冠状动脉旁路移植术后心房颤动治疗体会

心房颤动(房颤)是冠状动脉旁路移植术(CABG)后最为常见的心律失常,可导致低血压、心力衰竭、栓塞、心肌缺血,甚至诱发急性心肌梗死等严重并发症,一直是临床研究的热点[1].我院1999年1月～2005年12月施行CABG手术146例,其中术后新发房颤35例,发生率为24%,现报告如下.     

房颤的基础研究及治疗现状

心房颤动(房颤)是一种临床极为常见且危害严重的心律失常,人口的老龄化使得未来数十年其发病率将逐渐增加。未来,房颤将成为中国巨大的社会和经济负担。房颤治疗中的未知数还很多,需要从基础和临床同时入手深入研究。本文就房颤的病理生理和临床治疗现状作如下综述。1房颤流行趋势与危害据美国弗明汉心脏研究(Fragm ingham)和心血管健康研究(CH O)及房颤抗血栓研究(ATRIA)结果显示:美国60岁以下人群房颤患病率不足1%,但随着年龄的增加其发病率随之升高,80岁以上者中可超过9%。2001年我国的一项流行病学调查显示,我国房颤患病率0.61%,患…     

肠系膜上动脉栓塞一例误诊

【病例】　女 ,71岁。因剧烈腹痛 3 2小时 ,以急性心肌梗死由乡医院转入我院。患者入院前 3 2小时突发剧烈腹痛 ,呈持续绞痛 ,不放散 ,伴有鲜红色血便 ,无胸痛、胸闷、心悸症状 ,在当地乡医院做心电图检查示心房纤颤 ,Ⅰ、aVL、V46导联的ST段呈弓背向上抬高约 0 2mV ,频发室早     

普罗帕酮和毛花苷丙转复非瓣膜病阵发性心房颤动疗效比较

目的:比较普罗帕酮和毛花苷丙(西地兰)转复非瓣膜病阵发性心房颤动的疗效.方法:将40例患者随机分为普罗帕酮组和毛花苷丙组各20例,分别静脉推注普罗帕酮70～210 mg或毛花苷丙0.4～0.6mg,观察治疗后心房颤动转复情况.结果:普罗帕酮组20例,转复成功16例(80%);毛花苷丙组20例,转复成功9例(45%);两组疗效差异有统计学意义,P＜O.05.结论:普罗帕酮转复非瓣膜病阵发性心房颤动的成功率较毛花苷丙高.     

曲美他嗪联合阿托伐他汀治疗原发性高血压伴阵发性心房颤动的疗效观察

Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.     

复律后左心房功能恢复与心房颤动持续时间相关性的临床研究

目的:应用心肌组织多普勒技术结合M型超声、脉冲血流多普勒和心尖搏动图评价心房颤动(房颤)复律后心房功能的变化及其相关因素。方法:正常对照组20例,房颤复律患者34例。根据房颤持续时间分成短期房颤组(n=18)和长期房颤组(n=16),于复律后1小时、1天、1周和1个月行超声检查。采用心肌组织多普勒技术测量二尖瓣环侧壁心房收缩期心肌组织运动峰速(Am)和舒张早期运动峰速(Em)并计算Am/Em比值,M型超声测量瓣环侧壁舒张晚期心肌最大运动幅度(DAD)和舒张早期最大运动幅度(DED)并计算DAD/DED比值,脉冲血流多普勒测量心房收缩期跨瓣血流最大流速(A)和心室舒张早期血流最大流速(E)并计算A/E比值,心尖搏动图记录心房收缩压力波。并筛选出与复律后1小时、1天、1周左心房心肌组织运动速度有关的临床变量。结果:复律后1小时、1天、1周与Am相关的临床变量均为房颤持续时间。左心房功能与房颤持续时间的关系:复律后1小时及1天,Am、Am/Em,A/E,DAD、DAD/DED在两房颤组均低于正常对照组(P<0.05);长期房颤组低于短期房颤组(P<0.05);复律后1周,长期房颤组仍低于正常对照组和短期房颤组(P<0.05);短期房颤组与正常对照组无差异(P>0.05)。复律后1个月,除长期房颤组DAD/DED仍低于正常对照组(P<0.05),其余指标3组间无差异(P>0.05)。复律后左心房顿抑仅发生于长期房颤组,其发生率于1小时为43.8%,1天为25%,1周为12.5%。结论:房颤复律后左心房功能的恢复及左心房顿抑的发生与房颤持续时间有明显相关性。     

风湿性心脏瓣膜病伴心房颤动患者血清IL-6和CRP水平变化及影响

目的 探讨炎症因子IL-6、CRP在风心瓣膜病房颤发生中的作用.方法 46例风湿性心脏瓣膜病患者分为窦性心律组17例、阵发性房颤组8例、持续性房颤组21例,另取窦性心律健康者对照组20例,取血清标本,采用放射免疫分析法测定IL-6、速率散射比浊法测定CRP水平浓度.结果 IL-6的水平四组间差异有统计学意义（F=9.247,P〈0.01）,持续 性房颤组、阵发性房颤组和窦性心律组IL-6水平均明显高于健康对照组（P〈0.01）;持续性房颤组和阵发性房颤组IL-6水平高于窦性心律组（P〈0.01）.CRP水平的变化在各组中也呈现出同样趋势.IL-6与CRP呈正相关（r=0.924,P〈0.01）.血清CRP水平是影响风心病患者房颤发生的独立危险因素.结论 炎症因子的改变在风心瓣膜病房颤发生中可能有一定作用.     

宁心除颤汤治疗房颤16例

心房纤颇好发于中老年人各种心脏病患者，治疗较为困难。西药常用洋地黄、奎尼丁以及电复律等治疗措施，病程较长，复发率高，有一定毒副作用。我们应用辩证施治原则，自拟宁心除颤汤治疗房颤16例获得较好疗效，现简述如下：1一般资料16例中，男性10例，女性6例；住院病人3例，门诊病人13例；年龄最大者71岁，最小者54岁。2方药组成及加减法已’方药组成：宁心除颤汤由太子参、丹参、黄茂、获书、当归、赤书、炙远志、葛根、枣六、生地、川等、甘草等组成。本方具有补气血、调阴阳，活血化瘀、定悸除颤的功效。以一个月为一疗程。2．2加减法…     

普罗帕酮治疗心房颤动致室性心动过速(附1例报告)

20 0 2年 8月 ,我们遇到 1例用普罗帕酮转心房颤动 (房颤 )的病人 ,在用药期间发生室性心动过速 (室速 ) ,现分析报告如下。1　临床资料病人 ,女 ,6 2岁。因二尖瓣分离术后 10年 ,活动后心慌、憋气 2个月入院。病人 10年前因“风湿性心脏病 ,二尖瓣狭窄”于外院行二尖瓣分离术 ,术后一般情况良好 ,可从事日常体力劳动 ,无胸闷、憋气。近 2个月病人于活动后感觉心慌、胸闷、憋气。心电图示 :房颤心律 ,电轴右偏 ,心室率为12 1min-1,QRS时限 0 .12s。入院体格检查 :二尖瓣面容 ,颈静脉充盈 ;双肺呼吸音清 ,无干湿性啰音 ;心率 98min-1,节律…