Tei index对经皮腔内冠脉成形术后左室功能的评价

目的利用Ｔｅｉ ｉｎｄｅｘ评价经皮腔内冠脉成形术（ＰＴＣＡ）对冠心病患者左室功能的影响。方法冠心病患者６０例,分为心绞痛组４０例,心梗组１２例,心衰组８例;正常对照组３０例。观察ＮＹＨＡ心功能分级,测定左室舒张末期内径（ＬＶＤｄ）,左室收缩末期内径（ＬＶＤｓ）,二尖瓣舒张晚、早期血流峰值比值（Ａ／Ｅ）,二尖瓣舒张早期血流Ｅ峰减速时间（ＥＤＴ）,等容舒张期（ＩＲＴ）,左室短轴缩短率（ＦＳ）,左室射血分数（ＥＦ）,等容收缩期（ＩＣＴ）,射血时间（ＥＴ）,Ｔｅｉ ｉｎｄｅｘ。Ｔｅｉ ｉｎｄｅｘ＝（ＩＲＴ…     

声学定量对维持性血透前后左心功能的对比研究

采用声学定量技术（ＡＱ）检查２６名维持性血透（ＨＤ）患者血透前后的心脏。由于在按压动静脉瘘管（ＡＶＦ）前后分别测量了左心功能各参数，故在较短时间内实现了对同一心脏四种不同负荷情况的心功能研究。ＡＱ法实时测定左室舒张末期容积（ＥＤＶ），是直接观察心脏前负荷的可靠指标。结果一次ＨＤ后，ＥＤＶ、收缩末期容积（ＥＳＶ）、每搏输出量（ＳＶ）、心排血量（ＣＯ）、左室径（ＬＶＤ）都明显降低。高峰充盈率（ＰＦＲ）和高峰射血率（ＰＥＲ）明显改善，分别由２．４４±０．６５增至２．７７±０．６８（Ｐ值＝０．００５）和２．１９±０．４９增至２．７８±０．７６（Ｐ值＝０．０００）。这是由于心脏前负荷减少、心肌代谢状况和很多其他因素改善的结果。     

超声心动图测量房室平面位移评价左室舒张功能

应用超声心动图测量房室平面位移评价左室舒张功能。对１００名健康者按年龄分组：Ⅰ组（ｎ＝３２）年龄３４岁以下；Ⅱ组（ｎ＝３４），年龄３５～５４岁；Ⅲ组（ｎ＝３４），年龄５５～８０岁。结果表明舒张期ＡＶ平面全位移随着年龄的增加而减低。Ⅰ组＞Ⅱ、Ⅲ组（Ｐ＜０．００１，Ｐ＜０．００１）。左房收缩引起ＡＶ平面位移与全舒张期ＡＶ平面位移比值Ⅱ组、Ⅲ组＞Ⅰ组（Ｐ＜０．００１，Ｐ＜０．００１）。同时该比值同受检者年龄及ＰＤ二尖瓣环血流Ａ／Ｅ比值存在良好线性相关（ｒ＝０．７８，ｒ＝０．８０，Ｐ＜０．００１，Ｐ＜０．００１）。超声心动图测量左房收缩引起ＡＶ平面位移与舒张期ＡＶ平面全位移比值可用于评价左室舒张功能。     

关于舒张期主动脉向外周供血量的讨论

关于舒张期主动脉向外周供血量的讨论编者按：本刊１９９７年第８卷第６期发表的经江西医学院生理教研室刘汉清教授审核、心内科罗雄教授指导的况明星教授等的《心阻抗图检测舒张期主动脉向外周供血量的初步探讨》，本刊按照毛泽东同志的“人类总得不断地总结经验，有所发...     

一种新高频通气方法对实验性急性呼吸窘迫综合征的疗效观察

在高频喷射通气（ＨＦＪＶ）治疗犬实验性急性呼吸窘迫综合征（ＡＲＤＳ）时，采用连续ＨＦＪＶ基础上间歇叠加深吸气（ＨＦＪＶ＋ＤＩ）的新通气方法，以期为ＡＲＤＳ的治疗寻找一种新途径。用油酸复制犬ＡＲＤＳ模型，并随机分为３组。ＨＦＪＶ＋ＤＩ组（ｎ＝１０）：在连续ＨＦＪＶ基础上每隔１０分钟加入１次深吸气；常规机械通气组（ＣＭＶ，ｎ＝１０），给予０．７８５ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ）呼气末正压（ＰＥＥＰ）治疗；对照组（ｎ＝１０），未予通气治疗。每隔１小时测定１次氧合及血流动力学指标，共观察５小时。注射油酸后，动脉氧分压（ＰａＯ２）由１２．４００ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）降至６．５６０ｋＰａ（Ｐ＜０．０１），动脉二氧化碳分压（Ｐａ－ＣＯ２）未见明显变化。通气治疗后，ＣＭＶ和ＨＦＪＶ＋ＤＩ均使ＰａＯ２明显升高，ＰａＣＯ２无明显变化（Ｐ＞０．０５），ＨＦＪＶ＋ＤＩ的氧释放指数（ＤＯ２Ｉ）明显高于ＣＭＶ组（Ｐ＞０．０５），心脏指数（ＣＩ）在ＣＭＶ组及ＨＦＪＶ＋ＤＩ组均明显减低（Ｐ＜０．０５）。提示：ＨＦＪＶ＋ＤＩ时ＰａＯ２的提高大于ＣＩ下降所致的不利影响，在改善组织缺氧方面明显优于ＣＭＶ时加用ＰＥＥＰ     

多普勒获取右室收缩时间间期评价右室收缩功能

本文研究目的应用多普勒获取右室收缩时间间期与超声心动图估测右室射血分数（ＲＶＥＦ）作相关分析。结果表明：应用多普勒获取ＰＥＰ／ＲＶＥＴ、Ｑ－Ｖｐｅａｋ、ＲＶＥＴ／ＴＲ－ｄ及校正Ｑ－Ｖｐｅａｋ、ＲＶＥＴ／ＴＲ－ｄ与超声心动图估测ＲＶＥＦ存在良好线性相关（ｒ分别为－０．７５，０．４８，０．６４，－０．５７，０．５８），因此多普勒获取上述指标可用于评价右室收缩功能。     

彩色三维经颅多普勒对脑动静脉畸形微导管血管内栓塞疗效的评估

采用彩色三维经颅多普勒对２１例脑动静脉畸形（ＡＶＭ）血管内治疗前后血流改变进行了对比研究。提出栓塞后原供血动脉血流速度的改变是评价疗效的重要指标；栓塞完全的供血动脉其舒张期未血流速度（Ｖｄ）降低率大于收缩峰速（Ｖｓ）降低率，认为舒张期未血流速度的变化更能敏感地反映供血动脉远端阻力的改变；单支供血的ＡＶＭ栓塞疗效远比多支供血的ＡＶＭ效果满意，多支供血的ＡＶＭ情况较复杂，认为与颅内血流再分配有关。应用     

CDFI评价M-3动作对颈动脉血流影响的价值

目的：探讨飞行中实施Ｍ－３动作时颈总动脉（ＣＣＡ）血流动力学变化及意义。方法：应用彩色多普勒血流显像（ＣＤＦＩ）测量３２名战斗机飞行员在地面＋１Ｇｚ条件下实施Ｍ－３动作时ＣＣＡ收缩期峰１速度（Ｖｓ１）、收缩峰２速度（Ｖｓ２）、舒张峰速度（ＶＤ）、舒张末速度（Ｖｄ）、平均血流速度（Ｖｍ）、血流量（Ｖ）、心率（ＨＲ）、心水平收缩压（ＨＳＰ）、血管阻力指数（ＲＩ）、搏动指数（ＰＩ）等参数。结果：与动作前平静状态参数比较,Ｖｓ２、ＶＤ、Ｖｍ、Ｖ和ＨＳＰ分别提高４１％、３１％、２３％、２６％和５６％（Ｐ＜０．０１）,ＲＩ和ＰＩ分别降低７％和２６％（Ｐ＜０．０１）,Ｖｍ与Ｖ间呈正相关（ｒ＝０．６９,Ｐ＜０．０５）,Ｖｓ１、Ｖｄ和ＨＲ与平静时比较无显著性差异（Ｐ＞０．０５）。结论：Ｍ－３动作能增加静脉回心血量,提高大动脉血压,加快ＣＣＡ的Ｖｓ２、ＶＤ和Ｖｍ值,降低脑血管阻力,有利于维持脑部供血     

吸入一氧化氮改善烟雾吸入性损伤犬肺通气功能的意义

目的评价吸入一氧化氮（ＮＯ）对犬烟雾吸入性损伤肺通气功能改善的效果。方法烟雾吸入伤后，将１７只犬随机分为２组，对照组（ｎ＝８）单纯吸氧（ＦｉＯ２，０．４５），治疗组（ｎ＝９）吸氧（ＦｉＯ２，０．４５）＋０．００４５％（４５ｐｐｍ）ＮＯ，连续监测１２小时血气变化；并按时相点抽血检测有关指标。数据行多个样本均数间方差分析。结果吸入ＮＯ治疗组ＰａＣＯ２、呼吸指数（ＲＩ）、肺泡死腔率（ＶＤ／ＶＴ）、肺动脉分流率（ＱＳ／ＱＴ）和碳氧血红蛋白（ＨｂＣＯ）含量比对照组均有不同程度的下降（Ｐ＜０．０５～０．０１），而动脉血浆亚硝酸盐（ＮＯ－２）水平则明显高于对照组（Ｐ＜０．０１）。结论吸入ＮＯ能明显改善肺通气功能，作为吸入性损伤的综合治疗，吸入ＮＯ疗法值得进一步研究。     

生脉注射液对缺血性心脏病患者心脏功能的影响

目的：观察生脉注射液对缺血性心脏病患者心脏功能的影响。方法：４８例缺血性心脏病患者静滴生脉注射液２５～３０ｍｌ，每日１次，连用２周，治疗前后分别测常规导联心电图、血脂及心脏功能各参数。结果：生脉注射液对缺血性心脏病患者心电图ＳＴＴ的改变有恢复作用（８５％），并有一定的降血脂作用（Ｐ＜０．０５）；对心脏功能左室射血时间（ＬＶＥＴ）、射血前期（ＰＥＰ）、射血分数（ＥＦ）、等容收缩期（ＩＣＴ）、心搏出量（ＳＶ）、心输出量（ＣＯ）、冠状动脉灌注压（ＣＡＰ）、心内膜下心肌存活率（ＥＶＲ）、心缩力指数（ＨＩ）、心搏指数（ＳＶＩ）和心脏指数（ＣＩ）均有显著影响（Ｐ均＜０．０５）；心电图ＳＴＴ改变与等容舒张期（ＩＲＴ，ｒ＝－０．３８）、ＬＶＥＴ（ｒ＝０．６６）、ＥＶＲ（ｒ＝－０．６２）、ＣＡＰ（ｒ＝－０．５１）和ＣＩ（ｒ＝－０．２７）均具有相关性（Ｐ均＜０．０５）。结论：生脉注射液能增强心肌收缩力，改善心肌顺应性与协调性，提高冠状动脉灌注压及心肌存活率，提高ＥＦ与ＣＩ，对缺血性心脏病患者不失为是改善心脏功能的有效药物之一。     

美托洛尔联合曲美他嗪治疗86例缺血性心力衰竭患者的疗效及预后分析

目的探讨美托洛尔联合曲美他嗪治疗86例缺血性心力衰竭患者的疗效及预后。方法选择172例缺血性心力衰竭患者,随机分为试验组(n=86)和对照组(n=86)。对照组使用曲美他嗪治疗,试验组联合美托洛尔治疗,连续治疗12周。比较2组收缩压(SBP)、舒张压(DBP)、心率(HR)及超声心电图检查结果及临床疗效。随访1年,记录脑梗死发病率。结果治疗后,2组SBP、DBP、HR及超声心电图检查结果较治疗前均显著改善(P0.05);试验组SBP、DBP、HR均显著低于对照组(P0.05);试验组左心室缩短分数(FS)、每博输出量(SV)、每分输出量(CO)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左室射血分数(LEVF)均显著优于对照组(P0.05);观察组总有效率显著高于对照组(P0.05);观察组脑梗死发生率显著低于对照组(P0.05)。结论在缺血性心力衰竭患者中应用美托洛尔联合曲美他嗪的效果显著,有助于预防脑梗死。     

Hemodynamic effects of quinidine and famotidine in patients with congestive heart failure.

In a randomized, placebo-controlled, double-blind study, 12 patients with congestive heart failure (New York Heart Association class II) were successively treated for 1 week each with placebo, 40 mg famotidine, and 1000 mg quinidine. On the seventh treatment day, heart rate, blood pressure, systolic time intervals, impedance cardiography, and Doppler ultrasound were measured. Heart rate and blood pressure were not markedly altered by either drug. By contrast, quinidine and famotidine significantly decreased stroke volume and cardiac output in impedance cardiography and Doppler ultrasound (p less than 0.05). A high correlation between both noninvasive methods was found for cardiac output and stroke volume (r = 0.93 and r = 0.97 for stroke volume 1 1/2 hours after quinidine and placebo administration, respectively). In addition, the mechanocardiographic ratio of the preejection period to the left ventricular ejection time in systolic time intervals increased significantly 1 1/2 and 3 hours after administration of quinidine and famotidine (p less than 0.05). In conclusion, both quinidine and famotidine exert similar negative effects on cardiac performance, with no significant differences in hemodynamic parameters emerging between the antiarrhythmic agent and the H2-receptor antagonist.     

超声血流向量成像技术评价扩张型心肌病左心室血流状态的变化

目的 应用超声血流向量成像(VFM)技术探讨心腔内血流的结构变化及其与左室功能之间的关系.方法 选取扩张型心肌病患者26例、正常对照44例为观察对象,利用VFM软件采集左室内血流向量图像,应用VFM分析软件DSA-RS1测量收缩期心尖部-主动脉瓣口速度阶差(△Vs)、心尖部-主动脉瓣口距离(Ds)、半距对应速度(Vs1/2);舒张期二尖瓣口-心尖部速度阶差(△Vd)、二尖瓣口-心尖部距离(Dd)、半距对应速度(Vd1/2).结果 与对照组相比,DCM组收缩期△Vs、Vs1/2与舒张期△Vd、Vd1/2明显降低,收缩期Ds与舒张期Dd明显延长,差异均具有统计学意义(P＜0.05).Ds、Dd与舒张末期容积、收缩末期容积、左室内径呈正相关(r＞0.4,P＜0.01),与收缩功能呈负相关(r＞0.3,P＜0.01);Vs1/2、Vd1/2与舒张末期容积、收缩末期容积、左室内径呈负相关(r＞0.3,P＜0.01),与收缩功能呈正相关(r＞0.3,P＜0.01).结论 扩张型心肌病患者心腔内血流速度明显低于正常人,VFM是一种无创评价扩张型心肌病左室内血流动力学变化的新方法.     

Impedance Cardiography for Cardiac Output Estimation in Pacemaker Patients: Review of the Literature

Impedance curdiogrciphy permits noninvasive beat-to-beat determination of cardiac output, the product of the amplitude of the first derivative of thonicic impedance signal (dZ/dt), the venfricular ejection time, and heart rate corrected by the distance between the measuring electrodes. Its use is based on: (1) the dZ/dt signal that originates from the upper thorax; (2) the ventricular ejection period measured by the dZ/dt curve that occurs between the opening and closing of the aortic vnlve: (3) the dZ/dt curve is similar in morphology and timing to the aortic flow curve measured by an electromagnetic flowmefer with a significant linear correlation (r = 0.9) between dZ/dt and peak aortic flow; (4) similarity of the linear correlation between stroke volume, determined by the flowmeter and the impedance signal; and (5) significant reduction of the dZ/dt signal by 90% follows simultaneous occlusion of the aorta and the pulmonary artery. The rapid systolic portion of the impedance signal occurs only when blood is ejected into the aorta and is independent of right ventricular ejection. Most studies comparing impedance cardiography results with standard cardiac output determination have shown a correlation of 0.7–0.9. While the accuracy of impedance cardiography remains controversial and can be affected by the inherent limitations of the technique and by low cardiac output, intracardiac shunts. and valvular regurgitation. the high reproducibility of the method is established and may be comparable or superior to other commonly used techniques. When accurate determination of cardiac output is crucial, impedance cardiography may be used in conjunction with a standard technique to establish a baseline reference, thereby permitting further analysis. If only the trend need be followed, the high reproducibility of impedance cardiography measurements allows small changes in cardiac output to be detected on a frequent and ongoing basis. The ease and precision of this technique warrants its more widespread use in the assessment of pacemaker patients. Further use of this promising technique will allow a better definition of its role in the assessment of a wide range of cardiac patients.     

心脏再同步化治疗对心力衰竭犬心脏功能及相关炎性因子的影响

目的探讨心脏再同步化治疗(CRT)对心力衰竭(HF)犬心脏功能及相关炎性因子的影响。方法 10条雌性健康清洁比格犬采用随机数字表法分为2组,实验组与对照组各5只。2组均给予开胸结扎冠脉制作HF动物模型,成模后仅实验组实施为期4周的CRT,对照组不给予CRT。记录与观察所有大鼠在实验期间的活动与进食情况;分别于实验前、HF建模后2周、同步化治疗4周后通过超声心动图检查测定各组大鼠左室舒张末容积(LVEDV)和左室收缩末容积(LVESV);测定所有犬的颈动脉收缩压与舒张压;酶联免疫吸附实验检测各组大鼠血清脑钠肽(BNP)、髓过氧化物酶(MPO)含量。结果所有比格犬均造模成功并完成实验,均无突然死亡或者心律失常发生。与实验前相比,HF后2周及同步化治疗4周后,2组大鼠颈动脉收缩压、舒张压、LVEDV、LVESV、血清BNP与MPO含量均显著升高(P <0.05),而同步化治疗4周后2组以上所有指标水平均显著低于HF后2周,差异均有统计学意义(P <0.05)。同步化治疗4周后,与对照组相比,实验组大鼠颈动脉收缩压、舒张压、LVEDV、LVESV、血清BNP与MPO含量均显著降低,差异均有统计学意义(P <0.05),而实验前及HF后2周,2组大鼠颈动脉收缩压、舒张压、LVEDV、LVESV、血清BNP与MPO含量差异均无统计学意义(P> 0.05)。结论应用CRT治疗HF犬可抑制BNP与MPO等相关炎性因子的表达,从而促进犬心功能与血压恢复正常。     

Dynamic responses to intravenous urapidil and dihydralazine in normal subjects

Hemodynamic responses after urapidil were compared with those after dihydralazine in placebo-controlled, double-blind studies after cumulative intravenous doses. We recorded heart rate, blood pressure, systolic time intervals corrected for heart rate (electromechanical systole and preejection period), electrical impedance cardiography [(dZ/dt)/RZ index and mean electrical thorax impedance], and M-mode echocardiogram (end-systolic and -diastolic diameters, end-systolic wall stress, fractional shortening, and cardiac output). Both drugs induced dose-dependent reductions in total peripheral resistance, which resulted in reduction in left ventricular end-systolic wall stress and increases in heart rate (limited at +10 bpm with urapidil), fractional shortening, cardiac output, and the (dZ/dt)/RZ index. With each drug, diastolic blood pressure fell by 5 mm Hg, the corrected preejection period shortened (dihydralazine greater than urapidil), the corrected electromechanical systole did not change, and mean electrical thorax impedance rose with urapidil. The spectrum of effects indicates that both drugs reduce left ventricular afterload, thereby increasing left ventricular pump performance. Urapidil also exerts some preload reduction.     

Effect of the initiation of noninvasive bi-level positive airway pressure on haemodynamic stability.

Noninvasive ventilation using noninvasive bilevel positive airway pressure (Bi-PAP) has been shown to be an effective means of improving oxygenation and respiratory status in patients with obstructive pulmonary disease (COPD) and acute congestive heart failure (CHF). However, it is uncertain what effects this positive airway pressure has on the haemodynamic condition of these patients. This study examines the acute changes in basic circulatory parameters with the initiation of Bi-PAP. Noninvasive measurements of the heart rate, systolic and diastolic arterial pressure, cardiac index, total peripheral resistance, ventricular ejection time, and total diastolic time were determined by impedance cardiography before and after the institution of Bi-PAP (pressures 15/5) in a group of healthy volunteers. In a collateral study, the same measurements were made in COPD patients in whom Bi-PAP was initiated for therapeutic reasons. Changes in the haemodynamic parameters were analysed using a paired t-test (p < 0.05). In the 12 healthy volunteers studied there were no significant differences in any of the haemodynamic parameters measured (average cardiac index: 2.75 +/- 0.78) over a period of 15 minutes after the placement of Bi-PAP. Similar results for most haemodynamic parameters were found in the 7 COPD patients with imminent respiratory failure (average respiratory rate 24.8 +/- 3.2) when Bi-PAP was utilized with the exception of significant but small increases in the cardiac index, stroke volume and oxygen saturation (p<0.05). While Bi-PAP is frequently used in the treatment of patients with acute respiratory failure, little is known about its effect on haemodynamics. This study suggests that the effects of the initiation of Bi-PAP on the general circulation and cardiac output may be of minor relevance.     

PDE测定心力衰竭患儿的左右心室功能

本文应用脉冲多普勒超声心动图（ＰＤＥ）对３２例心力衰竭患儿和２８名正常小儿的升主动脉和主肺动脉进行预测，从其血流频谱测定左、右心室收缩时间新时期（ＳＴＩ）和心排血量，来评价左、右心室功能。结果表明，ＰＥＰ、ＰＥＰ／√Ｒ－Ｒ，ＲＥＰ／ＥＴ／ＦＶＩ和ＳＶ可堆确反映左、右心室的收缩功能，用于心衰的诊断。ＤＴ、ＰＥＰ／ＥＴ、ＰＦＶ、Ｖｍｅａｎ和ＳＶ可敏感地反映心衰程度的轻重。     

三维经颅多普勒对心力衰竭患者脑血流的研究

应用三维经颅多普勒对４５例心力衰竭进行了动脉血流的观测。结果显示，心衰组与对照组比较其各 匀有显著性差异。心衰患者的大脑中动脉，大脑前动脉，大脑后动脉的收缩期峰值流速、平均流速舒张末期流速明显减低，脉动指数增高。本研究为以后研究心脏疾病对脑血流的影响探讨 了一种新途径。