组织多普勒评价心力衰竭患者双心室优化起搏与同步起搏即刻室壁运动不同步性

目的应用组织多普勒超声(TDI)同步化显像(TSI)、组织速度显像(TVI)比较双心室同步起搏与双心室优化起搏左心室室壁运动不同步性的即刻变化。方法对接受双心室优化起搏治疗的10例原发性扩张型心肌病患者,分别记录起搏器植入术前双心室同步起搏与优化起搏即刻状态下的左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)、每搏量(SV)主动脉瓣口的速度时间积分(VTI)、计算TVI模式下左心室12个节段的QRS时间起始点距左心室各节段收缩峰值时间的标准差(Ts-SD),根据TSI的色彩计算TSI指数(TSI-Index)。同时记录起搏器植入术前后6min步行实验(6MHW)和心功能NYHA分级。结果双心室优化起搏即刻Ts-SD、TSI指数与主动脉瓣VTI优化起搏状态(45.21±18.35ms,1.71±0.29,25.44±5.36cm)均明显优于同步起搏(50.16±19.72ms,1.87±0.31,22.44±5.43cm)(P<0.05)。SV优化起搏即刻(48.0±14.7ml)比术前(36.0±14.9ml)增加(P<0.05)。结论双心室优化起搏治疗重度充血性心力衰竭,能改善左心室室壁运动的不同步性并提高左心室射血量。在改善左心室射血和组织运动不同步性,术后优化起搏即刻显著优于同步起搏。     

经桡动脉无保护左主干分叉严重钙化病变旋磨术一例

患者男,68岁.主因“反复胸痛10个月,加重”入院.既往有高血压病史20年、吸烟史50年（20支/d）.体格检查：血压143/73 mm Hg（1 mm Hg=0.133 kPa）,心率79次/min,呼吸18次/min,心律齐,未闻及杂音,双肺呼吸音清,未闻及干湿哕音,双下肢无明显水肿.肌酸酐58 μmol/L,低密度脂蛋白1.39 mmol/L.超声心动图示：射血分数67％,左心室舒张末内径4.9 cm,二尖瓣轻度反流.诊断为冠状动脉粥样硬化性心脏病,不稳定型心绞痛.     

从噬菌体随机肽库筛选庚型肝炎病毒E2抗原表位

目的：筛选能识别庚型肝炎病毒（ＨＧＶ） Ｅ２区的单克隆抗体和有竞争抑制活性的多肽。方法：利用抗ＨＧＶ Ｅ２区的３株单克隆抗体Ｍ６,Ｍ１３,Ｍ３０作为筛选配基,对构象限制性的随机环９肽库进行亲和筛选,并对阳性噬菌体克隆进行功能鉴定。结果：证实亲和筛选具有良好的富集效果后,随机挑出１６个噬菌体克隆进行交叉结合实验,有１４个克隆与Ｍ６抗体有较强的特异结合;其中１０个克隆在竞争抑制实验后中抑制率大于５０％     

The effect of transient balloon occlusion of the mitral valve on left atrial appendage blood flow velocity and spontaneous echo contrast: a comparison in sinus rhythm and atrial fibrillation patients

Objective To investigate the relationship between spontaneous echo contrast (SEC) and left atrial appendage (LAA) blood flow velocity using transesophageal echocardiography (TEE) during percutaneous balloon mitral valvotomy (PBMV) in patients with atrial fibrillation and sinus rhythm.Methods Thirty-five patients （21 in sinus rhythm and 14 in atrial fibrillation ） with rheumatic mitral stenosis underwent PBMV with intraoperative transesophageal echocardiography monitoring. We measured LAA blood flow velocities and observed the left atrium for various grades of SEC (from 0=none to 4=severe), before and after each balloon inflation. Results Left atrial appendage maximal emptying velocity (LAA MEV) was reduced from 35±14 cm/s to 6±2 cm/s at peak balloon inflation and increased to 40±16 cm/s after balloon deflation. Comparison of the values before balloon inflation and after balloon deflation showed that LAA velocities were significantly lower (P&lt;0.001).During balloon inflation, both maximal emptying velocity (MEV) and maximal filling velocity (MFV) were significantly decreased, compared to those before inflation and after balloon deflation (P&lt;0.01).And both MEV and MFV were significantly higher after balloon deflation relative to those before balloon inflation. Patients with atrial fibrillation had significantly lower MEV and MFV before and during balloon inflation and after balloon deflation than patients with sinus rhythm.At peak balloon inflation, new or increased SEC grades were observed during 54 of 61 (88%) inflations and unchanged during 7 (12%) inflations.SEC grades were reduced after 55 balloon deflations (90%), completely disappeared after 18 deflations (30%) and remained unchanged after 6 deflations (10%). At peak balloon inflation,left atrium spontaneous echo contrast (LASEC) grade 4 was observed during 14 of 27 (93%) inflations in the atrial fibrillation patients, significantly higher than in patients with sinus rhythm (8 of 34, 24%; P&lt;0.05). LASEC completely disappeared after 16 of 34 deflations (47%) in the patients with sinus rhythm, significantly higher than in the atrial fibrillation patients (2 of 27 deflations; P&lt;0.01). The mean time to achieve maximal SEC grade (2.5±1.2 s) correlated with the mean time to trough LAA velocities (2.3±1.1 s ) after balloon inflation. Both the time to lowest LAA velocity and the time to highest LASEC were significantly longer in the patients with sinus rhythm than in the atrial fibrillation patients (2.6±1.1 s vs 1.7±1.0 s, P&lt;0.05 and 2.8±1.4 s vs 1.9±1.3 s, P&lt;0.05, respectively).Upon deflation, the mean time to lowest SEC grade (2.9±1.8 s) correlated with the mean time to achieve maximal LAA velocities (2.7±1.6 s).Both intervals are significantly shorter in the patients with sinus rhythm than in the atrial fibrillation patients (2.0±1.6 s vs 3.5±1.5 s, P&lt;0.01 and 2.2±1.7 s vs 3.6±1.6 s, P&lt;0.05). Conclusion Reducing the blood flow velocity in the human left atrium by balloon occlusion of the mitral valve may enhance SEC, whereas restoring blood flow after balloon deflation would cause enhanced echogenic blood to disappear or decrease in both groups of patients.Patients with atrial fibrillation demonstrate more severe blood stagnation of the left atrial body and appendage during transient balloon inflation at mitral valve orifice and slower recovery from the stagnation, decreasing to a lesser extent after balloon deflation, when compared to patients with sinus rhythm.     

经皮肾动脉去交感神经术治疗难治性高血压病例随访及适应证选择探讨

经皮肾动脉去交感神经术是近年来治疗难治性高血压的重大突破之一.据统计,目前仍有约50％的高血压患者血压控制并未达标.而在血压没有能够达标的患者中,部分患者尽管应用了3种或3种以上足量(或最大量)的降压药物(其中一种为利尿剂),血压仍然无法达到目标值,称为难治性高血压(resistant hypertension)[1-2].研究表明难治性高血压患者可能占全部高血压患者的20％～30％.肾交感神经自T10至L1椎体发出,包绕于肾动脉外膜一直走行至肾脏.     

肥厚型梗阻性心肌病间隔心肌消融术后心律失常观察

心律失常是肥厚梗阻型心肌病(hypertrophic obstruetive cardiomyopathy,HOCM)经皮间隔心肌消融术(percutaneous transluminal septal myocardial ablation,PTSMA)治疗的主要并发症.现总结5例患者PTSMA前、后心电图检查结果.     

消化道间质瘤18例影像学分析

选择 1 998～ 2 0 0 2年本院与陕西省人民医院收治的资料完整的消化道间质瘤 ( Digestive tractstromal tumor,DTST) 1 8例 ,并均经手术与病理证实 ,将其影像学表现进行分析 ,现报告如下。资料与方法　　 1　一般资料　本组 1 8例 ,其中男 1 3例 ,女5例 ,年龄 40～ 71岁。本组均有完整的 X线胃肠道双重对比造影 ,CT检查资料 ,临床主要表现为腹部肿块及腹痛 1 0例 ,消化道出血 7例 ,肠梗阻3例 ,并全部经手术和病理 (免疫组化 )确诊。2　方　法　应用岛津 32 0胃肠道造影机进行 X线胃肠道气 -钡双对比造影 (包括钡餐钡灌肠 )。常规肠道准…     

第四届全国干细胞治疗终末期心血管疾病研讨会纪要

由中华医学会心血管病学分会、中华心血管病学杂志编辑委员会主办,浙江大学医学院附属第二医院、复旦大学附属中山医院、上海市心血管病研究所共同承办的第三届全国干细胞移植在心血管疾病中应用研讨会暨第四届全国干细胞治疗终末期心血管疾病研讨会(SCIENCE-Ⅳ)于2007年11月30日至12月1日在杭州举行,来自国内外近500名相关领域的专家学者参与了此次会议.     

射频消融对心脏自主神经损伤及部分相关因素研究

目的：研究射频消融（RFCA）对心脏自主神经损伤与消融部位、累积能量、心肌损伤生化指标改变间的相关性。方法：测定41例因阵发性室上性心动过速接受RFCA者，手术前后心率变异性和心肌损伤生化指标。将房室结折返性心动过速15例与间隔部旁道5例归为间隔组，左侧游离壁旁道19例与右侧游离壁旁道2例归为游离壁组。结果：间隔组RFCA术后HF、LF较术前显著下降（P＜0．05），游离壁组术后F较术前显著下降（P＜0．05）；术后即刻cTnI阳性率为58．3％，AST为41．7％，显著高于其它指标CK：4．2%,CK－MB：10．4％，LDH：20．8％）；术后1h、12h、24hcTnI阳性率，分别为58．3％、54．2％、56．3％、52．1％；游离壁组△HF、△LF与累积能量显著相关（△HF：γ=0.688,P＜0．01；△LF：γ=0.462,P＜0．05）；未发现心率变异性改变与生化指标改变间有相关性。结论：间隔部RFCA可损伤迷走与交感神经，游离壁RFCA可损伤迷走神经，RFCA对心脏自主神经损伤与消融部位、累积能量有关，而与心肌损伤间无相关性。     

细胞移植治疗心血管疾病近况

自二十世纪九十年代初以来，众多的动物模型及临床应用后证实，平滑肌细胞、骨骼肌细胞、心肌细胞及骨髓间质干细胞移植于受损心肌后，在受损的心肌中存活，增殖，局部毛细血管增生，瘢痕组织增厚和瘢痕面积减少，抑制了心室重构，改善了心肌缺血和心脏功能。