心房颤动患者血浆C反应蛋白浓度的变化研究

目的探讨C反应蛋白（CRP）作为系统因子在心房颤动的发生与维持中的变化及意义。方法用酶联免疫吸附双抗体夹心法（hsCRP ELLSA）对21例孤立性阵发性房颤者（LPAF）分别于房颤发作及终止后1周测定外周静脉血浆CRP浓度，并与28例孤立性持续性房颤（LSAF）、27例风心病二尖瓣狭窄伴持续性房颤（RHD）、32例阵发性室上性心动过速（PSVT）及20例健康对照组相比较。结果LB心病人房颤发作时及终止后，LSAF和RHD组病人血浆CRP浓度较PS、丌及正常对照组明显上升。LPAF病人房颤发作时血浆CRP浓度与房颤发作持续时间呈正相关，与患者年龄、性别及左心房内径无关。而PSVT时血浆CRP浓度与心动过速持续时间无明显相关性。结论炎症反应可能参与孤立性房颤的发生与维持。     

心房颤动患者血浆纤维蛋白原、D-二聚体浓度及t-PA活性变化的研究

目的　研究心房颤动 (房颤 )病人血液纤溶系统功能改变 ,探讨房颤引起血栓前状态的原因。方法　用散射比浊及酶联免疫吸附双抗体夹心法对 2 1例孤立性阵发性房颤 (LPAF)患者分别于房颤发作时及终止后 1周、2 8例孤立性持续性房颤 (LSAF)、2 7例风心病二尖瓣狭窄伴持续性房颤 (RHD)测定外周静脉血浆纤维蛋白原 (Fib)、D -二聚体 (D -D)浓度及组织型纤溶酶原激活物 (t-PA)活性变化 ,并与 32例阵发性室上性心动过速 (PSVT)及 2 0例健康志愿者相对照。结果　LPAF组患者房颤发作时、LSAF和RHD组病人 ,反映纤溶功能的血浆Fib、D -D浓度比房颤终止后1周、PSVT、正常对照组明显上升 ,而血浆t-PA活性无明显改变。LPAF组患者房颤发作时血浆Fib含量与房颤持续时间呈正相关。结论　无论是孤立性房颤还是器质性心脏病房颤 ,无论是持续性房颤还是阵发性房颤发作时都存在纤溶系统功能的低下。     

心房颤动患者血浆C反应蛋白水平变化的临床研究

目的探讨C反应蛋白(CRP)在心房颤动(AF)的发生与维持中的变化从而了解其相关性。方法对32例阵发性AF患者分别于发作时及终止后1周、26例持续性AF患者分别于发作时及发作2周时测外周静脉血浆CRP浓度,与30例同期住院体检者作对照,进行统计学分析。结果AF组患者AF发作时血浆CRP浓度(阵发性AF组16.8±5.1mg/L、持续性AF组21.1±5.9mg/L)比正常对照组(2.3±1.1mg/L)明显升高,P<0.01,且升高持续至AF终止后1周或持续发作2周时;在AF组中,持续性AF组CRP浓度显著高于阵发性AF组,P<0.01。结论CRP增高反映的炎症状态可能与AF的发生与持续性密切相关。     

心房颤动患者血浆C反应蛋白水平变化的临床研究

目的探讨C反应蛋白（CRP）在心房颤动（AF）的发生与维持中的变化从而了解其相关性。方法对32例阵发性AF患者分别于发作时及终止后1周、26例持续性AF患者分别于发作时及发作2周时测外周静脉血浆CRP浓度，与30例同期住院体检者作对照，进行统计学分析。结果AF组患者AF发作时血浆CRP浓度（阵发性AF组16．8&#177;5．1mg／L、持续性AF组21．1&#177;5．9mg／L）比正常对照组（2．3＋1．1mg／L）明显升高，P〈0．01，且升高持续至AF终止后1周或持续发作2周时；在AF组中，持续性AF组CRP浓度显著高于阵发性AF组，P〈0．01。结论CRP增高反映的炎症状态可能与AF的发生与持续性密切相关。     

阵发性室上性心动过速27例治疗体会

阵发性室上性心动过速(PSVT)是临床上常见的心律失常,可见于有或无心脏病病人,其临床特点是突然发生,突然终止,频率一般是150～220次/min,心房内刺激及房(室)性早搏可诱发或终止发作。     

食管心房调搏诊断及终止阵发室上心动过速31例

目的:总结食管心房调搏诊断及终止阵发性室上性心动过速(PSVT)31例体会.方法:回顾性分析31例阵发性室上性心动过速的临床资料.结果:31例均行食管心房调搏明确诊断及终止,其中房室结内折返性心动过速(AVNRT)16例,房室折返性心动过速(AVRT)15例,1例AVNRT终止无效.无明显副作用.结论:食管心房调搏诊断及终止阵发性室上性心动过速简单易行、安全可靠.     

50例室上性心动过速病因探讨

阵发性室上性心动过速(Paraoxysmal supraventricular (?)acnycardia, PSVT),临床较为多见,病人多有心悸、胸闷、气短、恐惧不安等症状,PSVT是一种阵发性快速而规则的异位心律,其特征是突然发作和突然终止,严重时可引起血压下降或心力衰竭,亦可危及生命。PSVT是心脏急症之     

心房颤动患者血清C反应蛋白水平的临床观察

目的:观察不同类型房颤患者清C反应蛋白(CRP)水平,探讨其与房颤的关系及临床意义.方法和结果:选择住院房颤患者共82例,其中阵发性房颤30例,持续性房颤27例,永久性房颠25例,及正常人对照组30例.阵发性房颠组CRP水平低于持续性房颤组的(P<0.05),持续性房颤组低于永久性房颠组(P<0.05),所有房颤组CRP水平均高于对照组(P<0.01).结论:房颤的发生与发展可能与炎症导致心房肌的重构与纤维化有关.     

阵发性室上性心动过速的应急治疗

阵发性室上性心动过速(PSVT)是一种最常见的阵发性心动过速,多发于心脏正常的年轻人。发作起始与终止都很突然,每次发作可持续几分钟至几小时或数天。心率每分钟140～240之间,通常为170～220,平均为200左右,且心律完全规则,多数患者发作能自行停止,一般无明显症状,仅觉心悸、心跳快速。假如发作持续时间长,可有胸闷、紧迫     

血清C反应蛋白水平与心房颤动复律后早期复发的关系

目的探讨C反应蛋白(CRP)水平与心房颤动复律后早期复发的关系。方法45例孤立性房颤患者经电复律后即刻抽取静脉血检测其CRP水平,随访30天,观测CRP水平在维持窦性节律患者与房颤复发患者中的差异。结果18例患者30天房颤复发,27例患者继续维持窦性节律。房颤复发组平均CRP水平(5.89±0.85)mg/L明显高于窦性节律组(2.59±0.51mg/L),P<0.01。结论孤立性房颤患者复律后,其血浆中CRP水平是复律后再复发的危险因素,提示炎性因子在心房重塑过程中起重要作用。     

心房颤动120例临床分析

目的分析心房颤动的病因,临床特点。方法对我院1999~20004年120例心房颤动患者的临床资料进行回顾性分析。结果120例患者中阵发性、持续性和持久性房颤分别占31例(25.8%)、24例(20.0%)、65例(54.2%);最常见为冠心病、高血压、风湿性心脏病分别占31.7%、24.2%、18.3%;应用抗血栓治疗患者87例(72.5%),120例患者中发生动脉栓塞25例(20.8%),脑栓塞18例(15.0%)。阵发性房颤多采用复律治疗(62.6%),以胺碘酮为主(71.0%),心律平(19.0%);慢性房颤患者,试行复律者不足1/2,主要采用控制心室率治疗(87.0%),药物主要有地高辛(42.0%)、β-受体阻滞剂(38.0%)和钙离子拮抗剂(20.0%)。结论房颤常见病因是冠心病、高血压、风湿性心脏病,栓塞是其重要并发症,预防卒中,高危组需用华法林,低危组可用阿司匹林。     

双极射频消融迷宫术在治疗风湿性心脏瓣膜病合并心房颤动中的疗效观察

目的 探讨风湿性心脏瓣膜病合并心房颤动患者在行瓣膜替换术的同时行双极射频消融迷宫术的疗效.方法 选取风湿性心脏瓣膜病合并心房颤动患者15例(治疗组),在行瓣膜替换术的同时行双极射频消融迷宫术治疗心房颤动.同期随机选择15例仅行心脏瓣膜替换术而未行双极射频消融迷宫术的患者作为对照组.对两组患者的治疗结果进行比较.结果 治疗组15例患者术后全部恢复窦性心律.随访6个月,14例维持窦性心律,1例偶发阵发性心房颤动.对照组13例术中心脏复跳后即为心房颤动心律,2例心脏复跳后为窦性心律,分别在术后1、2 d后转为心房颤动心律,应用胺碘酮均不能恢复窦性心律.两组术后左房内径、左室收缩末期内径、左室舒张末期内径、心胸比率均较术前显著降低(P＜0.01),左室射血分数较术前显著增加(P＜0.05).治疗组术后左房内径及心胸比率显著低于对照组术后[(31.06±2.28)mm比(36.16±2.23)mm,t=11.645,P=0.002;(50±9)%比(56±10)%,t=8.052,P=0.008].结论 风湿性心脏瓣膜病合并心房颤动患者在行瓣膜替换术的同时行双极射频消融迷宫术疗效较好,操作简便,耗时短.     

Health-related quality of life in different clinical subgroups with typical AFL who have undergone cavo-tricuspid isthmus ablation

ABSTRACT: BACKGROUND: To evaluate changes in health-related quality of life (HRQOL) in different sub-groups of a cohort of patients with typical atrial flutter (AFL) treated with cavotricuspid isthmus (CTI) radiofrequency catheter ablation. METHODS: 95 consecutive patients due to undergo CTI ablation were enrolled in a study involving their completion of two SF-36 HRQOL questionnaires, before ablation and at one-year follow-up. RESULTS: 88 of the initial 95 patients finished the study. Regardless of whether patients experienced atrial fibrillation (AF) during follow-up, a statistically significant improvement in HRQOL was observed, compared with pre-ablation scores and in all dimensions except Bodily Pain. However, patients without AF during follow-up had significantly higher absolute HRQOL scores in most dimensions. No differences were seen in most HRQOL dimensions, with respect to AFL type (paroxysmal, persistent) or duration, whether AFL was first-episode or recurrent, Class I-III drug dependent, sex, or presence of structural heart disease or tachycardiomyopathy. Patients with persistent AFL showed the greatest improvement in HRQOL when they also had a ventricular cycle length [less than or equal to]500ms. The combination of recurrent AFL, ventricular cycle length [less than or equal to]500ms and structural heart disease led to a significantly greater improvement in physical HRQOL dimensions than did first-episode AFL, no structural heart disease and ventricular cycle >500ms. CONCLUSIONS: CTI-ablation treatment leads to a significant improvement in HRQOL in patients with typical AFL. Patients with AF during follow-up show a significantly lower HRQOL at one-year post-ablation. The combination of characteristics was also used to identify a sub-group who benefitted more in terms of HRQOL.     

室上性心动过速电生理检查中特殊现象分析

目的分析阵发性室上性心动过速电生理检查中特殊现象。方法3例中老年体表心电图显示阵发性室上性心动过速的患者,拟进行射频消融治疗,术前常规进行电生理检查,以明确其类型进而进行消融。结果3例患者行心房基础及程控刺激,未见跳跃现象;心室基础及程控刺激,未发现存在隐匿性旁路;3例均未能诱发出室上性心动过速,静脉滴注盐酸异丙肾上腺素后,仍不能诱发出。在此电生理检查过程中,3例均诱发出阵发性心房纤颤。且在静脉滴注盐酸异丙肾上腺素后出现加速交界性心律。行窦房结恢复试验,1例显著延长。结论部分阵发性室上性心动过速的患者,电生理检查难以诱发,排除了房室旁路,考虑房室结双径路,且慢快径不应期接近。故难以诱发。此类患者容易诱发出房颤。不排除存在病态窦房结综合症的可能。     

Lone atrial fibrillation: where are we now?

There is a growing pandemic of atrial fibrillation (AF), affecting nearly 2% of the general adult population. Atrial fibrillation is commonly associated with structural heart disease, and AF itself causes a sequence of complex processes of electrical, contractile, and structural remodeling of the atrial myocardium, which facilitate further AF progression. Nonetheless, AF may also affect individuals aged ≤ 65 years who have no evidence of associated cardiopulmonary or other disease, including hypertension; this is otherwise referred to as "lone" AF and is considered to have a generally favorable prognosis. The true prevalence of lone AF is unknown. Growing insights into the diversity of numerous mechanisms involved in the pathogenesis of AF, including acute atrial stretch, structural and electrophysiological alterations, systemic inflammation, oxidative stress, autonomic imbalance, genetic predisposition, and many others, and increasing recognition of novel risk factors for AF, including obesity, metabolic syndrome, subclinical atherosclerosis, sleep apnea, alcohol consumption, and endurance sports, suggest that apparently lone AF might not be so "lone" in many patients, which could have important prognostic and therapeutic implications. In this article, we summarize the current knowledge of epidemiology, etiopathogenesis, and pathophysiology of so-called lone AF and discuss the issues of long-term prognosis and management of patients who have an apparently lone AF.     

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Abstract

There is a growing pandemic of atrial fibrillation (AF), affecting nearly 2% of the general adult population. Atrial fibrillation is commonly associated with structural heart disease, and AF itself causes a sequence of complex processes of electrical, contractile, and structural remodeling of the atrial myocardium, which facilitate further AF progression. Nonetheless, AF may also affect individuals aged ≤ 65 years who have no evidence of associated cardiopulmonary or other disease, including hypertension; this is otherwise referred to as “lone” AF and is considered to have a generally favorable prognosis. The true prevalence of lone AF is unknown. Growing insights into the diversity of numerous mechanisms involved in the pathogenesis of AF, including acute atrial stretch, structural and electrophysiological alterations, systemic inflammation, oxidative stress, autonomic imbalance, genetic predisposition, and many others, and increasing recognition of novel risk factors for AF, including obesity, metabolic syndrome, subclinical atherosclerosis, sleep apnea, alcohol consumption, and endurance sports, suggest that apparently lone AF might not be so “lone” in many patients, which could have important prognostic and therapeutic implications. In this article, we summarize the current knowledge of epidemiology, etiopathogenesis, and pathophysiology of so-called lone AF and discuss the issues of long-term prognosis and management of patients who have an apparently lone AF.     

普伐他汀和缬沙坦联合应用对慢性心功能不全患者阵发性心房颤动的影响

目的 探讨他汀类药物及血管紧张素受体拮抗剂对慢性心功能不全患者阵发性心房颤动的影响.方法 145例伴有阵发性心房颤动的慢性心功能不全患者随机分为四组:胺碘酮组(Ⅰ组)、胺碘酮+缬沙坦组(Ⅱ组)、胺碘酮+普伐他汀组(Ⅲ组)、胺碘酮+缬沙坦+普伐他汀组(Ⅳ组),治疗随访2年,比较四组治疗前后左心房内径、C反应蛋白(CRP)水平变化及窦性心律维持率.结果 治疗后,Ⅰ、Ⅱ、Ⅲ、Ⅳ组的左心房内径分别为(44.1±2.1)、(41.7±2.8)、(44.4±3.1)、(40.1±2.5)mm.Ⅰ组和Ⅲ组左心房内径均大于Ⅱ组和Ⅳ组(P<0.05),而Ⅰ组和Ⅲ组,Ⅱ组和Ⅳ组比较差异无统计学意义;Ⅰ、Ⅱ、Ⅲ、Ⅳ组的CRP水平分别为(4.56 ±0.24)、(4.47±0.45)、(2.87±0.53)、(2.54 ±0.42)mg/L Ⅰ组和Ⅱ组CRP水平高于Ⅲ组和Ⅳ组(P<0.05),I组和Ⅱ组、Ⅲ组和Ⅳ组比较差异无统计学意义;Ⅰ、Ⅱ、Ⅲ、Ⅳ组的窦性心律维持率分别为57.9%、79.4%、77.1%、85.3%,Ⅰ组窦性心律维持率低于Ⅱ、Ⅲ和Ⅳ组(P<0.05).结论 缬沙坦和普伐他汀联合应用能减少慢性心力衰竭患者阵发性心房颤动的复发.缬沙坦能抑制左心房的扩大.而普伐他汀能有效降低血中CRP的水平.     

老年心房颤动159例临床分析

目的分析老年人心房颤动病因、临床特点和抗凝治疗的状况。方法选择1998年至今在我院住院的患者，年龄〉65岁，有心房颤动史159例，观察心电图、动态心电图、超声心动图及甲状腺功能的血清学检查等，对患者的临床资料进行回顾性分析。结果老年心房颤动病因复杂，多数伴有基础疾病或全身其他疾病。基础疾病依次为：冠心病71例（44．65％），高血压病37例（23．27％），老年性瓣膜病13例（8．18％）。病因不明38例（23．89％）。老年心房颤动患者中持久性房颤比率高（73．58％）。心房颤动患者血栓栓塞事件发生率为31．06％。结论老年人心房颤动常见原因是冠心病、高血压性心脏病。老年心房颤动患者中持久性房颤比率高。血栓栓塞是房颤的重要并发症，抗凝治疗应得到重视。     

风心病瓣膜手术中辅助射频消融治疗房颤

目的 探讨射频消融Maze Ⅲ型手术治疗风湿性心脏病房颤的效果及其影响因素。方法 42例风湿性心脏病伴房颤病人在心脏瓣膜手术的同时行射频消融MazeⅢ型手术,并应用可达龙6个月,观察术后心律变化,对病人的术前资料加以对比,研究影响手术效果的因素。结果 窦性心律转复率为77.5%,术前病人的房颤时间、左房内径是其影响因素。结论 射频消融Maze Ⅲ型手术治疗风心病房颤的效果好,操作简便、安全可靠。