冠心病经皮冠状动脉成形术前后QT离散度的对比研究

目的 评价ＰＴＣＡ对冠心病电稳定性的影响,并比较不同冠脉病变支数和不同冠心地ＱＴ离散度（ＱＴｄ）的影响。方法 对７８例冠心病经皮冠皮状动脉成形术（ＰＴＣＡ）前后ＱＴ离散度的对比研究。结果 急性心肌梗塞（ＡＭＩ）组ＱＴｃｄ与稳定型心绞痛（ＳＡＰ）组相比有显性差异（Ｐ〈０．０５）;不同支数冠脉病变ＱＴｃｄ相比均无显性差异（Ｐ〉０．０５）;冠心病经ＰＴＣＡ后ＱＴｃｄ明显减少,与ＰＴＣＡ前相比差异有极     

急诊经皮冠状动脉腔内成形术患者心电图变化特征及临床意义

目的：观察急性心肌梗死（ＡＭＩ）患者接受急诊经皮冠状动脉腔内成形术（ＰＴＣＡ）前后的心电图变化特征，并探讨其可能机制及临床意义。方法：９例ＰＴＣＡ患者术前及术后即刻至３小时内，每半小时测１次１８导联心电图。结果：①４例下壁ＡＭＩ患者梗死相关动脉（ＩＲＡ）再通后，其合并的胸前导联ＳＴ段压低于术后２小时内均回到等电位线，提示这种胸前导联的ＳＴ段压低是梗死范围广泛的标志，而非既往认为的“对应性”改变；②成功的急诊ＰＴＣＡ术后１小时有６例患者出现终末Ｔ波倒置，且其残留血管狭窄明显小于未出现终末Ｔ波倒置者（Ｐ＜０．０５）；③７例患者术后未出现ｑ波，其中３例术后３小时原Ｒ波幅值增高０．１０ｍＶ～０．２０ｍＶ。结论：成功的急诊ＰＴＣＡ后可出现与ＩＲＡ再通相关的特征性心电图变化，下壁梗死合并胸前导联ＳＴ段压低提示更广泛的心肌缺血；早期终末Ｔ波倒置和Ｒ波波幅回升均提示成功的血管再通和存活心肌数量的增加。     

经皮冠状动脉腔内成形术对心绞痛和心肌梗塞QT离散度的影响及其临床意义

目的：探讨经皮冠状动脉内成形术（ＰＴＣＡ）对心绞痛和心肌梗塞病人ＱＴ离散度（ＱＴｄ）的影响及其意义。方法：分析８４例心绞痛和心肌梗塞患者ＰＴＣＡ术前、术后一天内所记录的心电图,测算ＱＴ间期、ＱＴ离散度、心率校正ＱＴ离散度（ＱＴｃｄ）。病例分为三组：心绞痛ＰＴＣＡ成功组、心肌梗塞ＰＴＣＡ成功组、心肌梗塞ＰＴＣＡ失败组。分别对三组ＱＴｄ、ＱＴｃｄ作术前、术后比较。结果：前二组术后ＱＴｄ、ＱＴｃｄ较术前显著减少（Ｐ＜０．０１）,失败组术前、术后ＱＴｄ及ＱＴｃｄ差异无显著性（Ｐ＞０．０５）。结论：成功的ＰＴＣＡ能显著减少心绞痛和心肌梗塞患者的ＱＴｄ,提示可能减少心律失常的发生率,从而减少心肌缺血患者的死亡率,可以改善患者的预后,术后心肌梗塞患者ＱＴｄ减少可能反映了顿抑或冬眠心肌的“苏醒“,并表明梗塞区内尚有存活心肌。     

急性心肌梗死直接PTCA后心电图变化与临床预后的关系

目的 探讨直接经皮冠状动脉腔内球囊成形术（ＰＴＣＡ）治疗急性心肌梗死（ＡＭＩ）后心电图抬高的ＳＴ段的变化与临床预后的关系。方法 １０８例成功行直接ＰＴＣＡ的ＡＭＩ患者,分析术后１ｈ１２导联心电图抬高的ＳＴ段下移幅度,分为四组：Ａ组：抬高ＳＴ段下移１００％;Ｂ组：抬高ＳＴ段下移５０％～１００％;Ｃ组：抬高ＳＴ段下移０～５０％;Ｄ组：ＳＴ段无下移。结果 四组梗死相关血管（ＩＲＡ）开通时间相似,Ａ组患者     

紫外线照射弃氧自血回输对心肌梗塞患者QT离散度等的影响

目的 探讨有效地治疗急性心肌梗塞（ＡＭＩ）的方法。方法 ＡＭＩ患者５４例,随机 紫外线照射充氧自血回输治疗（ＵＢＩＯ）组及常规治疗组各２７例。ＵＢＩＯ组在常规治疗的基础上每日１次采静脉血２００ｍｌ,经紫外线照射度充氧后回输,６ｄ为１疗程,治疗前后分别测定心电图校正的ＱＴ离散度（ＱＴｃｄ）及血浆肿瘤坏死因子（ＴＮＦα）和内皮素（ＥＴ）含量。结果 ＡＭＩ患者ＱＴｃｄ、ＴＮＦα及ＥＴ均较正常组显著增高（Ｐ〈０．０１）。经ＵＢＩＯ治疗后明显下降（Ｐ〈０．０１）。常规治疗组治疗后ＱＴｃｄ下降（Ｐ〈０．０１）,但下降幅度低于ＵＢＩＯ组（Ｐ〈０．０１）。结论 ＡＭＩ患者配合ＵＢＩＯ治疗可取得更佳效果。     

电视辅助胸腔镜手术对外周血HCT,WBC的影响

１９９６年１月～１９９９年１１月,经检测１５例胸腔镜手术病人及１５例常规开胸手术病人术前１天、术后第１天、术后第５天肘静脉血ＨＣＴ值以及ＷＢＣ计数并作统计学分析。结果胸腔镜组手术前后ＨＣＴ值相比无显著性差异（Ｐ〉０．０５）。常规开胸组术后第１天ＨＣＴ值低于胸腔镜组（Ｐ〈０．０５）,ＷＢＣ计数高于胸腔组（Ｐ〈０．０１）,胸腔镜组ＷＢＣ计数术后第１天高于术前第１天（Ｐ〈０．０５）,术后第５天与术前１天相比无显著性差异（Ｐ〉０．０５）。常规开胸组ＷＢＣ计数术后第１天高于术前１天及术后第５天（Ｐ〈０．０１）,术后第５天仍高于术前水平（Ｐ〈０．０５）。结果表明：ＶＡＴＳ手术与常规开胸手术相比,出血量较少,对机体创伤较小。     

医院对社区冠心病患者的临床行为医学干预研究

目的：探索冠心病区临床心理行为医学干预方法和效果。方法：运用具有中国特色的一体化干预方案。对冠心病患者进行全科式社区干预,对２１６例冠心病进行了随机分组对照观察。结果 住院人次数,心绞痛发作显著减少（Ｐ〈０．０１）,心律失常明显减少（Ｐ〈０．０５）;ＥＣＧ的ＳＴ－Ｔ段显著改善（Ｐ〈０．０１）,Ａ型行为显著改善（Ｐ〈０．０１）血清胆固醇,甘油三酯降低（Ｐ〈０．０１）,高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）     

恒磁场对家兔急性实验性心肌缺血的影响

目的 观察恒磁场对垂体后叶素致家兔急性心肌缺血的影响。方法 家兔３０只,采用静脉注射重体后叶素（２Ｕ／ｋｇ）造成急性心肌缺血的动物模型,以交叉对照方法将动物分为对照组及恒磁场处理组,观察并让其心电图ＳＴ－Ｔ变化。结果 两组心电图ＳＴ－Ｔ变化的潜伏期无明显差异（Ｐ〉０．０５）。但恒磁场处理组ＳＴ段升高幅度、Ｔ波振幅及Ｔ变化的潜伏期无明显差异（Ｐ〉０．０５）,但恒磁场处理组的ＳＴ段升高幅度、Ｔ 振幅及     

肝素对尿激酶静脉溶栓的强化作用

１７０例急性心肌梗塞患者中，尿激酶应用前给予小剂量肝素（强化溶栓组）９２例与对照组（尿激酶应用前未用肝素）７８例相比，早期冠脉再通率明显提高（６９．５％和４６．２％，Ｐ〈０．０５），心电图ＳＴ段回落及Ｔ波反转明显加快，Ｐ〈０．０５，两组出血并发症相似。     

体外反搏治疗冠心病的心电图分析

应用体外反搏（ＥＣＰ）治疗冠心病３４例，进行反搏前后的常规１２个导联心电图的记录分析。反搏前后改变的有ＰＴＦＶ＿１、Ｒ波振幅、ＳＴ段、Ｔ波和Ｑ－Ｔ间期，有效率分别为７２％，５２％，９３．５％，６４．７％，３５．３％。因此，以心电图衡量体外反搏的效果，除大家公认的ＳＴ－Ｔ外，还应注意ＰＴＦＶ＿１，Ｑ－Ｔ间期及Ｒ波振幅。     

Coronary Occlusion and Coronary Insufficiency

Acute coronary attacks may be divided clinically, electrocardiographically, pathologically and therapeutically into (i) classical angina pectoris, (2) acute coronary insufficiency and (3) acute coronary occlusion. In 1000 consecutive cardiac consultations, 450 of 618 cases with organic heart disease had coronary artery disease. Of these 450 cases, 38 per cent had chronic coronary insufficiency (angina pectoris or congestive failure), 26 per cent had acute coronary insufficiency, and 36 per cent had acute coronary occlusion. The differentiation between coronary occlusion and insufficiency which can be made electrocardiographically in 95 per cent of cases is discussed in this paper.     

经皮冠状动脉腔内成形术与旋磨术治疗冠心病

本文报告我院1992年7月至1994年11月间采用经皮冠状动脉腔内成形术治疗13例冠心病,对18支血管18处病变进行扩张,狭窄度由78±11％降至17±11％;采用经皮冠状动脉腔内斑块旋磨治疗6例冠心病,对13支血管17处斑块进行旋磨,狭窄度由86±9％降至14±6％。PTCA和PTCRA是治疗冠状动脉粥样硬化安全而有效的方法。     

Automated Interpretation and Reporting of Coronary CT Coronary Angiography

Coronary CT angiography (CTA) has become a well-accepted imaging modality in the evaluation of coronary artery disease (CAD) due to its high negative predictive value. The ability to exclude CAD in patients presenting with chest pain in a low to intermediate risk population makes it very useful in emergency departments for optimizing resource utilization and reducing expenditure. The limited availability of trained cardiac imagers is a potential obstacle in implementing this strategy. Towards the goal of prompt and accurate interpretation of coronary CTA, there has been a recent interest in the development of automated coronary CTA interpretation and reporting. This article aims to review the current applications and scientific evidence on the utility of automated techniques for interpretation and reporting of coronary CTA.     

Sugar and Coronary Thrombosis

Extensive research has failed to establish conclusively that a high intake of fat is the major cause of coronary thrombosis. However, there is no known exception to the generalization that the incidence of coronary thrombosis in populations is proportional to their sugar consumption. This hypothesis deserves research equally as intensive as that done on fat intake and blood cholesterol.     

Automated Coronary Plaque and Stenosis Assessment on Coronary CT Angiography: A Closer Look at Coronary Atherosclerosis

Coronary artery disease remains the leading cause of morbidity and mortality in the United States and worldwide. Morphological changes in coronary vasculature can be detected by computed tomography angiography (CTA). Besides qualitative assessment, there has been an increased utilization of quantitative assessment of plaque and stenosis on CTA. For this purpose highly standardized methods have been developed, which are sufficiently reproducible on high quality datasets on a population level. This type of analysis could be potentially useful for not only follow-up of plaque progression but also for enhancing prediction of obstructive coronary arterial lesions and has been validated against current standards such as intra vascular ultrasound, optical coherence tomography, and near-infrared spectroscopy. Studies have demonstrated that types of plaque visualized on CTA have prognostic implications. However, classification of lesions as mild, moderate, or severe might not be enough to answer the clinical question of whether or not the lesion is causing ischemia. Fractional flow reserve computed tomography (CT) and transluminal attenuation gradient are new methods, which have shown great promise in assessment of severity and functional significance of stenosis. Similarly, CT stress testing for assessment of functional significance has been found to be feasible and studies are ongoing to evaluate the accuracy of CT stress perfusion. The promise of cardiovascular CT is to potentially become a comprehensive modality in patients with suspected CAD, by combining plaque imaging, stenosis detection, and the assessment of myocardial ischemia, to provide first-line evaluation in selected patient population.     

冠状动脉造影对心肌桥的检测及临床意义

目的 探讨冠脉造影中心肌桥的检出率及其临床意义。 方法 根据冠状动脉造影显示冠状动脉管腔收缩期狭窄判定心肌桥，并根据收缩期狭窄程度分为3级。 结果 1447例行冠状动脉造影的患者中共检出心肌桥10例，检出率2．2％，全部位于左前降支。2例在心肌桥近端有粥样硬化病变，管腔固定狭窄达70％以上，置入支架。其他有症状病例经药物治疗，临床症状消失。 结论 冠状动脉造影时收缩期狭窄是判定心肌桥的惟一依据，心肌桥可导致缺血性心脏事件，对有缺血症状者应予适当治疗。     

经食管心脏超声及冠脉造影对冠状动脉的对照研究

采用经食管心脏超声技术在20例成年患者中成功的显示了27条左和/或右冠状动脉.并对其中10例作了同期冠脉造影,结果提示两种方法对冠脉直径测定值近似。结论认为,作为非创伤、非放射线性冠状动脉解剖学诊断措施。经食管心脏超声具有潜在优势。     

超声心动图与冠状静脉窦造影的对比研究

目的 :对冠状静脉窦 (CS)造影与超声心动图检测 CS进行对比研究 ,建立经胸超声心动图(TTE)检测冠状静脉窦的方法学。方法 :对 10例阵发性室上性心动过速患者术前行 TTE检查 ,在变更的心尖四腔心切面分别测量冠状静脉窦口 (CSO)和距窦口 1cm处 (CS1)冠状静脉窦收缩末期、舒张末期内径 ;术中行冠状静脉窦逆行造影 ,测量 CSO和 CS1最大内径。结果 :左前斜位 45°CS造影图像与 TTE变更的心尖四腔心 CS长轴形态相似 ,CS造影测量的 CS内径最大值与 TTE收缩末期 CS内径测值存在高度正相关 (CSO r=0 .92 ,P<0 .0 0 1;CS1r=0 .91,P<0 .0 0 1)。结论 :TTE变更的心尖四腔心切面为测量 CS内径的可靠方法