心脏磁共振对心房颤动射频消融术后早期复发的预测价值

目的观察心房颤动患者射频消融术后心电图、心脏三维超声、心脏磁共振(cardiac magnetic resonance, CMR)的参数变化,探讨CMR对心房颤动患者射频消融术后早期复发的预测价值。方法接受射频消融术治疗的心房颤动患者66例,根据是否早期复发分为复发组35例和无复发组31例。比较2组心电图、心脏三维超声及CMR测量指标;多因素logistic回归分析心房颤动患者射频消融术后早期复发的影响因素;绘制ROC曲线,评估左心房容积指数及左心房存储期应变力对心房颤动患者射频消融术后早期复发的预测价值。结果复发组持续性心房颤动比率(60.00%)高于无复发组(35.48%)(P<0.05),心脏三维超声测量的左心房上下径[(5.91±0.64)cm]、左心房左右径[(4.65±0.54)cm]及CMR测量的左心房容积指数[(59.77±12.18)mL/m²]均大于无复发组[(5.54±0.52)cm、(4.13±0.37)cm、(53.78±11.23)mL/m²](P<0.05),CMR测量的左心房存储期应变力[(32.1...     

左心室舒张功能对射频消融术后心房颤动复发的影响

目的探讨左心室舒张功能评估射频消融术后心房颤动复发的价值。方法首次行射频消融治疗孤立性心房颤动患者47例,根据左心室舒张功能分为舒张功能正常组33例和舒张功能不全组14例,随访观察2组射频消融术后心房颤动复发情况。结果随访6个月,3例失访,28例维持窦性心律(无复发组),16例心房颤动复发(复发组),其中舒张功能不全组复发率85.7%(12/14),舒张功能正常组复发率12.1%(4/33),差异有统计学意义(P0.05);术后6个月复发组左心房前后径指数[(24.60±2.50)mm/m2]、左心房容积指数[(37.22±11.47)mL/m2]、二尖瓣血流频谱E峰速度[(94.25±19.19)cm/s]、术前E/e(10.75±4.29)、肺静脉D峰速度[(66.20±17.05)cm/s]高于无复发组[(23.20±2.10)mm/m2、(31.82±8.43)mL/m2、(80.98±14.48)cm/s、7.84±1.79、(45.46±6.28)cm/s](P均0.05);复发组术前左室射血分数[(53.97±8.27)%]低于无复发组[(58.62±7.54)%](P0.05);logistic多因素分析显示,术前E/e是射频消融术后心房颤动复发的独立危险因素(OR=1.145,95%CI:1.03~1.29,P=0.045)。结论心房颤动患者射频消融术前舒张功能状态与术后6个月心房颤动复发有关。     

阵发性心房颤动患者射频消融术后心房颤动晚期复发的相关因素

目的探讨阵发性心房颤动患者射频消融术后心房颤动晚期复发的相关因素。方法收集接受三维电解剖标测系统指导下射频消融手术治疗的阵发性心房颤动患者80例,对其年龄、左房内径、术后48h内心房颤动复发及术中电复律等情况进行多因素分析,寻找心房颤动晚期复发的相关因素。结果80例患者接受82次心房颤动射频消融手术;在术后12个月的随访期内,共有25例患者心房颤动晚期复发。组间比较显示年龄、左房内径及术后48h内心房颤动复发两组之间差异有统计学意义;多元Logistic回归分析提示术后48h内心房颤动复发是阵发性心房颤动射频消融术后心房颤动晚期复发的临床预测指标（OR=3．861,95％CI=1．142～13．056,P=0．03）。结论术后48h内心房颤动复发是阵发性心房颤动射频消融术后心房颤动晚期复发的临床预测指标,术后48h内心房颤动复发患者晚期复发率增高。     

心房颤动患者血清miR-29b和miR-135b水平表达与心房纤维化程度及射频消融术后复发的相关性研究

目的 观察心房颤动（atrial fibrillation,AF）患者血清微小核糖核酸（micro RNA,miRNA,miR）-29b和miR-135b的表达变化,探讨二者表达与心房纤维化程度及射频消融术后复发的关系。方法 选取2019年7月～2022年7月于沧州市人民医院心血管内科住院诊治并接受射频消融术治疗的AF患者（病例组,n=158）以及同期体检的健康者（对照组,n=126）。收集AF患者的一般临床资料及生化指标,采用实时荧光定量PCR法检测血清miR-29b和miR-135b相对表达水平。采用多因素Logistic回归分析AF患者术后复发的影响因素;绘制受试者工作特征（receiver operating characteristic,ROC）曲线分析血清miR-29b和miR-135b水平对AF患者术后复发的预测价值,曲线下面积（area under the curve,AUC）比较采用Z检验。结果 与对照组比较,病例组血清miR-29b(0.64±0.13 vs 1.04±0.24)和mi R-135b水平（0.45±0.08 vs 1.00±0.14）均降低,差异均有...     

阵发性心房颤动射频消融术后复发的因素探讨

目的探讨阵发性心房颤动患者射频消融术后复发的因素。方法选取接受三维电解剖标测系统指导下行阵发性心房颤动射频消融手术治疗的患者117例,随访(24.6±2.91)个月,根据术后心房颤动是否复发分为复发组和未复发组,分析其术前临床资料,行多因素Logistic回归分析。结果共有117位患者完成术后随访,术后复发共43例(36.7%),组间比较显示体质量指数、合并高血压、心房颤动病程、左房内径、高密度脂蛋白、尿酸水平两组间差异有统计学意义,多元Logistic回归分析显示,心房颤动病程(P=0.000;OR:1.344;95%CI:1.164~1.552)、高密度脂蛋白(P=0.017;OR:0.060;95%CI:0.006~0.601)、尿酸(P=0.000;OR:1.009;95%CI:1.004~1.014)。结论心房颤动病程、高密度脂蛋白和血尿酸水平是阵发性心房颤动患者射频消融治疗术后复发的独立预测因素。     

高龄心房颤动患者射频导管消融术后复发高危因素分析与护理对策

目的探讨高龄心房颤动患者射频消融术后复发高危因素与护理对策。方法采用随机抽样法,选择2017年1月至2018年11月在我院心内科行射频导管消融术的高龄心房颤动患者228例作为研究对象,于术后1年进行门诊复查或电话随访,收集患者主诉与24 h动态心电图监测结果,观察患者心房颤动复发情况。采用logistic回归分析术后心房颤动复发的高危因素,并给予针对性护理措施。结果本组术后心房颤动复发62例,复发率为27.19%。多因素logistic回归分析显示,肥胖(OR=4.406)、合并高血压(OR=6.449)、合并糖尿病(OR=4.816)、合并睡眠呼吸暂停综合征(OR=5.737)、左心房内径扩大(OR=4.773)是影响老年心房颤动患者术后复发的高危因素。结论明确高龄心房颤动患者射频导管消融术术后复发的高危因素,为降低消融术后心房颤动复发率、提高患者生命质量提供理论依据。     

术前血清可溶性ST2水平对心房颤动射频消融术后复发的预测价值研究

目的 探究术前可溶性生长刺激表达基因2(soluble growth stimulation expressed gene 2,sST2)蛋白对心房颤动射频消融术后复发的预测价值。方法 选择2019年12月～2021年9月于佛山市第一人民医院行射频消融术治疗的心房颤动患者作为研究对象,根据术后复发情况,将患者分为复发组（41例）和非复发组（79例）。比较两组患者的一般资料、心脏彩超检查指标及血液生化指标,多因素Logistic回归分析影响患者术后复发的因素;受试者工作特征曲线（ROC）评价术前sST2对患者术后复发的预测价值并获得最佳临界值,根据临界值将患者分为sST2低表达组和高表达组,Kaplan-Meier法绘制生存曲线比较两组患者的术后复发情况;Pearson检验分析术前sST2与其它危险因素的相关性;构建反向传播（back propagation,BP）神经网络模型,评价其预测效能。结果 左房内径（left artrial diameter, LAD）增加、血清尿酸（uric acid, UA）升高、氨基末端脑钠肽前体（N-terminal pro-brain natriur...     

血清Hcy和BNP水平对心房颤动患者射频消融术后复发的预测价值

目的:探究血清同型半胱氨酸(homocysteine,Hcy)、脑钠肽(brain natriuretic peptide,BNP)水平对心房颤动(atrial fibrillation,AF)患者射频消融术后复发的预测价值。方法:选择2016年1月至2018年10月成都市龙泉驿区第一人民医院心内科收治的95例AF患者为AF组,选择同期体格检查健康的成年人为对照组。两组受试者均于入院后测定血清Hcy和BNP水平,AF组接受射频消融术后进行为期12个月的随访,统计复发情况,分析AF患者复发的危险因素及血清Hcy和BNP的预测价值。结果:AF组患者血清Hcy和BNP水平显著高于对照组受试者(P0.05)。AF患者术后随访复发32例,复发率为33.68%;经比较,复发组患者高血压、糖尿病比例显著高于未复发组(P0.05);左心房直径、血清Hcy和BNP水平显著高于未复发组,差异具统计学意义(P0.05)。Logistic多因素分析示:在矫正其他影响因素后,高血清Hcy和BNP水平是AF患者射频消融术术后复发的独立危险因素(P0.05)。血清Hcy和BNP预测复发的曲线下面积(area under the area,AUC)分别为0.774,0.828,预测最佳截点值分别为2 5.7μmol/L, 7 8.4p g/mL;两者联合预测复发的曲线下面积为0.865。结论:血清Hcy和BNP水平与AF患者射频消融术后复发相关,临床可根据截点值筛选复发高风险人群,进行病情检测及早期干预。     

P波离散度预测阵发性心房颤动射频消融术后复发的价值

【目的】探讨阵发性房颤射频消融术后复发的预测因素。【方法】145例行环肺静脉导管射频消融术的阵发性房颤患者,记录术前及术后心电图,测量最大、最小P波时限,计算P波离散度。【结果】术后平均随访（6．1±0．2）个月,根据是否复发房颤分为复发组51例和未复发组94例。复发组较未复发组的术前最大P渡时限增大[（120．2±11．0）ms比（105．6±7．8）ms,P〈0．001];P波离散度明显增大[（53．6±6．2）ms比（39．9±4．7）ms,P〈0．001];两组P波最小时限及其他临床指标均无统计学差异。多因素分析示术前P波离散度≥46ms（P=0．04）和发作频率≥5次／月（P=0．01）是房颤复发的预测因素,二者预测复发的灵敏度分别是87％和86％;特异度92％和85％。【结论】术前P波离散度及房颤发作频率一定程度上可预测阵发性房颤射频消融术后的复发。     

P波离散度与阵发性房颤经导管射频消融术后复发的关系

目的：探讨P波离散度与阵发性房颤经导管射频消融术后房颤复发的关系。方法：78例初次行导管射频消融治疗的阵发性房颤患者,消融术式为电解剖标测系统加单环状标测电极指导下的环肺静脉线性消融术。测量术前体表心电图各导联的P波时限,计算P波离散度。结果：术后随访32．9±4．8个月,有效组64例,复发组14例。复发组术前的P波离散度（46．2±11．8ms）较有效组（37．4±14．2ms）大（P〈0．05）。若以40ms为界值,术前P波离散度预测术后房颤复发的敏感性为86％,特异性为59％。其他的临床及心电图指标在两组间无显著差异。结论：经导管射频消融治疗阵发性房颤的疗效肯定,复发组患者术前的P波离散度明显大于非复发组,术前P渡离散度对术后房颤的复发有一定预测价值。     

Use of crystepin in combination with obsidan in patients with diabetes mellitus with arterial hypertension

Examination included 70 patients with diabetes mellitus in combination with arterial hypertension of different origin (II stage essential hypertension and symptomatic renal arterial hypertension). Crystepin (2-3 tablets per 24 h) in combination with beta-adrenoblocker obsidan (40-80 mg/24 h) was used for treatment. Basic hemodynamic parameters and the state of the renin-aldosterone system were determined. The hemodynamic hypotensive effects in these patients due to the influence of the above therapy are uniform and depend on the form of attendant arterial hypertension. The hypotensive effect of crystepin used in combination with obsidan was more pronounced in patients with diabetes and II stage essential hypertension than that in those with diabetes and renal hypertension. The concentration of aldosterone and renin activity of blood plasma in patients with diabetes and arterial hypertension during treatment with crystepin and obsidan had no regular connection with the hemodynamic parameters.     

硝酸甘油联合托拉塞米在高血压危象并发急性肺水肿患者的应用

目的研究硝酸甘油联合托拉塞米治疗高血压危象合并急性肺水肿的效果。方法选取我院收治的高血压危象合并急性肺水肿患者80例作为研究对象。随机分为对照组40例,采用托拉塞米治疗;试验组40例,采用硝酸甘油联合托拉塞米治疗。比较两组患者治疗效果、临床指标改善程度及并发症发生率。结果治疗后对照组患者血压、呼吸频率及氧分压改善程度均低于试验组,且治疗有效率(77.5%)低于试验组(92.5%),差异显著(P0.05);对照组患者并发症发生率(20.0%)高于试验组(7.5%),差异显著(P0.05)。结论采用硝酸甘油联合托拉塞米在治疗高血压危象合并急性肺水肿安全性高,可减少并发症,改善治疗效果,提高患者生活质量。     

Satisfaction with upper-extremity surgery in individuals with tetraplegia

OBJECTIVE: To measure the satisfaction of individuals with tetraplegia with their upper-extremity reconstructive surgery. DESIGN: Survey. SETTING: Two Spinal Cord Injury Model Systems centers. PARTICIPANTS: Sixty-seven individuals with spinal cord injury at the C4 through C8 motor level (107 arms). INTERVENTIONS: Participants had upper-extremity surgery to improve function. The surgical procedures included tendon transfers for elbow extension, wrist extension, hand grasp, and pinch or hand grasp neuroprosthesis. MAIN OUTCOME MEASURE: A survey was mailed to participants, who were asked to respond to statements such as, "If I had it to do over, I would have the hand/arm surgery again," using a 5-level Likert scale (ranging from strongly agree to strongly disagree). RESULTS: Seventy percent of the participants were generally satisfied with the results of their upper-extremity surgery, 77% reported a positive impact on their lives, 68% reported improvements in activities of daily living (ADLs), 66% reported improved independence, 69% reported improvement in occupation, 71% reported improved appearance or neutral, 78% reported their hand worked as well (or neutral) as it did when surgery was first performed, and 86% reported postoperative therapy as being beneficial. CONCLUSIONS: Upper-extremity surgery had a positive impact on life, increased ability to perform ADLs and to be independent, and improved quality of life.     

Observations with Rabenid in patients with locomotor disease

By examining 139 patients suffering from locomotor diseases the author could observe the characteristic accompanying diseases as well as high uric acid level in 40 cases. She analyses the current opinions on hyperuricaemia and reports on her observations with uricosuric and antithrombotic coated Rabenid tablet (RG). She found sulfinpyrazone to be effective and valuable in the examined indication field.     

休克状态下PSVT多种药物转复成功1例

1 临床资料 患者女，77岁，主因心慌、乏力、大汗六小时就诊。查体，急性面容，血压波动在70～86/37～54mmHg；心率：160次/分；呼吸：26次/分；口唇紫绀，双肺呼吸音清；心率齐，心电图示阵发性室上心动过度，无预激综合症和房颤；血生化示电解质正常。     

Changes in myocardial function in patients with hypertension during treatment with minipress

Altogether 33 patients with arterial hypertension were investigated to study changes of left ventricular systolic phasic analysis, caused by prazosin therapy. Two groups were identified on the basis of these changes: indices in the 1st group (intrasystolic index, myocardial tension index, Blumberger coefficient) improved, in the 2nd group they deteriorated. The antihypertensive effect of prazosin should be assessed not only by the level of BP reduction but also by changes of left ventricular systolic phasic analysis. In the deterioration of indices of left ventricular systolic phasic analysis during a test with single administration of prazosin, antihypertensive therapy should be reconsidered.