18例孕产妇围产期死因分析

对８年住院分娩２３３８８例孕产妇资料进行分析，孕产妇死亡１８例，死亡率占同期住院分娩孕产妇７６．９／１０万，死亡原因依次为妊高征、产科出血、风湿性心瓣膜病、剖宫产后猝死、脂肪肝、产后感染。对死亡原因进行分析。并对妊高征合并心脏病、脑血管病、孕产妇风心病、剖宫产后猝死进行讨论。     

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.     

风湿性心脏病患者血浆s-ICAM-1,s-VCAM-1和vWF的含量及意义

目的：测定风湿性心脏病患者在风湿热静止后血浆中可溶性细胞间黏附分子-1（s-ICAM-1）、可溶性血管细胞间黏附分子-1（s-VCAM-1）和血管性血友病因子（vWF）含量，为研究风湿性心脏病瓣膜和心肌损害过程提供理论依据。方法：空腹抽取40例风湿性心脏病患者和40例健康对照人群的外周静脉血，用酶联免疫吸附法测定血浆中s-ICAM-1,s-VCAM-1和vWF含量。结果：风湿性心脏病患者血浆中s-ICAM-1,s-VCAM-1,vWF浓度都高于健康人群(P<0.01);而且风湿性心脏病房颤患者血浆中s-ICAM-1浓度高于风心病无房颤患者（P<0.05）。结论：风湿性心脏病患者在风湿热静止后心脏瓣膜和心肌的损害与高表达的s-ICAM-1, s-VCAM-1和vWF水平有关。     

Sudden death in young Aboriginal adults with rheumatic heart disease

A retrospective review for the period 1983 to 1988 was made of all sudden deaths in young Aboriginal adults from the Darwin and East Arnhem regions who had known rheumatic heart disease. A total of five cases was identified from autopsy reports. The age range was between 16 and 35 years. All were being treated for asymptomatic heart disease (grade I). The sudden, unexpected death in each of these patients resulted in their deaths all being reported to the coroner. In all cases there was no evidence at autopsy of significant coronary artery disease or bacterial endocarditis. All had evidence of rheumatic valvular heart disease affecting either one or both mitral and aortic valves to varying degrees. No other cause of death was found. This report serves to illustrate the fact that rheumatic heart disease is still a significant contributor to morbidity and mortality in Aborigines, and that while the usual picture of progressive deterioration in exercise tolerance may be the norm, sudden death without any apparent preceding symptomatology can occur.     

老年风心病75例临床分析

1975～1986年,我院住院的心脏病患者中,老年(≥60岁)风心病次于老年冠心病和老年肺心病占第3位。前6年(1975年～1980年)和后6年(1981～1986年)分别为6%、7. 4%,老年风心病住院人数有增加趋势。老年风心病瓣膜损害较轻,并发症以栓塞、肺内感染为主。老年风心病病死率较过去有明显下降,12年间由36. 3%降至13. 3%,存活时间延长。死亡原因以栓塞为主,其次是心衰、心律失常。误诊原因则为对老年风心病认识不足和未与冠心病仔细鉴别。     

风湿性心脏病合并心脏黏液瘤的临床诊断探讨

目的 探讨风湿性心脏病（简称风心病）合并心脏黏液瘤的诊断特点。方法 对3例临床资料进行回顾性临床分析。结果 风湿性心脏病合并心脏黏液瘤以风湿病史为特点常伴有突发晕厥,间歇性特异性心脏瓣膜杂音与栓塞等综合征。且血浆ASO、ESR及粘蛋白在二者并存时常有不同程度的增高表现,心电图（EKG）、心脏二维超声（2-DE）及磁共振（MRI）等检查均有助于诊断。结论 根据仔细的病史询问并结合血生化检查及相关物理检查如EKG、2-DE、MRI等有助于提高风心病合并心脏黏液瘤的诊断。     

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。     

21例人血过氧化脂质检测分析

对21例风湿性心脏病(RHD)患者及30例健康者进行人血过氧化脂质(LPO)水平检测,结果发现:RHD患者血LPO水平明显高于正常组,且多瓣模病变者血LPO水平高于单瓣膜病变者;在风湿活动期血LPO水平增高更加明显,治疗后则显著下降。表明脂质过氧化增加在RHD的发生、发展中可能起重要的促进作用。     

An Australian guideline for rheumatic fever and rheumatic heart disease: an abridged outline

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are diseases of poverty. They occur at world-record rates in Indigenous Australians, yet individual cases are often poorly managed, and most jurisdictions with high rates of these diseases do not have formal control strategies in place. New Australian guidelines formulated in 2005 by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand for diagnosis and management of ARF and RHD are a valuable resource for clinicians and policymakers. Key recommendations of the guidelines include: New diagnostic criteria for ARF in high-risk populations, including Indigenous Australians, which include echocardiographic evidence of subclinical valvular disease, and polyarthralgia or aseptic monoarthritis as major manifestations. Clear guidance about treatment of ARF. Non-steroidal anti-inflammatory drugs should be withheld until the diagnosis is confirmed, and corticosteroids may be an option in severe acute carditis. Most cases of chorea do not require medication, but use of carbamazepine or sodium valproate is recommended if medication is needed. Clear guidance about dose, dosing frequency and duration of secondary prophylaxis. Benzathine penicillin G is the preferred medication for this purpose. Establishment of a coordinated control program for all regions of Australia where there are populations with high prevalence of ARF and RHD. Key elements and indicators for evaluation are recommended. Active screening and legislated notification of ARF and RHD, where possible. Development of a structured care plan for all patients with a history of ARF or with established RHD, to be recorded in the patient's primary health care record.     

聚合酶链反应检测宫颈糜烂患者单纯疱疹病毒感染

目的 :探讨宫颈糜烂患者单纯疱疹病毒 (HSV)感染情况。方法 :用聚合酶链反应检测宫颈糜烂患者和正常对照组单纯疱疹病毒感染情况。结果 :10 2例宫颈糜烂患者中 ,HSV- 1和 HSV- 2阳性率分别是 4 .9%和 30 .4 % ,正常对照组中 ,HSV- 1和 HSV- 2阳性率分别为 2 .7%和 12 .0 %。结论 :HSV感染与宫颈糜烂关系密切 ,且以 HSV- 2感染为主。     

风湿性心瓣膜病心房颤动患者心房组织纤维化重构与TGF-β1表达的相关性研究

目的 探讨风湿性心脏病(风心病)心房颤动(房颤)患者心房组织纤维化重构及其可能机制.方法 收集四川省宜宾市第二人民医院2013年10月至2015年10月风湿性心瓣膜病行二尖瓣置换术或先天性心脏病开胸修补术患者的临床资料和右心房组织标本,分为窦性心律组(RHD-SR组)、阵发性房颤组(RHD-pAF组)、持续性房颤组(RHD-cAF组),以行先天性心脏病开胸修补术且为窦性心律组(CHD-SR组).普通光镜下观察各组患者心房组织结构,苦味酸天狼猩红染色偏振光显微镜分析各组Ⅰ、Ⅲ型胶原容积分数(CVF)及Ⅰ/Ⅲ型CVF比值,Western blot及逆转录多聚酶链反应(RT-PCR)检测各组TGF-β1的表达.结果 RHD-cAF组患者左心房内径(LAd)明显大于RHD-SR组(P＜0.05),其余临床资料各组比较差异无统计学意义(P＞0.05).苦味酸天狼猩红染色提示胶原分布于心肌间质中,Ⅰ、Ⅲ型CVF及其比值在CHD-SR组、RHD-SR组、RHD-pAF组和RHD-cAF组逐渐升高,差异有统计学意义(P＜0.05).TGF-β1蛋白和mRNA的表达在CHD-SR组、RHD-SR组、RHD-pAF组和RHD-cAF逐渐增加.结论 心房组织纤维化重构是风湿性心瓣膜病患者房颤的重要机制,TGF-β1高表达可能参与心组织房纤维化重构.     

风湿性心脏病心房颤动患者心房附壁血栓危险因素的相关性研究

目的探讨风湿性心脏病(RHD)合并心房颤动(AF)患者心房附壁血栓形成的危险因素,为临床干预提供依据。方法将100例风湿性心脏病心房颤动患者按是否合并心房附壁血栓分为两个组,对相关因素进行回顾性分析研究。结果AF患者左房血栓的危险因素有:单纯二尖瓣狭窄;联合瓣膜病;左室射血分数的下降。结论左室射血分数的下降是RHD合并AF患者左房血栓形成的危险因素;单纯二尖瓣狭窄时二尖瓣关闭不全的存在使左房血栓形成的风险下降。     

风湿性心脏瓣膜病肝脏病理改变的临床意义

目的：探讨风湿性心脏瓣膜病（简称风心病）肝脏病理改变的临床意义。方法：选择风心病41例,其中合并三尖瓣关闭不全患30例,施行心脏瓣膜置换术,在体外循环建立前取肝组织活检,采用光学显微镜及H－800透视电镜检查。结果：风心病合并三尖瓣关闭不全,且有一定反流量患的肝脏典型病理改变主要表现为：（1）肝细胞间质改变：肝窦状隙淤血、扩张,肝纤维组织增生;（2）肝细胞改变：肝细胞肿胀,线粒体肿胀,嵴消失、肝细胞坏死。而且,本组患肝脏病理改变程度与三尖瓣反流量有关,反流量越大病理损伤越严重。结论：强调风心病合并三尖瓣关闭不全患应尽早手术,术中积极矫正三尖瓣关闭不全,是改善和恢复肝脏病理改变的重要措施。     

风湿性联合瓣膜病小主动脉瓣环的外科治疗

目的：探讨风湿性联合瓣膜病小主动脉瓣环的外科治疗手术技巧的临床意义。方法：对47例联合瓣膜病小主动脉瓣环者,常规建立体外循环,采用改良联合瓣膜替换方法,先替换主动脉瓣,再替换二尖瓣。结果：小主动脉瓣环者,在不拓宽主动脉瓣环的情况下,也能替换足够大口径的人造瓣膜,未出现瓣环周围组织撕裂出血、瓣周漏及主动脉切口出血。主要并发症有：低心排3例,肺部感染2例,多脏器功能衰竭3例,其中死亡1例,死亡率2．13％。超声心动图提示术后心功能均有明显改善,左心室较术前缩小。结论：小主动脉瓣环者,如果按照常规瓣膜替换顺序,将带来瓣膜座环困难、瓣周漏、主动脉切口出血等并发症。采用改良联合人造瓣膜替换方法,能避免常规瓣膜替换法的并发症,是处理小主动脉瓣环的一种安全有效的方法。     

呼吸道感染患儿快速A组β溶血性链球菌检测临床分析

目的:研究儿童A组β溶血性链球菌(GABHS)感染的情况,对快速GABHS抗原检测方法进行评价。方法:随机选择呼吸道感染患儿1485例,对其进行快速GABHS抗原检测,对部分阳性者进行青霉素类药物治疗1周后复查,并与抗链O及咽培养比较。结果:1485例呼吸道感染患儿中GABHS阳性率为23.2%(345例),主要为上呼吸道感染,下呼吸道感染则较少见。咽炎合并急性肾炎患者GABHS阳性率高达80%,与普通咽炎(21.6%)比较,P<0.01,有统计学意义,治疗1周后,复查抗链O阳性率改变较前无显著差异,GABHS抗原检测阳性率与咽培养无显著差异(P>0.05),抗原检测转阴率与临床症状转阴率无显著差异。结论:GABHS感染是小儿呼吸道感染疾病常见病因,常引起肾炎及风湿热等,快速GABHS抗原检测可作为其感染的诊断方法及疾病恢复的快速检测指标之一,对判断疾病转归很有帮助。     

Experience with cardiac valve operations in Cape York Peninsula and the Torres Strait Islands, Australia

OBJECTIVE: To describe the outcome of valve surgery, for rheumatic heart disease (RHD) and non-RHD, in residents of Cape York Peninsula and the Torres Strait Islands referred to the Cairns Base Hospital specialist outreach service. DESIGN AND PARTICIPANTS: Retrospective review of medical records on all patients residing in the outreach area who had surgery for valvular heart disease between 1 January 1992 and 31 December 2004. MAIN OUTCOME MEASURES: Operation type and perioperative characteristics; 5- and 10-year survival rates; reoperation rates; complications. RESULTS: Forty-seven patients met the selection criteria; the median age was 40 years (range, 4-76 years); and 39 patients were Indigenous. RHD was the predominant cause of valve dysfunction (30/47 patients). Thirty-seven patients had valve replacements, six had valve repair and four had balloon valvotomy as the initial procedure. There were three bleeding complications, two episodes of operated valve endocarditis, and six embolic complications. There were nine valve-related deaths (six in the first 5 years). At 5 years, all seven patients who had had valve repair or balloon valvotomy were alive. Seven of the 47 patients required reoperation. Survival analysis showed freedom from valve-related deaths to be 83% (95% CI, 66%-92%) at 5 years and 61% (95% CI, 33%-80%) at 10 years. Freedom from reoperation at 5 years was 88% (95% CI, 71%-95%). Among the 30 patients with RHD, freedom from valve-related death was 80% (95% CI, 60%-92%) at 5 years and 52% (95% CI, 21%-75%) at 10 years. In patients with RHD, freedom from reoperation at 5 years was 87% (95% CI, 65%-96%). CONCLUSION: Valvular heart disease results in substantial morbidity and mortality, despite intervention. Efforts need to focus on prevention of rheumatic fever and closer follow-up.     

风湿性心脏病患者心肌肌球蛋白轻链的变化

目的:研究风湿性心脏病(RHD)心衰时心室肌中肌球蛋白轻链(VMLC)的变化与心脏重塑的关系。方法:采用Western blotting技术对13例RHD心衰患者及7例意外死亡者VMLC-1,VMLC-2含量进行定量分析。结果:RHD组VMLC-1,VMLC-2含量均显著低于正常对照组,以VMLC-2含量下降最明显,VMLC-1/VMLC-2比值在1∶0.95-1∶0.61。结论:RHD心衰发展过程中涉及了VMLC-1,VMLC-2蛋白水平的改变,这种改变可能对心功能的进行性恶化有直接影响。     

One year echocardiographic study of rheumatic heart disease at Enugu, Nigeria

BACKGROUND: Rheumatic heart disease is one of the commonest causes of heart disease in Nigeria. Previous studies on rheumatic heart disease in Nigeria were either clinical or retrospective echocardiographic studies. This study was aimed at determining the burden of chronic rheumatic mitral valve disease, pattern of valvular involvement, severity and associated valvular lesions, using echocardiography. PATIENTS AND METHODS: Between May, 2004 and April 2005, patients with symptomatic rheumatic heart disease, seen in the cardiac clinics of University of Nigeria Teaching Hospital, Enugu, were recruited for the study. The patients were investigated non-invasively with M-mode, Two-dimensional, Pulsed wave, Continuous wave and colour flow Doppler echocardiographic techniques in order to assess the mitral and other intracardiac valves for evidence of rheumatic heart disease. RESULTS: There were a total of 55 patients, 39 (70.9%) females and 16 (29.1%) males with a mean age of 29.34 +/- 11.57 years. Mitral valve disease was found in 54 (98.2%) and isolated aortic valve disease in 1 (1.8%) of cases. Mitral regurgitation occurred in 64.8%, mixed mitral valve disease in 25.9% and pure mitral stenosis in 9.3%. Mitral valve disease was associated with aortic valve disease in 33.3%, with tricuspid valve disease in 24.1% and with functional pulmonary incompetence in 9.3% of cases. CONCLUSION: Rheumatic heart disease in Nigeria is essentially a disease of the mitral valve as seen elsewhere in the world. Echocardiography should be done routinely for patients with rheumatic heart disease to facilitate accurate diagnosis and definitive treatment.     

老年及老年前期风湿性心脏病的临床特点

目的：研究老年及老年前期风湿性心脏病的临床特点。方法：对５２例４５岁以上的风心病病人与同期５３例１４～４４岁的风心病病人的资料进行对比分析。结果：显示老年及老年前期风心病起病隐袭，有风湿史者少，风湿活动少，病程长，合并症多，瓣膜病变重，发生二尖瓣钙化的病例多，左房增大明显，发生持续性心房纤颤例数多，与对照组比较，差别显著或非常显著。结论：了解老年风湿性心脏病的临床特点，采取积极的治疗措施，将有助于改善患者的预后。