8—12单纯性肥胖儿童心功能研究

利用多导生理仪，同步记录心电图、心音图、颈动脉搏动图和心阻抗微分图，测试８￣１２岁肥胖儿童９４名，对照组儿童７６名，分析比较有关心功能数据。结果显示肥胖儿童收缩压、舒张压、平均动脉压、左室射血时间和心搏出量高于对照组儿童，心输出量与对照组比较差异无显著性，心功能指数低于对照组儿童。提示肥胖儿童由于回心血量增加，血压增高，而使心脏前、后负荷加重，心肌收缩力代偿性增强，单位体表面积心输出量下降，部分心     

肥胖对儿童健康的影响

世界卫生组织警告,人类肥胖趋势已成为灾难,肥胖症正以每5年增加一倍的趋势发展。据报道,国外儿童肥胖率高达5％～25％[1,2];国内在1．64％～3．92％,有的高3％～7％。本文就近年来有关这方面的资料扼要综述如下。1肥胖对儿童心血管系统的影响1．1对儿童心功能的影响邸敏等[3]用多导生理仪测定了北京地区98名肥胖儿童的心电图、心音图、颈动脉搏动图和心阻抗微分图。结果肥胖儿童的收缩压、舒张压、平均动脉压、在室时血时间和心搏出量高于对照组,心功能指数低于对照组。上海的卞金陵等［‘」用踏车式心功量机对肥胖儿童进行路车运动…     

高温环境下负重行军对士兵心功能的影响及适宜负重的研究

观察了８名男青年士兵在干球温度（ＤＢ）３５℃和湿球温度（ＷＢ）２９℃的高温环境下负重行军时的心率、心肌耗氧指数和心输出量的变化特点。结果表明，行军速度４．５、５．０和６．０ｋｍ／ｈ各组的心率、心肌耗氧指数和心输出量的每小时增加值均随负荷重量的增加呈非线性增加。在劳动中心率保持相对稳定状态以及心率、心肌耗氧指数和心输出量每小时增加值与负荷量非线性相关“转折点”相应的负荷量分别为体重的３２％、２３％、和１４％左右。结果提示，当负荷量的增加超过某一数值时，劳动者的心功能紧张程度明显增加，单兵的携行重量以不超过生理反应的非线性“转折点”的负荷量为宜     

用心阻抗图评价单纯性肥胖学生心功能状态

近年来有的作者应用不同的检测方法,对单纽性肥胖儿童的心功能状态进行了评价。不同的检测方法。得出不同的参数,都证明了单纯性肥胖对儿童的心血管系统有一定的危害l‘”l。心阻抗图在成人冠心病的诊断中应用较多,并被认为是一种敏感性较好的定创性评价心功能曲线的方法。湖南医科大学及上海市第～人民医院,对正常儿童心阻抗图做了大量的研究t’l。1995年10～12丹,我们对上海市普陀区某小学四、五年级单纯性肥胖学生用心阻抗血流图仪测定他们的心功能状态,旨在进～步探讨单纯性肥胖对学生心脏功能的影响。l对象及方法1．l对导普陀【…     

超声心排出量监测仪在婴幼儿肺炎左心功能及血流动力学评估中的应用

目的：观察婴幼儿肺炎左心功能和血流动力学评估中超声心排出量检测仪的应用价值。方法：选取2021年5月～2022年5月本院收治的35例肺炎婴幼儿作为观察组,选取同期接受健康体检的婴幼儿作为对照组,对其均实施超声心排出量监测仪监测,对两组左心功能、血流动力学情况进行对比。结果：对照组心率、射血分数低于观察组（P<0.05）,对照组每搏输出量、每搏输出量指数和心输出量、心脏指数高于观察组（P<0.05）;对照组速度峰值、速度时间积分、流动时间高于观察组（P<0.05）,对照组外周阻力、血管阻力指数低于观察组（P<0.05）。结论：在婴幼儿肺炎左心功能和血流动力学评估中超声心排出量检测仪,能够科学的评估婴幼儿的左心功能,为后续的临床疾病诊治提供有效依据,临床应用价值显著。     

空间-时间相关成像技术 虚拟器官计算机辅助分析联合3D超声评估孕前糖尿病孕妇胎儿心功能和心腔容积的价值

目的 探讨空间-时间相关成像技术(STIC)、虚拟器官计算机辅助分析(VOCAL)联合3D超声评估孕前糖尿病孕妇胎儿心功能和心腔容积的价值。方法 纳入2019年1月1日—2021年8月16日丽水市人民医院86例孕前糖尿病孕妇和86例具可比性的健康孕妇进行研究，通过STIC、VOCAL联合3D超声对胎儿心功能和心腔容积进行评估，比较两组患者各参数差异。结果 观察组糖化血红蛋白水平为(8.16±1.93)%。观察组初次妊娠年龄为(29.44±2.71)岁，显著高于对照组的(27.63±3.54)岁，差异有统计学意义(t=-3.782,P<0.05)。两组年龄、分娩次数、孕周、体质量、胎儿体质量、胎心率比较，差异均无统计学意义(均P>0.05)。观察组胎儿左心房容积为(0.63±0.08)ml,明显低于对照组的(0.67±0.09)ml,差异有统计学意义(P<0.05)。两组胎儿右心房容积、左心室舒张容积、左心室收缩容积、右心室舒张容积、右心室收缩容积、左心室射血分数、右心室射血分数、左心室心输出量、右心室心输出量、总心输出量比较，差异均无统计学意义(均P>0.05)。母亲糖化血红蛋白水平与胎儿心功能参数均缺乏线性相关关系(均P>0.05)。结论 两组胎儿左心房容积有显著差异，可能与左心房功能障碍和/或左心房顺应性有关，反映了心脏功能障碍的早期阶段，STIC、VOCAL联合3D超声评估胎儿心功能障碍高危人群有良好的应用价值。     

减肥对心功能的影响

已知肥胖是心脏病的一种促发因素。伴随肥胖发生的血液动力学变化是多种心功能失调的原因。随着体重增加，血容量和心输出量也随之增加。这便引起血压升高和迫使心脏做更多的功。随着心脏负担加重，心脏开始肥大，最终有可能发生心力衰竭。尽管已知减肥可改善某些引起心力...     

高温对作业工人心血管系统功能的影响

目的从心功能和血流变方面探讨高温对心血管系统的影响。方法对200名高温作业工人心功能以及血液流变学指标进行测定。结果与对照组比较,高温作业工人心脏的每搏输出量、心输出量、心脏指数减少,总外周阻力明显增高(P<0.05);全血比黏度的高切变、低切变、血浆比黏度、血沉、红细胞压积两组之间差异有显著性(P<0.05)。结论高温作业对机体心血管系统有不良影响。     

缬沙坦治疗慢性心力衰竭120例临床观察

目的通过缬沙坦治疗慢性心力衰竭的观察,探讨缬沙坦的疗效与安全性。方法选择冠心病、扩张型心肌病、高血压性心脏病、风湿性心脏病所导致的慢性心力衰竭患者120例,对照组常规治疗,即休息、限盐,使用利尿剂、毛地黄类药物、硝酸酯类药物,观察组在对照组基础上加用血管紧张素受体拮抗剂缬沙坦口服,观察治疗前后的心功能改善情况以及心率、血压、每搏心输出量、每分钟心输出量的改变,评估有效性及安全性。结果治疗3个月后观察组心功能改善及心率、血压控制及每搏心输出量、每分钟心输出量均明显改善,差异具有统计学意义(P0.05)。结论观察组在对照组基础上加用缬沙坦治疗慢性心力衰竭有显著提高疗效。可改善心功能及临床症状,提高患者生活质量。     

超声心输出量监测技术在脓毒症患者诊疗中的应用

目的探讨超声心输出量监测技术(USCOM)在脓毒症患者诊疗中的应用。方法回顾性分析医院内科ICU 2017年1月至2018年6月收治的脓毒症患者42例,随机分为试验组和对照组,各21例。试验组采用USCOM监测,对照组采用脉搏波形指示的连续心输出量(Pi CCO)监测。比较两组心功能各项指标。结果试验组的心输出量检测各指标与对照组相比,差异具有统计学意义(P <0. 05);且试验组的心输出量(CO)、心脏指数(CI)、单次心搏输出量(SV)均明显低于对照组,差异有统计学意义(P <0. 05)。结论 USCOM应用于脓毒症患者的诊疗中,具有快速、安全、准确、无创的优势,可有效评估患者的病情及疗效。     

Early cardiovascular changes in 10- to 15-year-old stunted children: the Transition and Health during Urbanization in South Africa in Children study

OBJECTIVE: Early changes in vascular function could be associated with stunting, which may contribute to the development of cardiovascular diseases in later life. In this study we tested the hypothesis that stunting may be related to changes in cardiovascular function in African children ages 10 to 15 y. METHODS: In the Transition and Health during Urbanization in South Africa in Children study, the health status of children in the North-West Province of South Africa was studied. It was an epidemiologic, cross-sectional study in which 583 black non-stunted and 192 stunted children (stature below the fifth percentile for age) of both sexes ages 10 to 15 y were recruited from 44 schools. Blood pressure was monitored with the Finapres (finger-arterial pressure) apparatus and by means of the Fast Modelflo software program; measurements for systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, heart rate, cardiac output, stroke volume, total peripheral resistance, and arterial compliance were obtained. Dietary intake data were collected with a 24-h dietary recall questionnaire. Nutrient coding was the same for all recalls and macro- and micronutrients were calculated. Anthropometric measurements were done according to standard methods. RESULTS: There were no significant differences in systolic blood pressure and diastolic blood pressure between stunted and non-stunted children after correction for body mass index and heart rate. Stroke volume, arterial compliance, and cardiac output were significantly lower and total peripheral resistance was significantly higher in stunted children than in non-stunted children. No significant differences in dietary intake could be detected, although dietary intakes were slightly lower in the stunted children. CONCLUSIONS: We found that compliance, a marker of vascular function, is significantly lower in stunted children. Stunting was related to early changes in cardiovascular function in African children ages 10 to 15 y.     

儿童单纯性肥胖症对循环系统损害的研究

【目的】探讨小儿单纯性肥胖症对循环系统的早期损害，为防治小儿单纯性肥胖症提供科学依据。【方法】对肥胖组(73例)及正常对照组(23例)儿童进行血脂、血压及左心结构和功能测定。【结果】肥胖儿童总胆固醇、甘油三酯、低密度脂蛋白C及载脂蛋白B明显升高，高密度脂蛋白C与载脂蛋白A明显降低；肥胖儿童收缩压和舒张压高于健康儿童；肥胖儿童左室舒张末期内径、室间隔舒张末期厚度、左室后壁舒张末期厚度及舒张晚期的A峰峰值速度增加，左室射血分数、二尖瓣口舒张早期的E峰峰值速度及E／A值下降；且随着肥胖度的增加，以上各指标的改变更加明显。体重及脂质代谢紊乱是影响心脏结构和功能的主要因素。【结论】加强肥胖儿童的早期干预将对增进儿童健康、降低成人心血管疾病的发病率和死亡率、提高生命质量起到重要作用。     

Obesity and hypertension. Hemodynamic aspects.

Elevated arterial pressure in patients with obesity-hypertension is associated with an increased cardiac output and total peripheral resistance. The elevated output is related to expanded intravascular volume that increases cardiopulmonary volume, venous return, and left ventricular preload; the elevated pressure and total peripheral resistance increase afterload. This dual ventricular overload promotes a dimorphic, concentric, and eccentric hypertrophy in response to the volume and pressure overload. Increased myocardial oxygen demand results from the elevated tension in the left ventricular wall, reflecting its increased diameter and pressure, and provides physiologic rationale for the greater potential of coronary arterial insufficiency and cardiac failure. There are greater renal blood flow and lower renal vascular resistance in patients with obesity-hypertension at any level of arterial pressure. This may be offset by an increased renal filtration fraction that may favor protein deposition and glomerulosclerosis, and predisposition of obese patients for diabetes may aggravate this problem. With weight reduction, these hemodynamic derangements may be reversed: intravascular volume contracts, cardiac output decreases, and arterial pressure falls.     

单纯性肥胖儿童血压,EDLF,血脂的改变及相关因素问卷调查

目的 探讨单纯性肥胖儿童血压变化及影响因素。 方法 检测４０例肥胖儿及４０例正常儿血压、内源性洋地黄样因子（ＥＤＬＦ）及血脂并调查相关因素。 结果 肥胖儿血压显著升高，肥胖合并高血压的发生率为１２．５％。ＥＤＬＦ在重度肥胖儿及血压偏高儿均显著高于对照组儿童（Ｐ〈０．０５）。肥胖儿甘油三酯升高，高密度脂蛋白胆固醇降低。肥胖儿ＢＭＩ与母亲ＢＭＩ正相关。肥胖儿６０％喜油炸食品，６０％有被动吸烟。 结论     

CARDIAC FUNCTION AFTER ALCOHOL INGESTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AND CARDIOMYOPATHY: A CONTROLLED STUDY

Thirty male patients with ischemic heart disease and cardiomyopathyentered a controlled study of the acute effects of alcohol oncardiac function evaluated by right heart catheterization. Twentypatients, nine with angina pectoris and 11 with congestive heartfailure, were studied during alcohol intoxication, and ten patients,five with angina pectoris and five with heart failure, servedas a control group. The mean serum ethanol concentration inthe alcohol group was 93 mg/100 ml (S.D. 17). The systemic arterialblood pressure was reduced by 6% in the alcohol group, P<0.05compared with the control group. No significant changes occurredin the central venous pressure, the pulmonary artery pressure,the pulmonary capillary wedge pressure, or in cardiac output,stroke volume and total peripheral resistance. Alcohol intakein moderate doses has no measurable effect on pulmonary bloodpressures or cardiac output in patients with ischemic heartdisease and cardiomyopathy. Such an effect may, however, bemasked by a reduction of afterload.     

Effect of acute alcohol intake on certain cardiovascular functions in healthy young males

.15, 0.25 and 0.5 g/kg alcohol in the form of 40% brandy in one week intervals was consumed by eight healthy, regularly trained young men volunteers. Blood alcohol level, blood pressure and ECG were registered before and 30, 60 and 90 min after, each alcohol consumption. The cardiac output was measured with a radiocirculographic method before and 45 min after alcohol consumption. The cardiac index, stroke volume, stroke index, and total peripheral resistance (TPR) were calculated. With increase of the alcohol dose the blood alcohol level increased, while cardiac output, cardiac index, stroke volume, stroke index, and the systolic blood pressure fell. The other parameters examined--heart rate, diastolic blood pressure, TPR among others--remained unchanged. The ECG was normal. The highest no effect alcohol dose was less than 0.15 g/kg (0.1, k/kg). It is concluded that, depending on the dose, alcohol has practically no effect on the majority of the heart-functions, however, in the range of 0.1 to 0.5 g/kg it has a depressive influence, i.e. lowers the pump-function of the heart and, at 0.5 g/kg the arterial blood pressure.     

张家口市卫华小学7~12岁儿童肥胖与血压及肺活量的相关分析

目的 了解张家口市卫华小学7~12岁儿童肥胖发生情况,分析儿童期肥胖与血压及肺活量的关系。 方法 于2012年9月通过整群抽样的方法,对张家口市卫华小学1 530名儿童进行体重、身高、血压、肺活量等相关指标进行测量。计算体质指数(body mass index,BMI),依据BMI值筛查超重、肥胖儿童,统计分析肥胖与血压水平及肺活量的关系。结果 受检人群总体超重检出率为13.01%,肥胖检出率为14.25%,其中男童、女童超重检出率分别为17.2%和8.31%,男童、女童肥胖检出率分别为14.23%和8.59%,男童超重、肥胖检出率均显著高于女童(P<0.01);超重和肥胖儿童的收缩压和舒张压水平均显著高于体重正常儿童(P<0.01),且超重、肥胖和体重正常儿童高血压检出率分别为10.55%、39.95%和4.85%,差异有统计学意义(P<0.01);当儿童BMI<30时,BMI与肺活量呈正相关,当BMI≥30时,BMI与肺活量呈负相关。 结论张家口市卫华小学儿童超重、肥胖流行趋势显著,男童更为突出;随着肥胖程度的增加,儿童的收缩压和舒张压水平呈现上升趋势,高血压检出率增加;当儿童BMI≥30时,肥胖已影响肺功能。提示儿童超重、肥胖使心、肺功能降低,预防和控制儿童肥胖刻不容缓。     

A circulation model for teaching fluid dynamics in laboratory courses in physiology

Medical students in Germany do not usually have a strong enough basis in physics to understand the mechanical and fluid dynamic problems involved in the physiology of the circulation. To alleviate this situation we developed a circulation model for use in laboratory courses in physiology. The following parameters can be varied: stroke volume, heart rate, systemic filling pressure, compliance of the arterial system (Windkessel), and total peripheral resistance. Arterial and venous pressure are recorded as a function of time. The following points are worked out by the students by adjusting the parameters of the model and by calculation: static equilibrium, transient and steady state in flow, compliance of the arterial and venous system, arteriovenous pressure difference, cardiac output, total peripheral resistance, regulation of cardiac output, pulse pressure amplitude, volume stored periodically in the arterial Windkessel, diastolic pressure decay of arterial pressure, diagnosis of arterial hypertension at different Windkessel compliances.     

肥胖儿童生理状况及健康干预研究

目的了解肥胖对儿童生理功能的危害,为建立有效而又易于接受的健康教育及健康促进模式提供科学依据.方法随机抽取贵阳市3所(好、中、差各1所)学校肥胖儿童106名与相应对照组进行生理指标检测,并对这些肥胖儿童中90人进行为期1 a的健康干预.结果肥胖组血压、皮褶厚度、50 m跑时间高于对照组,肺活量指数低于对照组;三酰甘油、胆固醇、血尿酸值高于对照组;脂肪及总能量摄入高于对照组.通过健康干预体重、收缩压、三酰甘油、血尿酸等多项指标降低,饮食行为中总能量及脂肪摄入减少,且运动形式转变,运动量增加.结论儿童单纯性肥胖症对儿童身体的损害累及心血管系统、呼吸系统、生殖系统等多个系统,但通过采用科学的健康干预手段,各项指标值能有所改善.     

Assessment of cardiac autonomic modulation during adolescent obesity

OBJECTIVE: To investigate the cardiovascular autonomic function in pediatric obesity of different duration by using standard time domain, spectral heart rate variability (HRV), and nonlinear methods. RESEARCH METHODS AND PROCEDURES: Fifty obese children (13.9 +/- 1.7 years) were compared with 12 lean subjects (12.9 +/- 1.6 years). Obese children were classified as recent obese (ROB) (<4 years), intermediate obese (IOB) (4 to 7 years), and long-term obese (OB) (>7 years). In all participants, we performed blood pressure (BP) measurements, laboratory tests, and 24-hour electrocardiogram/ambulatory BP monitoring. The spectral power was quantified in total power, very low-frequency (LF) power, high-frequency (HF) power, and LF to HF ratio. Total, long-term, and short-term time domain HRV were calculated. Poincaré plot and quadrant methods were used as nonlinear techniques. RESULTS: All obese groups had higher casual and ambulatory BP and higher glucose, homeostasis model assessment, and triglyceride levels. All parameters reflecting parasympathetic tone (HF band, root mean square successive difference, proportion of successive normal-to-normal intervals, and scatterplot width) were significantly and persistently reduced in all obese groups in comparison with lean controls. LF normalized units, LF/HF, and cardiac acceleration (reflecting sympathetic activation) were significantly increased in the ROB group. In IOB and OB groups, LF, but not nonlinear, measures were similar to lean controls, suggesting biphasic behavior of sympathetic tone, whereas nonlinear analysis showed a decreasing trend with the duration of obesity. Long-term HRV measures were significantly reduced in ROB and IOB. DISCUSSION: Autonomic nervous system changes in adolescent obesity seem to be related to its duration. Nonlinear methods of scatterplot and quadrant analysis permit assessment of autonomic balance, despite measuring different aspects of HRV.