体元模型三维重建定量高血压病者左室重量

二维超声心动图是当前临床评价左室肥厚（LVH）最常用的方法。但用二维超声定量左室心肌重量（LVM）需要几何学假设，如何提高其定量LVM的准确性一直是我们研究的方向。近年来三维重建技术及计算机图象处理技术的发展使这一研究得到很大的进步。我们采用最新的经食管多平面Voxel模型三维重建技术定量离体猪心和高血压病人的LVM，评价该技术在临床上运用的可行性及实用价值。材料和方法实验研究取新鲜猪心17只，沿房室沟切除左、右心房，离断健索后切除二尖瓣、主动脉瓣，左室内加压塞人棉花，使其横切面呈不规则形。置10％福尔马林溶…     

厄贝沙坦的降压治疗和靶器官保护

厄贝沙坦(安博维)是血管紧张素受体拮抗剂(ARB)中的重要成员,自1997年首次批准用于高血压治疗至今,已经在全球50多个国家获得广泛应用.最近的研究显示,厄贝沙坦除降压作用外,还具有独立于降压以外的心血管事件链干预作用,在左室肥厚、糖尿病肾病、心房颤动、心力衰竭的治疗中具有独特的作用.     

慢性心力衰竭患者血浆氨基末端脑钠素前体水平的影响因素分析

目的:综合分析慢性心衰患者血浆氨基末端脑钠素前体水平(NT-proBNP)的影响因素。方法:对261例有不同程度心功能不全的患者进行检测,分析NT-proBNP与心脏结构、功能、房颤、患者的性别、年龄、体重指数及QRS波时限等因素的相关性。结果:单因素及多因素分析均显示血浆NT-proBNP水平与心功能、年龄、BMI、左室射血分数、左室收缩末内径(LVDs)等因素有关,而与性别、左心室舒张末内径、室间隔厚度、左心室后壁厚度、QRS波时限、有无房颤无相关性。结论:慢性心衰患者血浆NT-proBNP水平与患者左心室收缩功能、年龄、BMI、LVDs等因素有关。     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.     

心力衰竭诊断的认识

心力衰竭(简称心衰)是可影响心功能的各种心脏病发展的最终结果,近年对于心衰发病机制的研究和治疗取得了重要的进展.     

C-反应蛋白与冠心病

C-反应蛋白(CRP)是系统炎症产生的急性蛋白之一，它有助于评价心血管的危险因素。高敏C-反应蛋白(hsCRP)的检测越来越受到广泛运用。     

铁缺乏症是慢性心力衰竭治疗的新目标

慢性心力衰竭(chronic heart failure,CHF)的治疗是近年来心血管疾病治疗的难点之一,随着CHF规范化治疗的推广应用,对于经充分规范化药物治疗后仍有明显心力衰竭症状的患者,应用铁剂治疗改善心力衰竭的症状和预后成为该领域的研究热点之一。1慢性心力衰竭患者的贫血与铁缺乏症CHF患者常见贫血,虽然我国目前尚无关于CHF患者中贫血发生率的流行病学资料,但一项美国近期的流行病学调查显示,CHF患者中贫血     

慢性心力衰竭的器械治疗及进展

正慢性心力衰竭(心衰)是一种复杂的临床综合征,是多种心脏病的严重阶段或终末期表现。临床表现为呼吸困难、乏力和体液潴留。规范的药物治疗是心衰治疗的基础,血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)、血管紧张素Ⅱ受体阻滞剂(angiotensin receptor     

心房颤动对不同心功能分级的患者血浆脑钠肽水平的影响

Objective To assess the effect of atrial fibriUation (AF) on plasma levels of NT-proBNP in patients with different cardiac functions. Methods One hundred and ninty-one patients with chronic heart failure (CHF) were divided into two groups: minor CHF group (NYHA Ⅰ/Ⅱ class) and sever CHF group (NYHA Ⅲ/Ⅳ class). In addition,84 patients without HF (non-HF group) were enrolled as control The plas-ma NT-proBNP were assayed and the effect of AF on the NT-proBNP levels was analyzed to determine inde-pendent of NT-proBNP levels in 3 groups. Results Patients with AF in non-HF had higher NT-proBNP levels than those with sinus rhythm (SR) [(2.95 ±0.41) vs (2.21±0.44) ng/L, P < 0.01], and multi-variables regression demonstrated that age, AF and left atrial diameter (LAD) were independent determinants of NT-proBNP levels (P <0.001). NT-proBNP levels in minor CHF were also higher in patients with AF than that in patients with SR [(3.26±0.40) ng/L vs (2.98±0.54) ng/L, P < 0.05] ; AF, LAD, left ventricular end-systolic dimension (LVESD) and left vontric-ular eject fraction (LVEF) were the independent factors of NT-proBNP levels (P < 0.05). However, there was no difference of NT-proBNP levels between patients with AF and patients with SR [(3.59±0.52) ng/L vs (3.56±0.55) ng/L,P =0.73] ; while age and LVEF were in-dependent factors (P < 0.05). In patients with LVEF < 0.40, AF had not significant affect on NT-proBNP lev-els [AF vs SR: (3.70±0.60) ng/L vs (3.46±0.56) ng/L,P >0.10]; however,AF patients with LVEF≥ 0.40, NT-proBNP levels were increased [AF vs SR: (3.08 ±0.57) ng/L vs (2.67±0.73) ng/L, P < 0.001]. Conclusion The effect of AF on plasma NT-proBNP was related with cardiac functions: in AF pa-tients without or with minor cardiac dysfunction (NYHA Ⅰ /Ⅱ class or LVEF≥0.40) ,NT-proBNP increased; in AF patients with sever cardiac dysfunction (NYHA Ⅲ/Ⅳ class or LVEF < 0.40), NT-proBNP had no sig-nificant changes.     

肾素抑制剂阿利吉仑

阿利吉仑是第一个获准临床应用的肾素抑制剂,能够有效降低血浆肾素活性以及血管紧张素Ⅱ和醛固酮水平。本文主要介绍阿利吉仑的药代动力学和药效学特点以及治疗高血压、慢性肾病和心力衰竭等疾病的临床研究进展。