfunction are important determinants of exercise capacity following heart transplantation. Pacing that restores chronotropic competence improves exercise capacity, confirming the importance of impaired heart rate response. As in other settings, pacing that preserves atrioventricular (AV) synchrony results in increased cardiac output. For these reasons when pacing is necessary we recommend the DDDR mode (AAIR if intact AV nodal conduction is present) so that the 30%-50% of patients who remain pacemaker-dependent long-term obtain maximal benefit from their transplant.     

Pathological aspects of transcutaneous cardiac pacing

Although electrical energy has the potential to produce myocardial injury, the risk of tissue damage from transcutaneous cardiac pacing is largely unknown. This study reports the anatomical findings of a canine transcutaneous stimulation study. Ten dogs had 100-mA, 20-msec (pulse duration), transcutaneous impulses delivered across the thorax for 30 minutes at a rate of 80 stimuli per minute. Seventy-two hours later the animals were sacrificed, and the heart, lungs, and tissues of the chest wall were examined for pathological changes. Gross and microscopic lesions consistent with electrically induced myocardial damage were found in all hearts examined. These lesions included myocardial pallor and focal myofibril coagulation necrosis in the right ventricular outflow tract and perivascular microinfarcts in the posterior left ventricular myocardium. These lesions were not extensive; less than 5% of the right ventricular free wall and less than 1% of the left ventricular posterior wall were involved. Lesions of this extent would not be expected to cause clinically detectable changes in cardiovascular status. Short-term use of transcutaneous pacing appears to be safe. Determination of the potential for clinically significant injury with long-term use requires further study.     

Electrocardiographic patterns during: pacing the great cardiac and middle cardiac veins

BACKGROUND: The electrocardiogram (ECG) patterns during pacing from the great cardiac vein (GCV) and the middle cardiac vein (MCV) are not well known. METHODS: We recorded 12-lead ECGs during GCV and MCV pacing in 26 patients undergoing implantation of a cardiac resynchronization device. The left ventricular (LV) lead was passed down the GCV (n = 19) or MCV (n = 7) prior to moving it to a lateral or posterolateral vein for permanent implantation. RESULTS AND CONCLUSIONS: Pacing within the GCV resulted in a left bundle branch block (LBBB) morphology with no or minimal R-wave in V(1) in 14 patients and a right bundle branch block (RBBB) pattern (R > S in lead V(1)) in four patients. In one patient, lead V1 during GCV pacing was isoelectric (R = S). A more distal pacing site in the GCV yielded a LBBB pattern in all the patients. All leads placed in the MCV resulted in a LBBB configuration. An ECG pattern with a RBBB pattern was invariably recorded during LV pacing in 125 consecutive outpatients with biventricular pacemakers and LV leads in the posterolatral and lateral coronary veins. Knowledge of the ECG patterns from various pacing sites in the coronary venous system may be helpful for troubleshooting all types of pacing systems, especially those where the coronary venous pacing site is unintentional.     

床旁球囊漂浮电极起搏在心脏术后缓慢性心律失常中应用

目的评估心脏外科术后缓慢性心律失常行床旁球囊漂浮电极导管紧急心脏起搏的可行性和有效性。方法心脏外科术后并发缓慢性心律失常患者21例,均给予漂浮电极导管临时起搏治疗,观察临时起搏手术入路、手术时间、电极导管放置部位及起搏阈值,评估治疗成功率和安全性。结果本组起搏器电极安置经右侧锁骨下静脉15例,经右侧颈内静脉6例;手术时间5-12min;电极导管置入右心室心尖部18例,右心室流出道3例;起搏阈值〈1.0mV;床旁球囊漂浮电极起搏治疗成功率100%,发生导管移位、感知起搏不良各2例,无严重并发症发生。结论床旁球囊漂浮电极起搏操作简单,用于治疗心脏术后缓慢性心律失常安全、可行,疗效确切。     

常用心肌标志物在儿童疾病中的应用进展

常见心肌标志物多用于成人急性冠脉综合征和心力衰竭的临床诊疗，而在儿童疾病中的相关研究较少。由于儿童心肌功能尚未成熟，以及不同生长发育阶段的特殊性，儿童心肌损伤的发病机制和病理生理过程与成人不尽相同。因此，心肌标志物的检测和结果解读在儿科领域中显得尤为重要。该文围绕临床常用心肌标志物在儿童心源性和非心源性心肌损伤疾病中的应用进展进行综述。     

胸外心脏按压是否需要改进

通过对5例难以成活的患者,以两组人员进行胸外心脏按压(ECM),又以不同频率按压,比较其对循环支持的效果。初步认为:在正规熟练的胸外按压基础上,提高按压频率,心排量可高于开胸心脏按摩(OCCM),与直接心室机械激动(DMVA)的结果相似。肯定了胸外心脏按压的普及、简便、大范围使用的优点,目前仍视为临床复苏的主要方法,并提出了对标准心肺复苏的改进见解。     

探讨心脏电生理昼夜变异性与缺血性心脏病的关系

[目的]探讨心脏电生理改变,即Q -T间期变异昼夜规律及心率变异性与缺血性心脏病的关系。[方法]观察5 5例缺血性心脏病病人(观察组)和5 0例正常成人(对照组)的2 4h心脏电生理改变,监测0 6:0 1～2 2 :0 0和2 2 :0 1～0 6:0 0时段的动态心电图中Q -T间期、Q -T间期变异、Q -T/HR斜率的变化及昼夜规律。[结果]两组心率、Q -T间期、Q -T间期变异、Q -T/HR斜率均呈明显的昼夜规律,两组比较昼夜心率、Q -T间期无统计学意义(P >0 .0 5 ) ;但Q -T间期变异、Q -T/HR斜率有统计学意义(P <0 .0 5 )。[结论]Q -T间期变异、Q -T/HR斜率能反映心室水平的自主神经调节及心室肌本身的状态,对预测室性心律失常及猝死的发生具有重要的价值和临床意义。     

Mechanism exploration on effects of cardiac sympathetic anesthesia on cardiac performance of dilated cardiomyopathy

Idiopathic dilated cardiomyopathy（IDC）is a primary myocar－dial disease of unknown cause characterized by cardiac dilatation and impaired myocardial contractil ity．There is increasing incidence of IDC in recent years．Although modern medical technology has developed a lot,IDC' s mortality is still high,which is ab out ２５percent at one year and approximately ５０percent at five years．Therefore,it presents great challe nges in this field ．We just give a report of our five －year st…     

Unusual echocardiographic appearance of a cardiac metastasis from lung carcinoma

During hospitalization in the Oncology Department, a woman with nonsmall cell lung cancer and no previous cardiac event complained of episodes of chest pain and palpitations. Preliminary instrumental examinations diagnosed atrial fibrillation in pericarditis. A subsequent complete transthoracic echocardiogram showed the presence of a large mass involving the left ventricular apex, without echo‐contrast enhancement. A thoracic CT with iodized contrast agent revealed its necrotic composition and was concluded as cardiac metastasis. This is an unusual case of a malignant neoplasm showing no contrast enhancement at echocardiogram because of its necrotic composition, mimicking a thrombus. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44 :392–394, 2016