心肌病

世界卫生组织心脏病学专家委员会于1983年4月在日内瓦就心肌疾病(Cardiomyopathy)进行了专题讨论,并简要地概述了当前对心肌病的认识。一、概况 1957年曾把非冠状动脉病变引起的一组病因不明的心肌病变统称心肌病。1980年以来心肌病的定义是:“原因未明的心肌的疾病”。     

慢性难治性充血性心力衰竭的处理

充血性心力衰竭(CHF)是临床常遇到的课题。慢性CHF 患者经休息、饮食调节、洋地黄和利尿剂治疗无效时称为难治性CHF。为了改善患者的心功能,宜从以下几方面着手:了解基本病因及有关的病理生理变化,评价诊断,鉴别加重CHF 的心外因素和判定治疗方案的合理性,使之趋于完善。一、病因心力衰竭并非是一完整的诊断,应了解导致心衰的基本病因。许多可以经手术治疗彻底解决,如房室间隔缺损、动静脉瘘、缩     

急性心肌梗塞并低血压状态

患者男,57岁。8年前始阵发性心前区痛,每次持续1～5分钟,含硝酸甘油或休息好转。近4年多发作渐频,时有夜间憋醒和下肢浮肿。1984年10月27日劳累后心前区痛复发,多次含服硝酸甘油和吸入亚硝酸异戊酯后不缓解,当晚9时余入急诊室查心电图(ECG)示ST Ⅱ,Ⅲ、avF明显抬高     

非冠心病误诊为冠心病60例浅析

冠心病系一种常见病,但亦有不少非冠心病患者临床表现与其相似,易混淆。兹将我院1988～1989年以“冠心病”就诊,后经详细检查予以除外的一组病例浅析如下。临床资料本组60例,男31例,女29例。年龄30～39岁12例;40～49岁24例;50～69岁24例。病程1～4     

胎儿宫内发育与成年期脑血管病患病风险的相关性

Objective To investigate the possible relationship between the risk of cerebral vascular disease (CVD) in adulthood and the intrauterine growth in a Chinese cohort.Methods Two thousand five hundred and three infants born in the Peking Union Medical College Hospital in Beijing during 1921 to 1941 and 1948 to 1954 were followed-up and their medical records at birth were reviewed.Among them,2085 grown-ups agreed to participate in this study at the Department of Neurology of Peking Union Medical College Hospital from September 2003 to March 2005.Patient questionnaire,case history,clinical assessment and computer tomography brain scan were examined in each of patients to make a diagnosis of CVD.Statistic analysis of X2 test,t-test and Logistic regression analysis were conducted to investigate a relationship between the risk of adult CVD and intrauterine growth.Results One hundred and twenty-eight(6.1%)participants were diagnosed with CVD,including 68 of infarction,9 of hemorrhage and 53 of asymptomatic infarction.Risk for CVD was significantly related to low birth weight. The association remained significant after adjusting for other growth indexes at birth and adulthood confounding factors using multiple factors Logistic regression analysis.Compared to the control group(birth weight 3001-3500g),the rate of CVD increased by 86% to 8.7%in lower birth weight (2500-3000 g) and showed to be a risk factor for CVD (OR=1.86,95%CI1. 14-3.00),while higher birth weight (＞3500g)with 2.4% rate of CVD was a risk factor (OR=0.32,95%CI0.13-0.77).Multiple factors logistic regression analysis suggested that age,hypertension and overweight were also significantly related to adult CVD (P＜0.05).Conclusions The study for the first time indicates strong evidence of an association between birth weight and adult cerebral Vascular disease in a Chinese population.Lower birth weight (2500-3000g) relates to a high risk of CVD,and higher birth weight (＞3500g) relates to a protective role in CVD.Age,hypertension and obesity are also risk factors of CVD.     

频率应答式起搏的血液动力学变化和临床观察

本文报告18例需置起搏器患者的血液动力学测定结果,提示心室起搏在70～100ppm范围时心排血量(CO)随起搏频率增加而渐增,3例肺毛细血管楔嵌压(PCWP)较自身对照值升高,1例右房压(RAP)明显升高。与心室起搏比较,心房及房室顺序起搏在增加 CO、降低 PCWP 和RAP 等血液动力学效应方面均优于前者。对11例置入 SWING 100—SSIR 型起搏器患者随访表明,频率应答式起搏有益于改善心脏功能和提高生活质量。     

胎儿宫内发育与成年期脑血管病患病风险的相关性

目的 在一个中国人群中分析胎儿宫内发育与成年期脑血管病患病风险的相关性.方法 采用历史回顾性研究方法,以中国医学科学院北京协和医院1921-1941、1948-1954年出生的2085名出生队列人群为研究对象.从产科病历获得他们与宫内发育有关的围产资料,通过对该人群临床体检和问卷调查,综合病史、体检、血生化检查、头颅CT扫描等方法诊断脑血管病病例以及成年期脑血管病危险因子;分别应用单因素和多因素统计分析方法,分析测量宫内发育与调查时点现患脑血管病之间的关联强度,探讨胎儿宫内发育状况与成年期脑血管病患病风险的相关性.结果 共检出128例(6.1%)脑血管疾病患者,其中脑梗死68例,脑出血9例,无症状性脑梗死53例.单因素分析显示脑血管病组出生体重、出生头围均低于未患病组;多因素Logistic回归分析在调整性别、孕周、出生时父亲职业等其他围产资料以及年龄、高血压病、糖尿病、高低密度脂蛋白胆同醇血症、超重、吸烟、文化程度等成年期危险因子后,出生体重按连续计量资料进入多因素分析模型,出生体重每增加1 kg,成年期脑血管病患病风险下降67%(OR=0.33,95% CI0.17～0.62);出生体重按等级计数资料进入多因素分析模型,2500～3000 g组脑血管病患病风险较3001～3500 g对照组增加86%(OR=1.86,95%CI1.14～3.00,该组患病率8.7%);而3500 g以上组患病危险则较对照组下降68%(OR=0.32,95% CI0.13～0.77,该组患病率2.4%),出生头围和其他围产资料与成年期脑血管病之间未见到显著相关性;多因素分析提示高年龄、高血压病、超重等成年期危险因子也是本组脑血管病的危险因素.结论 与国外类似流行病学研究结果一致,在首次对一个中国出生队列人群研究中同样发现,以低出生体重为标志的宫内发育迟缓与成年期脑血管病患病风险存在相关性;低出生体重(2500～3000 g)是成年期脑血管病的危险因素,高出生体重(＞3500 g)是成年期脑血管病的保护因素.高年龄、高血压病、超重等成年期因子也是本组脑血管病的危险因素.     

经头部CT扫描检出的无症状腔隙性脑梗死与有症状非腔隙性脑梗死的危险因素比较分析

目的 探讨经头CT扫描检出的无症状腔隙性脑梗死与有症状非腔隙性脑梗死两病例组的危险因素以及危险因素在两病例组间分布的差异.方法 对一个有2085例的回顾性出生队列研究人群中所检出的52例有症状非腔隙性脑梗死、49例无症状腔隙性脑梗死分别与1908例非脑血管病对照组进行危险因素的单因素及多因素分析,然后在两病例组间进行危险因素的比较分析;以及两病例组间危险因素数量的比较分析.结果 Logistic多元回归发现年龄、性别、糖尿病、酗酒、卒中家族史、颅内动脉狭窄是有症状非腔隙性脑梗死的独立危险因素,而年龄、高血压、吸烟是无症状腔隙性脑梗死的独立危险因素.两组间比较显示糖尿病、颅内动脉狭窄在两病例间分布的差异有统计学意义(P值分别为0.005、0.002).有症状非腔隙性脑梗死组的危险因素数量多于无症状腔隙性脑梗死组(P=0.009).结论 有症状非腔隙性脑梗死与无症状性脑梗死危险因素存在差异,血管机制可能也有不同,糖尿病和颅内动脉狭窄更多见于有症状非腔隙性脑梗死病例组.

Abstract：

Objective To investigate the respective risk factors of the symptomatic nonlacunar intaction and the asymptomatic lacunar infaction diagnosed by brain scan of computed tomography alone as well as their differences. Methods 52 symptomatic nonlacunar infaction patients and 49 asymptomatic lacunar infaction patients diagnosed by brain scan of computed tomography alone were found from a sample for retrospective birth cohort study. X~2 - test, t - test and Logistic regression analysis were used for determing the risk factors for each disease when comparing to the contrast group of 1908 who hadnt suffered form cerebrovascular disease respectively. Each risk factor and the amount of risk factors for the two disease were compared between the 52 symptomatic nonlacunar infaction patients and 49 asymptomatic lacunar infaction patients.Results Age, sex, diabetes mellitus, drinking, family history of stroke and the stenosis of intracrianial artery were the independent predictors of the symptomatic nonlacunar infaction ; age, hypertension, smoking were the independent predictors of asymptomatic lacunar infaction. Both the rate of diabetes mellitus ( cerebral infaction 43.1% vs asymptomatic lacunar infaction 16.6% ) and stenosis of intracrianial artery (45.4% vs 15.2% ) were higher in patients with the symptomatic nonlacunar infaction than those with asymptomatic lacunar infaction. Patients with symptomatic nonlacunar infaction had a significant increase in the amount of the risk factors than those with asymptomatic lacunar infaction. Conclusion There may have different distribution of the risk factors and different vascular mechanism between the symptomatic nonlacunar infaction and asymptomatic lacunar infaction. Diabetes mellitus and the stenosis of intracrianial artery more commonlg exist in the patients with the symptomatic nonlacunar infarction.     

心房颤动合并栓塞及其预防（附113例报告）

心房颤动 (ＡＦ)患者体循环动脉血栓栓塞风险增加 ,其中 85 %为缺血性脑血管意外 ,构成ＡＦ患者的重要死因。Ｆｒａｍｉｎｇｈａｍ研究表明 ,风湿性心脏病 (风心病 )ＡＦ(ｒｈｅｕｍａｔｉｃａｔｒｉａｌｆｉｂｒｉｌｌａｔｉｏｎ ,ＲＡＦ)患者栓塞风险较对照组高 17 6倍[1] 。非风心病ＡＦ(ｎｏｎｒｈｅｕｍａｔｉｃａｔ ｒｉａｌｆｉｂｒｉｌｌａｔｉｏｎ ,ＮＲＡＦ)患者栓塞风险较对照组高 5 6倍 ,兹就我院ＡＦ患者合并栓塞情况简要回顾并结合文献复习如下。1　临床资料1996～ 2 0 0 0年我院收住各种心脏病合并ＡＦ患者630例 ,其中ＲＡ…     

心室舒张功能衰竭--老年人心力衰竭的重要原因

老年人心力衰竭 (心衰 )常见 ,4 5岁以后每增龄 10岁 ,新的心衰病例成倍增多 [1]。心衰是构成老年患者住院和反复住院的最主要原因。其致死率高 ,症状出现后1～ 5年致死率从 2 8%升至 62 % [2 ]。既往心衰归因于心室收缩功能衰竭 ,自 1984年Doughery等 [3]首次报道一组左室收缩