不同臂围有创血压与无创血压测量结果的对比分析

目的：了解不同臂围有创血压和无创血压测量值的差别。方法：178例冠脉造影患者分为臂围＜27cm组(46例)和臂围≥27cm组(132例),分别测量两组主动脉有创血压和肱动脉无创血压。结果：有创血压的收缩压明显高于无创血压的收缩压,差异具有统计学意义(P＜0.05);有创血压的舒张压明显低于无创血压的舒张压,差异具有统计学意义(P＜0.01,P＜0.05)。无创血压与有创血压收缩压测量值的差值,臂围＜27cm者明显高于臂围≥27cm者(P＜0.01);臂围＜27cm者与臂围≥27cm者无创血压与有创血压舒张压测量值的差值比较,差异无统计学意义。结论：无论臂围,无创血压测量的收缩压和舒张压与有创血压的测量结果均有差别;臂围≥27cm者无创血压的收缩压更接近真实的血压水平。     

脑钠素与心血管疾病

脑钠素(BNP)和心钠素(ANP)一样是C型利钠肽系统的又一成员,1988年由日本学者Sudoh等人由猪脑内分离提纯而成[1].其广泛分布于心、脑、肺、肾,主要由心室分泌.与心房肽相似,它具有利尿、利钠、扩张血管和降压作用,在心血管病的诊断、治疗和预后的预测等方面都具有重要意义.     

老年人主动脉有创血压测量与肱动脉无创血压测量对比研究

目的 了解老年人主动脉有创血压测量与肱动脉无创血压测量是否不同.方法 选择78例冠状动脉造影的老年患者,经周围动脉将导管送到升主动脉测量有创血压,同时用监护仪测量左侧上肢肱动脉无创血压.结果 无创血压测量的收缩压比有创测量的收缩压值平均低12.28 mm Hg(1 mm Hg=0.133 kPa)(P＜0.01),无创...     

甲状腺功能亢进症合并冠状动脉痉挛1例

患者,男,60岁,主因发作性胸痛20 d于2014年5月6日收入院治疗。患者近20 d间断于体力活动时或晨起时出现胸痛,位于整个胸骨后,为烧灼样疼痛,向下颌部放散,伴胸闷、气短、出汗,每次持续1～2 min均可自行缓解。遂于当地医院住院治疗,描记到胸痛发作时心电图提示Ⅱ、Ⅲ、aVF导联ST段抬高0．1～1．2 mV,胸痛缓解后抬高的ST段回落到等电位线。患者近1年出现怕热、多汗、消瘦等症状,查甲状腺功能提示甲状腺功能亢进症。经给予阿司匹林100 mg／次,1次／d、辛伐他汀20 mg／次,每晚1次、硝酸异山梨酯10 mg／次,3次／d、美托洛尔25 mg／次,2次／d等药物治疗无好转,后转至我院,经给予双联抗血小板（阿司匹林100 mg／次,1次／d、氯吡格雷75 mg／次,1次／d ）、抗凝（低分子肝素4100 U／次,2次／d皮下注射）、强化调脂（阿托伐他汀20 mg／次,每晚1次）、加量美托洛尔至25 mg／次,3次／d控制心率等药物治疗,症状仍有发作,遂行冠状动脉造影术,冠状动脉造影术提示血管未见明显狭窄,考虑为冠状动脉痉挛所致,给予美托洛尔减量,加用地尔硫卓治疗后,患者未再胸痛发作,好转出院。     

64层螺旋CT在评价冠状动脉支架内再狭窄的价值

随着冠心病发病率的逐年提高,作为冠心病治疗的主要手段之一,冠状动脉内支架置入术被广泛应用.冠状动脉支架内再狭窄(In-stent restenosis,ISR)仍然是一个无法回避的问题 [1],虽然药物涂层支架大大减少了ISR,但还有一个晚期支架内血栓形成问题.目前,对支架置入术后病人的疗效评价及再次出现胸痛时诊断是否有ISR主要靠再次行冠状动脉造影术(CAG),但其有创性、费用偏高及有一定的手术并发症使大多数患者很难接受.多层螺旋CT(MSCT)冠状动脉成像具有无创、费用适中等特点,目前已逐渐成为冠心病的无创检查手段 [2],64层螺旋CT其时间分辨率和空间分辨率较以往有较大的提高,有望成为常规诊断冠状动脉ISR的无创检查方法.本研究着重探讨64层螺旋CT冠状动脉成像在评价冠状动脉ISR的价值.     

介入治疗对老年人急性ST段抬高性心肌梗死预后的影响

Objective To investigate the effect of percutaneous eoronary intervention (PCI) on the prognosis of acute ST-segment elevation myocardial infarction (ASTEMI) in the elderly.Methods The 1318 ASTEMI patients in our hospital from June 1998 to June 2008 were retrospectively analyzed. Among them, 338 (25.6%) elderly patients were over 60 years old, and 316patients consistent with inclusion and exclusion criteria were consecutively enrolled in our research.Then they were divided into two groups: PCI group (136 cases, 43.0%) and conservative drug treatment group (180 cases, 57. 0%). The clinical data of study objects were collected. Then they were followed up regularly for two years. Results There were no statistically significant differences between the two groups in mean age, gender, hypertension, diabetes, dyslipidemia, excess smoking,wine and family history (all P＞ 0.05). And there were no statistically significant differences in anterior wall STEMI, Killip Ⅲ-Ⅳ class, thrombolysis therapy and malignant ventricular arrhythmia (all P＞0. 05). Most of the objects proceeded therapeutic lifestyle improvements, such as giving up smoking, restricting wine, regulating diet, losing weight and insisting on exercises, and so on.Secondary prevention drugs of acute myocardial infarction including angiotensin converting enzyme inhibitor, angiotensin receptors blockers, beta receptor, aspirin and statins were regularly administrated in the two follow-up years. In the retrospective research, incidence rates of reinfarction, NYHA (New York Heart Association) Ⅲ-Ⅳ class heart function and one-month mortality were much higher in conservative treatment group than in PCI group (17.2% vs. 2. 2%, OR=9. 224,95% CI: 2. 756-30. 857; 31.1% vs. 8.1%,OR=5.132, 95%CI: 2. 568-10. 257; 8. 3% vs. 1.5%,OR= 6. 091, 95% CI: 1. 369-27. 105, respectively; all P ＜ 0. 01). Above all, one and two-year mortalities were much higher in conservative treatment group than in PCI group (21.1% vs. 2. 2 %,OR=11.864, 95%CI: 3.577-39.349; 32.2% vs. 4.4%, OR=10.301, 95%CI: 4.289-24.736,respectively; all P＜0. 01). Conclusions PCI may reduce the re-infarction, NYHA Ⅲ-Ⅳ class heart function and one-month mortality, especially so in view of the one and two-year mortality. PCIcan significantly improve the prognosis of ASTEMI in the elderly.     

不同性别冠状动脉粥样硬化性心脏病患者危险因素分析

目的通过建立不同性别患者冠状动脉粥样硬化性心脏病(CHD)的多重危险因素回归模型,分析各危险因素对CHD的致病风险。方法连续入选2009年1月至2018年1月,于承德医学院附属医院心脏内科住院,并符合纳入标准的对象8028例,女性2894例,男性5134例;同时连续入选同期住院经冠状动脉造影排除CHD的患者作为对照组(336例),女性129例,男性207例。收集患者的人口学特征及临床资料,分别建立不同性别CHD患者的多因素Logistic回归模型。结果年龄55岁、血脂异常、2型糖尿病、高血压病等均为CHD患病的独立危险因素(均P0.05),但各因素对女性与男性CHD的致病风险不同。女性55岁以后,年龄每增加10岁,CHD患病风险增加2.597倍,而男性则增加1.424倍(P0.05);血脂异常、高血压病、2型糖尿病、冠心病家族史,导致女性患CHD的风险(OR)分别为3.297、1.484、3.187、3.714倍(均P0.05),血脂异常、高血压病、2型糖尿病、现症吸烟,导致男性患CHD的风险(OR)分别为1.398、1.800、2.303、5.642倍(均P0.05)。女性患者以冠心病家族史、2型糖尿病、血脂异常致病危险最高,尤其冠心病家族史最显著;而男性以现症吸烟、高血压病导致男性CHD的发病风险最高,现症吸烟尤为显著。结论血脂异常、高血压病、2型糖尿病、吸烟等危险因素,对不同性别患者导致CHD的危险不同,在CHD的一级与二级预防中应予积极防治。     

经食管心房调搏终止室上性心动过速的临床体会

目的 探讨一种起效迅速，无副作用的终止室上性心动过速方法。方法 经食管行心房起搏法。结果 36例中有效33例，无效3例。结论 经食管行心房调搏应用于急诊终止室上性心动过速方法简便，起效迅速，安全，无用抗心率失常药的不良反应。