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The Cure Hypertension and Chronic Beautiful Tuoluoer Cardiac Failure Curative Effect Is Observed

摘要:目的:觀察美托洛爾對高血壓并慢性心衰(CHF)患者的心功能影響及臨床療效。方法:擇高血壓并高心病或冠心病60例,心功能Ⅱ～Ⅳ級的患者,隨機分為兩組,常規組(30例),給與控制血壓、利尿、轉換酶抑制劑(ACEI)、洋地黃治療。美托洛爾組(30例),在常規治療基礎上加用美托洛爾。結果：美托洛爾組臨床顯效率(667%),總有效率(93.4%),較常規組顯著提高(Plt;0.05)。美托洛爾組與常規組治療前后,心率、血壓、左室舒張末期直徑、左室收縮末期直徑、左室射血分數、心輸出量、E/A、等容舒張期時間均有顯著改善(美托洛爾組Plt;0.01,常規組Plt;0.05),且美托洛爾組上述指標改善更明顯(Plt;0.01或Plt;0.05)。結論:美托洛爾顯著改善高血壓并慢性心力衰竭患者的心功能,是一種安全有效的治療方法。Abstract: Objective: To observe US to hold Luo river to hypertension and the chronic heart failure (CHF) patient’s heart function influence and the clinical curative effect. Methods: Selects hypertension and the high worry or the coronary disease 60 examples, the heart functionⅡ~ⅣThe level patient, divides into two groups stochastically, the conventional group (30 examples), gives the control blood pressure, the diuresis, the transformation enzyme inhibitor (ACEI), the digitalis treatment. US holds Luo river Zu (30 examples), adds in the conventional treatment foundation with US holds Luo river. Results: US holds the Luo river group clinical obviously efficiency (66.7%), the total effectiveness (93.4%), compares the conventional group remarkable enhancement (Plt;0.05). Around US holds Luo river Zu and the conventional group treats, the heart rate, the blood pressure, the left room diastole last stage diameter, the left room contraction last stage diameter, the left room shoot the menstruation number, the cardiac output, E/A, the constant volume relaxing period time to have the remarkable improvement (US to hold Luo river ZuPlt;0.01, conventional group (P lt;0.05), and US holds the Luo river group above target improvement to be more obvious (Plt;001 or Plt;0.05). Conclusion: US holds Luo river obviously to improve hypertension and the chronic heart

同種帶瓣主動脈片修補心內分流合并重度肺動脈高壓

目的 探討同種帶瓣主動脈補片在治療先天性心臟病重度肺動脈高壓中對右心功能的保護作用.方法 自1998年5月至2001年5月應用同種帶瓣主動脈補片修補先天性心臟病重度肺動脈高壓患者心內缺損10例.平均肺動脈壓55～98mmHg(1kPa=7.5mmHg),平均72.46±12.41mmHg.動脈血氧飽和度0.87～0.95,平均0.91±0.03. 結果 術后48小時內均順利脫機,無死亡.隨訪3～28個月,平均10.3±4.2個月,活瓣均已關閉;平均肺動脈壓20～48 mmHg,平均36.37±9.66 mmHg;動脈血氧飽和度0.95～0.98,平均0.97±0.01;臨床癥狀明顯改善. 結論 同種帶瓣主動脈補片的應用能有效預防右心功能不全的發生.

單純心內修復矯治法洛四聯癥115例

目的 總結采用單純心內修復的方法對法洛四聯癥（TOF）患者進行矯治的臨床經驗，為患者選擇個性化的手術方案，盡可能保護右心功能。 方法 2005年1月至2008年7月武漢亞洲心臟病醫院心外科對115例TOF患者施行單純心內修復，其中男72例，女43例；年齡5個月～39歲。在充分疏通右心室流出道、修補室間隔缺損后，直接縫合右心室切口。 結果 無圍術期死亡。呼吸機輔助呼吸時間 12.29±8.67 h,住ICU時間35.10±19.80 h。術后發生殘余漏2例，因漏口lt;3 mm未作處理；發生一過性Ⅲ度房室傳導阻滯1例，因胸腔積液放置胸腔閉式引流管2例，少量心包積液2例，均經藥物或相應的治療后好轉。灌注肺二次氣管內插管1例，術后二次開胸止血2例，無低心排血量綜合征和腎功能不全發生。術后隨訪103例，隨訪時間3~39個月，所有患者均恢復良好，紫紺消失，恢復正常生活和工作，心功能分級（NYHA）Ⅰ級97例，Ⅱ級6例。術后3~6個月復查超聲心動圖提示：肺動脈瓣無反流或僅有輕度反流。結論 TOF的矯治宜選擇個性化的手術方案，對單純漏斗部狹窄、室間隔缺損為嵴下型的患者，采用單純心內修復方法是可行的，有利于心功能的保護及術后恢復。

Clinical Study of Strain and Strain Rate on the Evaluation of Left Ventricular Function for Patients with Different Geometric Patterns of Hypertension

目的:應用應變率探討不同左心室構型的原發性高血壓患者左心室長軸方向應變－應變率成像的變化,及其與EF、FS及二尖瓣血流測量評價左室功能的對照研究。方法:采用M型、二維、多普勒超聲及應變率成像技術,測量左室室壁厚度、左室內徑、EF、FS,二尖瓣血流頻譜E、A及左室平均應變ε,應變率S、e、a。結果:高血壓離心性肥厚組EF、FS明顯低于對照組,高血壓其余各組EF、FS與對照組無統計學差異;收縮期應變率S應變ε在五組間差異均有顯著性意義:高血壓各組較正常對照組減小(I--Ⅴ呈遞減);舒張期應變率e減低、a增高,e/a比值減小,各組間存在統計學差異(Plt;0.05); E/A,e/a結果大體一致。結論:應變率成像為臨床提供了一個敏感、簡便、可靠的評價原發性高血壓患者左室心肌功能的指標。

Prognostic Value of C-Reactive Protein Levels on the Patients with Acute Myocardial Infarction

目的:觀察血清C-反應蛋白(CRP) 水平與急性心肌梗死(AMI)患者6個月時心功能及病死率的關系。方法:入選我院572例AMI住院患者,根據入院時CRP水平分為CRP升高組及CRP正常組,隨訪6個月,記錄超聲心動圖結果及死亡例數。結果:兩組基線資料無明顯差異。與入院時CRP正常組比較,CRP升高組患者6個月時LVEDD、LVESD,住院期間及隨訪期間病死率顯著增加,而6個月時LVEF顯著降低 (P lt; 0.05)。多因素分析結果顯示入院時CRP升高是AMI患者住院期間及6個月病死率的獨立危險因素。結論:血清CRP升高是AMI患者心功能及病死率的預測因素,關注AMI患者血清CRP水平,盡早開始控制,有利于改善AMI的預后。

The Value and Significance of Brain Natriuretic Peptide in Evaluating the Heart Function of Functional Single Ventricle after TCPC Procedure

Objective To investigate the value and significance of the changes of plasma level of brain natriuretic peptide（BNP） in evaluating ventricle performance of functional single ventricle after total cavopulmonary connection （TCPC）. Methods We studied 11 patients with functional single ventricle undergone TCPC procedure after 2.1 years, who were followed-up at our ward between April 2004 and November 2004, 7 of them were males and 4 of them were females （TCPC group）. The clinical heart function of patients was scored according to the modified scoring system described by Ross. We obtained 3ml blood samples from the extremital vein of all subjects. Blood was collected into chilled tubes containing EDTA and aprotinin （4.5mg and 1 500u/ml blood, respectively）. The blood samples were promptly centrifuged （-4℃, 3 000r/min for 10 min） and the plasma was separated. BNP concentration was determined using immunoradiometric assay kits. Magnetic resonance imaging （MRI） examination was undertaken in 6 patients of TCPC group to analyse the relative factors with the change of BNP. Control group included 9 healthy children. Results （1） Median plasma BNP level for TCPC group and control group was 400pg/ ml （IQR200-690） and 110 pg/ml （IQR90-190）, respectively. There was a significant difference in plasma BNP between them （P=0. 003）. （2） The results of the index of heart function of TCPC group determined by MRI were 65. 76±8. 65 ml/m2 in end-diastolic volume index, 31. 90±6. 36ml/m2 in end-systolic volume index, 39.09±11.76ml/m2 in stroke volume index, 0. 52± 0. 06 in ejection fraction（EF）, 2.38±0.58L/min·m2 in cardiac index （CI）, 103.49±21.57g/m2 in mass index and 1.57±0.24 in mass/EDV. （3） The plasma BNP level for TCPC group was significant correlation with operation ages（r=0.632, P=0.041 ）. There was no correlation between plasma BNP level with EF, CI, score of Ross, gender, ages, percutaneous oxygen saturation（SpO2） and the type of dominant ventricle, respectively. Conclusions Raised concentration of plasma BNP in patients 2 years after undertaken TCPC procedure indicates that nervous-endosecretory system is still under stress condition. This pattern suggests that neurohormonal activation is primarily related to the altered postoperative physiology. the significance of BNP in patients of functional single ventricle after undertaken TCPC is different from tat in biventricular physiology patiens. The plasma BNP level could not be correctly evaluated the cardiac function after TCPC operation.

Analysis of preoperative left ventricular dysfunction and perioperative complications in coronary artery bypass grafting: A case control study

Objective To identify the relationship between preoperative left ventricular dysfunction and perioperative risk factors in coronary artery bypass grafting (CABG). Methods The clinical data of 192 patients who underwent CABG from November 2015 to October 2016 were analyzed retrospectively. The patients were divided into three groups by preoperative left ventricular ejection fraction (LVEF) in echocardiography: a serious left ventricular dysfunction group (LVEF≤35%, 23 patients, 15 males and 8 females at age of 63.91±5.36 years), a moderate left ventricular dysfunction group (35%<LVEF<50%, 24 patients, 20 males and 4 females at age of 66.29±6.03 years) and a normal left ventricular function group (LVEF≥50%, 145 patients, 86 males and 59 females at age of 66.60±6.41 years). Results The overall mortality was 4.16% (8/192), 17.39% (4/23) in patients with LVEF≤35% and 2.76% (4/145) in those with LVEF≥50%. Preoperative LVEF≤35%, hypoxia, assisted circulation, acute kidney injury (AKI) and postoperative continuous renal replacement therapy (CRRT) were risk factors of perioperative mortality in coronary artery surgery. LVEF≤35% and CRRT were independent preditors of mortality. There were significant differences in mortality and postoperative complications between the serious left ventricular dysfunction group and other two groups. Conclusion Postoperative mortality and complications are obviously serious in the patients with LVEF≤35%. We should pay more attention to preoperative risk factors. Postoperative individual manipulation, intra-aortic balloon pump and CRRT can enhance survival of those patients.

改良超濾對心瓣膜置換術后心肺功能的影響

目的 探討改良超濾對成人心臟瓣膜置換術后心肺功能的影響，以改善術后心肺功能。 方法 67例成人心瓣膜置換術患者隨機分為改良超濾組(超濾組，n=33)和無超濾對照組(對照組，n=34), 動態觀察體外循環(CPB)前、CPB停機及改良超濾結束時（對照組在CPB停機20min）氧分壓(PO2)及二氧化碳分壓(PCO2)、術后呼吸機輔助呼吸時間、血管活性藥物用量及使用時間、左心室射血分數(LVEF)等心肺功能指標。 結果 兩組的PO2 CPB前與CPB停機時相比均明顯下降；超濾組在改良超濾結束時PO2明顯回升，接近CPB前水平，而對照組PO2僅輕度回升，但仍明顯低于CPB前；CPB停機20min時超濾組PO2高于對照組(P=0.044). CPB停機后兩組PCO2輕度升高，改良超濾后PCO2輕度下降，但組內、組間比較差異無統計學意義。術后超濾組呼吸機輔助時間、血管活性藥物用量及使用時間明顯低于對照組(P=0.005,0.001, 0.012)。術后1周心臟超聲心動圖檢查提示兩組LVEF均較術前明顯提高，但組間比較差異無統計學意義(t=0.91, P=0.367). 結論 改良超濾有利于改善成人心瓣膜置換術后早期心、肺功能。

Therapeutic Effect of Low Dose of Digitalis in Lung Cancer Patients After Pneumonectomy

ObjectiveTo investigate the clinical significance of applying digitalis preparations after pneumonec-tomy. MethodsWe retrospectively analyzed the clinical data of 78 patients who underwent pneumonectomy in the Tangdu Hospital of The Fourth Military Medical University from August 2010 to August 2013. The patients were divided into a control group (39 patients with 27 males and 12 females at a mean age of 56.8±14.8 years) and a trial group (39 patients with 24 males and 15 females at a mean age of 57.4±10.1 years). After pneumonectomy, the trial group received low dose of digitalis treatment. On 3, 5, and 7 days, the arterial partial pressure of oxygen (PaO2), systolic pulmonary artery pressure (SPAP), mean arterial pressure (MAP), diastolic pulmonary artery pressure (DPAP), and the rate of complications were examined. ResultsAfter treatment with the low dose of digitalis, the SPAP, MAP, DPAP of the trial group were statistically lower than those of the control group (P < 0.05). Incidence of arrhythmia in the trial group was statistically lower than that of the control group (P < 0.05). There was no statistical difference between the two groups in the PaO2, the incidence of pulmonary infection, and circulation disorder (P > 0.05). ConclusionLow dose of digitalis preparations can improve cardiac function after pneumonectomy.

超聲心動圖對心功能的評估