一种无创脉搏波检测分析系统的研制

研制了一套无创脉搏信号检测分析系统，系统采用生理压力传感器同时采集两路脉搏波信号，实现了脉搏波信号的实时采集、存储、动态显示、波形波速度分析和诊断报告的打印，能够较全面的评价心血管系统的功能。该系统采用单片机与计算机结合的设计方式，同时具有单片机小型化、便携的特点和计算机强大的数据存储、分析、处理的能力。初步临床实验表明，该系统操作方便，稳定性好，检测的可重复性较好。     

陈旧心肌梗死患者的心率变异性分析

目的分析陈旧心肌梗死患者的心率变异性。方法选取我院收治的陈旧性心肌梗死患者40例,将其作为本研究的实验组,选取同时期于我院就诊的心绞痛患者40例及身体健康者40名作为本研究的对照组,对三组入选病例的心率变异性进行分析,总结陈旧心肌梗死患者的心率变异性特点。结果实验组与心绞痛对照组心率变异性指标均低于正常对照组(P<0.05),但组间比较无明显差异(P>0.05)。结论陈旧心肌梗死及心绞痛患者心率变异性明显低于正常人,心率变异性检测可反映自主神经活性,评估心血管患者预后。     

基于脉搏波检测技术的心血管健康评测

脉搏波中蕴含丰富的生理病理信息,能反映心功能参数的早期变化趋势。因此,脉搏波信息的量化对心血管疾病具有重要的参考价值。从脉搏波的形成机制角度,阐述脉搏波与心血管生理病理信息的关系;从脉搏波的波形分析,阐述临床中应用脉搏波技术的心血管无创检测指标;将心血管的生理病理信息和脉搏波理论相结合,建立评测心功能健康状况的评价指标。基于脉搏波理论建立的心血管无创检测方法,有助于全面维护心血管健康,为心血管系统疾病的早发现、早预防、早治疗提供重要医疗手段;其次,可以简化临床检测过程,降低检测成本,实现心血管疾病适时地健康普检,降低心血管疾病的致死率和致残率。     

基于脉搏-心电的便携式血压仪的研制

设计一种体积小巧,测量过程无任何束缚的基于脉搏波传导时间(pulse wave transit time,PWTT)的血压仪。从反射式容积脉搏波(photoplethysmography,PPG)和心电波形(electrocardiogram,ECG)中提取脉搏波传导时间,再综合心率、每搏输出量和外周阻力对血压的影响,通过回归分析建立血压模型,最终实现血压测量。应用样机对20名志愿者进行血压测量,同时以传统水银血压计的测量结果作为标准,结果显示收缩压和舒张压的95%一致性界限分别为(-8.3,11.6),(-9.9,12.7),说明两种方法所测的血压值有较好的一致性。血压仪样机实体小巧,使用方便,使用过程没有任何束缚,同时在理论上对基于脉搏波传导时间的血压测量方法进行优化,实现了收缩压和舒张压的测量。     

老年无症状动脉硬化的baPWV检测及危险因素分析

目的:探讨老年无症状动脉硬化的检测及危险因素特征。方法:以上臂-脚踝脉搏波传导速度(baPWV)这项与大动脉脉搏波传导速度之间有较好相关性的指标作为测量指标,对204名入住我科的老年人进行baPWV测定,以1400cm/s为界值将所有对象分为对照组与动脉硬化组,比较各危险因素在二组中的分布特征。结果:动脉硬化组的空腹血糖(FBG)、超敏C-反应蛋白(hs-CRP)、尿酸(UA)、收缩压(SBP)、脉压(PP)和体重指数(BMI)均高于对照组,而舒张压(DBP)低于对照组(P<0.05)。Logistic回归显示FBG、hs-CRP、SBP和PP是老年无症状动脉硬化的独立危险因子。结论:FBG、hs-CRP、SBP和PP可能对动脉硬化的发展过程起到促进作用,加强对这些因素的早期预防和干预,有望减少心血管事件的发生。     

基于脉搏波的心输出量监测技术研究进展

心输出量（CO）是人体血流动力学监测的核心参数,对心血管疾病的诊断和治疗具有重要意义,而脉搏波包含了丰富的生理病理信息,其波形特征与血流动力学参数的变化密切相关,因此在CO监测上有着广泛的应用。脉搏波主要分为压力脉搏波和容积脉搏波两类,前者在CO监测上已有成熟的产品,后者则仍在科研阶段,尚未有能满足应用要求的技术产品。本文首先分别介绍压力脉搏波和容积脉搏波各自的特点以及计算CO的理论基础,然后从微创及无创两个方面,介绍几种基于两类脉搏波的CO监测技术,并分析它们的基本原理和优缺点,最后对监测技术的发展和应用做了展望。     

基于LabVIEW的心血管动力学参数分析与研究

目的:根据脉搏波理论设计出一套基于虚拟仪器的心血管动力学参数分析系统。方法:本文以LabVIEW7.0作为软件开发平台,根据示波法原理和弹性腔理论总结提炼出收缩压、平均压、舒张压、心率、每搏心输出量、每分心输出量、外周阻力等参数。结果:通过心血管动力学参数的分析能判断心血管病患者与正常人的差异性,对心血管病的预防及疾病早期发现都能发挥很大的作用。大量的实测结果表明系统有较好的准确性和稳定性。结论:此采集分析系统有操作便捷,灵活性高,可扩展性好的特点,可以直观地观测病人的心血管状况以便及时的对心血管疾病采取措施和进行预防,为心血管动力学参数的分析研究提供了一种简便有效的途径。     

溶栓治疗后急性心肌梗死患者心率变异性的变化

目的观察急性心梗患者(AMI)溶栓后心率变异性(HRV)变化。方法41例患者被分为两组溶栓再通组21例;常规治疗组20例。观察两组患者病后心率变异性的改变。结果溶栓再通组病人在各时间点的HRV均高于常规治疗组(P<0.05);组内比较,3月、6月时的HRV均高于2周时(P<0.05)。2周时再通者室性心律失常低于常规治疗组(P<0.05)。结论溶栓后冠脉再通可改善心脏自主神经系统功能,减少室性心律失常。     

两种计算正常成年人短时心率变异性方法的比较研究

目的利用光电容积脉搏波法分析心率变异性,为通过心率变异性(heart rate variability,HRV)参数表征自主神经系统的变化提供新的研究方法。方法对46个健康成年受试者分别同步采集自主呼吸状态下的心电信号和光电容积脉搏波信号,利用二阶差分极大值提取心电图的RR间期,搜索脉搏波极大值提取脉搏波主波波峰间期PP,然后计算通用HRV参数SDNN、RMSSD和LF/HF,并利用回归的统计学方法结合Bland-Altman随机分析法对这两种方法获取的HRV结果进行比较。结果两种方法计算得到的心率变异性参数结果的Pearson相关系数分别为0.998、0.995和0.992,均显著相关(P0.01),Bland-Altman分布图也均在一致性区间内,说明这两种方法在计算心率变异性上具有一致性。结论利用光电容积脉搏波法分析心率变异具有可行性。     

一种适用于心率变异分析的R波检测与定位算法

在心率变异分析中,不仅要可靠地检测出 R 波,而且要对 R 波的峰值点进行准确定位。本文提出一种简单有效的 R 波检测方法,它不仅能够有效地抑制心率变异分析中的基线漂移、工频噪声、肌电、运动伪迹等干扰,提高实时检测 R 波准确率,并且能够对 R 波的峰值点准确定位。由于算法简单,适用于便携式心率变异分析仪。     

Influenza Virus Infection and Risk of Acute Myocardial Infarction

Increasing evidences have shown that pathogens might promote atherosclerosis and trigger acute myocardial infarction (AMI). But the conclusions from various studies on the correlation between previous influenza virus (IV) infection and AMI were inconsistent. We conducted a case-control study to assess the association of previous IV infection and AMI. Questionnaire survey was conducted to collect information about demographic characteristics and heart disease risk factors. Fasting blood sample was obtained to measure IgG antibodies to influenza virus A(IV-A), influenza virus B(IV-B), cytomegalovirus (CMV), herpes simplex virus type-1 (HSV-1) and type-2 (HSV-2), adenovirus (ADV), rubella virus (RV) and Chlamydia pneumoniae (CP) and measure the level of some biochemistry markers. Compared to controls, cases were more likely to have positive IgG antibodies to IV-A and IV-B (IV-A: OR, 3.3; 95%CI, 1.5 to 7.4; IV-B: OR, 17.2; 95%CI, 7.7 to 38.0). After adjustment for potential confounding variables, the risk of AMI was still associated with the presence of IgG antibodies to IV-A (adjusted OR, 7.5; 95%CI, 1.3 to 43.0) and IV-B (adjusted OR, 27.3; 95%CI, 6.6 to 113.8). The study supported the hypothesis that previous IV infection took part in the development of atherosclerosis and trigger the occurrence of AMI.     

心肌梗死患者TWA现象分析

目的分析心肌梗死患者发生T波电交替(T-wave alternans,TWA)的规律以及各种并发症对TWA的影响。方法在European ST-T数据库中选取部分心肌梗死患者的心电信号利用改进的谱分析法与相关分析法进行TWA检测。结果各类型心肌梗死患者都出现明显的TWA现象;②前壁心肌梗死患者TWA现象相对较少,下壁心肌梗死患者TWA易检测出来;③并发心绞痛与冠状动脉疾病的各类型心肌梗死患者TWA现象较多;④相关分析法平均交替幅度(Acm)与谱分析法平均交替幅度(Asm)无明显特征性,是否与其他心电参数有关,需要进一步研究。结论TWA的检测确可作为诊断心肌梗死疾病及其并发症的一项重要指标。     

Long-Term Clinical Outcomes according to Initial Management and Thrombolysis In Myocardial Infarction Risk Score in Patients with Acute Non-ST-Segment Elevation Myocardial Infarction

Purpose

There is still debate about the timing of revascularization in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). We analyzed the long-term clinical outcomes of the timing of revascularization in patients with acute NSTEMI obtained from the Korea Acute Myocardial Infarction Registry (KAMIR).

Materials and Methods

2,845 patients with acute NSTEMI (65.6 ± 12.5 years, 1,836 males) who were enrolled in KAMIR were included in the present study. The therapeutic strategy of NSTEMI was categorized into early invasive (within 48 hours, 65.8 ± 12.6 years, 856 males) and late invasive treatment (65.3 ± 12.1 years, 979 males). The initial- and long-term clinical outcomes were compared between two groups according to the level of Thrombolysis In Myocardial Infarction (TIMI) risk score.

Results

There were significant differences in-hospital mortality and the incidence of major adverse cardiac events during one-year clinical follow-up between two groups (2.1% vs. 4.8%, p < 0.001, 10.0% vs. 13.5%, p = 0.004, respectively). According to the TIMI risk score, there was no significant difference of long-term clinical outcomes in patients with low to moderate TIMI risk score, but significant difference in patients with high TIMI risk score (≥ 5 points).

Conclusions

The old age, high Killip class, low ejection fraction, high TIMI risk score, and late invasive treatment strategy are the independent predictors for the long-term clinical outcomes in patients with NSTEMI.     

普外科术后继发脑梗死的多因素Logistic回归分析

目的 探讨普外科术后并发脑梗死的高危因素,为早期识别及干预提供依据。方法 收集2013年1月~2017年12月我院普外科术后发生脑梗死患者及同期其它手术患者共2835例的临床资料,通过多因素Logistic回归分析确定普外科术后并发脑梗死的独立危险因素。结果 多因素回归分析显示,年龄（OR=2.001,95%CI:1.117~3.472）、手术类型（OR=2.199,95%CI:1.203~4.425）及术中低灌注（OR=2.421,95%CI:1.387~4.974）是普外科术后继发脑梗死的独立因素（P＜0.05）。结论 年龄≥65岁、恶性肿瘤手术及术中低灌注是普外科术后脑梗死形成的可能原因,早期识别高危患者及对相关高危因素进行干预,对预防普外科围手术期脑梗死的发生意义重大。     

大鼠心肌梗死后心力衰竭模型的建立及评价

目的 探讨大鼠心肌梗死后慢性心力衰竭模型建立方法及指标评价体系.方法 SD大鼠麻醉后开胸,手术组结扎左侧冠状动脉前降支,制备心梗后心衰模型,假手术组采取仅在相同结扎位置穿针,不结扎的方法.术后8周处死.术前、术后5分钟、处死前分别记录标准肢体导联心电图、心脏超声,评价电生理、心功能指标;处死后采用苏木素-伊红(HE)染色、Masson染色评价病理改变;使用酶联免疫吸附法(ELISA)测定血清中B型尿钠肽(brain natriuretic peptide,BNP)浓度.结果 该研究中手术组及假手术组手术存活率分别为72.5％、75.0％;手术组术后5分钟心电图Ⅰ、Ⅱ、aVL导联出现ST段抬高,T波高耸的典型心肌梗死心电图改变,术后8周ST段、T波回落;此外,术后8周的手术组左室射血分数和左室短轴缩短率均低于假手术组(均为P＜0.01),HE染色可见残存心肌细胞、成纤维细胞、毛细血管增生等慢性纤维化表现,Masson染色显示梗死区残存心肌纤维之间纤维瘢痕组织形成;血清BNP水平也明显高于假手术组(均为P＜0.01).结论 冠脉结扎法建立心梗后心衰模型存活率高、简单易行,采取的心电、心功能、病理、检验评价指标获取简单、重复性强,便于对模型进行筛选.     

非ST段改变的急性心肌梗死临床分析

目的 探讨非ST段改变的急性心肌梗死患者冠状动脉病变情况,指导进一步治疗。方法 选取我院2013年12月~2018年12月因胸闷、胸痛不适入住苏州高新区人民医院、新疆自治区人民医院的患者76例,入院行心电图未见相关导联ST段改变,动态观察心电图及血清超敏肌钙蛋白T、肌酸激酶同工酶,多次复查未发现心电图有动态改变,但血清超敏肌钙蛋白、肌酸激酶同工酶数小时,甚至更长时间开始升高,急诊行冠状动脉造影术（CAG）,观察有无冠状动脉急性闭塞或次全闭塞,同时观察病变冠脉血管的部位、内径。结果 纳入的76例心电图无ST段改变,但数小时后血清心肌标志物升高的胸闷、胸痛患者行冠状动脉造影术发现:冠状动脉急性闭塞或次全闭塞的患者占94.74%,比例较高,多见于钝缘支,占78.95%,且冠脉血管内径均＞1.5 mm。结论 除了ST段抬高和ST段压低的急性心肌梗死,非ST段改变的急性心肌梗死也常常出现在临床当中,对此类不典型的患者,早期识别很重要,及时有效的处理,预后良好。     

New Horizons of Acute Myocardial Infarction: From the Korea Acute Myocardial Infarction Registry

As the first nationwide Korean prospective multicenter data collection registry, the Korea Acute Myocardial Infarction Registry (KAMIR) launched in November 2005. Through a number of innovative approaches, KAMIR suggested new horizons about acute myocardial infarction (AMI) which contains unique features of Asian patients from baseline characteristics to treatment strategy. Obesity paradox was existed in Korean AMI patients, whereas no gender differences among them. KAMIR score suggested new risk stratifying method with increased convenience and an enhanced accuracy for the prediction of adverse outcomes. Standard loading dose of clopidogrel was enough for Asian AMI patients. Triple antiplatelet therapy with aspirin, clopidogrel and cilostazol could improve clinical outcomes than dual antiplatelet therapy with aspirin and clopidogrel. Statin improved clinical outcomes even in AMI patients with very low LDL-C levels. The rate of percutaneous coronary intervention was higher and door-to-balloon time was shorter than the previous reports. Zotarolimus eluting stents as the 2nd generation drug-eluting stent (DES) was not superior to the 1st generation DES, in contrast to the western AMI studies. KAMIR made a cornerstone in the study of Korean AMI and expected to be new standards of care for AMI with the renewal of KAMIR design to overcome its pitfalls.     

Evaluation of Heart-type Fatty Acid-binding Protein in Early Diagnosis of Acute Myocardial Infarction

BackgroundAlthough electrocardiography and cardiac troponin play important roles in the diagnosis of acute coronary syndrome (ACS), there remain unmet clinical needs. Heart-type fatty acid-binding protein (H-FABP) has been identified as an early diagnostic marker of acute myocardial infarction (AMI). In this study, we examined the diagnostic and prognostic value of H-FABP in patients suspected with ACS.MethodsWe conducted an observational single-center cohort study, including 89 adults aged 30 years or older, who presented to the emergency room (ER) within 24 hours after the onset of chest pain and/or dyspnea. We performed laboratory analysis and point-of-care testing (POCT) for cardiac markers, including H-FABP, troponin I, and creatine kinase-myocardial band. We also evaluated the correlation between cardiac markers and left ventricular (LV) dysfunction and extent of coronary artery disease (CAD).ResultsIn patients presented to ER within 4 hours after symptom onset (n = 49), the diagnostic accuracy of H-FABP for AMI, as quantified by the area under the receiver operating characteristic curve, was higher (0.738; 95% confidence interval [CI], 0.591–0.885) than other cardiac markers. In POCT, the diagnostic accuracy of H-FABP (56%; 95% CI, 45–67) was significantly higher than other cardiac markers. H-FABP was correlated with not extent of CAD but post-AMI LV dysfunction.ConclusionH-FABP is a useful cardiac marker for the early diagnosis of AMI and prediction of myocardia injury. Difference in the circulatory release timeline of cardiac markers could explain its utility in early-stage of myocardial injury.     

爱通立溶栓治疗心肌梗塞的临床分析

目的 分析心肌梗塞的临床诊治。方法 全组患者均经爱通立溶栓治疗治疗;结果 死亡3例,存活27例,23例患者2年随防无再梗塞。结论 溶栓疗效存在时间依赖性,从发病至开始溶栓时间间隔越短冠脉再通率越高,近期疗效较差的可能因素等。