老年人单纯性收缩压增高心脏受累的超声研究

老年人单纯性收缩压增高心脏受累的超声研究邮政编码１０００３４北京医科大学第一医院内科老年学科王利生，郭凤英，赵玮，何萍，祁芸芸，张树彬本研究以多普勒超声心动图技术对２０例老年人单纯性收缩压增高（平均年龄７２．１±６．９）及２０例同龄（７１±４．０）正...     

左室室壁瘤的临床及超声诊断(附1例报告)

本文报告1例广泛前壁心肌梗塞患者用超声诊断并发心室壁瘤及巨大血栓,后经溶栓,血栓完全消失。 患者,男,37岁,劳力性心绞痛4年,1990年12月8日心前区剧痛,诊断急性广泛前壁心梗,并频发室早,12月30日始上腹隐痛,渐加重转为全腹剧痛,伴黑便,诊断为急性肠系膜动脉栓塞,手术切除肠管1.2米。1991年1月14日转来我院,体检:神清,平卧,Bp 12/8 kPa。心向左扩大,心率80次/分,早搏15次/分,无杂音,肺清,腹软,肝脾未及,下肢不肿。UCG:左房左室扩大,室间隔及前壁运动明显减     

不同类型维生素E对人脐静脉内皮细胞细胞间黏附分子-1表达的影响

目的:观察不同类型维生素E(α、γ、mixed-tocopherols)对氧化型低密度脂蛋白 (oxLDL)及重组人C反应蛋白 (rhCRP)诱导的人脐静脉内皮细胞 (HUVECs)细胞间黏附分子-1 (ICAM-1)表达的影响,以探讨不同类型维生素E的抗炎、抗动脉粥样硬化机制及不同效果. 方法: 体外培养HUVECs,分别加oxLDL、oxLDL α-tocopherol、oxLDL γ-tocopherol、oxLDL mixed-tocopherols、rhCRP、rhCRP α-tocopherol、rhCRP γ-tocopherol、rhCRP mixed-tocopherols孵育 24 h,采用细胞酶联免疫吸附(ELISA)、流式细胞、RT-PCR技术分别测定ICAM-1蛋白和mRNA表达水平. 结果: oxLDL和rhCRP均可诱导HUVECs的ICAM-1蛋白和mRNA表达增加,不同类型维生素E均可抑制oxLDL诱导的HUVECs的ICAM-1蛋白和mRNA表达,并呈浓度依赖性(50～200 μmol/L).与相同浓度的α、γ-tocopherol相比, mixed-tocopherols抑制作用最强.不同类型维生素E均不能抑制 rhCRP诱导的HUVECs的ICAM-1蛋白和mRNA表达.结论: 不同类型维生素E均可抑制oxLDL诱导的HUVECs的ICAM-1蛋白和mRNA表达,与α、γ-tocopherol相比,mixed-tocopherols对oxLDL诱导HUVECs表达ICAM-1的抑制作用最强.     

老年人冠状动脉起源异常研究

目的 分析老年人冠状动脉起源异常的类型及检出率,总结其冠状动脉分布的优势情况,并探讨冠状动脉起源异常与冠状动脉粥样硬化的关系.方法 回顾性分析北京大学第一医院接受冠状动脉造影检查的老年患者资料,记录冠状动脉起源异常的检出频度和类型,及发生冠状动脉粥样硬化性狭窄的情况.结果 冠状动脉造影总数2031例,检出冠状动脉起源异常46例(2.3%).右冠状动脉起源异常26例(56.5%),右冠状动脉起源异常多于左冠状动脉(19例,41.3%).其中以右冠状动脉起源于左冠状动脉窦为最常见类型,占总异常的28.3%(13例).并存冠状动脉粥样硬化性狭窄者37例(80.4%),其中17例(37.0%)累及起源异常的冠状动脉.结论 我国老年人冠状动脉起源异常多见于右冠状动脉,其中具有潜在临床危险的右冠状动脉起源于左冠状动脉窦为最常见类型.冠状动脉起源异常与冠状动脉粥样硬化存在相关性.

Abstract：

Objective To estimate the patterns and frequency of anomalous coronary origin with angiography in the Chinese elderly population and evaluate the correlation between anomalous coronary origin and development of coronary atherosclerotic stenosis. Methods A retrospective analysis was performed on the basis of angiographic data among elderly patients who underwent coronary arteriography in Beijing University First Hospital. Those with anomalous origin of coronary arteries were selected for further assessment and significant stenosis in coronary arteries was recorded.Results Among 2031 patients, 46 patients were found to have anomalous origin of coronary artery,with an incidence rate of 2.3%. Right coronary artery was the most common anomalous vessel, being involved in 26 patients (56.5%). The anomalous origin was more frequent in right coronary artery than in left coronary artery (41.3%). The most common anomaly was right coronary artery arising from left coronary sinus in 13 patients (28.3%). Significant atherosclerotic lesions in the anomalous arteries were seen in 37 patients (80.4%). Conclusions In Chinese elderly population, the anomalous origin of coronary artery is more frequent in right coronary artery, the most common anomaly resides in right coronary artery arising from left coronary sinus. The anomalous coronary artery increases risk for development of coronary atherosclerotic stenosis.     

运动~(99m)Tc-CPI心肌SPECT显像在冠心病诊断中的初步应用

~(201)Tl心肌灌注显像已成为冠心病临床诊断、预后及疗效评价的重要无创作手段,但由于~(201)Tl的核性质及价格等方面的原因,限制其更广泛的临床应用。 ~(99m)Tc标记的甲酯异丙基异腈(~(99m)Tc-Carbomethoxy isopropyl isnoitrile,~(99m)Tc-CPI)是~(99m)Tc标记的异腈类化合物中较有希望的一个心肌显像剂,除了~(99m)Tc的核性质适宜和价格低廉外,还具有肺、肝清除较快、心肌图像清晰等优点,国内外初步临床应用结果比较满意。文献     

几种无创性方法测定左心室射血分数的对比评价

本文以20例正常人,20例陈旧性心肌梗塞患者应用多功能超声记录仪同步测定心缩间期,左心室面积及直径,计算其射血分数,并与同位素~(99m)Tc左心室功能测定结果相比,证明几种方法所得的射血分数值大部分相关,其中以面积公式法高度相关。     

多普勒超声心动图运动负荷试验对老年冠心病患者左心室储备功能的评价

］　Purpose　To investigate left ventricular systolic and diastolic reserved function of normal aged and aged subjects with coronary heart disease (CHD) under submaximal stress conditions. Methods　89 subjects (young healthy 20,aged healthy 31,aged CHD 38) performed submaximal supine bicycle exercise with electrocardiography,ultrasonic cardiography and 99m-Technetium imaging exercise testings done synchronously.The aortic and mitral flow patterns were recorded by Doppler echocardiography. Results　The percent changes in aortic variables of systolic function of aged healthy subjects were much lower than those of young healthy subjects,and much higher than those of aged CHD patients.After exercise,the A/E ratio increased in young group,while decreased in aged healthy and CHD groups. Conclusion　Under submaximal stress conditions,the cardiac systolic reserved function was obviously decreased in aged healthy subjects,and much lower in aged CHD patients.The changes of left ventricular filling patterns in healthy aged and aged CHD groups might suggest an elevation in left atrial pressure and decreased cardiac diastolic reserved and left atrial compensatory functions.     

老年急性初发心肌梗死前有无心绞痛对心功能及预后的影响

目的观察老年急性心肌梗死前有无心绞痛对心功能及预后的影响。方法76例老年初发急性心肌梗死患者按急性心肌梗死发病前有无心绞痛发作分为两组,有心绞痛发作组42例,无心绞痛发作组34例,观察其心律失常、梗死后心绞痛、心功能和病死率。结果心肌梗死前有心绞痛发作组的心原性休克和心力衰竭的发生率及病死率均低于心肌梗死前无心绞痛发作组(分别为33.3%vs58.8%,2.4%vs23.5%),两组间差异有显著性,P<0.05;超声心动图检查发现LVEF和E/A有心绞痛发作组高于无心绞痛发作组(分别为0.52±0.056vs0.45±0.03,0.86±0.29vs0.54±0.35),两组间差异有显著性,P<0.05。结论心肌梗死前有心绞痛对老年初发急性心肌梗死患者的心功能有保护作用,可改善患者的近期预后。     

多普勒超声对瓣膜病诊断和替换术后瓣膜功能的评价

近年来,我院对30例心脏瓣膜替换术及分离术患者进行了多普勒超声诊断,结果及评价报告如下。 资料与方法 一、病例选择:我院心外科1985～1991年住院患者30例,男16例,女14例,年龄20～64岁,平均39.4岁。风心瓣膜病28例,二尖瓣脱垂伴二尖瓣重度关闭不全1例,Lutenbach 1例。30例中二尖瓣分     

多普勒超声心动图多项指标与左室舒张功能的关系

本文研究了60例冠心病人的多普勒超声心动图测得的二尖瓣血流改变的多项指标变化,分析其与心脏舒张功能的关系及所代表的意义。发现冠心病人的快速充盈期指标、等容舒张期指标及缓慢充盈期指标均不同于正常人,多普勒多项指标的改变分别反映了心脏不同的舒张过程及心肌本身舒张特性,如心肌弛张、被动顺应性及负荷状况的改变。在多种指标中,以等容舒张时间最为敏感88％,与其它指标有显著差别。