感染性心内膜炎68例临床特点及治疗演变分析

目的 分析感染性心内膜炎(IE)临床特点的演变趋势.方法 回顾性分析1987年7月至2007年7月北京大学第三医院确诊的68例IE患者病例资料,比较前后10年的临床表现.结果 68例患者中有基础心脏病者61例(89.7%),发热67例(98.5%),心脏杂音62例(91.2%);经胸超声心动图赘生物检出率为83.8%(57/68),血培养阳性率60.3%(41/68);外科手术治愈率19.1%;总体治愈率66.7%(52/68).前后10年比较:近10年发病年龄推后[(36.7±12.7)岁对(44.4±18.6)岁,P<0.05];基础心脏病中先天性心脏病和风湿性心脏病比例减少(分别44.4%对24.4%和33.3%对17.1%,P<0.05),而瓣膜松弛症的比例增加(0对29.3%);心力衰竭、器官或血管栓塞发生率在近10年显著下降(77.8%对46.3%和44.4%对17.1%,P<0.05).结论 IE临床表现复杂,发热、心脏杂音仍为主要症状;近10年发病年龄推后;及时、反复血培养和超声心动图检查可提高确诊率,规范、充分的抗生素治疗和及时、合理的手术治疗可降低病死率.     

教练员的左心结构与功能的多普勒超声心动图评价

本文对比９３例平均年龄４９±６．７岁的国家级运动教练员与相应年龄的１００例对照组的多普勒超声检查结果。发现运动教练员的心内结构和功能与对照组有差异,表现在左心室增大（Ｐ＜０．００１）,左室心肌重量及重量指数增加（均Ｐ＜０．００１）,左室收缩功能储备能力增加,左室舒张功能受损较早。因此,本文发现大强度的体育训练对心脏的结构和功能将产生长久的影响。     

高同型半胱氨酸血症对大鼠心室重塑的作用

目的:观察饮食诱导的高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)对大鼠心室重塑的作用及终止饮食诱导后的恢复情况.方法:健康雄性Wistar大鼠分为(1)饮食诱导组(HHcy组):1g/(kg·d)L-蛋氨酸灌胃4周,(2)终止诱导组(Quit hcy,QHcy组):L-蛋氨酸灌胃4周后再普通饲养4周,(3)对照组(Control)分4周组和8周组:饮用水灌胃作为对照.以超声心动图评价心脏结构和收缩功能,苏木素-伊红(HE)、胶原纤维、免疫组化染色观察心脏组织形态、胶原和小血管的变化.结果:血浆同型半胱氨酸(homocysteine,Hcy)浓度HHcy组为(106.19±19.75)μmol/L,QHcy组为(6.52±0.94)μmol/L,对照组为(4.90±0.10)μmol/L;HHcy组与对照组相比大鼠室壁张力升高62.1%(P＜0.01),收缩功能即射血分数(ejection fraction,EF)值下降10.7%(P＜0.01),小血管数减少45.9%(P＜0.01),小动脉管壁厚度增加2.9倍(P＜0.01),心肌细胞横径无增大,心肌间质和血管壁周围胶原增多;QHcy组与HHcy组相比大鼠室壁张力降低27.6%(P＜0.01),但与对照4周组和8周组相比仍分别高于17.3%和27.1%(P＜0.01);QHcy组与HHcy组相比心脏收缩功能恢复,即EF值提高14.0%(P＜0.01),与对照组比较差异无统计学意义,QHcy组与HHcy组相比心肌细胞横径增加11.9%(P＜0.01),与对照组相比增加15.4%(P＜0.01),QHcy组与HHcy组相比小血管数回升79.1%(P＜0.01),与对照组相比差异无统计学意义,QHcy组与HHcy组相比小动脉管壁厚度和胶原改变无改善.结论:高同型半胱氨酸能引起大鼠心室重塑,胶原纤维化,室壁张力升高,收缩功能降低.终止饮食诱导后4周血浆Hcy浓度能降低,但心脏重塑的改变未完全逆转.     

急性心肌梗死早期室性心律失常相关因素分析

目的探讨急性心肌梗死(AMI)早期各类室性心律失常(VA)的相关因素和对近期预后的影响.方法161例确诊为AMI患者.根据心电记录将VA分为5组.单发室性早搏组(单发室早组,10例);成对,二联律的室性早搏组(成对室早组,21例);非持续性室性心动过速组(非持续室速组,31例);室性心动过速,心室颤动组(室速室颤组,11例);对照组88例.每位均接受了冠状动脉造影,超声心动图检查.结果左主干病变在室速室颤组较对照组发生率显著升高,差异具有统计学意义(P＜0.05);右冠状动脉病变发生率在非持续室速组较对照组显著增高,差异具有统计学意义(P＜0.05);梗死相关血管再通未达到心肌梗死溶栓治疗临床试验(TIMI)Ⅲ级发生率在室速室颤组较对照组显著增高,差异具有统计学意义(P＜0.05);三支血管存在大于70%冠状动脉狭窄病变发生率在室速室颤组较对照组显著增高,差异具有统计学意义(P＜0.05);左心室射血分数在室速室颤组较对照组明显降低,差异具有统计学意义(P＜0.01).30天病死率室速室颤组与对照组比较,差异具有统计学意义(P＜0.05).结论AMI早期发生的各类VA中,室速室颤的发生影响患者近期预后.持续性室速室颤发生的相关因素为梗死相关血管为左主干病变,再通血流未达到TIMIⅢ级,多支血管病变和左心室射血分数明显降低.     

床旁超声心动图在冠心病介入性治疗并发心脏压塞中的应用

目的 探讨急诊床旁超声心动图在冠心病介入性治疗并发的心脏压塞中的诊断和治疗价值。方法 回顾分析我院1993～2003年10年间行冠心病介入性治疗并发心脏压塞的病例。结果 经皮冠状动脉球囊扩张术和支架植入术(PTCA Stent)2 100例，发生心脏压塞3例，发生率为0．14％。PTCA Stent术合并心脏压塞者均为慢性完全堵塞性病变。其中1例血管远端穿孔；另2例病人未找到穿孔部位。3例病人均为延迟出现的心脏压塞，术后4～6h发生。经皮激光心肌血运重建术(PMR)5例，发生心脏压塞1例。PMR1例在手术后即刻出现心脏压塞。4例病人均有胸痛及难以纠正的低血压。全部病例均通过床旁超声心动图确定诊断，并在其指导下迅速进行心包穿刺，留置引流，取得良好的治疗效果，无一例死亡。结论 急性心脏压塞是冠心病介入治疗极为少见但十分严重的并发症，急诊床旁超声心动图对其诊断和治疗至关重要。     

组织多普勒对高血压左心室舒张功能的评估

Objective To evaluate Left ventricular(LV) diastolic function in essential hypertension by conventional pulse-wave Doppler echocardiography (cPWD) and Doppler tissue imaging (DTI) and compare the two modalities. Methods Two hundred patients with essential hypertension were classified as NLVH subgroup (n = 160) and LVH subgroup (n =40) based on left ventricular mass index (LVMI) with one hundred and sixty health subjects as control group. The mitral valve flow pattern (MVFP) was obtained.Early diastolic (E) and late velocities (A) were measured and E/A was calculated. DTI was used to obtain the left ventricular lateral wall early diastolic mitral annulus velocity (Em) and E/Em was calculated.Results Essential hypertension patients had LV diastolic dysfunction both by cPWD (higher E and lower E/A ratio) and DTI (lower Em and higher E/Em ratio) compared with healthy subjects [E:(0. 88 ±0. 18)cm/s vs (0. 76 ±0. 19) cm/s;E/A ratio:0. 86 ±0. 28 vs 1.02 ±0. 38;Em: (9. 4 ±2. 8)cm/s vs (11. 9 ±3. 8)cm/s;E/Em ratio;7. 9 ± 2. 7 vs 6. 0 ± 1. 8: with all P value ＜0.01]. Em was significantly reduced and E/Em was significantly elevated in LVH subgroup than NLVH subgroup [Em; (7.7 ±2. 6) cm/s vs (9. 9 ± 2. 8) cm/s, E/Em: 9. 6 ± 3. 6 vs 7. 4 ± 2. 4, P ＜ 0. 05]. No significant difference was found in A and E/A between these two subgroups [(0. 90 ± 0. 22) cm/s vs (0. 87 ± 0. 17) cm/s; 0. 80 ± 0. 34 vs 0.88 ±0.28, P ＞ 0.05]. Conclusions cPWD and DTI both had implications to detect diastolic dysfunction in non-hypertrophic stage hypertension. Em、E/Em could be more sensitive and precise to reflect the impairment of diastolic function in the progress of hypertension.     

组织多普勒对高血压左心室舒张功能的评估

Objective To evaluate Left ventricular(LV) diastolic function in essential hypertension by conventional pulse-wave Doppler echocardiography (cPWD) and Doppler tissue imaging (DTI) and compare the two modalities. Methods Two hundred patients with essential hypertension were classified as NLVH subgroup (n = 160) and LVH subgroup (n =40) based on left ventricular mass index (LVMI) with one hundred and sixty health subjects as control group. The mitral valve flow pattern (MVFP) was obtained.Early diastolic (E) and late velocities (A) were measured and E/A was calculated. DTI was used to obtain the left ventricular lateral wall early diastolic mitral annulus velocity (Em) and E/Em was calculated.Results Essential hypertension patients had LV diastolic dysfunction both by cPWD (higher E and lower E/A ratio) and DTI (lower Em and higher E/Em ratio) compared with healthy subjects [E:(0. 88 ±0. 18)cm/s vs (0. 76 ±0. 19) cm/s;E/A ratio:0. 86 ±0. 28 vs 1.02 ±0. 38;Em: (9. 4 ±2. 8)cm/s vs (11. 9 ±3. 8)cm/s;E/Em ratio;7. 9 ± 2. 7 vs 6. 0 ± 1. 8: with all P value ＜0.01]. Em was significantly reduced and E/Em was significantly elevated in LVH subgroup than NLVH subgroup [Em; (7.7 ±2. 6) cm/s vs (9. 9 ± 2. 8) cm/s, E/Em: 9. 6 ± 3. 6 vs 7. 4 ± 2. 4, P ＜ 0. 05]. No significant difference was found in A and E/A between these two subgroups [(0. 90 ± 0. 22) cm/s vs (0. 87 ± 0. 17) cm/s; 0. 80 ± 0. 34 vs 0.88 ±0.28, P ＞ 0.05]. Conclusions cPWD and DTI both had implications to detect diastolic dysfunction in non-hypertrophic stage hypertension. Em、E/Em could be more sensitive and precise to reflect the impairment of diastolic function in the progress of hypertension.     

急性心肌梗死后氮末端脑钠素前体水平与左室扩张的关系

氮末端脑钠素前体（N—terminal pro—brain natriuretic peptide，NT—proBNP）是体内脑钠素前体（pro-brain natriuretic peptide，proBNP）裂解成脑钠素（BNP）时的产物，主要来源于心肌细胞，在心室的张力及负荷增加时NT—proBNP和BNP升高。本研究通过检测初发急性心肌梗死（AMI）患的急性期血浆NT-proBNP并行超声心动图随访，探讨NT—proBNP对AMI后近期左室重构（LVR）的评价价值。     

妊娠与心脏瓣膜病

心脏瓣膜病是母体和胎儿不良结局的重要原因之一.妊娠期女性对瓣膜狭窄的耐受性差,容易发生心力衰竭,而对瓣膜反流的耐受相对较好.人工机械瓣膜置换术后女性在妊娠期间既有瓣膜血栓风险,又有抗凝治疗带来的出血风险.患有心脏瓣膜病的女性在计划妊娠前应接受充分的妊娠心血管风险评估.中重度二尖瓣狭窄患者、有症状的重度主动脉瓣狭窄患者、...