血清胆红素与冠心病发病的关系

目的　探讨血清胆红素与冠心病 (CHD)发病的关系。方法　将 190 5例患者按冠状动脉造影结果分为CHD组 ( 10 74例 )和对照组 ( 831例 )。采清晨空腹静脉血测定血清总胆红素浓度 ,比较两组间临床特征及实验室指标的差异 ,对血清总胆红素浓度与CHD之间的关系进行单因素及多元逐步Logistic回归分析。 结果　CHD组血清总胆红素浓度显著低于对照组 [( 12 .6± 6 .1)μmol/L和 ( 15 .9± 5 .7) μmol/L ,P <0 .0 1] ,单因素分析显示血清总胆红素浓度越低 ,CHD发病率越高 (P <0 .0 1)。多元逐步Logistic回归分析发现 ,血清总胆红素浓度与CHD的发生显著负相关(P =0 .0 0 0 1,OR =0 .939) ,低血清总胆红素浓度是CHD的独立危险因子。结论　血清总胆红素浓度减低可能在CHD的发病中具有一定的作用。     

5F 诊断性心导管检查后早期走动:多中心研究结果

对门诊病人行心导管检查可减少费用,而且提高设备的利用率。但是,用7F 和8F导管经股动脉逆行插管心血管造影术后过早走动,常发生局部出血。作者报道用5F 导管行左心导管检查的安全性以及早期走动有关的并发症和心性意外。方法本研究包括5个医疗中心的260     

经皮球囊导管治疗严重二尖瓣狭窄

作者对11例严重风湿性二尖瓣狭窄患者行经皮球囊扩张的治疗,结果9例成功,有良好疗效,2例未成功。文内对病例选择、操作技术和并发症处理等进行讨论。     

太极拳锻炼时心率及心电图的变化——100名遥测心电图分析(摘要)

民间中普遍认为太极拳有增强体质和治疗各种慢性病的功效,国内有报道对防治高血压病及冠心病确有一定作用。但它不同于一般体育锻炼。为了解太极拳锻炼时的心率及心电图改变,对100名熟练掌握太极拳的受检者进行遥测心电图观察.     

冠状动脉内注射腺苷对血压、心律的影响

目的 评估冠状动脉（冠脉）血流储备测定时冠脉内注射腺苷对血压、心率和心律的影响。方法 60例胸痛、冠脉造影正常及18例单支冠脉病变行冠脉内支架术患者测定冠脉血流储备，比较各例注射腺苷（左冠脉18μg，右冠脉12μg）后血压、心电的变化。结果 冠状造影正常者注射腺苷后收缩压、舒张压及平均动脉压和心率显著降低；5例（8．3％）于注射腺苷后出现Ⅲ度房室传导阻滞（右冠脉3例、左前降支2例，P＝0．005）；单支冠脉病变患者于支架术前注射腺苷后血压、心率无显著变化，术后注射腺苷其血压、心率显著减低。结论 冠脉内注射腺苷测定冠脉血流储备是一种安全和可靠的方法。     

用QRS积分法估价心肌梗塞患者左心室功能

作者对41例首次穿壁性心肌梗塞患者,于左心室和冠状动脉造影24小时内记录心电图,发现前壁心肌梗塞较下壁心肌梗塞患者QRS积分明显增高,QRS积分与左心室射血分数及局部室壁活动异常显著相关。本文指出,用QRS积分可精确估价心肌梗塞患者的左心室功能。     

THE EFFECT EARLY VERSUS LATE CORONARY STENT PLACEMENT IN PATIENTS WITH INFARCT-RELATED ARTERY OCCLUSION ON LEFT VENTRICULAR FUNCTIONAL RECOVERY

Objective To evaluate the effect of early versus late revascularization of asynptomatic patients with a totally occluded infarct-related artery (IRA) on left ventricular ( LV) functional recovery.Methods Sixty-four consecutive asymptomatic patients after a first Q wave anterior wall myocardial infarction (MI) with persistent left anterior descending artery occlusion and infarct-zone akinesia were studied. Coronary stenting was performed 2～ 3 weeks after infarction in 34 patients (group Ⅰ ), and 3 ～ 6 months after acute event in 30 patients (grout Ⅱ ). Resting two-dimensional echocardiographic examinations were made before the procedure and during 4 ～ 6 months of follow-up. Results In group Ⅰ , the occluded left anterior descending artery could be reopened, and full anterograde flow was restored in all patients. In group Ⅱ , stent implantation was successful in 26 patients (100% vs 86. 7%, P = 0. 04 ), and was not possible in 4 patients ( guidewire failed to pass the lesion and no vessel stump visible ). No complications occurred and residual stenosis was ≤30% after stenting in two groups. In group Ⅰ , LV ejection fraction increased from (55 ± 14 )% to (62 ± 13)% (P＜ 0. 001 ) and L V end-systolic volume had a decrease, but the end-diastolic volume remained unchanged. In group Ⅱ LV ejection fraction, infarct zone wall motion and LV volume did not improve.Conclusion The study indicates that myocardial viability (hibernation) may persists for 2 to 3 weeks but notfor 3 months after acute MI. During the time, restoration of patency of IRA artery after a Q-wave MI is benefi-cial even for asymptomatic patients.     

风湿性心脏病二尖瓣狭窄伴严重肺动脉高压的球囊扩张术疗效

目的　评估风湿性心脏病二尖瓣狭窄 (风心二狭 )伴严重肺动脉高压的经皮球囊导管二尖瓣扩张术疗效 ;以超声多普勒检查观察术后近期的肺动脉压变化。方法　 4 2例风心二狭伴严重肺动脉高压 (肺动脉收缩压≥ 75mmHg)患者以标准Inoue技术行经皮二尖瓣扩张术 ,并测定随访期临床心功能和多普勒超声肺动脉收缩压的变化。结果　 39例扩张术成功 (93% )。术后二尖瓣瓣口面积自 (0 .83±0 .12 )cm2 增至 (1.75± 0 .11)cm2 ,肺动脉收缩压自 (85± 7)mmHg降至 (6 1± 13)mmHg(P值均 <0 .0 0 1)。3例并发严重二尖瓣返流 ,其中 1例行二尖瓣置换术。在平均 6个月的随访中 ,39例成功扩张者 ,尽管二尖瓣瓣口面积无显著改变 ,但临床心功能明显改善 ,肺动脉收缩压进一步降低。结论　风心二狭伴严重肺动脉高压患者行经皮球囊导管扩张术安全、有效。术后短期内肺动脉收缩压继续减低 ,临床心功能进一步改善。