冠心宁片对冠心病舒张性心力衰竭患者穿透素3及相关性血细胞分析数值水平的影响

目的 观察冠心宁片对冠心病舒张性心力衰竭（diastolic heart failure,DHF）患者穿透素3（pentraxin-3,PTX-3）及相关性血细胞分析数值水平的影响。方法 选取2018年11月—2019年11月在丽水市中医院就诊的80例冠心病DHF血瘀证患者作为研究对象,采用随机数字表法分为对照组和治疗组,各40例,对照组予以西药治疗,治疗组在对照组基础上加用冠心宁片,连续治疗4周。观察2组中医证候积分、临床疗效、舒张早期的二尖瓣血流峰速度/舒张早期的二尖瓣舒张速度比值（E/E'）、氨基末端B型脑利钠肽前体（N-terminal pro-brain natriuretic peptide,NT-proBNP）、PTX-3及相关性血细胞分析数值水平[包括红细胞分布宽度（red blood cell distribution width,RDW）、血小板/淋巴细胞比值（platelet to lymphocyte ratio,PLR）、单核细胞/淋巴细胞比值（monocyte to lymphocyte ratio,MLR）、中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）]的变化,评估冠心病DHF血瘀证患者的治疗效果。结果 治疗组总有效率为90.0%,明显优于对照组的77.5%（P<0.05）。治疗前,2组中医证候积分、E/E'、NT-proBNP、PTX-3、RDW、PLR、MLR和NLR比较,差异无统计学意义;治疗后,2组中医证候积分、E/E'、NT-proBNP、PTX-3、RDW、PLR、MLR和NLR明显低于治疗前（P<0.05）,且治疗组各指标低于对照组（P<0.05）;并且治疗后2组均未见不良反应。结论 冠心宁片治疗冠心病DHF患者能够有效改善临床症状,降低中医证候积分、E/E'、NT-proBNP、PTX-3及相关性血细胞分析数值水平,提高临床疗效。     

Could severity of mitral annular calcification predict other left sided structural or functional abnormalities?

ObjectiveThe prognostic value of MAC severity is important not only because it shares a common risk factors with vascular atherosclerotic changes but also through increasing the cardiovascular morbidity and mortality. This study was conducted in order to evaluate association between severity of MAC and left sided echocardiographic abnormalities mainly left sided valvular abnormalities as well as left atrial systolic and diastolic functional abnormalities.MethodsWe prospectively obtained 12-leads electrocardiograms and transthoracic echocardiograms (TTE) on patients scheduled for non-emergent echocardiographic assessment at tertiary care hospital. MAC was graded as mild, moderate and severe. LA linear dimensions, LA filling and emptying volumes and left atrium ejection fraction were done specifically in addition to commonly measured TTE parameters.ResultsFrom the 80 patients considered for the study, 47 patients had mild MAC, 29 patients had moderate MAC and 4 patients had severe MAC. Valvular affection through echo-doppler assessment that included mainly mitral stenosis, mitral incompetence, aortic sclerosis as well as aortic incompetence showed a highly significant statistical difference (p-values 0.00, 0.00, 0.00 and 0.00 respectively). There was a highly significant statistical difference between patients with different degrees of MAC and LA linear dimension (p-value 0.00), all LA filling and emptying volumes as well as LA ejection fractions with the exception of LA passive emptying volume and LA passive ejection fraction was insignificant.ConclusionsThere is a direct proportionate relationship between severity of MAC and associated left sided valvular affection, increase LA linear dimension as well as lower overall LA function.     

玻璃体切除联合硅油填充术治疗老年复杂性视网膜脱离病人的护理

目的：探讨用玻璃体切除联合硅油填充术的方法治疗老年复杂性视网膜脱离病人的护理方法。方法对52例老年复杂性视网膜脱离病人进行手术前后护理干预。结果48例视网膜复位，42例视力提高，视网膜复位率及视力改善率分别为92．30％和80．76％。术后并发高血压8例，心律失常1例，心绞痛1例，眼压升高13例，经对症处理均好转。结论术前做好心理疏导，予以相关知识教育，术后严密观察病情变化，及时发现并发症，并做好相应处理，对老年复杂性视网膜脱离病人的视网膜复位率及视力改善率均有帮助。     

Right heart function in impaired left ventricular diastolic function: 2D speckle tracking echocardiography–based and Doppler tissue imaging–based analysis of right atrial and ventricular function

Aim

The aim of our study was to describe right atrial (RA) and right ventricular (RV) function, assessed by Doppler tissue imaging and 2D speckle tracking echocardiography (2DSTE), in women with signs of early impaired left ventricular diastolic function (DD).

Methods and Results

In a cross‐sectional trial, standard parameters of diastolic and right heart function were investigated in 438 women of the Berlin Female Risk Evaluation (BEFRI) study. In a subset of women, average peak systolic RA strain (RAS), as well as the average peak systolic RV strain of the free wall (RVS free wall) and of all RV segments (average RV strain; RVS Avg), was analyzed using 2DSTE. Compared to women with normal diastolic function (DD0), RAS, RVS free wall and RVS Avg were significantly reduced in DD (43.1% ± 11.9%, ?26.7% ± 5.6%, and ?23.3% ± 3.5% in DD0; vs 35.1% ± 10.4%, ?23.9% ± 5.5%, and ?20.6% ± 3.8% in DD; P < .01). Peak RV myocardial velocity (RV‐IVV) and acceleration during isovolumetric contraction (RV‐IVA) were markedly higher in DD (15.0 ± 3.9 cm/s and 3.1 ± 1.0 m/s² in DD vs 11.9 ± 3.2 cm/s and 2.8 ± 0.8 m/s² in DD0; P < .05). RAS and RV‐IVV were significantly associated with DD after adjustment to age, BMI, and left atrial strain in multivariate regression analysis.

Conclusion

Systolic right heart function is significantly altered in DD. DTI as well as 2DSTE constitute sensitive echocardiographic tools that enable the diagnosis of impaired right heart mechanics in early‐staged DD.