抗心肌ADP/ATP载体对小儿心脏病的诊断价值

目的 :探讨抗心肌ADP/ATP载体 (ANT)抗体对小儿心脏病的诊断价值。方法 :运用免疫印转法检测了 3 0例病毒性心肌炎 (VMC)、14例扩张型心肌型 (DCM) ,10例风湿性心脏病 (RHD)、2 2例先天性心脏病 (CHD)患儿血浆抗ANT水平。结果 :抗ANT抗体在VMC和DCM患儿中的阳性率显著高于RHD、CHD和NC三组研究对象 (P均 <0 .0 1)。抗ANT抗体诊断VMC和DCM的敏感性为 72 73 % ,特异性为 98 2 5 %。结论 :抗ANT抗体在小儿心脏病的鉴别诊断中有重要价值 ,可作为小儿VMC和DCM的特异性诊断指标     

抗心肌肌球蛋白抗体对小儿心脏病的诊断价值

目的 :探讨抗心肌肌球蛋白抗体对小儿心脏病的诊断价值。方法 :运用酶联免疫吸附法检测了 3 0例病毒性心肌炎 (VMC)、 14例扩张型心肌病 (DCM)、 10例风湿性心脏病 (RHD)、 2 2例先天性心脏病 (CHD)患儿血浆抗肌球蛋白抗体水平。结果 :抗肌球蛋白抗体在VMC和DCM患儿中的阳性率显著高于RHD、CHD和NC三组研究对象 (P均 <0 . 0 5 )。抗肌球蛋白抗体诊断VMC和DCM的敏感性为 5 4 5 5 % ,特异性为 89 47%。结论 :抗肌球蛋白抗体可作为小儿VMC和DCM的特异性诊断指标 ,有推广到基层医院的实用价值     

心脏病患儿抗心肌β-肾上腺素能受体抗体的测定

目的探讨抗心肌β-肾上腺素能受体(简称β-受体)抗体对小儿心脏病的诊断价值。方法运用免疫印转法检测了30例病毒性心肌炎(VMC),14例扩张型心肌病(DCM),22例先天性心脏病(CHD),10例风湿性心脏病(RHD)患儿和25例正常对照组(NC)血浆抗β-受体抗体水平。结果VMC和DCM患几中抗β-受体抗体的阳性率显著高于CHD、RHD和NC组(P＜0.01)。抗β-受体抗体诊断VMC和DCM的灵敏度为80％,特异度为98％。结论小儿心脏病的鉴别诊断中抗β-受体抗体的测定有重要价值,可作为小儿VMC和DCM的特异性诊断指标。     

Epidemiology of rheumatic and congenital heart diseases in school children.

A stratified random sample of 10,263 school-going children in the age group of 6-16 years from government and private schools were screened for the prevalence of rheumatic fever, rheumatic heart diseases and congenital heart diseases. Fourteen children were found to have rheumatic heart disease with valvular lesions either single or in combination eg, pure mitral stenosis (6 cases), mitral regurgitation (4 cases), combined mitral stenosis and mitral regurgitation (3 cases) and aortic and mitral regurgitation (one case). Eight children had congenital heart diseases in the form of ventricular septal defect (3 cases), atrial septal defect (2 cases), patent ductus arteriosus (2 cases) and congenital bicuspid aortic valve (one case) while none had active rheumatic fever.     

Effect of cardiopulmonary bypass on the specific immunity of the host

Summary T cell subsets and immunoglobulin (Ig) were observed sequentially with the OKT monoclonal antibodies rosette test and the rate scattering turbidimetry in 13 patients who underwent open heart surgery under cardiopulmonary bypass (CPB) for rheumatic heart diseases (RHD) and congenital heart diseases (CHD), before and after operation. Compared with preoperative values, in the early period after CPB, T helper cells, T helper cells to T suppressor cells ratio and IgG decreased significantly; whereas T suppressor cells increased, in RHD and CHD. The T cell subsets returned to the preoperative levels two weeks after CPB in RHD and CHD. The IgG came back to the preoperative levels two weeks after CPB in RHD and only one week after CPB in CHD.     

再次心脏手术二尖瓣替换术77例临床分析

目的：报告再次心脏手术二尖瓣替换术77例的治疗经验。方法：77例中二尖瓣闭式扩张术后再狭窄56例，生物瓣替换术后瓣膜毁损15例，机械瓣替换术后瓣膜功能障碍4例，部分房室管畸形术后二尖瓣关闭不全1例，房间隔缺损术后风湿性二尖瓣病变1例。55例在体外循环心脏停搏下手术，22例在浅低温体外循环心脏跳动下进行手术。结果：手术早期死亡4例（死亡率5．2％）。晚期死亡2例。随访存活病人心功能明显改善。结论：病人术前心功能是导致再次手术二尖瓣替换术后并发症和死亡率的重要因素，心脏跳动下进行手术可简化手术过程，改善心肌保护，减少并发症的发生。     

心脏病住院病例10年构成比的变迁

本文分析了一所综合医院1976～1985年10年中3793例住院心脏病病例的构成比。5年为一个阶段,从病因、性别、年龄及住院当时病死率四个方面对比两个阶段住院心脏病病例的构成比,并与国内外同期资料作一比较。结论是本地区冠心病的相对发病率最高并在继续增长;风心病正在逐渐减少,与国内其它地区的资料对比大致相同。住院心脏病例中风心病女多于男1.67:1;冠心病男多于女,1:0.51。住院风心病的高峰年龄目前在50～59岁,冠心病为6O～79岁,肺心病在6O～69岁。住院当时病死率以肺心病最高为20～30％;冠心病与风心病在10％左右。     

新疆墨玉县及皮山县医院维吾尔族住院病人心血管病病种10年演变回顾性研究

目的：探讨新疆和田地区墨玉县及皮山县医院维吾尔族心血管病病种近10年演变趋势。方法：收集新疆和田地区墨玉县及皮山县医院内科1996年1月～2005年12月住院维吾尔族心血管病患者16654例住院病历，统计冠心病、原发性高血压病、风湿性心脏病、原发性心肌病、先天性心脏病、肺原性心脏病构成比，并分析心血管病病种近10年演变情况。结果：16654例中，原发性高血压病的构成比由1996年的12．6％上升为2005年的21．0％，冠心病的构成比由1996年的8．6％上升为2005年的16．7％，风湿性心脏病的构成比由1996年的1．3％上升为2005年的3．2％，原发性心肌病的构成比由1996年的1．2％上升为2005年的2．3％。从1996年到2005年原发性高血压病、冠心病构成比呈明显增高趋势（P均〈0．05），风湿性心脏病、原发性心肌病构成比呈逐渐增高趋势（P均〈0．05），先天性心脏病、肺原性心脏病的构成比无演变趋势（P均〉0．05）。结论：应加强此地区人群心血管病，尤其原发性高血压病，冠心病的预防工作。     

冠状动脉搭桥同期行瓣膜置换术近期疗效

目的探讨冠状动脉粥样硬化性心脏病(冠心病)合并心脏瓣膜病,风湿性心脏病合并冠心病同期行冠状动脉搭桥术(CABG)及瓣膜置换术的安全性及适应证。方法首都医科大学宣武医院心血管外科自2001年5月至2004年12月间,在中低温体外循环下完成12例冠心病合并瓣膜病变、风湿性心脏病合并冠心病同期施行冠状动脉搭桥和瓣膜替换手术。12例中男8例,女4例,年龄52~78岁,平均64.5岁。3例以多年风湿性心脏病、心功能不全为主诉,近年出现胸痛,手术前冠状动脉造影发现冠状动脉病变;9例以心肌缺血症状为主诉,同时合并瓣膜病变。冠状动脉造影提示单支病变1例,双支病变3例,3支病变8例。合并原发性高血压8例,糖尿病6例,心力衰竭病史5例,心房颤动7例。手术前左心室舒张末期内径(LVED)45~87 mm[(56.7±77)mm],左心室射血分数(LVEF)24%~67%(50.3%±11.7%)。心功能NYHAⅠ级1例,Ⅱ、Ⅲ和Ⅳ级分别为8、2和1例。12例患者中MVR(二尖瓣置换)+CABG 9例,AVR(主动脉瓣置换)+CABG 2例,DVR(双瓣置换)+CABG 1例。结果全组术后恢复顺利,随访3个月至2年无1例死亡。结论年龄超过50岁风湿性心脏病患者,无论有无心绞痛症状均需行冠状动脉造影检查,决定是否同期行CABG;冠心病合并二尖瓣中到重度反流及主动脉瓣严重钙化者,应同期行瓣膜置换术。对于冠状动脉病变与瓣膜病变同时存在的病例,2种手术同期进行可降低病死率,改善预后。     

Rheumatic fever and rheumatic heart disease: clinical profile of 550 cases in India

BACKGROUND: The aims and objectives of this paper were to analyze the clinical presentation of children with rheumatic fever (RF) and rheumatic heart disease (RHD), to determine the cardiac sequel of RF and valvular affection due to RF, and to study clinical manifestations in recurrences of RF. METHODS: Our study, a retrospective analysis, was conducted at a tertiary-care teaching hospital with specialty follow-up clinic for patients with RF/RHD. This retrospective study was conducted to include a period of 31 years (from January 1971 through December 2001). Pre-completed case protocols of patients with RF/RHD were analyzed to record the following information: demographic data; clinical features on admission/presentation; relevant investigations; recurrences; cardiac valvular affection, and outcome. Modified Jones' criteria were used for diagnosis of RF. RESULTS: The study included 550 patients. Mean age of presentation was 9.62 years and sex ratio was 1.15:1 favoring males. A total of 250 patients presented with initial/first attack of RF. Arthritis and carditis were seen in 169 (67.6%) and 105 cases (42%), respectively. Chorea was seen in 47 cases (18.8%) and erythema marginatum, in four. A total of 224 patients presented with recurrence of RF (with pre-existing RHD). Arthritis and carditis were seen in 109 (48.66%) and 178 cases (79.46%), respectively, in these patients; 76 cases presented with chronic RHD. Mitral regurgitation was the most common cardiac valvular lesion observed (150 cases) followed by a combination of mitral stenosis and mitral regurgitation (98 cases). Congestive cardiac failure was seen in 201 cases (36.54%) and infective endocarditis in 30 (5.45%). 2-D echocardiography and/or color Doppler was performed in 201 patients (36.54%). Average duration of follow-up was 3.19 years; 74.72% of cases were lost to follow-up. Benzathine penicillin prophylaxis was regular in 42.18% cases. Positive family history of RF/RHD was present in 2% of cases. Twenty three patients (4.18%) died. CONCLUSIONS: Arthritis was the most common manifestation in the initial attack of RF, while carditis was the most common manifestation in patients presenting with rheumatic recurrences (with pre-existing RHD) and mitral regurgitation was the most common valvular lesion. Rate of patient dropout from penicillin prophylaxis was high. Clinical manifestations in initial/first attack of RF have not significantly changed in the last 31 years.     

心脏不停跳心内直视手术113例

目的探讨不停跳心内直视手术的方法和意义。方法浅低温（31℃-34℃）不停跳心脏直视手术共113例,男59例,女54例。年龄4-73岁,平均31.4岁。其中房间隔缺损（atrial septal defect,ASD）22例,室间隔缺损（ventricular septal defect,VSD）32例,法乐氏三联征（triad of Fallot,F3）3例,双腔右心室1例,Ebstein畸形3例,二尖瓣置换手术（mitral valve replacement,MVR）36例,主动脉瓣置换手术（aortic valve replacement,AVR）9例,双瓣置换手术（double valves replacemnet,DVR）7例。结果1例二尖瓣置换手术因术中暴露极差而被迫降温心脏停跳操作外,其余全为非停跳手术,全组手术顺利,无死亡,术后恢复良好。结论心脏不停跳手术简化了手术操作程序,方便手术后管理,减少了心脏停跳后的负面影响。     

Perioperative management of pregnant patients with heart disease for caesarian section under anaesthesia

One hundred pregnant patients, of age group 22 to 35 years, with different types of cardiac ailments (mitral stenosis, mitral regurgitation, mitral valve prolapse, aortic regurgitation, atrial septal defect, ventricular septal defect, coarctation of the aorta, Eisenmenger syndrome, hypertrophic obstructive cardiomyopathy and operated tetralogy of fallot), put up for elective caesarian section underanaesthesia, were managed in the department of anaesthesiology at IPGME&R/SSKM Hospital, Kolkata from January 1996 to December 2002. The aim of the study was to observe the maternal and foetal outcome in different heart diseases. Death occurred in 2 patients (67%) with Eisenmenger syndrome, in one patient (20%) with hypertrophic obstructive cardiomyopathy and in one patient (5%) with critical mitral stenosis (mitral orifice area = 0.6 cm2) with pulmonary arterial hypertension (PAH). Neonatal mortality was observed in 4 patients [Eisenmenger syndrome--3 (100%); coarctation of the aorta--1 (33%)]. Another 8 patients developed severe heart failure (HF) [severe mitral stenosis (mitral orifice area = 1-1.2 cm2)--2 (10%); hypertrophic obstructive cardiomyopathy--4 (80%); coarctation of the aorta--2 (66%)]. Foetal dysmaturity was observed in 20 neonates (54%) belonging to mothers of New York Heart Association (NYHA) classes III and IV. Congenital heart disease (ventricular septal defect) was detected in 3 offsprings (20%) of mothers with ventricular septal defect. The study concludes that most pregnant cardiac patients can have a satisfactory outcome with careful perioperative management.     

分析妊娠合并风湿性心脏病的临床治疗

目的探讨妊娠合并风湿性心脏病的有效治疗手段。方法收集首都医科大学附属北京安贞医院妇产科就诊于2002年1月至2009年1月期间的妊娠合并风湿性心脏病的25例患者的临床资料,对其进行回顾性分析。根据心脏病病种的治疗方式、心功能分级、产科检查情况进行分组分析。结果妊娠合并风湿性心脏病的发病率为0.49%。内科药物治疗14例,新生儿死亡1例。心脏手术治疗11例,其中孕前行瓣膜置换术5例,孕期行经皮二尖瓣球囊扩张术6例。结论妊娠合并风湿性心脏病严重危害母儿健康。心脏手术有效治疗妊娠合并风湿性心脏病。对比孕前行瓣膜置换术、孕期行经皮二尖瓣球囊扩张术对母儿预后的改善差异无统计学意义。     

Profile of cardiac diseases in Ethiopian children

A review of cardiac admissions to the Ethio-Swedish Children's Hospital from January 1981 to December 1988 revealed 365 cases. Patients were included in the study if they had clinical, laboratory and echocardiographic (M, 2D-Modes, doppler) proofs of the specific disease entity. One hundred and ten patients were eligible. This accounted for 0.65% of all admissions (N = 16,905). Rheumatic heart disease accounted for 54.5% (N = 60), congenital heart disease for 35.5% (N = 39), and acquired heart disease of nonrheumatic origin for 10% (N = 11) or cardiac admissions. Of patients with rheumatic heart disease, the mitral valve was involved in 41.7% (N = 25). Pure mitral stenosis was seen in 8.3% (N = 5). Ventricular septal defect was seen in 33.3% (N = 13) of patients with congenital heart disease. The mean hospital stay for patients with rheumatic heart disease was 35.4 days, and 24.7 days for patients with congenital heart. As rheumatic heart disease predominates, methods for decreasing its incidence are discussed.     

先天性心脏病介入治疗285例疗效评价

目的探讨先天性心脏病介入治疗的临床疗效。方法回顾分析该院2003年6月￣2005年4月连续施行的先天性心脏病介入治疗285例,其中动脉导管未闭(PDA)封堵术87例,房间隔缺损(ASD)封堵术104例,室间隔缺损(VSD)封堵术75例,肺动脉瓣狭窄球囊扩张术(PBPV)15例,冠状动脉瘘栓塞术4例;采用经皮穿刺股静脉和/或股动脉法,术前、术后行左、右心导管造影检查。结果技术成功率97.54%(278/285),并发症2.81%(8/285),紧急手术0.70%(2/285),死亡率0.35%(1/285)。结论先天性心脏病介入治疗具有成功率高、创伤小、并发症及死亡率低等特点,对大部分病例可替代外科手术。     

复合先心病的彩色多普勒超声诊断

目的 :应用彩色多普勒超声心动图 (CDE)诊断 4例复合型先心病。方法 :回顾分析经CDE检查及手术证实的患者。结果 :3例房间间隔缺损分别合并部分肺静脉异位引流、三房心、二尖瓣脱垂及三尖瓣裂孔 ;1例室间隔缺损合并左上腔。除左上腔被漏诊外 ,其余都与手术符合。结论 :超声对复合型先心病具有无创性、可重复性、诊断率高的重要价值。     

脉搏血氧饱和度监测在心血管疾病中的应用

目的探讨脉氧饱和度(SpO2)的变化与心肌梗死面积、心功能状况、合并阻塞性睡眠呼吸暂停综合征(OSAS)和肥胖低通气综合征以及病死率的关系。方法选择2003年10月至2006年6月鹤壁第一人民医院心内科220例心血管病患者,其中急性心肌梗死(AMI)患者149例,冠状动脉粥样硬化性心脏病心力衰竭40例,扩张型心肌病心力衰竭18例,风湿性心脏病心力衰竭13例。采用美国Hewlett-PackardCompany的OmnicareModel24型床边监护仪,用一光电传感器夹与患者食指相连接,连续监测脉搏血氧饱和度的变化。结果AMI病例中,SpO2>95%者100例,梗死面积皆较小,且无心力衰竭等严重并发症;SpO2在90%～95%者30例合并心力衰竭,且梗死面积较大。全组病例(220例)死亡11例,其中7例为大面积心肌梗死并心源性休克,2例为AMI合并OSAS,1例为冠状动脉粥样硬化性心脏病心力衰竭合并肥胖低通气综合征,1例为缺血性心肌病严重心力衰竭,SpO2均<85%。结论SpO2值越高,心肌梗死面积越小,合并症越少;SpO2越低,心肌梗死面积越大,合并症越多。SpO2值与心血管疾病病死率呈负相关(r=-0.64,P<0.05),SpO2<85%是心血管疾病预后不良的指标。     

新疆和田地区心血管病种住院患者临床分析

目的分析新疆和田地区心血管病病种10年演变趋势。方法入选1996-2005年新疆和田皮山县医院内科住院病例5748例,统计冠心病、原发性高血压、风湿性心脏病、原发性心肌病、先天性心脏病、肺源性心脏病的构成比,分析其演变情况。结果新疆和田皮山县内科住院患者原发性高血压的构成比1996年为10．5％,2005年为18．7％;冠心病的构成比1996年为10．0％,2005年为20．0％。风湿性心脏病的构成比1996年为1．1％,2005年为2．7％、原发性心肌病的构成比1996年为0．0％,2005年为0．9％、先天性心脏病的构成比1996年为0．5％,2005年为0．6％、肺源性心脏病的构成比1996年为8．9％,2005年为10．6％。新疆和田皮山县住院患者原发性高血压、冠心病有上升趋势（P〈0．05）。住院患者中近10年,风湿性心脏病、原发性心肌病逐渐增多趋势（P〈0．05）。结论应加强此地区人群心血管病预防工作。     

基质金属蛋白酶在风湿性心脏病二尖瓣病变组织中的表达研究

目的探讨基质金属蛋白酶（MMPs）在风湿性心脏病（RHD）二尖瓣膜病理改变中的作用及其机制。方法实验组为成人RHD患者二尖瓣16例，对照组为同期意外死亡的无心脏病变的成人二尖瓣7例。经HE染色及电镜观察两组形态学和超微结构变化，采用逆转录-聚合酶链反应（RT-PCR）和免疫组织化学染色（SABC法）测定MMP-2、MMP-13在二尖瓣组织的mRNA含量和蛋白表达。结果实验组为风湿性病理改变，对照组结构基本正常。实验组MMP-2、MMP-13的mRNA表达分别为0．96±0．27，0．93±0．38，较对照组均明显增加（P〈0．01）；其MMP-2、MMP-13蛋白表达亦明显高于对照组。结论RHD患者二尖瓣膜中MMPs表达增强，可能参与二尖瓣细胞外基质（ECM）的重构，是其风湿性改变的重要分子机制之一。