阵发性心房纤颤患者P波离散度研究

目的 :探讨阵发性心房纤颤患者P波离散度的改变规律及临床价值。方法 :观察 41例非瓣膜性心脏病和2 1例瓣膜性心脏病阵发性心房纤颤患者最宽P波 (Pmax)和P波离散度及与左房大小关系 ,并与 30例正常人对比。结果 :阵发性心房纤颤的左房大小、Pmax、P波离散度、Pmax≥ 110ms、P波离散度≥ 40ms等均显著高于正常对照组(P <0 .0 1) ,非瓣膜性心脏病组年龄大于瓣膜性心脏病组 ,左房大小及Pmax均小于瓣膜性心脏病组 ,差异有非常显著性 (P <0 .0 1)。结论 :Pmax、P波离散度结合左房大小、年龄对预测阵发性心房纤颤的发生有重要意义。     

Anomalous Insertion of the Superior or the Inferior Vena Cava into the Right Atrium

Three cases with anomalous insertion of the superior or inferior vena cava into the right atrium are presented. One case was a 25-year-old healthy man with anomalous low insertion of the right superior vena cava into the right atrium. The remaining two cases were infants with complex cardiac anomalies showing anomalous high insertion of the inferior vena cava into the right atrium. The congenital anomalies of the connection between the superior and the inferior vena cava and the right atrium are rare. Angiographic and computed tomographic findings of these anomalies were reported.     

N-端脑钠素前体与心钠素对冠心病慢性心力衰竭诊断及预后判断价值的比较研究

目的 比较N-端脑钠素前体(NT-proBNP)和心钠素(ANP)对冠心病慢性心力衰竭(心衰)的诊断及预后判定价值.方法 入选118例冠心病患者,其中伴心衰78例,无心衰40例.用电化学发光法测定血浆NT-proBNP,用放射免疫法测定血浆ANP,并与40例正常人进行比较.定期随访、记录冠心病患者心脏事件的发生情况.结果 心衰患者血浆NT-proBNP和ANP浓度均显著高于无心衰患者及正常人组(P均＜0.05).心功能Ⅳ级者NT-proBNP浓度显著高于心功能Ⅱ、Ⅲ级者,血浆ANP浓度显著高于心功能Ⅲ级者,但与Ⅱ级者比较差异无显著性.血浆NT-proBNP和ANP对于冠心病心衰诊断的敏感性分别为91.25%和73.46%;特异性分别为90.25%和80.33%.心衰组中死亡者与存活者血浆NT-proBNP和ANP水平差异无显著性.结论 NT-proBNP对冠心病心衰的诊断价值高于ANP,二者均与冠心病心衰患者短期心源性死亡无关.     

去甲乌药碱对离体豚鼠心房生理特性的影响

去甲乌药碱对离体豚鼠心房具有加强收缩力,缩短功能不应期,提高兴奋性和自律性等作用,但其效能低于异丙肾下腺素。普萘洛尔可使去甲乌药碱加速右心房自发节律的量效曲线平行右移,最大反应不变。实验还发现,去甲乌药碱可在一定程度上增强由增频电刺激所致正性阶梯现象。提示去甲乌药碱可能为β受体的部分激动剂,其增强心肌收缩力的作用似与促进Ca~(2+)的跨膜内流有关。     

血清尿酸水平与心房颤动的关系

目的探究血尿酸水平与心房颤动(简称房颤)的关系。方法将116例房颤患者根据房颤类型分为阵发性房颤组(53例)和持续性房颤组(63例)。选择同期在重庆市开县人民医院体检的78例健康体检者作为对照组。分别测量三组的血尿酸、心脏彩超,并记录既往患病史及用药情况。结果三组在年龄、运用β受体阻滞剂、左心室射血分数(LVEF)、左心房直径、尿酸水平方面比较差异有统计学意义(P<0.05);单因素回归分析显示,年龄、运用β受体阻滞剂、LVEF、左心房直径、尿酸水平与房颤发生显著相关(P<0.01);多因素Logistic回归分析显示,尿酸水平和LVEF是房颤发生的独立危险因素(P<0.01)。结论血清尿酸是一个简便的且较容易监测的房颤危险因子,可以作为研究房颤发病机制的一个研究方向。     

局部晚期肺癌外科手术治疗(附18例报告)

目的为提高晚期肺癌患者的外科手术切除率及提高手术疗效,总结18例晚期肺癌患者手术治疗中切开心包处理肺静脉或切除部分左心房的经验。方法对18例晚期肺癌患者施行肺叶或全肺切除时,在心包内处理肺静脉或切除部分左心房。左肺下叶切除5例、左全肺切除3例、右肺中下叶切除4例、右肺下叶切除4例、右全肺切除2例;术中发现13例患者的肺静脉根部有癌侵犯或有癌栓,在心包外元法常规处理肺静脉,在切开心包后可较满意地处理肺静脉,切开心包后发现其中有9例明显有左心房侵犯,行肺切除的同时切除部分左房;5例虽可在心包外处理,但癌肿离肺静脉根部太近处理肺静脉困难,而切开心包后处理肺静脉很轻松。结果18例均无手术死亡,术后有2例发生心律失常,2例并发肺炎,1年生存率61．2％（11／18）、3年生存率38．8％（7／18）、2例生存〉5年。结论晚期肺癌累及肺静脉根部或左心房时应切开心包处理肺静脉或同时切除部分左心房以达到肿瘤学上的根治性切除,从而延长病人的寿命。     

后负荷心衰大鼠左心房游离心肌细胞计量学的研究

目的　研究慢性后负荷心衰大鼠左心房游离心肌细胞形态计量学的改变。方法　采用生后 5～ 6周Wistar大鼠制作升主动脉缩窄模型 ,术后 3～ 5个月检测心功能 ,以升主动脉逆行灌注胶原酶制备游离心肌细胞 ,用图像分析仪测量其长度、宽度。结果　实验组左心房心肌细胞与对照组相比 ,表面积、宽度显著增加 (P <0 .0 1)。结论　慢性心衰时左心房心肌细胞为以宽度增加为主的肥大性生长。     

人胎心房和窦房结心房利钠因子的免疫组织化学研究

用免疫组织化学方法对１８例人胎心（１２～４０周胎）进行了心房利钠因子（ＡＮＤ）分布的研究。结果表明，心房利钠因子免疫反应颗粒存在于大部分心房肌细胞内，少部分心房肌细胞无染色颗粒。ＡＮＦ在心房肌细胞中的染色为颗粒状，分布在核周胞浆中，偶尔可见散在胞浆外周。在心房近心内膜侧的心肌细胞可见染色反应增强。免疫反应在左右心房和房中隔无明显不同。左右心耳有很强的免疫反应且右耳强于左耳。窦房结ＡＮＦ免疫反应亦为阳性，但染色较同时期心房肌弱，较心室肌强。窦房结的头、体、尾无免疫染色强度变化。在１２～２０周胎心室肌中有弱的ＡＮＦ免疫反应。从１２～２０周不同胎龄胎心的染色对比看，ＡＮＦ在人胎心有其发展变化规律，随着胎儿增大出现心室免疫染色减弱而心房免疫染色增强的趋势。对心脏作为内分泌器官可能在调节心脏本身的活动和其他生理活动中的意义进行了讨论。     

Electrophysiologic characteristics of atrial tachycardia originating from the right pulmonary veins or posterior right atrium: double potentials obtained from the posterior wall of the right atrium can be useful to predict foci of atrial tachycardia in right pulmonary veins or posterior right atrium

INTRODUCTION: The right pulmonary veins (RPVs) and posterior wall of the right atrium (PRA) are anatomically located adjacent to each other. The aim of this study was to demonstrate the electrophysiologic characteristics of atrial tachycardia (AT) originating from the PRA or RPVs. METHODS AND RESULTS: A total of 26 consecutive patients with AT originating from the RPVs or PRA underwent detailed atrial endocardial mapping and successful radiofrequency catheter ablation. Eight foci were found in the PRA and 18 foci in the RPVs. Analysis of P wave configuration showed that lead V1 was the most helpful in distinguishing the AT foci between these two sites. In all cases, double potential (DP) configurations were recorded from several electrodes of a multielectrode catheter placed in the PRA, and the first DP component (FP) was the earliest potential recorded from the right atrium during the tachycardia. The amplitude of the FP was higher than that of the second DP component (SP) for AT foci originating in the PRA, whereas the reverse occurred for those in the RPV. The activation sequence of the FP was from superior to inferior for the AT foci in the superior RPV, whereas the reverse occurred for the AT foci in the inferior RPV. CONCLUSION: P wave configuration in lead V1 is helpful in distinguishing AT foci between those originating in the PRA and RPVs. The DPs obtained from the PRA can be useful in predicting whether AT foci originate from the PRA or RPVs.