同型半胱氨酸与肺血栓栓塞症的关系

同型半胱氨酸（HCY）属于含硫氨基酸,其代谢酶或酶的辅助因子缺乏或功能下降,均会使HCY在血中升高,造成高同型半胱氨酸血症（HHCY）。目前多方面研究证实HHCY是肺血栓栓塞症的一个独立危险因素。本文现就HH-CY形成的原因及其与肺血栓栓塞症的关联性做一综述,旨在为临床及科研提供一个特异性和敏感性都较好的指标,为进一步探讨其在肺血栓栓塞症中的地位打下基础。     

肺血栓栓塞症并逆行血栓栓塞1例

1　病历介绍患者男性,5 0岁,因“右侧胸痛,伴气短、发热4 d”,于2 0 0 3年12月2 7日入院。患者5年前出现右下肢静脉曲张,并曾发生右下肢肿胀、疼痛。入院后检查:心率112次/ m in,呼吸35次/ min,血压为12 0 / 90 m m Hg( 1m m Hg=0 .133k Pa) ;颜面及口唇发绀;左肺呼吸音清晰,右下肺叩诊浊音、呼吸音消失,无口罗音;心界叩诊向右侧略扩大,胸骨左缘第二肋间可闻及低调舒张期杂音;左右下肢周径不等,右>左2 .0 cm,右侧腓肠肌有触痛,右下肢大隐静脉蛇状迂曲,有色素沉着。实验室检查:白细胞14 .8×10 9/ L,中性粒细胞0 .6 9,血红蛋白188g/ L,血沉…     

左心房血栓与血栓栓塞并发症

目的探讨二尖瓣狭窄合并左心房血栓患者的血栓栓塞发生率及其危险因素。方法观察 5 16例二尖瓣狭窄患者的一般资料、经食管超声心动图检查结果及血栓栓塞发生率 ,并予溶栓治疗和随访。结果二尖瓣狭窄患者在近期 ( 6个月内 )的血栓栓塞发生率为7.3 6% ,左房血栓患者、无左房血栓患者的近期血栓栓塞发生率分别为 2 8.40 %、3 .45 % ( P<0 .0 1)。窦性心律和二尖瓣口面积较大的左房血栓患者血栓栓塞发生率高。华法林治疗后 92 .11%的患者左房血栓溶解 ,随访 6～ 9个月血栓栓塞发生率为 1.3 2 %。结论二尖瓣狭窄合并左心房血栓患者的血栓栓塞发生率高 ;窦性心律和二尖瓣口面积较大的左房血栓患者易发生血栓栓塞。华法林治疗能溶解血栓和降低血栓栓塞发生率。     

血栓栓塞性疾病血栓前状态的实验室诊断

血栓栓塞性疾病是一组以血管内血栓形成或者栓子脱落栓塞到某处血管所引起的疾病。包括血栓性疾病与栓塞性疾病两大类。根据其形成部位可分为:动脉血栓(包括冠状动脉缺血性心脏病、急性心肌梗死和脑动脉血栓形成);静脉血栓(包括深静脉血栓形成如上肢、下肢、门静脉、盆腔等和浅静脉血栓形成);局部微血管血栓及弥漫性血管内凝血等。导致血栓栓塞的根本原因是血液的高凝状态,血管内形成血栓。据统计心脑血管疾病病死率逐年增高,为在血管事件发生前及早发现,提出了血栓前状态的定义及概念和血栓前诊断的问题。1　血栓前状态的定义血栓前状态(pr…     

肺血栓栓塞症的临床表现与诊断

１引言肺血栓栓塞症（肺栓塞）的临床表现多种多样，其主要取决于栓塞的肺段数、栓塞发生的速度及心肺的基础状态，可从临床上无症状到发生猝死，呈现复杂多变的临床表现，并且各种表现也缺乏特异性。肺栓塞的临床类型因分类方法不同而异，目的是便于临床医生对不同程度的肺栓塞采取相应治疗措施。肺栓塞的诊断主要依据临床症状、体征以及有关筛选检查和确诊检查来确定。２临床类型肺栓塞可按血栓大小、发生时间、临床可诊断范围及临床表现类型等进行分类。按血栓大小可分为大块血栓性肺栓塞（血栓堵塞区域性肺动脉分支以上的动脉）和微小血…     

心房颤动持续时间与左房血栓的发生关系

目的 评价心房颤动(房颤)持续时间与左心房血栓的发生关系.方法 111例经食管超声诊断的房颤患者分为阵发性房颤组、持续性房颤组、永久性房颤组,观察患者左房血栓的发生情况,统计分析房颤持续时间与左心房血栓的发生关系.结果 111例房颤患者均经食管超声检查,发现左心房血栓15例,占13.5%.阵发性房颤组、持续性房颤组、永久性房颤组的左心房血栓发生率比较差异无统计学意义,房颤病史与左心房血栓的发生无明显相关性.结论 房颤持续时间可能不是左心房血栓形成的主要因素.     

肺血栓栓塞病人护理

通过对6例肺血栓栓塞病例的治理处理，认为对有潜在PTE可能的患者应了解其病史，协助诊断或积极预防，监测心肺功能了解病情进展，保持稳定的心理状况，对容栓抗凝治疗应掌握指征，防止出血并发症，在日常工作中防止其高危因素形成。     

心房颤动患者血栓栓塞的防治

1引言 心房颤动是成年人最常见的心律失常,其发生率是所有其他心律失常总和的2倍.心房颤动的危害一是引起血流动力学障碍,二是心房、心室发生重构,三是增加血栓栓塞并发症.心房颤动合并血栓栓塞,尤其是脑栓塞,致残率和病死率较高,给患者本人、家庭和社会带来沉重的负担.本文重点阐述心房颤动患者血栓栓塞的防治.     

心房纤颤与动脉栓塞分析

探讨房颤形成附壁血栓，血栓脱落造成多脏器栓塞的防治方法。本文25例，采用低分子右旋糖酐及肝素钠左静脉滴注，肠溶阿斯匹林或华法令口服抗凝治疗，96％痊愈，4％死亡。建议早期预防栓塞，减少病死率，提高生活质量。     

风湿性二尖瓣狭窄并左房巨大血栓误诊1例

风湿性二尖瓣狭窄并左房巨大血栓误诊１例焦志俭巴彦县人民医院１５１８００１病历摘要患者男性，４３岁。９个月前患过“肺炎”，以后反复出现咳嗽，咳少许白粘痰，偶带血丝，伴心悸、气短。当地医院拟诊为“风湿性心脏病”。一个月前出现声嘶，伴周身浮肿，服用地高辛、...     

收缩期左房应变及应变率与阵发性房颤射频消融治疗效果的研究

【目的】用基于斑点追踪技术的应变及应变率来评价房颤患者左房机械功能,并探讨其与射频消融治疗效果的关系。【方法】对拟行射频消融治疗的42例阵发性房颤患者术前测量收缩期左房应变及应变率,追踪观察患者射频消融术治疗效果。分析收缩期左房应变及应变率与射频消融治疗效果的关系。【结果】42患者均顺利完成射频消融治疗,在3个月追踪期内13例患者出现房颤复发（33．3％）,余29例维持窦性心率。复发组年龄、性别比、左房内径、左房客积、左室射血分数与无复发组比较均无显著性差异（P〉0.05）;复发组左房收缩期总体应变及应变率均低于无复发组,其差异有统计学意义（P〈0.05）。【结论】收缩期左房应变及应变率与房颤患者射频消融术成功率有明显关系。     

Single Chamber Atrial Fibrillation Involving Only the Left Atrium:

KARCH, M.R., et al. : Single Chamber Atrial Fibrillation Involving Only the Left Atrium: Implications for Maintenance and Radiofrequency Ablation Therapy. Due to the anatomic and the functional interatrial relationship, AF is a biatrial process. Whether one of the atria could sustain AF is not known. This study included 11 patients (mean age   ^{± 1}   years, 7 men) with AF who showed a distinct activation pattern, characterized by regular activity in the right atrium (RA) and irregular fibrillatory activity confined to the left atrium (LA) throughout the AF episodes. Each of the atria was mapped with 64-electrode basket catheters. AF was monitored for   74 ± 26 minutes   . Complex and irregular activity with a cycle length of   138 ± 43 ms   was observed in the LA throughout the monitoring time. The posterior and the roof of the LA showed the highest degree of disorganization. RA was activated by regular wavefronts with a cycle length of   194 ± 22 ms   (   P < 0.001   , compared with LA). No fibrillatory activity was observed in the RA. All wavefronts that activated the RA were of septal origin: high anteroseptal 52%, low posteroseptal 22%, mid-septal 18, and dual wavefronts (from the high anteroseptal and low posteroseptal pathways) 8%. The lateral wall of the RA was activated in a superoinferior direction in 82% of all activations. A left-to-right conduction block during AF and a rotor of fibrillatory activity located in the posterior wall of the LA were observed in two patients. Isolated AF in the LA showed various surface electrocardiographic patterns. It is concluded that LA alone without participation of the RA can sustain AF. These data have implications for mechanisms and the ablative therapy of AF. (PACE 2003; 26[Pt. I]:883–891)     

Left Atrial Voltage during Atrial Fibrillation in Paroxysmal and Persistent Atrial Fibrillation Patients

Background: Left atrial (LA) endocardial voltage characteristics assessed during atrial fibrillation (AF) have not been previously compared in different AF types. This study was aimed at investigating the LA voltages and volumes in patients with paroxysmal and persistent AF. Methods: LA electroanatomic voltage maps acquired during AF were compared between consecutive patients without major structural heart disease undergoing first catheter ablation for paroxysmal AF (n = 100) or persistent AF (n = 100). The groups were comparable in baseline clinical characteristics. Results: Patients with persistent AF presented with lower median LA voltage (median 0.41, interquartile range [IQR] 0.31–0.51 mV versus median 0.99, IQR 0.47–1.56 mV; P < 0.001), and maximum LA voltage (4.07 ± 1.76 vs 6.42 ± 2.16 mV; P < 0.001). They also had a higher proportion of the LA points exhibiting voltage <0.2 mV (30 ± 20 vs 12 ± 11%; P < 0.001) and voltage 0.2–1.0 mV (55 ± 15 vs 42 ± 19%; P < 0.001). They further displayed higher LA volume/body surface area (75 ± 16 vs 58 ± 13 mL/m²; P < 0.001). In the multivariate regression model, both LA voltage (P < 10^?9) and LA volume (P < 10^?5) were significant determinants of AF type. Conclusion: Patients with persistent AF had significantly lower LA voltage compared with patients with paroxysmal AF even after adjustment for differences in indexed LA volume. LA voltage represents an independent covariate of clinical manifestation of AF. (PACE 2010; 541–548)     

左心房与阵发性房颤复发率的相关性研究

【目的】探讨左心房（LA）大小及功能对阵发性心房颤动（PAF）患者复发频率的影响。【方法】选取PAF患者167例,依据左室收缩末期左房内径（LAD）将患者分为LAD≥55mm、45mm≤LAD〈55mm、35mm≤LAD〈45mm、LAD〈35mm四组,分别测量左室舒张功能、左房收缩及舒张期容积、左房排空指数,随访PAF发作频率,并与上述指标进行相关性分析。【结果】四组PAF发生频率有明显差异,LAD增大PAF发作频率增加（P〈O．05）,左室舒张功能与PAF发作频率相关,左室舒张功能下降,AF发作频率增加（P〈0．05）。【结论】PAF患者,LAD增大、左室舒张功能下降,AF发作次数明显增加,LAD、左室舒张功能是PAF复发和维持的独立预测因子。     

Morphology-Enhanced Atrial Event Classification Improves Sensing in Pacemakers

BACKGROUND: In atrial-based pacing, appropriate therapy and reliable diagnostics depend on detection and discrimination of atrial signals. Accurate classification of atrial events is mainly confounded by oversensing of ventricular far-field R-wave signals (FFRW), but attempts to reject FFRWs by manipulating atrial sensitivity and/or postventricular atrial blanking period (PVAB) may result in undersensing (especially of atrial fibrillation, AF) or in 2:1 atrial flutter detection. The objective of this study is therefore to evaluate if such methods can be improved by morphology-enhanced atrial event classification (MORPH). METHODS: Twenty-four-hour ambulatory atrial electrograms were recorded from continuous telemetry of digital pacemakers. Half of the recording was used for collecting two individual morphology parameters that discriminated P-waves from FFRWs in every patient (learning phase). The other half was used to test the MORPH algorithm against traditional methods (classification phase). RESULTS: In 44/48 patients, data were suitable for analysis. Average P and FFRW amplitudes were 1.96 mV versus 0.61 mV (P < 0.001). The interval between ventricular events and FFRW oversensing (VA interval) averaged at 14 ms during sensing and at 118 ms during pacing in the ventricle. Compared to nominal ("Factory") settings, the MORPH algorithm improved the sensitivity for P-wave recognition from 97.2% to 99.2%, the specificity from 91.9% to 99.96%, and the accuracy from 95.3% to 99.4% (P < 0.01 for all). CONCLUSIONS: By improving atrial signal discrimination, morphology analysis of atrial electrograms allows for high atrial sensitivity settings, and potentially improves the reliability of atrial arrhythmia diagnostics in heart rhythm devices.     

非风湿性心房纤颤患者左心耳及左房功能的超声研究

目的： 了解非风湿性心房纤颤患者的左心耳及左房功能改变的特点。方法： 分析了２７ 例患者左心耳和左房的超声表现。结果： 左心耳血流频谱可为两种： 清晰型 （峰速≥２５ｃｍ ／ｓ） 占 ４０．８％ （１１／２７）, 模糊型 （峰速＜ ２５ｃｍ ／ｓ） 占５９．２％ （１６／２７）。与清晰型相比, 频谱模糊型患者的左心耳充盈血流峰速、排血峰速及左心耳面积变化率显著减小, 左心耳内径及面积增大, 自发性超声对比 （ＳＥＣ） 现象检出率显著增高 （Ｐ＜ ０．０５）, 且４ 例患者发现血栓。而两型间的左房功能无显著性差异。结论： 非风湿性房颤患者的左心耳功能改变有其特点, 超声了解之有助临床预测血栓形成及指导治疗。     

实时三维超声心动图定量冠心病、扩张型心肌病心房和心室容积及功能的研究

目的应用实时三维超声心动图(RT-3DE)定量评价冠心病、扩张型心肌病患者左心室、左心房、右心室和右心房容积及收缩功能。方法在24例正常人、16例扩张性心肌病和27例心肌梗死患者中,应用实时三维超声心动图获取各房室全容积三维图像,分别应用2、4、8平面方法测量各房室收缩末期容积(ESV)、舒张末期容积(EDV)和射血分数(EF),并与二维超声心动图(2DE)Simpson法和声学定量(AQ)技术测值比较。结果在扩张性心肌病和心肌梗死患者中,2DE、AQ技术和RT-3DE2平面法测量的左、右心房和左、右心室ESV、EDV明显低于RT-3DE4平面法、8平面法测值(P<0.05);各种方法检测的EF值差异无统计学意义(P>0.05)。2DE、AQ技术和RT-3DE检测结果均显示扩张性心肌病、心肌梗死患者各房室ESV、EDV均明显大于正常组(P<0.05),EF明显低于正常组(P<0.05)。结论应用实时三维超声心动图能显示心腔立体结构,测量各心腔容积,评价心脏功能。     

房间隔缺损时左房扩大的机理探讨

本文应用日本ＡｌｏｋａＳＳＤ－８６０及美国ＨＰＳＯＮＯＳ１０００彩色多普勒超声心动图诊断仪，对５０例被手术证实的房间隔缺损患者及１００例正常对照的左右心腔及大血管内径和血流频谱进行了系统观察，结果发现：房间隔缺损时不仅右心系统血容量增大，而且左房扩大，其左房的大小与心房水平的左向右分流量密切相关，ｒ＝０．８０７，与肺体循环血量相比，ｒ＝０．６１１，与房间隔缺损的大小相比，ｒ＝０．５１４。