高血压病患者左房容积改变及其影响因素

应用二维超声心动图,采用双平面面积长度法,测定65例高血压病患者及40例正常人的左房最大容积(MAXV)、左房容积指数(MAXVI)。结果显示,高血压病患者MAXV和MAXVI较正常人显著增大(P<0.001)。对导致高血压病患者左房容积改变的可能因素进行研究分析,发现高血压病患者左房容积增大与左室重量指数(LVMI)、年龄、体循环舒张压有关。     

普罗帕酮与毛花苷丙治疗快速心房颤动的疗效比较

目的比较静脉应用普罗帕酮与毛花苷丙治疗快速心房颤动(简称房颤)并发充血性心力衰竭(心衰)患者心室率的即时效应及安全性.方法46例房颤患者,心室率≥120次/min,心功能Ⅱ级以上(NYHA).采用随机方法分组,分别静脉应用普罗帕酮与毛花苷丙.结果普罗帕酮、毛花苷丙组控制房颤快速心室率的总有效率分别为810%和609%(P＜005);心室率平均下降幅度分别为35%和25%(P＜001);平均起效时间分别为(231±82)min和(507±104)min(P＜001).普罗帕酮有1例出现症状性低血压,1例出现第一度房室传导阻滞,无心衰加重表现.结论静脉应用普罗帕酮能迅速、安全、有效地控制房颤并发充血性心衰患者的快速心室率.     

浅低温心脏跳动下房、室间隔缺损修补术56例临床分析

目的探讨浅低温体外循环心脏跳动下房、室间隔缺损修补术的应用前景.方法应用浅低温心脏跳动下心内直视手术方法,对先天性心脏病房间隔缺损15例及室间隔缺损(室缺)41例患者施行房、室间隔缺损修补术.结果全部患者手术过程顺利,术中未出现心室颤动,术后胸腔引流量少,未发生严重心律失常、低心排血量综合征、空气栓塞等并发症.结论本方法避免了主动脉阻断所引起的心肌缺血、缺氧和再灌注损伤以及心脏局部冰屑及冷停跳液所致的物理性损伤,是一种较接近生理状态的心肌保护法,能较好地保护心肌功能,手术操作简单,能清楚地发现隐匿及多发性室缺,降低残余漏;避免传导系统的损伤;在做好排气措施下,是一种安全可行的方法.     

HEART RATE VARIABILITY AND LEFT VENTRICULAR DIASTOLIC FUNCTION IN PATIENTS WITH BORDERLINE HYPERTENSION WITH AND WITHOUT LEFT VENTRICULAR HYPERTROPHY

The relationships between heart rate variability (HRV), left ventricular mass and diastolic function in borderline hypertensive patients (BHT) were evaluated. 24 h Holter electrocardiogram (ECG) and blood pressure (BP) monitoring, M and 2 D echocardiogram and Doppler analysis in 42 BHT with and without left ventricular hypertrophy (LVH) and in 20 normotensive controls were assessed. From 24-h ECG, time domain indexes of HRV were calculated. Standard Deviation of all Cycles (SDNN) and Standard Deviation of the means of heart periods over five-minute intervals (SDANN) were significantly reduced in BHT with LVH but not in BHT without LVH. No significant differences of short-term variability measures were detectable, although a progressive decrease among control subjects and BHT with and without LVH was observed.

Diastolic left ventricular compliance evaluated by early to late transmitral flow velocity ratio (E/A ratio) significantly declined from normotensive subjects to BHT with LVH. There was a significant positive correlation between E/A and SDNN and SDANN throughout all studied groups. This indicates that BHT with LVH has a reduced HRV compared to other groups. This impairment is probably related to left ventricular mass and left ventricular filling abnormalities.