氯沙坦和福辛普利对心功能不全及心肌肥厚的疗效

目的探讨血管紧张素(ANG)Ⅱ受体拮抗剂氯沙坦和血管紧张素转换酶抑制剂(ACEI)福辛普利在治疗心肌肥厚和心功能不全中的作用.方法选择NHYA心功能分级为Ⅱ～Ⅳ级、EF≤50%的病人80例,随机单盲分为氯沙坦组和福辛普利组,于服药前和服药后6个月测定临床症状和超声心动图.结果二组左心室收缩功能显著改善,室间隔和室壁厚度减低,但左心室舒张功能均无明显变化(P＞0.05).福辛普利组中5例出现干咳症状(11.63%),而氯沙坦组耐受性较好.结论尽管氯沙坦和福辛普利均能改善左心室收缩功能及逆转心肌肥厚,但氯沙坦的耐受性较福辛普利为佳.     

进一步提高糖尿病合并冠心病患者的介入疗效

血糖异常通过影响脂质代谢、血凝系统和内皮功能等,促使动脉粥样硬化形成.同时,糖尿病也对经皮冠状动脉介入治疗(PCI)产生不良影响.药物洗脱支架的临床应用,使PCI术后再狭窄和心脏事件发生率降低,并与非糖尿病患者的疗效接近.加强PCI时动脉粥样硬化斑块的危险分层和术后二级预防,有望进一步提高糖尿病合并冠心病患者的总体PCI疗效.     

老年冠心病患者止凝血功能与血脂的关系

目的探讨止凝血功能和血脂对老年冠心病患者发病的作用及其关系。方法采用ELISA法测定250例冠心病患者和80例对照者的凝血酶-抗凝血酶Ⅲ复合物(TAT)、血浆血管性血友病因子抗原(vWF:Ag)、P-选择素(P-selectin)、D-二聚体(D-D)水平,以Clauss法测定血浆纤维蛋白原(FG)水平,双抗体酶联免疫吸附法测定血浆Lp(a)浓度,并检测血清TC、TG、LDL-C、HDL-C水平。结果冠心病组血浆FG、TAT、vWF:Ag、P-selectin、D-D及血脂水平明显高于对照组(P<0.05);随着冠状动脉病变支数增加,除HDL-C逐渐降低外,其余指标均明显升高(P<0.05)。FG、LDL-C、Lp(α)与冠状动脉病变程度密切相关(P<0.05),且LDL-C、Lp(α)与FG水平相关。结论FG、LDL-C、Lp(α)是冠心病发病的独立危险因子,对冠心病发生和发展起协同促进作用;血浆FG、TAT、vWF:Ag、P-selectin、D-D浓度的动态连续监测对体内高凝状态和冠心病预防具重要意义;临床抗凝和降纤治疗与降脂治疗宜同时进行。     

射频消融术治疗室上性心动过速1 000例的疗效

目的评价射频消融术治疗阵发性室上性心动过速的安全性和有效性. 方法 1*!000 例阵发性室上性心动过速的患者接受射频消融术,术后平均随访25±19月(1～110月). 结果射频消融术治疗室上性心动过速的总成功率为98.9%(989/1 000),其中旁道参与的心动速度590例(598条旁道),阻断588条,成功率98.3%;房室结折返性心动过速410例,慢径消融成功率为99.8%.14例(1.4%)患者出现并发症.随访期间,16例(1.6%)患者复发,再次接受射频消融术均获成功. 结论射频消融术是目前治疗阵发性室上性心动过速最为有效的手段,其成功率高,并发症少,复发率低.     

对先天性长QT综合征进行有效的基因分型

过去十年来，研究揭示了多种长QT综合征（long QT syndromes，LQTSs）的遗传学基础。其中包括由KCNQ1基因突变导致缓慢延迟整流钾电流IKs异常的LQT1；KCNH2突变引起快速延迟整流钾电流IKr异常的LQT2；以及SCASA突变导致异常INa（一种钠通道电流）的LQ33L。有了这些遗传学检测，就能清楚地对单凭静息心电图无法查出的LQTS患者进行评估。事实上，LQTS患者与非受累者的QT间期有着相当大的重叠。除临床评价外，遗传学检测可对确定患者发生心脏事件以及把LQTS遗传给下一代的危险提供重要的信息。     

Relationship between age and effect of early and long-term captopril treatment in patients with acute myocardial infarction

Objective To analyse the relationship between age and treatment with captopril after acute myocardial infarction (AMI). Methods In a randomized trial, 822 patients with a first AMI received conventional medic al treatment, including intravenous thrombolytic therapy and oral aspirin or metoprolol, and then were randomly allocated to captopril ［dosage fr om the first 6.25 mg to 25 mg/t.i.d, 209 younger patients (≤64 years), 269 elderly patients (65-75 years)］ or conventional treatment only (131 younger p atients, 213 elderly). Survival in the four groups was calculated with the Kapl an-Meier method. Multivariate analysis was performed to understand the degree that multi-variables (including age) affect survival in patients taking captopr il in the hospital or during long term follow-up. Results The survival of patients who took captopril correlated significantly with age ( P&lt;0.001). The survival of the elderly patients on captopril treatment did increase (P&lt;0.0001), but not of the younger ones (P&gt;0.05) during hosp italization. During follow-up, the survival of patients who took captopril cor related insignificantly with age (P&gt;0.05), but both the elderly and the you n ger patients have good survival rates (all P&lt;0.01) and lower cardiac events (all P&lt;0.01) when they took captopril.Conclusions Captopril exerts a weak effect on the younger patients but a beneficial effect o n the elderly patients during hospitalization after AMI. However, there is no d ifference between the younger and the elderly in the prognosis, both having good survival and lower cardiac events when they take captopril long term during fol low-up.     

Heart rate variability and its response to thyroxine replacement therapy in patients with hypothyroidism

目的　测定甲状腺功能减退 (甲减 )患者心率变异 (HRV)及观察甲状腺素替代治疗后的变化。方法　记录 38例甲减患者与 2 1例正常者 2 4小时动态心电图 ,并进行HRV分析。 18例甲减患者治疗 3月后重复HRV测定。结果　甲减时 ,HRV的时阈指标较对照组明显降低 ;频阈指标中 ,高频功率 (HF)较对照组明显增高 ,而低频 (LF)与HF比值较对照组显著减低。甲减患者经甲状腺素替代治疗后 ,HRV时阈指标和频阈指标均明显改善 ,且与FT3和FT4 的恢复程度相一致。结论　甲减时 ,自主神经活动明显改变 ,且以迷走神经兴奋性增加占优势。这种自主神经异常在甲状腺素替代治疗后可部分改善。     

AMI初期支架植入和rt—PA静脉溶栓加补救支架植入的比较

目的比较急性心肌梗塞(AMI)患者冠状动脉内初期支架植入和静脉rt-PA溶栓加补救支架植入治疗的临床疗效.方法98例首次AMI患者随机给以冠状动脉内初期支架植入(初期支架组48例)和静脉rt-PA溶栓加补救支架植入(溶栓加支架组50例).所有患者行急诊冠状动脉造影以TIMI血流分级法判断梗塞相关冠状动脉(IRA)开通情况;记录住院期心脏事件出院前用二维超声心动图测定两组患者左心室舒张末期和收缩末期容量并推算左心室射血分数(LVEF).结果急诊冠状动脉造影显示支架组47例(97.91%),溶栓加支架组50例(100%),IRA血流TIMI2～3级,但前者IRA前向血流TIMI3级者明显增多(分别为93.8%和60.0%,P=0.0001).两组患者住院期死亡率和心脏事件相似,但出院前超声心动图显示支架组LVEF(62.01%±14.03%)高于溶栓加支架组(50.01%±132%,P=0.0001).结论与静脉rt-PA溶栓加补救支架治疗相比,AMI初期支架植入可更好改善急性期心肌再灌注,并减少患者住院期心功能减退.     

PBMV治疗二尖瓣狭窄伴中-重度肺动脉高压

目的评价经皮二尖瓣球囊扩张术（ＰＢＭＶ）治疗二尖瓣狭窄伴中或重度肺动脉高压的疗效。方法用Ｉｎｏｕｅ球囊导管行ＰＢＭＶ治疗二尖瓣狭窄伴肺动脉收缩压≥６０ｍｍＨｇ（８．００ｋＰａ）患者１０１例。用超声心动图和心导管法观察血流动力学效应。结果术后血流动力学明显改善,二尖瓣瓣口面积增加（Ｐ〈０．０１）;肺动脉收缩压及肺循环阻力明显降低（Ｐ〈０．００１）,这些变化在心房颤中层得中尤为明显。结论ＰＢＭＶ治疗严