慢性房颤血栓栓塞并发症的危险因素

研究表明,房颤(AF)易发生血栓栓塞并发症。本研究旨在评价慢性 AF 发生血栓栓塞并发症的心血管危险因素。非风湿性慢性 AF 的门诊患者1007例中,335例接受华法令,336例接受阿司匹林抗凝治疗,以未接受上述药物治疗的336例患者为研究对象。收集患者 AF 的病因、心衰症状、既往心肌梗塞(MI)史、胸痛、糖尿病、吸烟习惯等有关情况,测血压,用超声心动图测定心脏相对容积     

北京城区医院非瓣膜性心房颤动患者阿司匹林剂量对预防缺血性脑卒中疗效的影响

心房颤动(房颤)是缺血性脑卒中的独立危险因素,非瓣膜性房颤患者脑卒中患病危险是无房颤者的5～6倍.抗凝和抗血小板治疗均为房颤患者预防脑卒中的重要措施,但预防效果抗凝治疗优于抗血小板治疗[1-2].我国房颤患者抗凝治疗率低,抗血小板治疗应用广泛,但阿司匹林剂量多在300 mg/d以下[3-5].国外临床试验结果显示,阿司匹林剂量低于325 mg/d不能显著降低脑卒中的危险.低剂量阿司匹林对房颤患者缺血性脑卒中的预防效果还需要随访研究证实.我们对非瓣膜性房颤患者阿司匹林服用剂量及对脑卒中的预防效果进行分析.     

心房颤动患者29495例缺血性卒中危险因素回顾性分析

目的分析心房颤动(atrial fibrillation,AF)患者发生缺血性卒中可能的危险因素。方法回顾性分析1991年1月至2015年12月在广东省人民医院出院诊断为AF的住院病历共计29495例,选取AF患者因缺血性卒中入院或住院期间有新发缺血性卒中事件的患者入组为病例组,而将其余AF患者作为对照组。以5年为一个时间段,观察一般情况(年龄、性别)及合并疾病[原发性高血压(高血压)、糖尿病、心力衰竭、风湿性心脏病、慢性阻塞性肺病、血脂异常、冠状动脉粥样硬化性心脏病(冠心病)、既往缺血性卒中、其他血管疾病(除心脑血管疾病)、甲状腺功能亢进、瓣膜置换及其他手术病史]与缺血性卒中的关系及年份间变化的情况。结果在1990年至2015年期间,住院AF患者总数增长了6.2倍。AF并发症患病率:高血压、糖尿病、冠心病、心肌病、血脂异常、慢性阻塞性肺病及缺血性卒中呈上升趋势,风湿性心脏病、瓣膜置换、心力衰竭呈下降趋势。采用相关性分析并计算相关系数(odd ratio,OR),结果显示年龄≥75岁,高血压、血脂异常,糖尿病、冠心病、既往缺血性卒中病史及其他血管疾病是AF患者新发缺血性卒中的危险因素且均有统计学意义(OR值1,P0.05)。女性(OR=0.994,P=0.898)、心力衰竭(OR=0.38,P0.001)及风湿性心脏病(OR=0.623,P0.001)不是缺血性卒中的危险因素。结论 AF住院患者合并缺血性卒中比例均呈明显上升趋势,可能与年龄≥75岁,高血压、血脂异常,糖尿病、冠心病、既往缺血性卒中病史及其他血管疾病等密切相关,控制相关危险因素应成为减少AF缺血性卒中的重要干预手段。     

心房颤动抗栓治疗及手术治疗的研究进展

心房纤颤(AF)是常见的心律失常.统计表明,人群中AF总发病率为0.5%～1.0%(70岁以上者上升至10%)[1].心房纤颤病人最大的危险因素之一是以缺血性脑卒中为主的血栓栓塞性并发症.非风湿性心脏病房颤和风湿性心脏病房颤病人发生栓塞事件的危险性分别是窦性心律者的5倍及17倍.血栓的检出和预测以及相应的抗凝药物的应用对房颤的治疗具有非常重要的作用.外科手术及经导管消融技术的发展则为房颤的治疗提供更广阔的前景.     

非瓣膜病心房颤动患者新型口服抗凝药的应用中国专家共识

非瓣膜病心房颤动（房颤）指未合并以下情况的房颤：①风湿性二尖瓣狭窄;②机械瓣或生物瓣置换术后;③二尖瓣修复术后.脑卒中和血栓栓塞是房颤最严重的并发症,缺血性脑卒中年发病率约为5％,病死率和致残率高.口服维生素K拮抗剂,如华法林抗凝治疗能有效降低脑卒中的风险.但是,这类药物在临床应用中有明显局限性,包括①不能根据剂量预测抗凝强度;②诸多因素（如包括食物和药物）都可影响其在体内的代谢和抗凝强度;③维持治疗时,每月至少应测1次国际标准化比值（INR）;④即使按时监测INR,并据此调整剂量,INR在目标治疗范围（2.0 ～3.0）的时间也很难超过整个疗程时间的65％;⑤大出血并发症发生率较高,每年可达3％[4-5].以上这些因素极大地限制了华法林的广泛使用.在我国,具有脑卒中高风险的房颤患者中,华法林的使用率不到20％.     

基层医院非瓣膜病房颤华法林抗凝治疗的临床问题

心房颤动(AF)是导致缺血性脑卒中的主要危险因素,近年来随着AF病因的变化,非瓣膜性AF导致的卒中比例越来越大。华法林预防卒中的效果得到肯定,而临床上以AF的华法林抗凝治疗预防脑卒中的处方率很低或量不足。临床医生要充分认识华法林抗凝治疗的必要性和重要性,自觉提高医生和患者的抗凝意识,严格遵循最新抗凝指南建议,规范抗凝治疗。     

心房颤动患者临床特征变化的单中心分析

目的心房颤动(AF)发病率逐渐升高,本研究对20年跨度的AF住院患者的临床特征进行分析。方法选择1986~1991年、1995~1996、2000~2001、2006年共21年在天津医科大学第二医院心脏科住院、出院诊断为AF(主要诊断或次要诊断)的患者1005例进行临床特征分析。结果①全部共1005例,年龄范围15~96岁,中位数为67岁,AF患者中≥65岁和≥75岁的比例在21年间均逐渐升高,性别的变化,各组男女性别比无统计学意义(p0.05);②在AF病因中风湿性心脏病居首位,到2006年降至第5位;冠心病从第2位升至第1位(1995年及以后);心力衰竭由第2位(1986)降至第6位(2001年),2006年又升至第4位;③AF合并脑梗塞者,从1986~1991年的11.4%升高至2006年的20.2%;华法令的使用率从1986~1996年的1.6%升至2006年的6.1%;阿司匹林使用率在1986~1991年仅为1.3%,至2006年已达87.7%。结论本研究的初步结果提示,非心脏瓣膜病AF患者已经成为AF最重要的病因,AF合并脑梗塞者比例升高,高龄AF患者的构成比明显增加。抗凝药物和抗血小板药物的应用还远远不够。     

超声心动图评价Chiari's网合并卵圆孔未闭与缺血性脑卒中的关系

【摘要】目的 探讨超声心动图评估Chiari''s网（Chiari''s network, CN）合并卵圆孔未闭（Patent foramen ovale, PFO）与缺血性脑卒中的关系。方法 回顾性分析自2013年1月-2016年12月我院根据临床表现和影像学检查诊断为缺血性脑卒中患者558例,其中房颤（atrial fibrillation,AF）组265例,非房颤组（non-atrial fibrillation,N-AF）293例。分别采用经胸超声心动图（transthoracic echocardiography,TTE）或经食道超声心动图（transesophageal echocardiography,TEE）选取四腔心切面、右心室流入道切面、右室流出道切面、双心房上下腔静脉切面,并结合右心声学造影检查,分析CN 和PFO与发生缺血性脑卒中的关系。结果 在缺血性脑卒中患者中,AF组合并N-PFO+N-CN患者病例数所占比例明显高于N-AF合并N-PFO+N-CN患者,AF组合并PFO患者病例数所占比例明显低于无合并N-AF的患者, PFO+CN合并N-AF患者病例数所占比例明显高于PFO+ CN合并AF患者,以上差异均具有统计学意义（p<0.05）;在N-AF患者中,合并PFO+ CN患者病例数所占比例明显高于合并N-PFO+N-CN、PFO、CN患者。结论 本研究提示CN与PFO可作为缺血性脑卒中病因之一,超声心动图可快捷、准确的诊断CN与PFO,结合右心声学造影对缺血性脑卒中的病因学研究提供客观依据。     

老年心房颤动患病率与缺血性卒中及CHA2DS2-VASc评分的相关性

目的:探讨老年(≥65岁)心房颤动(房颤)患病率与缺血性卒中及CHA2DS2-VASc评分的相关性,为其临床防治提供依据。方法:采集我院2013-10至2015-10连续住我科5 016例患者的住院资料,房颤患者437例为房颤组,非房颤患者4 579例为非房颤组。按年龄分为65岁、65~74岁、75~84岁、≥85岁四个年龄段,回顾性分析房颤的危险因素。结果:与非房颤组相比,房颤组患者年龄、男性房颤患者所占比例增加(P均0.001);合并高血压、冠心病、糖尿病、病态窦房结综合征和风湿性心脏病(风心病)的患者比例显著增高(P均0.001)。年龄、男性、冠心病、病态窦房结综合征和风心病是房颤发生的独立危险因素。房颤组患者缺血性卒中的患病率和发病年龄均高于非房颤组患者(P均0.01)。非瓣膜性房颤CHA2DS2-VASc评分≥2分患者所占比例明显高于CHA2DS2-VASc评分2分的患者(P0.001),其抗凝治疗率随增龄而下降(P均0.001)。结论:房颤的发生与年龄、男性、冠心病、病态窦房结综合征和风心病患病率独立相关。非瓣膜性房颤缺血性卒中的发病风险较非房颤者明显增加,需及早开始抗凝治疗。     

心房颤动的流行病学及治疗现状调查

目的:研究心房颤动(AF)的流行病学特征和治疗现状。方法:选择2000年1月-2002年12月期间本院心内科住院的全部AF患者211例,采用回顾性分析方法对其进行调查研究。结果:AF的发生率为同期住院患者4 399例的4.8％,年龄26-84(平均62.53±10.78)岁。与AF相关的病因谱发生明显变化,老龄排列第1位(42.7％),风湿性瓣膜病已由第1位下降至第5位(22.3％)。74.6％的阵发性AF患者接受节律控制治疗,70.8％的持续性AF患者采用心室率控制治疗。最常用且较安全的复律药物是胺碘酮,复律治疗后能稳定维持窦性心律者仅占26.0％。15.6％的AF患者发生缺血性脑卒中,抗凝治疗可使其发生率明显降低(29.3％:8.1％,P<0.01)。结论:非瓣膜性AF的防治应引起临床关注,药物仍是其主要治疗手段,应加强AF的抗凝治疗。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.