植入式循环心律监测仪在晕厥诊断中的应用

晕厥是临床就诊的常见原因之一,其病因多样,诊断较为困难.即使通过详细的检查,仍有许多病人不能明确诊断;尤其是与心律失常相关的晕厥,由于偶发性和不可预知等特点,很难得到晕厥发作时心律变化的资料,使得临床诊断更为困难.利用植入性循环心律监测仪(Implantable loop record,ILR)埋藏于皮下,进行长时间的心律监测,明显提高了心律失常性晕厥的诊断率,在国外已有较多的报道[1,2];我院于2002年4月4日进行了我省首例ILR植入,现结合临床应用及随访结果介绍如下.     

室间隔起搏损伤电流的临床应用研究

目的 探讨损伤电流(COI)与主动固定导线稳定性关系,为临床判断主动固定导线植入室间隔的可靠性和安全性提供依据.方法 入选按常规方法将主动固定导线植入右心室间隔患者193例,在导线螺旋旋出即刻测试COI,同时进行起搏参数测试.结果 按测得COI值分别为＜5 mV、5 ～10 mV、＞10 mV 3组,COI＜5 mV组平均(3.85±1.01) mV,COI 5～10 mV组平均(7.74±1.63) mV,COI＞10 mV组平均(10.63±0.55)mV.COI＜5 mV组阈值为(0.83±0.16)V,高于COI＞ 10 mV组阈值(0.69±0.15) V(P＜ 0.05),其余组间差异无统计学意义.COI＜5 mV组发生心室导线脱位2例,COI表现为“顶天立地”的发生心室导线穿孔1例.并发症的发生率为1.55％.结论 在室间隔起搏主动固定导线植入术中应测试COI,测得COI应至少在5 mV以上,但COI过大将增加导线穿孔的风险.     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

双腔起搏器自动房室间期搜索功能的临床应用观察

目的观察双腔起搏器自动AV间期搜索功能(auto AV search)减少心室起搏的有效性及对心功能和快速房性心律失常的影响。方法43例植入具有自动AV间期搜索功能的双腔DDD(R)起搏器的患者,术后6个月内随机交叉关闭或打开AV search功能各3个月,分别在第一阶段(3个月末)、第二阶段(6个月末)程控获取心室起搏百分比(Vp)、高频心房事件及测试血浆BNP值。结果43例患者按计划完成随访,AV search关闭组心室起搏(VP)比例为78.0±10.3%,心房高频事件为58±15次,血浆脑钠肽(BNP)水平为333±30pg/ml;AVsearch打开组Vp比例为15.9±4.8%,心房高频事件为29±13次,BNP65±21 pg/ml,两者相比具有显著统计学差异(P<0.01)。结论双腔起搏器的auto AV search功能可有效减少非必须的心室起搏,促进自身心室激动。     

老年非瓣膜病房颤患者华法林抗凝治疗临床应用

目的探讨老年非瓣膜病房颤患者华法林抗凝治疗剂量以及国际标准化比值(INR)监测,进一步推广华法林抗凝治疗临床应用。方法前瞻性观察52例老年非瓣膜病房颤患者华法林抗凝治疗的剂量、药物剂量调整方法、应用注意事项以及INR监测、出血并发症。结果华法林起始剂量为2.5mg,维持剂量为1.25mg~3.25mg,平均2.3±0.5mg,INR达到1.6~2.5水平需时间为5~12天,平均8±2天,INR稳定于1.6~2.5水平需10~28天,平均17±4天。随访1.5±0.9年,有3例出血,无缺血脑卒中及其他部位的血栓栓塞。结论老年非瓣膜病房颤患者,在合理有效INR强度(1.6~2.5)监测下,华法林的应用是安全可靠的,可在临床进一步的推广应用。     

房间隔起搏在心脏再同步治疗中的应用

目的通过简单的超声多普勒方法评价房间隔起搏在心脏再同步治疗（CRT）中的效果。方法在23例行CRT治疗的患者中进行了超声多普勒测量，9例患者存在房间阻滞，心房起搏导线固定在房间隔，其余14例常规固定在右心耳。结果右心耳起搏组中心房间传导延迟时间（IAD）延长[（46±20）ms vs（53±23）ms，P〈0．05]，IAD和心室间传导延迟时间（IVD）的差异增大[（53±23）ms VS（40±17）ms，P〈0．05]，左机械房室延迟时间（LMAVD）和右机械房室延迟时间（RMAVD）的差异明显增加[（172±25）ms vs（210±32）ms，P〈0．001]。房间隔起搏后IAD明显减小[（34±12）ms VS（12±11）ms，P〈0．001]，IAD和IVD的差别减少[（12±11）ms VS（18±16）ms，P〉0．05]，LMAVD和RMAVD差异无统计学意义[（187±43）ms vs（182±50）ms，P〉0．05]。二尖瓣A峰速度时间积分在房间隔起搏后明显增加[（8．9±4．9）cm vs（13．0±4．0）cm，P〈0．001]。结论房间阻滞可以导致左心和右心房室收缩顺序的差异，房间隔起搏能纠正这种差异，增加二尖瓣舒张期充盈进一步改善心脏再同步治疗。     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.