中国介入心脏病学杂志

  • 前言

    汪曼蕙;胡大一;

    <正> 近年来,介入心脏病学的迅猛发展,使冠心病、瓣膜病、心律失常和先心病等心血管疾病的诊治进入了一个崭新的阶段,不仅为我们心脏内科医生提供了多种可选择的诊治手段,更主要的是使疾病的诊治向着创伤小、操作简便、安全有效的方向发展,大大地减少了病人手术的痛若和并发症,缩短了住院时间,节省了医疗费用。由中国国际科技会议中心、首都医科大学心血管疾病研究所、北京朝阳医院心脏中心、日本湘南镰仓综合医院联合主办,中华医学会心血管病学分会、中国生物医学工

    1998年04期 151页 [查看摘要][在线阅读][下载 32K]
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  • CASE REPORT:130 CASES OF PERCUTANEOUS TRANSLUMINAL CORONARY AGIOPLASTY

    <正> Objective:An analysis of 130 cases admitted(during December.1993--December,1997)is reported b.All the patients were treated withprcutnous Transluminal Coronary agioplty (PTCA).In addition to it10 cases underwent a second PTCA because of rt.The totalnumber is 140 cases.Thi paper up the pathlolgic changs ratecharacterized by coronary lesion in type A,B,and C_1 percentage ofvaodilation;rate of success in type A,B,and C_1 and the rate ofrt.Method:Coronary arteriography was performed in most cases add then PTCAwas exercised on selective cases with 7-10 days interval according tothe t plan.Coronary arteriography and PTCA were done synchronouslyin the rest cases.Kissing bicatheter technique were employed in 3cases because of bifurcated lesion and PTCA with insertion of a stntinto the spaces of the coronary artery at a diagonal was applied to 1case.Results:Classification of coronary lesion:Type A 33 cases (23.67%),B57 (40.71%),and C 50 (35.71%).Number of coronary artery:single 40 (2857%),double 59 (42.14%),triple 39 (27.85%),main 2 (1.44%).Vasodilation:LAD 116(74.35%),LCX 22(14.1%),RCA 16(10.25%),Middle 2(1.2%).Rate of success:A 33 (100%),B 57 (94.8%),C 50 (94%).Total rate ofsuccess:95.8% Rate of failure:6 cases(4.2%),of which B 3 and C 3respectively,and one of limited myocardial infarction,one of coronaryabnormality,and others of 99-100% t with one failure of balloonwire to the lesion.Rtsis:10 cases had angina ptori 2-6 monthsafter PTCA and a second PTCA revealed LAD rtnosis,rated 5.7%.Concluon:In this group t lesion (76.42%) was found in Type B andType C,while lesion in Type A was L (23.5%).That's why highsuccess existed in Type A (100%),while Type B and C with complicatedlesion needed complicated performance and rated low in success (94-94.8%)Vdilation:LAD>LCX>RCA.The rate of success lies in the degree ofcomplicated lesion,balloon wire and selection of catheter.Theinsertion of a tnt into the coronary artery might be the best way totreat PTCA t.

    1998年04期 152页 [查看摘要][在线阅读][下载 57K]
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  • A STENT VESSEL OCCLUTION—TREATING AFTER 9 MONTHS OF PTCA AND RIGHT INTRACORONARY STENTING

    <正> An 63-year-old Chinese man had abruptly attacked a dull and choke cheatpain at midnight of January 26,1996 and e was admitted hospital due toconstanting pain no alleviation.The diagnose was Acute Inferior MyocardialInfarction confirmed by CG examination and serum C enzyme spectrumafterwards.An soon as admision in C.C.V,throbolyi agent urokinase 1.5million unit intravenous perfusion and and serious AMI medica therapy withpharmacologic agents nitrates,-adrenergic blockers,calcium antagonistswere used.The patient's chest pain was relieved after 2h and 30 minutesthat urokinase perfusion finished.The lost time from pain start to arrivalhospital and perfusion administration was 5 hours.The optimal ECG S-Tsegment descending amplitude >50%,accompaied with cheat pain detent.Seriesenzyme peak was ahead of time.All of those had proved that occludecoronary artery got patency.this patient discharged after 20 days.Thepatient was admitted again at 29.October 1996 and was informed to takecoronary artery engiography because he always felt palpitation,dyspnea andpresented dull chest pain still after the time of leave hospital.Thecoronary angiogram indicated that a length of 10mm long and a eccentric>95%stenosis had existed in middle segment of right coronary artery.Leftventriculogram observed cardianeuria at diaphrag and rear base.F was 61.3%Then a 4.0 mm angio-plasty balloon catheter followed 0.14 mm guidewiresuccessfully passed tenosis place and expansion twice effectively to bedone.atmospheric pressure was 4-6 and length of time was 10-20 seconds,Angiogram showed revascularization success and there was no residualtenosis.Stnt implantation of 15 mm Ang Dynamic was completed smoothlythen.Following 9 months,the patient become health and strong,quality oflife improved obviously.21,July,1997,the patient came to hospital to take ordinary coronaryartery angiography A stent v occlusion 100% found.Immediatelyngioplasty balloon expansion administered 5 times still v bloodreturn to normal completely.No stent implaced again.According to the investigation from American National PTCA Registry andsome European research center reports,re-occlusion occurring frequencyrange is 3 months to 6 months.Some patient even felt no cardiac sympto orjust a little distress.They advocate patient's coronary artery angiographyevery 6 months would be taken.Appearance of our case consider the problemof stent v occlusion occurred after 9 months warning that ordinarycoronary artery angiography taken after 6 months is necessary,sometimeballoon expansion residual stnsis or stent v occusion have to belone.

    1998年04期 152页 [查看摘要][在线阅读][下载 57K]
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  • 冠状动脉分叉处病变的PTCA治疗 辽宁省人民医院循环科

    关汝明;

    作者在澳大利亚 Geelong 医院学习一年,遇到48例冠状动脉分叉处病变行 PTCA 治疗,陈旧性心肌梗塞5例,冠心病心绞痛43例,冠状动脉完全闭2例,其余46例为70-95%狭窄。结果:3例失败,成功率3.7%,主干和分支均有病变的24例中2例失败,成功率91.6%,单纯分支血管口病变的9例中1例失败,成功率88.9%,单纯主干血管病变的12例均获成功,但2例造成分支血管口轻度损伤,1例右冠状动脉静脉桥吻合口处病变行 PTCA 治疗后残余狭窄小于10%,置入支架21枚。体会:对冠状动脉分叉处Ⅰ型病变行TCA 治疗易引起分支血管口严重损伤或关闭,分支血管直径≥2.5mm 和分支口狭窄≥50%时,应行双导引钢丝保护,无法放置双导引钢丝时可采用较低扩引压力(<6个大气压)和较短扩张时间(<1分钟)的首次试验扩张方法对主干血管病变进行扩张,球囊直径与被扩张的血管直径一致为宜。

    1998年04期 152页 [查看摘要][在线阅读][下载 57K]
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  • Effects and Operating Experience of Percutaneous Transluminal Coronary Angioplasty in 63 cases

    <正> Objective:To evaluate the effects of percutaneoustransluminal coronary angioplasty(PTCA) and intracoronarystents.Methods:PTCA was performed in 63 patients with 107diseased vessels and 121 lesions.Results:Effective dilatation was performed in 79 of the107 diseased vessels and 103 of the 121 lesions,type Alesions were 25(24.3%);type B and C 78(75.7%).Theaverage dilatation time was 3.6±2.8,the average dilatationduration was 68±98 secondes and the average maxiumdilatation pressure was 8.5±2.9 atm.The average severity ofthe coronary artery stenosis decreased from 90% to 6%,thestenosis was disappeared completely in 93 lesions afterPTCA.Forty-one coronary stents were implanted with theaim of treating acute vessels occlusion in 2 cases andpreventing restenosis after PTCA in 32 cases.The ischemicST-T Changes of ECG and symptoms were improvedsignificantly in these patients post-PTCA.Conclusion:PTCA is a safe and effective therapy for thepatients with coronary heart disease,and coronary stent is avery effective method to treat acute coronary occlusionduring PTCA.

    1998年04期 152页 [查看摘要][在线阅读][下载 57K]
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  • PRIMARY OUTCOME AND LATE RESULT OF T6 CASES CORONARY STENTING

    <正> Objectives.To summarize the primary outcome and late result of 76 casescoronary stenting and to evaluate the efficiency of preventing from acutecoronary closure and restenosis.Methods.Ninety-five coronary stents of 13 different types were implanted in 108lesions of 86 coronary arteries in 76 patients (67 males and 9 females,57.3 = 9.1years old).Stent expansion was completed with the balloon pressure of 10-14 atmfor 30-60 seconds.There were de novo stenting in 52 cases,bailout stenting in 3,stenting of restenotic lesions in 3 and suboptimal stenting in 18.Two or morestents were implanted in 1 vessel in 12 cases,and 5 stents were implanted in RCAin 1 case.Bamyl and ticlid 0.25 bid were taken respectively 3 days beforeprocedure.Hepain 10000 IU was infused to arterial sheaths during procedure.Heparin 600-800 IU/hr was dripped intravenously after procedure and lasting for1-2 days.Bamyl and ticlid 0.25 bid were still taken respectively and extenuatedto once a day after 4 weeks.Results Ninety-four of 96 stems were successfully implanted with a success rateof 97.9% and residual stenosis of 9.1±7.6%.Two stents fall off in 2 patients dueto severe calcification but successfully extracted.No acute coronary eventsoccurred during procedure.Primary outcome:Seventy-four of 76 patients werefree of symptoms,and 1 patient had AMI due to acute thrombosis 6 hours afterprocedure and re-PTCA successfully.Late result:Clinical symptoms disappearedor relieved obviously in 69 of 76 (90.8%) patients,and 7 patients (9.2%) sufferedfrom angina including 3 case with AMI m 24.4=13.6 months follow-up.Angiography of these 7 cases showed restenosis in stent site in 5 cases andocclusion in 2 cases.All of them received -PTCA successfully,but 1 patientdied of cardiogenic shock later.Noninvasive test:Echocardiography was taken in15 cases of old myocardial infarction pre- and post-procedure.The wall moonscore of infarction area is 2.1 and 1.1 respectively,and the ejection fraction is0.39 and 0.48 respectively.Conclusions.Coronary stenting has the charactenstics of few acute coronaryevents and high success rata.It can decrease restenosis and occlusion effectively,and improve the cardiac function.

    1998年04期 153页 [查看摘要][在线阅读][下载 54K]
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  • CLINICAL APPLICATION OF INTRACORONARY STENTING

    <正> Intracoronary stents were implanted in 61 patients(58 males and 3females,aged 52.1±8.3 years) with coronary heart disease in thishospital from June 1995 to May 1998.Seventy-two intracoronary stents (12Palmaz-Schatz.8 OR-I,45 Multilink,6 NIR and 1 Wiktor-i) were implanted,45 in LAD(62.5% ),22 in RCA(30.6%) and 5 in LCX(6.9%),Indications forstenting included 30 de novo(41.6%).4 bail-out(5.6%)and 38 Suboptimal(52.8%)stenting.The procedure success rate was 100%.Averagediameterstenosis decreased from 75-100% to -10-10% after stenting.There was one death from subacute stent thrombosis Two cases hadhematoma at the pancture site.There were no complication of acutethrombosis,cerebral hemorrhage and emergency CABG.During 1-36 monthsfollow-up,6 cases had relapse of chest pain,incinding 4 case ofrestenosis proved by argiography.Coronary stenting is a successfulmeans for atent"stand-by" and bail-out procedure for balloon angioplasty.Optimal angiographic results can be achieved in the majority ofpatients by proper stent sizing and deployment techniques.Anticoagulation should be given according to the characteristics oflesions and post-stenting angiographic findings so as to reducevascular and bleeding complications as well as hospital stay followingcoronary angioplasty.The results suggest that intracoronary stentinghas high success rate and low restenosis rate.It is an effective andsafe interventional therapy for acute coronary closure or selected denovo complex lesions following PTCA.

    1998年04期 153页 [查看摘要][在线阅读][下载 54K]
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  • PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY FOR COMPLICATED CORONARY ARTERY LESIONS

    <正> Objective To research the effect of percutaneous transluminalcoronary angioplasty (PTCA) on treating complicated artery lesions.Methods Type B or type C of complicated coronary artery lesionswere confirmed by selective coronary angingraphy in 16 cases with coronaryheart disease.Gruentzig's method was used in carring out PTCA.Results Fifteen of sixteen and thirty-two of thirty-five parts ofcoronary artery lesions were dilated successfully,the success rate was 93.7%and 88.5%,respectively.In failed four parts of PTCA,three parts werebecause of the guilding wire or the balloon failed to pass the narrow arterythrough,the other one was unable to be performed for the occurrencedsevere arrthymia during the procedure.Four stents were implantend foracute accident.Symptoms of the successful cases were improved ordisappeared after PTCA.Conclusion PTCA is also fit in treating complicated coronary arterylesions and has a better therapeutic effect,but it has more complications andrun more risks relatively.

    1998年04期 153页 [查看摘要][在线阅读][下载 54K]
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  • EXPERIENCE OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTT(PTCA) IN 30 PATIENTS

    <正> From 1992 to 1997,We perfomed PICA on 30 pts with corcoary beart dieeaselfaterial and methed:30 pts (26malea,4 females),aged 54(40-70)yrs,included 9post-infarction. 6 stable angina 15 unatable angina(course of diseaae lmonth12yrs cardiac function Ⅰ-Ⅱ°). The medical curative effects on them were poorAll were diagnosed as coraoary angiography.Tnere were 63 atenosis in 51 path-ologic lesions including 28 in LAD 9 in LCX 14in BCA 18 stenosis in 15 one-veoael cases,22 atenosis in 9 two-vesael caaos and 23 atenosis in 6 tbree-vessel cases.The atenosis degree was 75%-99% The medical curative effecta werepoor.Orumezig's technique was perfoned on them The pts were treated withaspirin(0.3g)po the day before operation hepr in(10000IU) iv when the leadingcatheter reached the right point,beprin(1000IU·h~(-1))ivgtt and nitroglycerin(5-10ug·min~(-1), 24h) ivgtt after operation Anticoagulant therapy kept for 3days then aspirin,persantina iaosorbide dinitrate po for 6-SmonthaResules:All pts had succassful PTCA Subjective aymptom was improved PTCA wassucceeaful in 44(86.3%) of 51 lesions, 54(85.7%) of 63 stenosis The guidewire(or the ballcon catheter) couldn't pass through the stenosis in 3LCX(ostial),2LAD(ostial)& 1 RCA(mid).Conclusion: The early indication of PTCA was one-Veasel(oatial) isolated.short, symmetrical and unclosed lesion,which had high rate of success andlittle Fiak In reacent yeara the indication included the complex lesions.The principle is to dilate the main lesion first,because the Vessel withaecondary lesion might be a functional one or a collateral circulation ofother coronary, The acute obliteration will lead to serious hemodynamicobstruction evem cardiogenic ahock or death Dilation by atagee is effectivein complicated lesions The rectenosis degree will decrease when we use theright htlloon in the loog tubular lesion The main reason for the failure isthat the guide wire or the balloon catheter can't pass the atenosis. When theguide wire can pass through the atenosis but the balloon can't,we shoulddilate the proximal part first then try to push the ballocm through theatencosis By this way,some serious lesions can be succesaful PTCA The maincomplication in PTCA is ventricular fibrillaton.because of the contrastmediun injected into the coronary artery.Sinus rhytlm can resume afterelectric defibrillation in time The aecond is acute obliteration because ofintimal laceration Balloom dilation with low preesure must be deployed, atfirst for a long time.The intima will bond togtber,and the vessel getsthrough Coronary Bypass mlat be perforned immediately if necessary.

    1998年04期 153页 [查看摘要][在线阅读][下载 54K]
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  • 经皮腔内冠状动脉成形术(PTCA)临床应用7例报告

    盛国太;洪浪;尹秋林;龙恭铭;

    我院自1998年3月至1998年9月共为7例患者施行了 PTCA 术,其中5例植入冠状动脉内支架5个,7例患者均为男性,年龄42-72岁,平均59岁,不稳定型心绞痛2例,急性心肌梗塞3例(均稳定在2-3周以上),急性心肌梗塞静脉溶栓失败2例,合并高血压病3例,高脂血症6例,抽烟史2例有2例患者术前心绞痛3-4级,2例梗塞后心绞痛,冠脉造影示单支病变2例,双支病变5例.狭窄程度平均83%(70-95%),PTCA 术后冠脉造影显示,4例扩张满意,3例残余狭窄,无急性心肌梗塞、猝死及急性冠脉搭桥,对其中5例植入冠脉内支架5个,术后造影无残余狭窄,术后随访平均3个月(1-5个月)症状明显改善,心绞痛为0-1级,尽管病人数少,观察时间短,仍可看出 PTCA 是一种安全有效的介入性治疗技术,对缓解临床症状、治疗心绞痛、抢救急性心肌梗塞静脉溶栓失败不失为一种有效的治疗方法.

    1998年04期 154页 [查看摘要][在线阅读][下载 51K]
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  • COMPLEX PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

    <正> Percutancous transluminal coronary angioplasty was pcrfonned in 70patients with high risk characteristics from Jan.1998 toDcc.1997 These factors include age>70(10patients),unstableangina(35patients),ejection fraction<40%(7 patients),multivesseldisease(50patients).There were 96 lesions(79 vessels)dilated,amongthem type Alesion 15,type B lesion 52,type C lesion 29.Autoperfusion balloon was used in 7 patients, coronary stcnl wasimplantcd in 50 paticnts.One patient undcrgoing directional coronaryathrectomy(DCA).The clinical success rate was 91.5% and lesionsuccess rate was 89.6%.Average predilation stenosis was 89.5+8.2%and average postdilation stenosis was 16.9+6.2%.Two patients diedfrom abrupt vessel closureno acule myocardial infarction andemergency coronary bypass operation.The considerations in selectionand management of these high risk patients were discussed. The resultsshowed that PTCA can be performed safely in the complex cases.

    1998年04期 154页 [查看摘要][在线阅读][下载 51K]
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  • DIFFERENT THUMBLOLYTIC EFFICACY IN DIFFERENT UNSTABLE ANGINA

    <正> Patients presenting to the emergency department or coronarycare unit of the First Affiliated Hospital of Jinzhou MedicalCollege and Jinzhou Medical Center of China in the 3 yearperiod beginning nevember 15,1995 were screened for entry intoa pilot trial to precede a large-scale multicenter trial.Weconducted a Controlled multicenter trial with centralrandomization and evaluation of efficacy under single-blindconditons involving 300 patients were treated either withConventional group(group C n=150)or with Conventional therapycombined with a low dose urokinase(1000-5000u/kg group T,n=150)According to the critieria of ISFC/WHO those patients wereclassified as initial onset angina(IA),crescendo angina(CA),resting angina(RA),variant angina(VA),intermedial syndrome(IS),postinfarction angina(PA),blending angina(BA).The results showsthat thrombolytic efficacy in IA.CA.PA.have siginficentdifference(P<0.01).RA.BA have no difference(P>O.O5).The resultsuggested the patient with RA.BA should be perphormed PTCA orCABG.The patient with IA,CA and PA should firstly beperpbormedPTCA or CABG in stable stage.

    1998年04期 154页 [查看摘要][在线阅读][下载 51K]
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  • FEATURES OF CORONARY ARTERY DISEASE IN DIABETIC PATIENTS OF CHINESE

    <正> To compare angiographically-determined coronary artery disease in diabeticpatients with nondiabetics of Chinese,782 patients coming to cardiaccatheterization were reviewed retrospectively to find 42 diabetic and 740nondiabetic patients matched for sex and age.The following results wereobtained:37 of 42 diabetic patients(88.10%)had coronar artery diseasecompared to 412 of 740 nondiabetics(55.68%)(P<0.005).18 of 37 diabeticpatients with coronary artery disease(48.65%)had multivessel diseasecompared to 143 of 412 nondiabetics(34.71%)(p<0.005)19 of 37 the diabeticpatients(51.35%)had diffuse coronary artery disease compared to 32 of 412nondiabetics (7.77%)(P<0.05)21 of 37 the diabetic patients (56.76%)hadsmall vessel disease compared to 114 of 412 nondiabetics (27.67%)(P<0.005).We conclude that diabetic patients have more coronary artery disease thannondiabetics and diabetic patients with coronary artery disease have morediffuse coronary disease more multivessel disease and more small vesseldisease than nondiabetics. The results have been attributed to many factors oftenassociated with diabetic patients:hypcrlipidemia obesity svstemichypertension.insulin resistance.silent myocardial ischemia and so on.

    1998年04期 154页 [查看摘要][在线阅读][下载 51K]
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  • Preliminary Experience of Intracoronary Stenting

    <正> This artlcle reports the results of 14 coronary stentsfmplamtation perfomed on 12 pstlonts with coronary artery disease. Successrate of the fmplantatlon was 100%. None of the patlents had stent-subacute thrombosfa or other severe complleatlons.Clinleal aymptomaof these patlenta wera reduced.This report showed that stenting is a asfe andemclebt interventlonal procedure with high success rate and few compllcations.It can fmprove the symptoms of patlents,with coronary artery dlsease.Intracoronary stenting expands the fndleations and decreases the compllcntionsof PTCA,It may reduce restenprls rate and defay its oecurronce.

    1998年04期 155页 [查看摘要][在线阅读][下载 51K]
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  • STENT TREATMENT FOR COMPLICATED CORONARY ABTERIOLESIONS

    <正> 41 cases of corouary artarioleaion admitted duringDeceuber,1995-Dacember 1997 were treated with otent andanalyzed of which 40 cases,36 hale and 4 fanalesuffered from complicated coronary arterioloaion.Stable angina pectoile 11 cues,unstable anginapactoriar 11 cases,cardiac infarction:10 casesSingle vasoleaion: 13 cases,double:21 cases,triple:6 cases Forty-two atants ware implanted in fortytwo lesioned vessals Vasolasion olassification inaccordance With ACC/AHA acors:Type Bl 4 locationa B2locations,C 16 locations.Clinical rate.of auccsasvithout complications was reach in 38 cases(95%)and two failed. Moan residuo atanonin rated -1.8%Follow-up visits aftar two years found no death oroccurrence of cardiac infarction 22 cases were raliovedcoapletely of thair angina pactoris and 17 casesware relived to diffarant degrese,and only onecase with his angina pactoris aggravated a Follow-upfour cases found none half aftar PTCA restanceierated 20%. The obtained ranults auggect that atenttreatmant is satisfactory for treating conplicatedcoronary artary dissases.

    1998年04期 155页 [查看摘要][在线阅读][下载 51K]
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  • 选择性冠状动脉造影在不稳定心绞痛的分层治疗中的应用

    张立新;姚立云;陆文豹;

    探讨选择性冠状动脉造影在不稳定心绞痛患者的冠状动脉病变与其治疗关系中的作用.方法:将临床上确诊的不稳定心绞痛患者87例分别行选择性冠状动脉造影,并按造影结果分别为:A 组,冠状动脉正常和/或狭窄<50%者9例;B 组,冠脉狭窄51-75%者37例;C 组,冠状动脉狭窄76-100%者28例;D 组,冠状动脉病变弥漫,三支病变和/或左主干病变且不宜行内科治疗者13例,分别行基础、药物、介入(冠状动脉成形术及支架植入术)及外科手术治疗(冠状动脉旁路移植术),所有患者出院后随诊半年.结果:B 组中有6例出院后,心绞痛控制不佳,再次造影发现原有瘸变狭窄>90%,经介入治疗后生活质量明显改善:C 组中有4例术后再狭窄,其中1例为支架内狭窄,余3例为新部位,狭窄程度均>90%,再次行介入治疗后无心绞痛发作,两组再狭窄率相比无统计学意义(P>0.05).而 A、D 两组未发现有再狭窄患者.结论:应用选择性冠状动脉造影技术,可使不稳定心绞痛患者缩短治疗曲线,得到及时合理的分层治疗,有利改善其预后.

    1998年04期 155页 [查看摘要][在线阅读][下载 51K]
    [阅读次数:24 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:12 ]
  • 642例冠心病患者冠脉造影结果分析

    张维东;吕树铮;贾长琪;陈韵岱;朱小玲;刘文娴;李海晏;陈惠敏;吴学思;

    目的:时经临床及造影确诊为冠心病者的冠脉造影结果及相关因素(年龄、性别、病变等)进行分析,积累资料,并为进一步防治工作提供依据.方法和结果:642例冠造证实冠脉病变≥50%直径狭窄,其中男性526例(81.9%),女性116例(18.1%);年龄27-83岁,平均55.3±9.7岁;有心肌梗塞史者363例(56.5%),无心梗史者279例(43.5%),冠脉呈右优势分布者540例(84.1%),左优势分布者43例(6.7%),均衡分布者59例(9.2%),单支冠脉病变253例(39.4%),两支病变者191例(29.8%),三支病变者198例(30.8%).受累冠脉数共1229支,其中 LAD 531支(43.2%),RCA 受累381支(31.0%),LCX 受累317支(25.8%).病变直径狭窄程度在50-69%者212支(17.2%),70-89%者362支(占29.5%).≥90%者655支冠脉(占53.3%).单支、两支和三支冠脉病变者平均年龄递增,且相互间有显著差异(P<0.05).结论:本研究所观察的患者绝大乡数为男性,冠脉分布绝大多数呈右优势型,以左前降支(LAD)最多受累;半数以上患者有心梗史,半数以上病变为严重(≥90%)狭窄性病变,病变范围随年龄增大而增加,提示患者应尽早接受冠造检查,以便尽早采取防治措施,争取较好预后.

    1998年04期 155页 [查看摘要][在线阅读][下载 51K]
    [阅读次数:17 ] |[引用频次:1 ] |[网刊下载次数:0 ] |[下载次数:44 ]
  • RELATION BETWEEN ECG CHANGES DURING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY AND IMPROVEMENT OF MYOCARDIAL VIABILITY

    <正> The purpose of this study was to demonstrate the relation between the transientchanges of electrocardiogram(ECG)on body surface during balloon dilating inpercutaneous transluminal coronary angioplasty(PTCA) and improvement of theresidual myocardial viability after PTCA,Eighteen patients with twenty-threecoronary arteries narrowing above 70% were underwent PTCA and myocardialviability was examined with 99mTc-MIB1 Singlephoton Emission ComputedTomography(SPECT)before and after the procedure.During the balloon dilating30-60s,the ECG with leads Ⅱ,Ⅲ.avF.V4 weve recorded.There were 15 caseswith ECG changes of T wave.ST-Seg-ment and QRS axis(65.2%,47 8% and26.1%.respectively),3 case without ECG chanse.More than 50% change of Twave altitude was scored as 1.ST segment shift(elevation≥lmm or depression≥0.5mm.10mm=lmv)as 2.QRS axis deviation≥15 as 3.Myocardial viabiliiy.was evaluated by SPECT with four-point of nine segments of the left ventricularwall.The integral value of ECG change dung PTCA was closely correlated withthe change value of SPECT(SPECT△)(r=0.74,p<0.01).The sensitivity of themethod was 80%;specificity 100%;the positive predictive value 100%;the negativepredictive value 50%;the accuracy 83.3%.This method was simple,useful and.excellent in evaluating myocardial viability.The rest myocardial viability afterPTCA was higher than it was before PTCA(21.2±3.8 vs 17.6±3.6point,P<0.01).The hibernating myocardial viability was improved post PTCA.

    1998年04期 156页 [查看摘要][在线阅读][下载 59K]
    [阅读次数:6 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • THE EFFCTS IN ELECTION INDICATION OF PERCUTANEOUS BALLOON ATHETER VALVULOPLASTY(PBVP)BY 2DE AND M-MODE ECHOCARDIOGRAPHY

    <正>Rheumatic beart dineare(RHD) was at most in valvalar iMM (RHD)Ka*tmo tawtalMr ao4i<Etem.PBVP wu .innktednew method l idthanewfen yeai.Mitral tUmm(MS). Puhnoniry tfaou(PS). Aatic caora( AS), md TrkutpU tfeBMB OS) . iD tuooMMd ilrady by PBVP. Tnii rafted wu & ufc, mill ff iy, *ra moaey.ndtki*Uidn^dafeinikfaSiurgic4c1^^Ob* of detcRBOMnt feton fcr ouwtiw effect wu oanwt cUctiao iwfiortko U key ud *y mrtod of d^a, ic^arUw^WMfawMm^i1JI>3pptartdws^^ tht 223 emi finW l by PBVP b our ndtypic^nwnurbdiiAH^ou w diviOMdby 2DE tad U-motoVCQ,aottiy 156eMBtrfMS wilh mitnl fawfficiwqr, 96 cmm with Aul fitriUdna PS mi 18 n>, ru e of gewK 12-41 yem oil llie otwmtioo -a mi ^p(kd with tocknl l tt mttiatbr b n wop Mdioa, Idt ratrioilv Aort u* Mcboa The imm point* of election ndcrtiov by ZDE nd M-mode eobocvdiognfihy wm 1) Obmving the locrtion gl degre* rfvih lhinlMning inrl tdh *op d movemm condition, deUfledly, fiwn then to ippnwe prthok>(k l type of MS axrtdly. Pnra dbtdofl t>pe it wh ^99 of MS mk PBVPO.e. PBMV) etpecitUy, MGoadlyttWHn±^typeefl^,MtlHflni^t)ffaorMS b ralh]ai^ Pun pulmaaaiy valvulvileaonimAPBVP. trtifitwifliitanMts rtngtt wttrioilM cwlput tnd or b toUJ p kno ry irtoy. fl wifl don1 IfuilPBVP 2) CcmprftoodfflethBdegrtHjrfrfhMoo. ft t ml ctta&xfon M d] -vmJvuUi unit ibuadttUy. Tbeio cmm with etianta wope d terioui d w dont wit PBVP (putisatoy, trilh *enoui dbenoo^tbicfceiiingttcxirdMlDndHi) 3) Cveflilly detraiutiiv At op<^ q>lituda ind vet of MV nd PV ww importJrt to elect opention md obeervg cuntive rfTect, ifflw opening uv* of MV HoaU Hun 0.7Deler mined mtx blood flow velocity MV opening in diutolk period md diutolk blood flow veloch> in pulmoiury utay by Doppkr ecbocanBognphy, Hwfllbmnorerdi bfci.Ttw 2DE M-modft UCO md Dopplcr-eobo wm very omy tad relwble method in election indication of PBVP deemed by fee rathor.

    1998年04期 156页 [查看摘要][在线阅读][下载 59K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • CLINICAL APPLICATIONS OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

    <正> Percutoneous transiuminal coronary anginplesty(PTCA)was performed in33 patients of coronary heart diseases(male 30 cases,female 3 cases, meanage 54.2) with Gruentzig's method.Of all the 33 patients,there were 26narrow parts in 20 cases of the single branch lesions,27 narrow parts in 11cases of the double branch lesions and 11 narrow parts in 2 cases of thethree branch lesions.In 48 branches with lesion vessels,there were 27branches of the left anterior descending coronary arteries (LAD),7 branchesof the left cicumflex coronary arteries(LCX)and 13 branches of the rightcoronaw arteries.The narrow degrees varied from 75% to 100%. The resultswere that,of 33 patients,48 branches of lesion vessels and 64 narrow parts,the successful rates of dilation were 96.9%,87.5%,85.9%,respectively.Ventricular fibrillation occurred in one case during the procedure,whichsoon recovered sinus rhythm through cardioversion.Symptoms of thesuccessful 32 patients were lmproved obviously or diappeared after PATC.Combining with the documents,we think that the successful rates are higherin type A lesion undergoing PTCA.When PTCA for the multiple branchlesions are performed,we ought to master the principle of dilating the mainlessinos in advence.The long-tube lesions were dilated by the long balloonfitting for these lesions.The causes of failure of PTCA in the severe narrowlesions are mainly the the guilding wires or the balloon catheters cann't passthrough the lesion parts,in addition,the complication problems in PTCA arealso discussed.

    1998年04期 156页 [查看摘要][在线阅读][下载 59K]
    [阅读次数:6 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • Angiographic Iongterm follow-up after coronary stent implantation in acute myocardial infarction

    Ailaiti Maimaitiming;Hans-Jrgen Rupprecht;Flex Post;Bernd Nowak;Jrgen Meyer;

    <正> Stent implantation in acute myocardial infarction(AMI)has been shown to improvethe acute angiographic outcomes.So far few data on long-term angiographic follow-up are avallble.Methods:We studied 130 consecutive patients(mean age 58±11,24 women)betweenOctober 1993 and October 1997,in whom coronary stonts were implanted afterunsuccessful percutaneous transluminal coronary angioplasty (PTCA)in AMI.Quantitative coronary angiography(QCA)was performed and residual stenosis wasmesuremesured for all patients immediately and for 74 patients at a mean of 6 months afterthat procedure.Results:The infarct related artery was the left anterior dascending in 60(46%)pts,the circumflex in 15(12%)and the right coronary artery in 55(42%).At baseline,72(55%)pts had a totally occluded artery(TLMI0)and 11(8%)TIMI 1 flow. Eight(6%) pte were given aboiximab(ReoPro) or thrombolyais to deal with acute slantthrombosis during the intervention.Immedately after stent implantation,angiographicsuccess(TLMI 3)was obtained in 113(87%)pts,TLMI2 in 14 (11%)and TLMI 1 intwo (2%). Only three pts had residual stonosis(≥50% stenosis)immediately aftertreatment.Except the patients who had coronary artery bypass grafting(CABG)ordied coronary angiographic follow-up was performed in 74(70%)pts at a mean of 6months following the intervention(Table).Conclusion:Rescue stent implantation after failed PTCA in AMI may improve initialangiographic results,but we found a higher restenosis-rate and reintervention-rate inthe long-term run as compared with selectiv stent implantation.

    1998年04期 156页 [查看摘要][在线阅读][下载 59K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • Rescue coronary stenting for cardiogenic shock following acute myocardial infarction

    Ailaiti Maimaitiming;Hans-Jurgen Rupprecht;Jurgen Meyer;

    <正> Cardiogenic shock(CS) is combined with a high mortality following acutemyocardial inferction(AMI),In non-randomized trials percutaneous transluminalcoronary angioplasty(PTCA) has been shown to improve the prognosis of patients(pts) with CS in AMI.We report the result of 40 pts with CS,in whom stentimplantation was performed due tO an insufficient PTCA result in AMI with CS.Methods:Analysis was performed in patients with CS following AMI andemergency revascuhuization(ER) with coronary stenting between October 1993 toDecember 1997.The primary clinical end point was survival and repeat ER within30 days after stoat implantation.Result:In 40 pts(mean age 63±10 years,male 31) we found CS after AMI andstent implantation was performed 7.3 h (rang 1.24 h) after onset of chest pain.I 1(28%) pts received thrombolysis(Lysis) before ER.ER within 6 h after the onset ofchest pain was performed in 22 (55%) pts,25(63%) pts were given ReoPro(mean14.3rag) as bolus during the intervention.TIMI grade 3 has been accomplished in 34(85%) pts.Two(5%) pts underwent repeat PTCA and four(10%) were referred forcoronary artery bypass grafting(CABG) at follow up.14(35%) pts died because ofpump failure within 30 days.Conclusion:Rescue stent implantation after failed PTCA may improve survival ofpatients having AMI complied,ted by cardiogenic shock.Whether early thrombolysisproceeding stent implantation may be benifical has to be shown in randomized trials.

    1998年04期 157页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:7 ]
  • A CLINICAL ANALYSIS OF 24 PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH PTCA AND INTRACORONARY STENT IMPLANTATION

    <正> The data of 24 cases(18men,6women) with AMI treated with directPTCA and intracoronary stant implantation were analyzed.The infart-related vessels were 13 LADs,4LCXs,7KCAs:The successful rate washigh(95.8%).The mean stenoses before and after performation were 95.6±5.4%,8.3±0.2%.18 stems were implanted in 16 cases.Lesscomplication happened during the procedure.There was a higher TIMI Ⅲflow patency rate in PTCA and intracoronary stent implantation than indrug thrombolysis (92% vs 40%).Stent implantation had a significanteffect on myocardial reperfution by enhancing the successful rate ofPTCA and reducing the stenosis significantly.

    1998年04期 157页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • 经皮腔内肾动脉狭窄成形术治疗肾血管性高血压——附12例次报告

    柴颖儒;张林虎;王继荣;谭建国;王宏智;

    目的:肾血管性高血压是我国常见的一种继发性高血压,药物治疗效果差,作者采用经皮穿刺肾动脉腔内成形术对12例次17支狭窄肾动脉进行治疗以探讨其临床应用价值.方法:在 X 线引导下,采用 Seldinger 氏穿刺技术将球囊导管送入狭窄肾动脉腔内充盈膨胀球囊,对狭窄病变施于机械压力使之扩张,达到解除肾动脉狭窄的目的。结果:12例次17支狭窄肾动脉扩张前后狭窄段直径平均扩张4.31±1.72mm,p<0.001(t=10.33).13支动脉扩张前、后狭窄段前后平均动脉压差平均降低11.41±7.23KPa,P<0.002(t=74).肢体血压:扩张前后右上臂血压平均下降5.52±2.23/3.15±2.22KPa,P<0.001(t=7 42)/0.002<P<0.005(t=4.26).随访36-77月,平均54±16.49月,较术后平均下降0.20±2.72/0.49±1.51kPa,P>0.5/P>0.4.按 Sos 标准:完全成功11例次,部分成功1例.临床疗效评定法评定:治愈9例,改善3例;两法评定总有效率均为100%.结论:该法治疗肾血管性高血压是一种简便、安全、疗效可靠实用,具可重复性,有条件的医院应将其列为泊疗肾血管性高血压首选疗法.

    1998年04期 157页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:19 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:18 ]
  • LATE ELECTIVE ANGIOPLASTY FOR PATIENTS WITH RESIODUAL STENOSIS AND EVIDENCE OF ISCHEMIA AFTER THROMBOLYTIC TREATMENT OF AMI

    <正> Background:Several studies have shown PTCA performed early afterthrombolysis to be unnecessary or even harmful.However,PTCA in these trialswas generally performed 1-3 days aider AMI,when the patient may be unsuitedfor PTCA,and the incidence of major complications was high.We observed theinitial results of dalayed PTCA(7-30 days) in patients with residual stenosis andevidence of iscbemia.Methods and Results:28 patients were eligible for inclusion:1)They hadreceived intravenous thrombolytic therapy within 12 hours of symtom onset ofAMI.2)They had postinfarction angina,or≥1mm fiat or downsloping STsegment depressions or T wave inversions,or the response of segmental wallmotion abnormalities to nitrates or dobutamine.3)They had an infarct-arterystenosis of≥50% diameter stenosis.Mean age was 56±10 yeats.Proceduralsuccess was obtained in 26 patients(92.8%),guidewire could not cross one totalocclusion lesion and balloon could not get through another.Intracoronarystenting was performed in 15 of 26 patients(57.7%).Diameter stenosis wasreduced from 75±12% to 22±10%.In-hospital or parioperativecomplications were as follows:digest tract bleeding,one(3.8%);subacuteclosure,one(3.8%).There was no significant increase in ejection fraction 4-weeks later.There was no reinfarction during the 12 months of follow-up.Cnnclusion:In this selected patient population,late elective PTCA results in alow incidence of in-hospital and parioparative complications.Clinical success,defined by absence of symptoms,appears to be sustained at 1 year.

    1998年04期 157页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • Treatment of AMI in elderly patients with direct PTCA

    <正> Objective The goals of this study were to examine the safety and feasibility ofdirect PTCA in elderly patients with acute myocardial infarction(AMI).Methods and Results:From January 1994 to January L998.42 cases elderlypatients were treated with direct PTCA for AMI.45 infarction related arteriesamong 40 cases patients acquired coronary artery repatency,a success rate of95.2(40/42).the time average after they suffered from thorcalgia was 5.8±3.1hours(2~11 hours),after the diagnosis of AMI was 4.0±2.4 hours(0.5~10hours).The average stenosis before direct PTCA were 86.2%±9.2%(90%~100%),after direct PTCA were 11.2%±3.2%(0%~20%).TIMI flowin infarction related arteries were 0~1 degree before direct PTCA,3 degreeafter direct PTCA.Among 40 cases patients,5 cases accompanied with leftventricular dysfunction(killip Ⅰ~Ⅱ),3 cases accompanied with cardiogenicshock,clinic symptom were obviously improved.Conclusions:Direct PTCA inelderly patients with AMI is safe and feasible,it has a lower mortality rate andbleeding rate.,in majority of elderly patients with AMI has excellent short-termoutcomes.

    1998年04期 158页 [查看摘要][在线阅读][下载 65K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • Coronary Artery Stenting in 150 Cases:Evaluation on Indications and Results

    <正> 150 patients were undergone coronary stenting from May 1996 to May1997 in our hospital.Nit,ACS,Wiktor.Cross-Flex,AVE,J-J,Cook JR-Ⅱ,XT,.To,and B-stents have been used to treat 178 lesions The resultsshowed that operational succesful and clinical succesful rates were 98%and 94.6%.Death and restenosis rates were 1.3% and 8.6% 65 ptswith AMI were treated with primary stenting rescue stenting,anddefered stenting In 34 pts.with acute coronary artery syndrome,theprogression were eontroled by coronary stenting Angiographic resultsshowed that the diameter of target vessels were increased from 0.68±0.42ram pre-operation to 3.32±0.45nun after-operation The stenosis isreduced from86±14% to 6±11% We consider the thrombns lesion inAMI(22%) is not the contraindication to coronary stenting 11 ptswith LMT lesion were stented without complications.We also considerthat LMT lesion is not the contraindication of coronary stenting.

    1998年04期 158页 [查看摘要][在线阅读][下载 65K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • INTRACORONARY STENT PLACEMENT IN THE RECOVERY PERIOD AFTER ACUTE MYOCARDIAL INFARCTION

    <正> Angiography and intracoronary arena was performed in 16 patients in therecovery period after acute myocardial infarction in our hospital fromNovember 1995 to October 1997.The group comprised 16 men.mean age was52.7±11.8 years.Six had postinfarction angina,ten had postinfarction heartfailure.The infart-related vessel was single in 15 cases.8 in LAD.5 inRCA.2 in LCX,infact-related veasel was double in 1 case,LAD+RCA.MeanLesion length was 19.5±5.3mm and average diameter stenosis beforeprocedure was 92.5±5.1%.Nineteen intracoronary atents were implanted.10in LAD.7 in RCA,2 in LCX.Three patients received 2 stents,respectively.The procedure succese rate was 100%.After the stente implanting,averagediameter stenosis decreased to 0-10%.postinfarct angina disappeared,In thepostinfart heartfailure group,the diameter of left atrial and left vertricularon the UCG were reduced,enjection fraction increased significantly.Ourresults indicate that intracoronary stent in the recovery period aftermyocadial infarction provides a benefial effcct in increasing coronary bloodflow.preventing left ventricular function and reducing mortality Ascompared with sngioplasty.coronary stent placement has a higher clinicalsuccses rate and reduces the incidence of reetenosis.

    1998年04期 158页 [查看摘要][在线阅读][下载 65K]
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  • CORRELATION OF CAROTID ATHEROSCLEROSIS AND CORONARY ARTERY DISEASE AND THEIR RISK FACTORS

    Huang Zheng MD;Liu Yili;Gong Lansheng;Shi Zhangwei;

    <正> Objectives.Relationship between carotid atherosclerosis(CAS) and severity ofcoronary artery disease(CAD) and different risk factors were investigated,Theseverity of CAD was tried to predict using carotid duplex scanning and riskfactors investigation.Methods.Carotid duplex scanning were performed in 103 patients who had beenconsecutively examined by coronary angiography.Patients were divided into 3groups(normal,I-vassal disease and multi-vessel disease group) according tocoronary angiographic results.To quantify the extent of CAS,maximal unicknessmeasurements of all plaques were summed for an individual plaque score.Gensini's CAD score was calculated to quantify the extent of coronary arteryatherosclerosis(CAAS),Relationship between carotid plaque score and extent ofCAAS was evaluated.Relationship between main risk factors and the degree ofatherosclerotic vascular involvement in carotid and coronary artery wasexamined using standard|sad partial correlation coefficients.Results.CAS plaques were more common in the bifurcation end in the left side.Intimal-medial thickness(IMT) of multi-vessel disease group was significantlylarger than that of the normal group(P<0.001).No significant differences werefound among these 3 groups with carotid Doppler parameters,A linearcorrelation between carotid duplex scanning parameters and carotid andcoronary atherosclerosis was found.Carotid plaque score was significantlyhigher in patients with l-vessel or multi-vessel CAD than that without significantCAD(P<0.001).There was e significant positive linear correlation betweencarotid plaque score and the extent of CAD(r=0.60,P<0.001).Age,male gender,smoking,hypertension,total cholesterol,LDL,plasma fibrinogen,and plateletaggregability were positively correlated with the extent of CAS and CAAS.HDLwas negatively correlated with CAS and CAAS.Formulas using carotid duplexscanning parameters and risk factors to predict the extent of CAD were provided.Contlusions.CAS was significantly correlated with the extent of CAAS.Age:male gender,smoking" hypertension,total cholesterol,LDL,plasma fibrinogen,and platelet aggregnbility were strong predictors for CAS and CAD.

    1998年04期 158页 [查看摘要][在线阅读][下载 65K]
    [阅读次数:17 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:9 ]
  • INTRACORONARY STENTING IN 31 PATIENTS WITH CORONARY HEART DISEASE

    <正> In order to prevent acute vessel closure and restenosis after percutaneoustransiuminal coronarg angioplesty(PTCA).36 intracoronarystents wereimplanted into 33 vessels in 30 patients aged 32-72 years with cororary heartdisease.20 patients had unstable angina,7 old myocardial infarction and 3acute myocardial infarction.Single vessel tesion was detected in 20 patients.double vessel lesion in 6 and triple vessel lesion in 4.23 stents wereimplanted in LAD,3 in LCX and 10 in RCA.Those stants include 17 Nirstents,8 Palmaz-Schatzstents and 11 Gianturco-Roubin stems.The meaninflation pressure was15+1.2 ATM.The procedure success rate was 100%.Thediarneter stenosis reducad from 87±11.9% to 5±9.8% after stenting.Thecombined use of aspirin and ticlopidine was a main anticoagulation therapy inour group.there were no complicatins such as acute or subacute thrombosis.cerebral bleeding,myocardial infarction,in-hospital death or emergencyCABG.Most patients were free from ischemic symptoms during 1 to 20 monthsfollow-up.There were two patients whose angina pectoris recurred in 6 monthof stenting,one was cured with repeat PTCA and the other with CABG.The results suggest that intracoronary stenting is an effective and safe methodfor vessel disection or acute closure following PTCA.It has high successrate and low restenosis rate.High pressure inflation for optimal stentdeployment,careful assessment of final angiographic result with near zeroresidual stenosis and the association of aspirin/ticlopidine can effectivellyprevent thrombosis and do not increase bleeding complications in themeantime.

    1998年04期 159页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:5 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • IN ASIVE CARDIOPHYSIOLOGY

    <正> The physiology could be conducted in the catheterization laboratory(CL)asthe development of Invasive Cardiology,which may emerge a newsubspecialty--Invasive CardiophysiologyMethods There are several modalities used in the CL to assess thefunctions of heart and coronary artery during interventional procedures.1.Coronary angiography:after interventions,the changes of the vesselprofile during cardiac cycle could be evaluated,and the recanalizedblood flow could be classified as TIMIⅠ~Ⅲ.2.Ventriculography:the cavity profile and the cardiac function(EF%)could be detected,and the regional motion of the wall could beclassified as normal,hypokinesis,hyperkinesis,akinesis and dyskinesis.3.Intracoronary ultrasound(ICUS) and Doppler ICUS could image the-changes of vessel lumen,wall and plaque before,during and afterinterventional procedures.IntracoronaW Doppler could monitor theblood flow improvement.4.Angioscopy:the surface of the plaque or lumen could be see inangioscope.5.Intracardiac electrophysiology:the functions of sinus node,A-V nodeand His bundles could be evaluated and the anti-arrhythmic drugs couldbe screened.6.Testing:the following drugs is used to test the endothelial function ofcoronary artery:acetylcholine,ergonovine,adenosine,papaverine,ornitroglycerine under the angiography and/or ICUS or Dopplerimagings.7.Intracardiac pacing:to test the reserve of the ischemic burden.Conclusion The development of Invasive Cardiophysiology in the CLmay conquer the thinking of the physicians from the"clinic-pathology"to"clinic-phystology"correlation,which might attract more attention to theresumption of physiological condition rather than anatomic correction.

    1998年04期 159页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • ROUTINE HIGH PRESSURE BALLOON INFLATIONS AFTER CORONARY STENT IMPLANTATION WITHOUT ANTICOAGULATION

    <正> Wikter-i and multilink Coronary stent has beenimplanted in 38 lesions in 31 patients.Theindications for stent implantation were 21 elective,11 chronic total occlusion.4 threatened closure and2 suboptimal.Vessel distribution was 21 LAD,8 RCA,9LCX,Successful stent implabation was achievied inall of pstients,Lession length was 15.3±8.6mm.Theaverage final balloon size after stent placement was4.5mm(range 3.5-6.0mm) end minimal luminal diameterwithin the stent was 3.75mm(range 3.0-4.0mm).Maximum inflation pressure was 14±2 atmospheres.AWiktor-i stent used in 21 lesions and multilinkstent in 17 lesion.All of patients were treated withonly antiplatelet therapy after successful stentimplantation,There was no stent thrombosis orvascular complication.Mean elapsed time from stentplacement to femoral sheath rsmoval was 5.6 hours(range 4-7hours).Patients were discharged from thehospital within 1 week of stent placement,allreceiving aspirin 300mg per day,end ticlopidine250ms twice a day,In three months of clinic follow-up,no patients experienced stent throebosJs.After astent is deployed,routine high pressure ballooninflation is performed within the stent to ensureuniform circumferential expansion and optimalopposition of the stent to the vessel wall.Whenoptimal stent expansion was achieved,there was nostent thrombosis despite the absence of anti-coagulation in all of patients.

    1998年04期 159页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • Clinical Application of Coronary Intervention

    <正> Objective To report coronary interventions in 23 patientswith CAD.Methods Twenty-three patients with 30 lesions were performedPTCA from July,1995 to May 1998 In our hospital.Thirty lesions,including16 type A,10 type B lesions and 4 total blocking were dilated,Fourteenlesions received ballon angloplasty.Eighteen stents were implanted into 16terger arteries.15 stents were for De Nove sions and 3 stents were fordisection after ballon angloplasty.Result The total success role was95.8%(22/23).The tatal succass rate for lesions was 93.6(28/30).Theauccess rate for stenting was 100%(18/18).Narrow ratio of Iumlnal diameterof artaries was 91.83±8.81 bafor dilation and 7.08±8.83 after dilation.All ofthe cases were followed up for 1-34 months(16.76.8.63).No aoute orsubacute thrombosis happen.NO acute myocardioinfarction,emergencybypass and died.Four patlents had reoccurred angina pectoris within 3monks.Two cases were showed restonosis by angiography.One case wasshowed the narrow ratio Incressingh from 10% to 40% by the anglography.Conclusioba In the initial stage of coronary intervention In the hiosptala it isvery important for the doctors to select the indication of PTCA according totheir skill and experience,to make full preparations for precedure and giveintensive treatment and nursing after oparation.It is also necessary tostrengthen collaboration with other specialists from the hospitals concernedin order to achieve a higher success rate and prevent major complicationsfrom happening.

    1998年04期 159页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • MONITOR AFTER THE TRANSMYOCARDIAL LASER REVASCULARIZATION

    <正> Transmyocardial Laser Revascularization(TMLR)is a techniqueuses a carbon dioxide laser to create transmyocardial channelsfor direct perfusion of the ischemia heart.It was used as thesole therapy for patients with ischemic heart disease notamenable to percutaneous transluminal coronary angioplasty orcoronary artery bypass grafting.Since 1996.33 patients atWanjie Hospital have undergone TMLR.using the high power1000W Heart Laser(PLC Medical Systems,MF.MA)Preoperatively.the patients underwent single photon emission computedtomography persion and positron emission tomography viabilityscans to identify the extent and severity of their ischemia.Onaverage 30±6 pulses were delivered and 25±9 were confirmed bytransesophageal echocardiography for each case.The chanels are1mm in diameter and were created a distrabution ofapproximatsly one per squre centimeter.All the patients weresent to the intensive care unit(ICU)after the procedure,therespiration,electrocardiogram,hemodynamic assessment,myocardial enzyme etc were observed.The heparine was routineused after the procedure,and change to wafarin when patientscan eat from mounth,and still take the nitrates and β-blockers.Most of them revealed the stable hemodynamic change,withoutreperfusion arrythmia.The S-T segment increased,T wavedecreased or inverted,combined with the myocardial enzymeincrease after the procedure,and returned to the baselinewithin about one week.TMLR was a new technique to end stagecoronary artery disease with limited injury,high security andreliable early-stage curative effect.

    1998年04期 160页 [查看摘要][在线阅读][下载 58K]
    [阅读次数:8 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • 急诊PTCA病人应用IABP6例分析

    郁华;冉华中;楚强;

    PTCA 已是当今冠状动脉团性病变治疗中行之有效的措施之一,而急诊 PICAAM治疗中更是优于静脉溶栓等其它方法的措施,因其能使冠状动脉开通早且注充分,疗效确切是静脉所不能比的.但 AMI 合并心源性休克者往往急诊 PTCA 的实施带来极大的困难,使之成功率大大下降.我们观察了6例 AMI 合并心源性休克病人在 IABP 的支持下顺利地进行了急诊 PTCA术,无一例死亡,血流动力学均在24小时内得以改善,生命体征稳定.分别24小时至72小时内逐渐机,无一例并发症发生,分别于住院14至10天痊愈出院.AMI 合并心源性休克者死亡率高,可达85%~90%.IABP 可使其降低20%,急诊 PTCA及支架置入术可使其更进一步降低,前者可在提高30%主动脉舒张压的同时,增加冠状动脉的灌注,减轻心脏前后负荷,增加心脏指数:后者能够尽早地开通闭塞的动脉血管,充分地灌注缺血心肌,二者有机地结合能够更大限度地挽救濒临死亡的心肠,缩小梗面积.减少心绞痛发作,维护心功能,改善预后,国外已有报道,在 IABP 的保护下成功地进行了冠状动脉左主干开口和近端等其它复杂病变的 PTCA 及支架术.此外,IABP 的应用也为冠状动脉多支病变病人合并血流动力学障碍者提供了冠脉搭桥等其它治疗的可行性时,为急性冠脉闭塞病变合并心源性休克的治疗开拓了更广阔的北景.我们认为,凡有血流动力学障碍的 AMI 人均应极早在 IABP 保护支持下急诊PTCF 术,以保证冠心病介入治疗更有效,及时,安全的实施,这降低病死率,提高存率,提高生活质量的目的.

    1998年04期 160页 [查看摘要][在线阅读][下载 58K]
    [阅读次数:17 ] |[引用频次:1 ] |[网刊下载次数:0 ] |[下载次数:11 ]
  • 经股静脉途径行法乐四联症选择性冠状动脉造影(摘要)

    张玉威;朱鲜阳;韩秀敏;邓东安;张端珍;张桂芝;

    目的:法乐四联症合并冠脉异常发生率为5-9%.术中误切术后常加重病情,甚至死亡.因此,术前常规行冠脉造影有利于体外循环术中根据异常冠脉的位置和行程的不同采取合适的成形术或外通道术,以达到理想的根治效果.方法:婴幼儿和儿童常规动脉穿刺施行冠脉造影存在一定的技术困难和增加动脉穿刺的并发症.我们于1996年起,经股静脉穿刺作右室造影确诊为法乐四联症者,疑有冠脉异常的25例,更换 Judkins5或6F右冠脉造影导管,经右心室过室间隔缺损直送到升主动脉根部,通过手法操作行左、右冠脉选择性造影怀满意效果。这25例,男15例,女111例,除1例年龄23岁外.余均在6-11岁之间(平均7-5岁).儿童体重13-33kg(平均21kg).结果:25例经右室造影均为单纯法乐四联症.左冠造影25例均成功,右冠脉成功16例,其中3例有异常的冠状动脉.25例无任何造影并发症.冠脉造影增加透视时间平均7.5±1.1min;结论:几乎所有复杂紫绀型先心病都伴有室缺,故在右心导管检查或选择性右室造影中,通过手法操作可通过室缺进入升主动脉而用此技术施行选择性冠脉造影.为广泛研究复杂先心病冠脉异常提供一简单、省时、安全的新技术.

    1998年04期 160页 [查看摘要][在线阅读][下载 58K]
    [阅读次数:26 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:7 ]
  • MINIMALLY INVASIVE ACCESS FOR AORTIC VALVE OPERATION:A LIMITED SUPERIOR MEDIAN STERNOTOMY

    <正> Minimath mvasive curdiac surgerv has been developed to offer pauents the benefitsal'open heart operationas with decrreascd pain and limited skin incision A limitedsuperior median sternotomy has been shown to provide a good exposure for aorticvalve replacement(AVR:and good results In this study we report the results ofminimaly AVR compared standard sternotomy AVR performed in the same period.I rom Muv 1996 to January 1998.86 patients received isolated aortic valvereplacement by the hmited stiperior median sternotom\(group 1).As a control groupreplacement by standard sternotomy in the same period.Surgical procedure.A midline skin mcision from the first to the first to the third intercostalspace and a median stemolomy from jugular notch to the fourth intercostal space areperformed.The pericardium is incised.e\posing the ascending sorta and rightatrium Aortic and right atrial cannulation are performed as usual Cardiopulmonarybypass and cardioplegia are applied by the usual technique.After opening the aorta.three traction sutures at the tip of the commissures ate placed elevating the valvefor better exposure.After being weaned from cardiopulmonary bypass,oneretrosternal tube is placed and the sternotomy is closed with one metal band and twoMedian ischemic time and median bypass time between the two groups showed nosignificant difference(p>0.05)Median entire operation time in group I wasobviously shorter than that in group 2(p<0.01).Median postoperative dramagewas 229ml in group one.369ml in group 2.The difference between the two groups(p<0.05)was significant.Median postoperative respiratory support time was 743hours(h)in group one.11.26h in group 2.with signifieant difference(p<0.05).Median duration of hospital stay were 6.2 days(d)in group 1.94d in group 2.withsignificant difference(p<0.01).Reoperntions for bleeding were 2 in group 1.4 ingroup 2.sternum infection or disruption one in group 1 and 3 in group 2 There weretwo hospital deaths respeclively in the two group(not procedure related,The limited superior median sternotomy provides good exposure to the leftventricular outflow tract aortie valve aseending norta.and even to the mitral valvethrough the roof of the left atrium Therefore it seems to be suitable for all kinds ofaortic valve operations Besides less pain.shorter skin incision.shorter respiratorysupport time and lower blood loss.it has more advantages as opening and elosure ofthe sternum is fuster.decreasing infection and disruption of the sternum.and linallydecreasing the time required for hospitah/ation and recovery.

    1998年04期 160页 [查看摘要][在线阅读][下载 58K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • MINIMALLY INVASIVE REVASCULARISATION ON THE BEATING HEART IN COMBINATION WTTH PTCA

    Wolfgang Kon;Jianshi Liu;Lars-Eric Pietsch;Horst Laube;Gerd Baumann;

    <正> With the experience of over 250 beating hear operations since Feb 1995 westarted minimally invasive revascularization of the LAD(MIDCAB).SinceFeb.1996 we operated upon 182 patients with this procedure Since June1996 we treated 40 patients with multivessel discase with a Hybridproccdurc(PTCA plus MIDCAB)The age of the patients ranged between 68 and 79 years.29 patients waremaic.28 patiens suffered from a double vessel discase.12 patients fromtriple vessel discase.The left ventricular ejeetion fraction was loss then 40%in 8 cases 2 patients underwent a reoperativc procedure.Further risk factorswere COLD(n=9).recent MI(n=6),renal insufliciency(n=13).Diabeiesinellitus(n-12).The left mammary was prepared in the usual manner.As access wechese a partial inferior sternotomy(n=4)or a lateral minithoracotomy(n=36).The anastomosis was performed on the beating heart.In all patients we conneeted the LIMA to the LAD.All patients survived andcould be discharged on the 6th postoperative day(mean).In two patients arevision due to bleeding became necessary.Two patients reccived a bloodtransfusions.Postoperatively 15 patients reccived a PTCA of the RCX.4 astentimplantation to the Rex.16 a PTCA of the RCA.5 a stentimplantationto the RCA and 3 patients a PTCA of a D1.3 patients developed a falscaneurysm after the cathcter intervention.By performing the nunimally invasive proeedure the trauma caused bycxtracorporeal circulation can be avoided.Through the combination withPTCA a less invasive therapy of coronary multivessel discase becomespossible in select patients.Postoperative complications and hospital stay canbe teduced.

    1998年04期 161页 [查看摘要][在线阅读][下载 412K]
    [阅读次数:13 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • Clinical Study of 21 Cases with myocardtal Brldging

    <正> There are 21(1.6%)patients with diagnosis of myocardial bridge among 1300 cases for coronaryangiography(CAG)over a three-year period since May.1995.18 of tbem are male(85.7%)and theirsuggestive of angina pectoris.Tbe mean time interval between the first symptoms and theangiographic diagnosis was 15 months.13(62%)patients had typical angina One case wasdiagnosed as myocardial infarction.The functional classification of angina(CCS) was definec asclass Ⅱ in 10(48%),class Ⅲ-Ⅳ in 11(52%).Risk factors were including hypercholesteroiaea in10(48%),cigarette smoking in 8(38%),positive family history of ischaemic heart diseaseFD in7(33%),hypertention in 6(29%),diabetes mellitus in 2(10%).There were 13 patients(62%)with ECGabnormslities(T wave inversion or ST segmem depression).6 of them had positive exertise testingMyocardial bridging were all exclusively confined to the left anterior descending coronaryartery(LAD).The narrowing degree of LAD was determined by quantitative angiograpnicmeasurements of systolic and diastolic lumen diameter reduction within the myocbridge,mild(50-70%)in 10 patients(48%),middle in 4 (19%),severe in 6(28%),and compietecollapsis in one.4 patients had been documented with atherosclerosis in CAG.Correlation co bedemonstrated between the angiographic narrowing degree of bridging and clinical patients with severe dynamic obstruction had evidences of ischemia.In additon,5 of strong angina had been documented severe stenosi Treatment with β-bockers was effective incontrolling angina in our 18 patients of 21(86%).Conclusion:Myocardial bridges may induce significant ischemia,even myocardial infarction,especially in patients with severewithin bridge.Treatment with β-bockers was effective.

    1998年04期 161页 [查看摘要][在线阅读][下载 412K]
    [阅读次数:5 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • Clinical analysis of 38 Cases of angina pectoris after CABG

    <正> From 1992.96 cases have treated by CABG.singCABG to treat angina pectoris for 38 cases.theresponse to treatment is usually dramatic.38 patients(male 31.female 7 age 45-77).Therewere no history of AMI.but 16 cases were complicatedby Hypertension,7 cases were complucated by Diabetes.9 cases were complicateol by Hyperlipidaemia,allpatienta had a long history of angina pectoris(From 1to 16 years).The ECG showed:normorl (2 case),RBBB(9 cases)LAH(2 cases)ST segment diminish(20 cases,but 10cases only V5.V6).T wave charged(6 cases).someDCG were negative.Cornonary angiocardiography showed:The stenosis ofcornonary artery were serious:LMCA 10 cases LAD 35cases lcx 21 cases,RA 34 cases.Diag 7 cases,OM 5cases.double vessel disease 3 case.three vesseldisease 35 cases,all patients could not treated by PTCA.but they recovery by CABG.The resulta suggest:1.If the patient of anginapectoris can not relieved by the drugs.they mustexamined by cornarary angiography.2.We must paymore attention to some casea.they have seiouslysngina pectoris but their ECG and other examinenormorl or alight abnormorl.

    1998年04期 161页 [查看摘要][在线阅读][下载 412K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • CLINICAL APPLICATION oF TEN TYPES OF INTRACORONARY STENTS

    <正> Prom April 1993 to December 1997.42 intracoronary stents of ten typeswere implanted in 40 patients with coronary artery disease.Of the 42stents,33(78.6%)wre implanted in LAD,2(4.8%)in LCX and 7(16.7%)inRCA.which included Cordis stent,Gianturco-Roubin stent,Nir stent,Wiktor stent,Angiostent and Be stent.etc.The success rate of stentimplantation was 100%.The stenostic percentage was reduced from 90.2%pre-operation to 4.5±8.2% post-operation and the average minimumdiamter of the vessels was increased from 0.35mm to 3.44mm.Subacutestent thrombosis occured in 2 patients because of inadequate anti-coagulant therapy.During 1-32 months follow-up,8 patienta developedrecurrent angine of whom 4 were showed restenosis by angiographicevidence.We concluded that selection of suitable stents acccrding tothe characteristics of lesions and administration of appropriateanticoagulant therapy are critical to successful stent implantation.

    1998年04期 161页 [查看摘要][在线阅读][下载 412K]
    [阅读次数:5 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • Clinicsl research of Palmaz-Schatz stent implantation

    <正> Objective To evaluate the clinical efficacy of Palmaz-Sctatz(P-S)stent,and sum up the experience of P-S stent implantation.Methods The P-S stent were implanted in 79 patients with 85 coronarylesions.According abscences of in hospital death.emergency coronary arterybypass grafting(CABG),Q wave myocardial infarctina(MI)or repeatintervention,measured the primary successfui rate of stent implantation atpostoperatively and the bail out rate of acute coronary closure afterpercutaneous transluminal coronary angioplasty(PTCA).Clinical follow upin 74 of 82 lesions of successful stent implantation was obteined at 3-6month after operation,the restnotic rate was measured by quantitativecoronary angiography.The restenosis was defined as>50% diameterstenosis at follow up.Results In 79 patients with 85 coronary lesion.82 were successfulimplanted.the successful rate was 96%.The Q wave MI 2 patients andemergency CABG 1 patient in 3 patients of unsuccessful stent implantation,and that have not death and repeat interveation.The 28 patients weredelivered in 31 patients with acute coronary closure after PTCA.The bailout rate was 90%.12 have restenosis in 82 lesions of follow up at 3-6month after stent implantation,the restenotic rate was 16%.Conclusion The successful rate of P-S stent implantation was high.andthe occur rete of major adverse events was lower than other stents.Thebail out rate was high in acute coronnry closure after PTCA.The restenotierate at 3-6 month after stunt implantation has lower than other stents.Butthe P-S stent yes not suitable for medium winding blood vessel and was not

    1998年04期 162页 [查看摘要][在线阅读][下载 421K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • PULSBD DYE LASER THROMBOLYSIS IN VITRO AND ITS EFFECTS ON VASCULAR FUNCTION AND STRUCTURE IN VIVO

    <正> The purpose of the study is to evatuate the feasibility of pulsed dye laser(PDL)throm bolysis In vitro and the effect of PDL on vascular function and structure invivo.In vitro,fifty hum an throm biwere divided into laser treated group(n=35),irritation group(n=11),and controgroup(n=4).In the laser treated group thethrom biwere irradiated by PDL with 300 pulses at 100m J/pulse.No irradiation wasgiven to the throm bi in the irritation group,while the catheter was put to and frointo the throm bi for there times,Neither irradintion nor irritation was given to thethrom bi in the controlgroup.Sixteen healthy dogs were studied in vivo.Under theguidance of the guide-w ire PDL catheter was put into the left coronary arteries(n=16)from which PDL was em itted for 1380±60 pulses at 100m J/pulse,whereasthe rightcoronary srteries(n=16)which did not receieve PDL em ission were servedas irritation group.Then the PDL were irradiated directly to the right coronaryarterial wall in the irritation group without the guidance of the guide-wire.AfterPDL irradiation.the weight of the throm bi was reduced from 1.79±0.23g to0.61±0.12g while in the irritation group theweight of the throm biwas only reducedfrom 1.65±0.19 to 1.42±0.15g.In these two aroups the reduction of throm biweightwere 68%±6% and 15%±7% resoectively(P<0.001).No self-dissolution of thethrom bi occurred in the control group.The finding under the contrast phasem icroscope indicated 91% of the debris size were smaller than the size of redcells.In vivo study,coronary angiography showed that no changes in luminalduam eter of both groups.Nomechanicalor thermal in jury to the coronary arterieswas found excepta light irregularity of the intima.PDL Throm bolysis was effectivein vitro.There was no mechanicaldam age or therm al in jury to the vessels during theprocedure of intracoronary PDL irradiation in vivo.

    1998年04期 162页 [查看摘要][在线阅读][下载 421K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:8 ]
  • Application of buttoned device in treated ventricular septal defects

    <正> purpose:To sum up the experience and appraise the efficacy oftrascatheter occlosion congenital ventricular sepal defects(VSD)usingbuttoned device from June 1994 to Jul 1998.Method:24 patients with VSD had treated by catheter buttoned device.Of these,15are male,9 are femle,with a mean age of 26 years(range 16-48).Ventricular septalgap size was 3-11(mean 6)mm.Befoer gap were occlued,left ventriculogrphy must bedo to find out the size of defects and the distance between gap from aorta-valve.Results:Among 24 cases,20 cases had successful treated using buttoned deviceand 4 cases fail account of more small devisce.3 cases had a slight shunt and 6 caseshad bundle branck block,3 cases aortic regurgitation sligthtly after catheter operation.No deathoccured,there was any serious complication.18 cases were followed up for3 to 6 months,3 of 6 patients who had a BBB was normalized while aorticregurgitation in 3 cases did not imptove or aggrate.Conclusion:Traseatheter ceelusion VSD in sdult patients using buttoned devicein a better method of aimple,safe,less compliation.Some of abnormal pioturee orcomplications can be avoided by master indication,seles device suitable,skilledoperation.

    1998年04期 162页 [查看摘要][在线阅读][下载 421K]
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  • 应用移动式C形臂植入冠状动脉支架(摘要)

    郭玉军;武长军;粟克兰;

    目的:探讨应用移动式 C 形臂(小 C 臂)开展冠心病介入治疗的可行性.方法:采用瑞士 Modile Lmaging-system 小 C 臂进行冠心病介入治疗,选择适宜病人植入冠状动脉支架.结果:例1,男,44岁,6月前患前间壁心梗,近2月频发劳性心绞痛,冠状动脉造影示前降支近段95%狭窄,植入支架后症状消失。例2,男,52岁,有冠心病史5年,近三月频发劳累性心较痛,冠状动脉选影见前降支,回旋支近段80%-90%狭窄,右冠近段80%狭窄,中段完全闭塞,予以右冠球囊成形后于中段植入1枚支架,造影见远端开通良好,因费用问题左冠未处理,术后症状消失.结论:2例患者均为明显适应症,其中例2为三支症变,且右冠闭塞,难度较大,应用小 C 臂植入支架均获成功.小 C 臂影像质量、热容量、机器操作等方面均无法与大 C 臂相比,但其价格亦远低于后者,另外,我国冠心病介入治疗远未普及,复杂病例仅少数大型医疗中心的少数知名专家才能完成。因此,就我国现状而言,购置小 C 臂可能成为地市级医院开展此项技术的捷径,小 C 臂可以满足临床需要,从某种意义上讲,在中、短期内,地市级医院购置小 C 臂亦体现了技术与设备的一致性.耗费巨资购置大型心血管造影仪未必能得到充分利用。

    1998年04期 162页 [查看摘要][在线阅读][下载 421K]
    [阅读次数:17 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:10 ]
  • 经导管钮扣式补片治疗先天性心脏病缺损

    曾建平;黄河;刘平;丁菊芬;柳碧云;肖玲玲;

    采用 Sideris 钮扣武补片经导管治疗先天性心脏病缺损5例.其中房间隔缺损(ASD)4例,均为继发孔中央型,缺损直径11-25mm.动脉导管未闭(PDA)1例,为漏斗型(A 型),最窄处内径3.5mm.结果:ASD 补片成功2例,失败1例,术中补片脱落,经外科开胸手术取出补片,并缝合 ASD,痊愈出院.PDA 1例补片成功,心脏杂音立即消失.补片成功病例经彩色多普勒检查基本无残余分流.随访1-12月,病人均感觉良好,X 线及彩色心脏 B 超复查补片无移位,无再分流现象.本文讨论了 Sideris 钮扣补片的特点、适应症和并发症,以及应用的初步体会.

    1998年04期 163页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:17 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:17 ]
  • INTERVENIENT TREATMENT OF CONGENITAL HEART DISEASE WITH LEFT TO RIGHT SHUNT

    <正> Objectiv:It is designed to study the transcatheter occlasion forthe treatment of left to right shunt in congenital heart diseaseThe purpose of this study was to assess the efficacy,feasibilityand prospects of intervenient mathods to treat congenital heartdisease.Methode:between October 1989 and February 1997,Fourteenpatient with congenital patent ductus arteriosus(PDA,n=12),andatrial septal defects(ASD,n=2),underwent transcatheterocclusion using the Porstman foam plug and the Sideris buttoneddevice.Thece were 5 males and 9 femals with the aged 8-27,yearsold.The diameter of PDA was 6-16 mm and ASD was 15-18 mm.ResultSuccessful occlusion was achieved in 11 PAD.I ASD except anenormous PDA and a large ASD patients.the left to right shuntwascompletely stopped in 9 of the 11 patients.and small residualshunts ware detected by color Doppler studies in I PDA and I ASDpatients using the buttoned devices.No major comoJications werenoticed.Conclusion:It is suggested that in selected casestranscathether closure is relative a simple,safe and effectivemethod in treating congenital heart disease of left to right shunt

    1998年04期 163页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:6 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • Transcatheter treatment of atrial septal defect versus surgery.Predictive rate of suitable defects

    P.Gavora;V.Hraska;J.Siman;J.Masura;

    <正> Introduction: A transcatheter closure of atrial septal defect(ASD)with the Amplatzer septal occluder(ASO)is a newperspective non-surgical method of treatment of this congenitalheart defect.The aim of the study was to determine the rate of suitable defectsfur this new non-surgical techuique.Patients and methods:From9/95-9/97,77 patients with secundum ASD underwent an attemptat transcatheter closure;.at a median age of 9.3 yr.(range,2.1-43.5 yr.)and meaian weight of 32 kg(range,13-68kg).The most important echocardiograghic criteria for successfulctosure are sufficient rims around the defect,diameter ot medefect and total length of atrial septum.3 pts which not fulfilcriteria were excluded from transthoracic echocardiograpny(TTE).11 pts were excluded from transesophageal TTE,2 ptswere excluded during intervention.we evaluate this results anacompare it with the values frrom perioperative morphomethry otASD's in 353 patients who underwent surgety(years-90).Results:The medlian ASD size measured by TEE was 11.7 mm(range,5-23 mm)and the median stretched diameter was 13.9mm(range,5-24 mm).All devices were placed correctly.Therewas no complication related to the closure.On a median follow-up interval of 8.5 months(range 0.4-2.2 yr)there has been noepisodes of endocarditis,thromboembofism or wire fracture and58/61 pts(95%)had complete closure,as assessed by TTE.Conclusion From 77 patiehts 61 fulfil criteria and successfullyunderwent a transcathter closure of ASD,which represents 79%.In 353 patients who underwent surgery authors compare the areaof the defect and the septal area.278 pts(78%)had suitabledefect for transcatheter closure.We conclude that a new selfexpandable,repositionable ASO is affording a safe and defectivemethod to close small-large secundum ASD's.Suitable defectsfor this procedure are in the majority(up to 80%)of patients withsecundum ASD.

    1998年04期 163页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • A SHORT-TERM STUDY ON CHANGES AND RELATIONSHIP IN HEMODYNAMICS AFTER PBMV

    <正> Objective: To find out some ragularity and relationship in thehemodynamics shortly after PBMV.Methods:55 cases of mitralstcnosis(MS)were studied who were performed PBMV successively inour hospital form Jan.1995 to JUn.1997,male 13,female 42,ageranged 11-65 years old.Mitral valve area(MVA),left atriumdiameter(LAd)),pulmonary artery pressure(PAP-Dopplar)weredetected echocardiographically before PBMV and within a week afterPBMV.Left atrium pressure(LAP)and PAP-duct were also measuredbefore and after dilatation of mitral waive during PBMY.Results:MVA increased significantly after PBMV(p<0.05),AMY 0.68±0.31cm~2increased proportion 69.3±40.7%;LAP reduced significantly(p<0.05), ALAP 12.3±4.6mmHg,reduced proportion 37.5±16.8%differences between before and after operation in PAP-Dopplar,PAP-duct and LAD were not significant.Correlation existed in AMVAand ALAP,also in PAP-Dopplar and PAP-duct.Conclusion:AMVA canbe deduced from ALAP.ALAP can reflect the effect of PBMV.

    1998年04期 163页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • Modlflcation of Sious Node by Epicardial radiofrequency Ablation in Rabblts

    <正>OajocUvt Ikn liann P wn arlw trm a naraMhr coaaltx 4!ttrlfeti4 olonfl th crlsta tnraJaallf <CT).HH parpoM of tali Italy l< to fartkar lavoitlonto tit taatlbUltj ai ntaty of aoalttcatlca of tlaai ncaMltn taeUol to tplcndltl rallofnajuacy ablatlan VOM tin Minn toralaalln la rabblti to control ilmi rnu. lflcotloo of iL*M M*Mk r fottctida is pirfontd ! n y ttlewlUl r^lo{r* nry *klttloa looR tn* nU umlaill>.B fon olitlon.- W|>W lii Uutrllilc k irt ntXlK) Hi tk. (uctloi of itaJ nlo.1t> iblitlog nlwlit li )0±sXiW ctloi lo Ih. ilm tiirt ritt or t t im Mtofle ihytlB.fe i tekLtvlm tk* L mttoi kltrt r t . ve tto fKtloi of tlmt Mil MoU. It r A firltar <klinm mi wrfamad In aivnr to ahsofm tkn patlbU conollntlats. b tlw *i of tko proc inr ,tM!tlfli mn ronirol fur kUulotlat it 4U alwrnortil Ibatlo> t cl lw ,RoMlti ocklirljf tW nni>eliu .t**n von tl onlMln <70.iJ>S>ta*t ttnlnri to. tuioul lUa rivtlt, I nUll> <n.llX)i*liJi inolnM th, u*lc ltltl rivttaL 1W io n Ut r, U cum ntiinri flaw TBylteiitormM tanrn M ] nbkUs tWt Ilia' t AtoU tk< tofont*! loort fnto. Afttr too MUHeatlod of ilmu noit fuctlan, w nanlMl too comctti tins oofo ncanry tlM (QHtT) tad tlOMtrlol coodactloa tte (SaCT), tkorn oro aft raaarfcabln 41ffnmeac?>I.IK)iilnf btnrt rtu iecrotind llanlf leant li (M.Wtl). AfUr ta> ixtltllri nolitln. It nlbltt Hill nulaed tki ilaat riortlfttlnolaaal atrlll itjtkH Inactlimnl itytla. No pirfontlu of Ike trial Mil mi foaal la alt eam.aeiu .i.lolonletl flallan ikowl cotmtotlon a cml< of t>> nlcai41>kixtaallail to tki aaiclo film nai iffiellng i tlini colt cilli.Coatlttaloa m* ataay taaoastrau tan fnanlklllty of aodlflHtlm of slam nMaanknr fnactlai far tlana fata eaatrel iy anlccrdlal radlofrnaanacy nklatlon.lt also lay n oaarlaaaul faaalatlaa of aoilfleilloi of lUn ncaanbr fanellon by atoearalal nblntlaLlt tboaU ht caulaaral at na altaraatln thorvy for pntluts III Hi tiM lanaaranrlntn ilan tncaycarjlnc 1ST) nfnetary to adlcnl aaa nnat. by fcrd lint aoan aotlflcatlna ndlofrnaoacy abUtlol

    1998年04期 164页 [查看摘要][在线阅读][下载 63K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:8 ]
  • 房室传导曲线连续的房室结折返性心动过速的射频消融

    陈志坚;于世龙;曾秋裳;张家明;李景东;■■;

    我院从开展身频消融(PFCA)治疗阵发性室上性心动过速(PSVT)以来,共收治房室传导曲线连续的房室结折返性心动过速(AVNRT)12例,报告如下:方法:自1992年4月至1998年8月共收治 PSVT 648例,其中 AVNRT 240例,男93例,女147例,年龄12~63岁.先行食管心房调搏初步诊断,然后进一步行心内电生理检查确诊后采用常规方法行 RFCA.结果:心内电生理检查时240例 AVNRT 患者均可诱发心动过速.其中228例可见 A-H 间期跳跃式延长50~240ms(房室传导曲线不连续);12例反复心房程序扫描均来见 A-H 间期跳跃延长(房室传导曲线连续),RFCA 有效放电靶点均位于 Kock 三角中下部,所有患者术后即刻成功,无1例发生Ⅲ°房室传导阻滞,随访3~36月,均未复发.讨论:临床上大多数 AVNRT 患者心内电生理检查时存在房室传导曲线不连续,但仍有少数房室传导曲线连续,可能与房室结慢径与快径的有效不应期接近等因素有关.这类患者 RFCA有效安全靶点与经典 AVNRT 类似,提示这类患者的快慢径分布特征无特异性,因此 RFCA 方法学无改变.结论:房室传导曲线连续的 AVNRT 可以采用常规方法进行房室结改良.

    1998年04期 164页 [查看摘要][在线阅读][下载 63K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:14 ]
  • 房性心动过速的射频消融治疗

    党书毅;涂远超;张群林;王崇全;许大国;葛永贵;邢海燕;张绪国;

    目的:总结4例房性心动过速(房速)患者射频消融的标测和消融方法,探讨房速的电生理特点.男女各2例,年龄24-56岁,平时心电图正常,心动过速发作时心室率150-220 bpm,R-P’>P’-R.方法:采用双大头消融导管标测心房,在推测房速的部位交替,移动标测,最早 A 波出现行放电消融.结果:4例均为右房房内折返性房速的房速,消融的靶点:2例在冠状窦中上方,1例在右房外侧壁,1例在右房中侧壁,靶点处 A 波较体表 P’波提前达25-40ms,4例房速消融全部成功,随访1-12M(平均6±3M)无复发.结论:射频消融是治疗房速安全而有效的方法,最早激动点的标测是其最基本的方法.

    1998年04期 164页 [查看摘要][在线阅读][下载 63K]
    [阅读次数:23 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:12 ]
  • Radiofrequency Catheter Ablation Of Inappropriate Sinus Tachycardia

    <正> Objective:To investigate the mechanism of inappropriate sinustachycardia and the safety,effectiveness on radiofrequency catheterablation of it.Methods:Radiofrequency catheter ablation wasperformed on a 52-year-old female patient and changes in Holter,heart rate variability,intrinsic heart rate and syndromes were comparedbetween before and after radiofrequeney catheter ablation.Results:The inappropriate sinus tachycardia could not be induced and terminatedby atrial program electric stimulation and burst stimulation,whichsuggests that the mechanism of inappropriate sinus tachycardia isreentry.After radiofrequency catheter ablation,the total heart beatsdecreased from 173490 to 129172 times,the lowest heart rate did from79 to 71 bpm,the highest heart rate from 200 to 122 bpm,the averageheart rate from 117 to 90 bpm,and intrinsic heart rate from 166 to 93Variables of heart rate variability varied too.PNN50 increased from O to11,RMSSD did from 8 to 35.However,LF/HF ratio decreased from12.23 to 0.86.Transesophageal eleetrophysiologic studies demonstratethat sinoatrial node function is normal after radioflequency catheterablation.The patient has been followed up for six months,she has beenbeing free of palpitation,chest distress and dizziness,etc.Conclusion:The inappropriate sinus tachycardia could be due to abnormal sinoatrialnodal automaticity resulting from excessive sympathetic nerve influencesor deficient vagal nerve influences and modification of sinus node withradiofrequency catheter ablation is a safe,effective method for thetreatment of inappropriate sinus tacbycardia.

    1998年04期 164页 [查看摘要][在线阅读][下载 63K]
    [阅读次数:12 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:15 ]
  • DEFIBRILATION-GUIDED RADIOFREQUENCY ABLATION OF ATRIAL FIBRILLATION SECONDART TO AN ATRIAL FOCUS

    Lau CP;Tse HF;Ayers G;

    <正> ObJective:We aim to identify a focal source of atrial fibrillnion(AF) by unmasking spontaneouscarly re-initiation AF after transvenous atrial defibrillation(TADF) and descride a method of usingrepeated TADF to map the earlicst focus of spontaneous AF re-initlation,followed by focalradiofrequency(RF)ablation,Baekgromod:AF may develop secondary to a rapidly dischargingatrial focus such the remainder of the atrium cannot follow synchonously,although the incidenceof this occuming in patients with AF is uncertain.Mapping and RF ablation of this focus may becurative but is limited if the patient is in AF.Consistent spontaneous early ne-initiation of AF byatrial ectopic beats have been observed following defibrillation,which we hypothesized mighthave a focal mechanism.Methods:We performed electmphysiology study and TADF onconsecuutive patients with ECG documented,drug refractory AF without structural heart disease.TADF was perforrmed using a 3/3ms biphasic wave form delivered using catheter based electrodesin the right atrium and the coronary sinus.We observed reproducible early re-initiation of AF(within 2 minutes)by art atrial focus thai showed a consistent atrial activation pattern and couplingcycle length to preceding sinus beat after repeated defibrillation which also facilitated mapping ofthe earliest site of the focus.Temperature guided RF ablation was then perfonned at this siteaiming at suppression of early AF re-initiation,Clinical and ambulatory ECG recording were madeto assess recumence,Resultn:44 lone AF patrients(40 men and 4 women)with a mean age of58±13 years underwent TADF.There were 32 persistent and 12 paroxysmal AF.Nine patients(20%;paroxysmal AF:5 persistent AF:4)had early re-initiation of AF immediately afterdefibrilation Their mead age was significantly younger than that without a putative focal re-initimtion(40±10 versus 62±9 years,p<0.001).The earliest atrial activation was mapped at the rightsuperior(n=4)and left superior(n=3)pulmonary vein orifices in the seven patients who underwentRF ablation with an average activation time of 86±38 ms ahead of the high right atrial electrogram.A left atrial focus was suggested by advabcement of all coronary sinus alrial recordings at firstthchycardia beat,compared to the right atrial activation sequence.The foci showed fragmentedatrial electrograms,a ptogressively shcrtened cycle length in the first eycles and conducthionblock to the rest of the atrium until AF was re-initiated.RF catheter ablation of the focus resultedin suppression of spontaneous AF re-initriation despite pace-inducibility Of AF,an improvclinical outcome was observed over s follow-up of 8±4 months.Concluslon:A novel method ofdefibrillation-guided mapping can help to unmask,map and eblate a potential atrial focus leadingto AF.beth for patients with paroxysmal and persistent AF.A rapidly discharging atrial focus isthe cause of AF recurrence after restoration of sinus rhythm in 20% of patients with lone AF whoare in general younger,and these patients may benefit from the identification of a potential curablecause of AF.

    1998年04期 165页 [查看摘要][在线阅读][下载 66K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:9 ]
  • 双心房—高位右室间隔三腔生理性永久心脏起搏

    傅向华;吴伟力;李世强;马宁;李亮;王仓海;杨新毅;张斌;汪绍全;

    目的:为探讨双心房-高位右室间隔起搏的临床应用和血流动力学效应.方法:为1例缺血性心脏病合并难治性心力衰竭患者进行三腔永久性起搏治疗:冠状窦电极固定于心大静脉中段起搏左房;"J"型心房电极固定于右心耳起搏右房;主动螺旋电极固定于高位右室间隔超搏心室.应用 Swan-Ganz 导管和计算机-核素心室造影(ERNA)测定不同起搏方式下心室/心房相位变化和血流动力学参数.结果:计算机-核素心室造影(ERNA)相位分析显示,双心房起搏的最早激动点(EAS)分别同时出现在右心耳和左房下部,高位右室间隔起搏的 EAS 与正常窦性心律时相似并保持正常的心室激动顺序(VAS)和心室收缩同步性(VSS),三腔起搏 LVER,RVEF,CO 均优于传统的双腔.结论:双心房-高位右室间脯三腔生理性永久心脏起搏可保持双心房同步收缩并维持正常的 VAS 和 VSS,有着更好的血流动力学效果.

    1998年04期 165页 [查看摘要][在线阅读][下载 66K]
    [阅读次数:15 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:26 ]
  • POSSIBILITIES TO MODIFY AV CONDUCTION IN ATRIAL FIBRILLATION PATIENTS

    I.V.Antonchenko;S.V.Popov;G.M.Savenkova;V.V.Aleev;

    <正> Most of atrial fibrillation(AF)pts have organic artrial injury which ismaintained at modified AV conduction as an AV substrate.Nevertheless this procedure allows to control ventricular contractionsrate(VCR)in AF pts.Supposing that "slow" pathways potentials arepotentials of atrial fibers eonneated with the AV node we used highfrequency current in the meadseptal right atrial area in 24 pts aged 52-74(mean 66±4.9 yrs)having paroxysmal(n=16)and chronic(n=8)AF.AF was induced in pts who had sinus rhythm before ablation andif VSR exceeded 50-70 beats/min the procedure was repeated.Favourable results were obtained in 18(75% of pts).These pts didnot reveal decreased Wenekebach point or increased effectiverefractory period of the AV junction.VSR decreased from 163±27 to65±9(p=0.001)during AF.Then atropine was given and if VSRexceeded 120/min we considered the procedure to be ineffective.Digoxine and beta-blockers which were ineffective before ablationbecame effective to control VSR after it.From 6 to 12 months afterthe procedure,these pts underwent exercise testing(AF was inducedin the sinus rhythm pts):maximum VCR was 116±10.8/min.Becauseof the procedure inefficacy,complete AV block was reached duringablation in 2(8%)pts in whom artificial pacemaker was implanted.Thus modification of AV conduction is an effective procedure tocontrol VSR in AF pts and allows to flee 75% of pts fromantiarrhythmic drugs.

    1998年04期 165页 [查看摘要][在线阅读][下载 66K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • INITIAL EXOERIENCE OF PACING LEAD EXTRACTION USING MECHANICAL AND LASER-ASSISTED DEVICE

    Lau CP;Leung SK;Chiang CS;Chung HK;NG W;Tse HF;

    <正> Objective:To describe our experience on lead extraction in Hong Kong.Background:Pacing lead extraction is required when there is infection,lead fracture with protrudingfiagments and absence of venous access during lead replacement.Methods:We performedthe first lead extraction in Hong Kong using the Cook sheath on March 1995.Since 1996,Spectranetics laser sheath using Excimer Laser System(Model CVX-300)was used.Theprocedure was performed under general anesthesis(Cook sheath)or conscious sedation(Laserextraction).Results:Twenty patients with a total of 26 leads were extracted.The indicationsfor lead extraction were:I.Fracture retention wire of Aceufix lead(15 patients)2,Infectedpacing leads(4 patients).3.Venous access problem(1 patient).9 leads were extracted withthe Cook sheath,the remaining 17 leads by larer-assisted device.There were 20 atrial leadsand 6 ventricular leads from Telectrontics,Medtronic.Cordis and Intermedics,with thelongest irnplanted lead of 15 years.Snccessful extraction eas achieved in 24/26(93%)of leadsIn one patient,fracture of outer insulation of Accutix at the superior vena cava occurred afierusccessful removal of the lead from the atrium,and this requited venotomy for extraction.Failure of advancement of locking styler occurred in another patient with an uninfectedvetricular lead which was not extractde,There was no mortality nor any other majorcomplictaion,Re-implantation was performed at the same setting except for the 4 infectedcases Conelmslom:Lead extraction can be perfomned effectively and smfely with,either theCook or Lmser extraction method,the latter can be chieved without general anesthesia.Aslead extraction may be incteasingly used in the young patients to reduce the qumber ofhardwares inside the beart and for the purpose of schieving venous access,lends that areabandoned at the time of pacernaker change should be capped rather than cut to facilitate leadextraction in the futureA.

    1998年04期 165页 [查看摘要][在线阅读][下载 66K]
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  • Radiofrequency Cathter Ablation for the treatment of 53 patients with paroxysmal supraventricular tachycardia

    <正> Radlofrequency Cathter Ablation was performed On 53 patientswith paroxysmal supraventrlcuinr tnchycnrdlm and gained fsfactory results.53 patients:male 32,female 20,aged about 44.4±13.18(21~70)yearn.All thepatients bad suprnventrlcuJar tachyeardla oceurrlng blatorles of more than 1year.Electrophyaiologte tests rhowed:18 with left-alded tecessory pathwayand 12 with concealed pathway,about 30 passways oll together in the left;4casea with right accessory pathway and I with eoncealed pathway,5 passwaysin the right;18 patients with atrioventrlenlar nodal dual pathway.EVA or EAAon A-V ring was the target picture In sceessory passwry sbletion.Middle orInferlor position was taken A-V nodal dual pathway ablation,with imall Alarge V as inrget pteture Includlng breaking up of wave A.The appenranceof slow A-V boarded rhythm daring electric ejection was marked as effectiveablation.Suprtventrlcular tachycardin cin't be Initiated by various stimulateswas regarded as our final afm.All these patients got suceessful ablation.2cases recurred during foUow-up of 30±12 monthe,but cured after aecondablatlon.One of the recurrers bad right-position heart with atrfoventricularaccessory passway.The trigger site was detacted 3.5cm distance fromcoronary and ablated Juceessfully.

    1998年04期 166页 [查看摘要][在线阅读][下载 49K]
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  • The pacing treatment of atrial fibrillation

    <正> The incidence of atrial fibrillation(Af)is on the first position in arThythmia and thetreatment is very difficuit The method of non-drug to prevent Af has been extensively paidattention to of late years.It is a relatively new idea to treat Af by means of pacing.In thispaper,we made a research to the Af's pacing treatment in 3 different conditions.The resultshowed that this method of pacing treatment Afis feaslble.In a long follow-up survey,we divided the patients into 3 groups:(1) group VVI:76 casesin all,in which 40 cases of male and 36 cases of female.All the pacemakers are unicameralVVI.(2) group AAI:46 cases in all,in which 30 cases of male and 16 cases of female.Allthe pacemakers are unicameral AAI.(3) group DDD:25 cases in all.in which 15 cases ofnude and 10 cases of female.All the pacemakers are double cameral DDD.We made afollow-up survey every 3 or 6 months after the pacemaker implantation and examined theclectrocardiogram(ECG).tested and carried out program control to the pacemaker.Theresults showed that the recunence rate of Af in VVI group is 41%,in AAI group is 4%,inDDD group is 5% This result is similar to the reports concemed overseas.It means that thepacing position had remarkable influence to the Af.In addition,the pacing treatment of Af also has some relationship pacing frequency.Itwas found in the follow-up study that the higher the frequency is,the lower the Af'srecurrence rate be comes,The reason may be that the atrium's vulncrable period is shortedwith the pacing frequency increasing and finally prevent Afs taking place.The primary factors that influence Af are as follows:(1)the size of atrium,(2) theexistence of structural conduction and the existence of dispersive refractory period.(3)thepulse's wave length.In a word,we think that different pacing position can influence Af's happening,and thepacing with high frequency also has a definite effect to prevent At's recurrence.

    1998年04期 166页 [查看摘要][在线阅读][下载 49K]
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  • CLINICAL SIGNIFICANCE OF TRANSESOPHAGUS Pv1-Pe ON DIAGNOSIS OF VARLDUS TYPES OF SUPRAVENTRICULAR TACHYCARDIA

    <正> Radiofrequency catheter ablation(RFCA)were performed in 142 patients with paroxysmal supraventricular reentranltechycardia(PSVT),including 67 patients of left side accessory pathway,20 patients of right side accessory pathway,48 patients with slow-fast type atrioventricular nodal reentrent tachyardia(AVNRT),and 7 patients with strialreetrant tachycardia(ART),The average of age was 40.9±13.8 years old(14-72ys).Transesophagus and intracardiacelectrophysiologic studies were carried out in all patients,and the Pv1-Pe,R-Pe were compared in these two methods.In order to assess the clinical significant of Pvl-Pe.R-Pe in diagnosis of various types of supratachycardia anddifferent accessory pathway.ResultsConclusionsThis article analysed the relations of the Pvl-Pe,R-Pe and the Δ A,V-A in all 142 patients with SVT.It is suggestthat AVRT with anterograde,Pvl-Pe was more than 25 ms,R-Pe more than 75ms,with the exception of RSAP Pvl-Pewas 0,R-Pe more than 75ms.In petients with ART,Pvl-Pe more than 25ms,R-Pe more than 150ms and R-Pe morethan Pe-R.AVNRT group Pvl-Pe less than 25ms,R-Pe less than 70ms.These are very sensitive and specific in makingthe diagnosis of SVT,It is also useful that conceled assessory pathway site can be decided,according to the trend ofchange of Pvl-Pe and R-Pe.We concluded that tranesophagus Pvl-Pe and R-Pe hold great value on diagnsis ofvarious types of supraventricular tachycardia

    1998年04期 166页 [查看摘要][在线阅读][下载 49K]
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  • RADIOFREQUENCY CATHETER ABLATION IN 66 CASES WITH REENTRANT PAROXYSMAL SUPERVENTRICULAR TACHYCARDIA

    <正> Sixty-six cases with reentrant supraventricular tachycardias were treatedby radiofrequency current cather ablation(RFCA).Forty one patients withatrioventricular reentrant tachycardia(male 30,femal 11,Group Ⅰ),Twenty fivepatients with atrloventricular nodal reentrant tachycaria(male 8,femal 17,Group Ⅱ).Group 1.41 patients had 43 accessory pathways(APs)of which23 located at left free wall(53.5),6 at left posteroseptal region(13.9%),14 atright free wall(32.6%).Successful RFCA were 26 in 27 cases with leftAPs(96.3%),14 in 14 cases with right APs(100%).In group 11.13 patientswith slow pathway were ablated,success rate is 92.3.The characteristics of local electrocardlogram at the ablation target sitewere:(1)A/V ratlo<1.(2)AV or VA Interval<40ms.(3)V-delta Interval>20ms.the 95%ablation target sites were slmler to this characteristics in oursuccessful RFCA.During a follow up of 1-7months,no Patients hadexparienced recurrence of arrhythmia.

    1998年04期 166页 [查看摘要][在线阅读][下载 49K]
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  • RADIOFREQUENCY CURRENT ABLATION TREATMENT IN 56 PATIENTS WITH INTRACTABLE SUPRAVENTRICULAR TACHYCARDIA

    <正> Fifty six patients with intractable supraventricular tachycardiainduced by 57 accessory pathways were treated by radiofrequencycurrent catheter ablatio(RFCA)from October,1993 to January,1998.34 sales and 22 females,aged from 16-63 years.They had no organiccardia disease and treated with antiarrhythemia agents in all casesbut failed before RFCA therapy,the electrophysiological examinaionwas done for dsterming the location of acceesory pathway andevaluating the results before and after the treatment,34 dominantpathways and 23 latent pathways,and 42 on the left side and 15 onthe right side were found in examination.We used 12±11 time ofmean pulses,29±2.6 watts of radiofrequency energy,8105±6059J ofcumulative electro-energy and 1.1±0.5 hours in each patient,allpatient had no arrhythemia even antiarrhythemia agents was withdrewafter the therapy and during 2-62 months follow-up.They had no arerecurrence.Tne results suggested as follows:1.The accurate location of the accessory pathway was a importantfactor in the successful ablation therapy and the standardlocation of ablation target was the shortest A-V or V-A interval;the accessory pathway potential wasn't a marker in the location inour study.2.The procedure time and consumption of ablation energy on theright side was wore and higher than that on the left(1h and 1.3h.5418J and 12864J respectlvely)which was due to the cathetercouldn't touch wih endocardia closely so result to the accessorypathway wasn't blocked properly.

    1998年04期 167页 [查看摘要][在线阅读][下载 52K]
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  • RFCA IN TREATMENT OF PRE-EXITATION WITH AF

    <正> When the pre-exitation is complicated with strial fibrilation,there is a potential ofventrial fibrilation because of the high ventricular rate.this can severely changethe dyamics of blood and induce sudden death.So it is important to be treatedtimely and correctly.In our study,among 252 patients with PSVT treated byRFCA in our hospital in recent years,there were 8 cases had atrial fibrilation,6 ofwhich had left excessory pathway(including 2 having conceal excessorypathway),the other 2 cases had right excassory pathway.4 cases with dominontexcessory pathway,of the eight patients were given no antiarrhythmic drugsbefore the operation and atrial fibrilation occured in 2 patients during theelectrode location surveying.The other two patients with dominant excessorypathway were given amiodarone before the operation,and no atrial fibrilationoccured during the dilation.No management was given to the 2 patients withconceal excessory pathway before the operations and atrial fibrilation occuredduring the operstion and the arrhythmia disappeared after using diazeparn andcadilanid.It is said that most of the excessory pathway are in left side in patientsof pre-exitation complicated with atrial fibrilation.It maybe due to the highpressure of atrium when ventricular pacing or hypoxia caused by reentranttechycardia or the unstability of electrophysilogy when in high heart rate.Toavoid complications,some procedures should be performed in the patients of pre-exitation with atrial fibrilation treated by RFCA.The procedure are as following:1)If the Patients had a definite history of AF,amiodarone should be used beingtaken for 7 days or 2-3 weeks to prevent the occurance of AF during theoperation.This can reduce the incidence rate of effectively,so as to increase thesuccess rate and reduce the malignant arrhythmias.Propafenone is effective forthe AF occured during the operation.The application of digltalis should beavoided.If the AF still occure after the application of drugs during the operations,defibrilation is to be used if necessary.2)reduced the excessive stimulation to themyocardium during the operation and shorten the stimulating time when the heartis pacing.

    1998年04期 167页 [查看摘要][在线阅读][下载 52K]
    [阅读次数:12 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • CLINICAL STUDY OF THE ELECTROPHYSIOLOGICAL CHARACTERISTICS AND RADIOFREQUENCY ABLTION OF SUPRAVENTRICULAR TACHYCARDIA

    <正> Radiofrequancy ablation is a popular and effective approach to cure arrhythmia.The present study is an analysis of the electrophysiological mechanism,charateristics and the best treatment of supraventricular tachycardia.Therecords of arrhythmia radiofrequancy ablation regestry were reviewed betweenDecember,1996 and July,1997.33 patients with supraventricular tachycardiawere examine by programmed electrial stimulation(PES,esophagus andintracardia PES),cured by radiofrequency ablation and its electrophysiologicalmechanism and characteristics was analyzed.Of all the patients,the rate ofAVNRT is 24.3%,that of AVRT is 75.7%,in which 68% were left pathways,32% right pathways.All the 33 patients were radiofrequency ablated,31patients were cured,the other two recurred within one month,and ablated again,no recurrence again,So we concluded that most supraventricular tachycardiawere caused by reentrant,catheter ablation is a safe and cured treatmant forsupraventricular tachycardia caused by reentrant.

    1998年04期 167页 [查看摘要][在线阅读][下载 52K]
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  • New Techniques For Treatment of Atrial Fibrillation

    Mark A.Wood;

    <正> Atrial Fibrillation is the most common arrhythmia requiring treatment inthe United States.Several new techniques are being developed for thepalliative and curative treatment of atrial fibrillation.Many recent studies have shown that radiofrequency AV junctionalablation and permanent pacing can dramatically alleviate symptoms inpatients with medically refractory atrial fibrillation.This technique issuperior to pharmacologic rate control and AV nodal modification insmall,controlled studies.Two different implantable atrial defibrillators are in clinical trials at thepresent time.These devices automatically detect and terminate atrialfibrillation by intra-atrial shock therapy.The two devices in trials arequite different in many technical respects.The discomfort of patientshocka remains a concern.Preliminary data suggests that preventingsustained atrial fibrillation recurrences may lead to less electricalremodeling and fewer recurrences.Radiofrequency ablation for the cure of atrial fibrillation has evolveslowly.The success rates for simplified procedures have been low.Moreaggressive,left-sided ablation may carry a higher riak of complications.Currently the technology of the ablation systems and the location ofcurative lesions is under investigation at several centers. Atrial flutter induced by cardiac electrophysiologic study ofSVT using transesophageal atrial pacing.A report of 4 cases,Nie yunzhang,Xinhua Hospital,shanghai Second medicalUniversity,Shanghai Institute for pediatric Research,Shanghai,China.105 cardiac electrophysilogical studies with transesophagealatrial pacing were performed in 66 patients with SVT.Atrialflutter(AF)was induced in 4 cases with incidence of 3..81%.Four cases,male 1,femal 3,age 4-12 years,all had historyof SVT,no cardiac structure abnormality.ECG showedWPW type B in 2 cases,WPW type A in 1 case,normalsinus rhythm in 1 case who had concealed WPW confirmedby electrophysiological study.Electrophysiological studydemonstrated that SVT was easily induced with rate of 214-250/min,CW conduction type of AVRT in 2 cases,slow-fasttype of AVNRT in 2 cases.AF occurred before takingpropaferone in 2cases.after taking propaferone in 2 cases.AF was induced in 1 case while the SNRT was performing,in 3 case while SVT was terminated using S_1S_1 overdriveatrial pacing.The S_1S_1 excitative rate was 200-300 ms(300-200/min).The rate of AF was 180-200ms(330-300/min)with 2:1 AVB in majority.Two eases recovered using S_1S_1overdrive excitation with the rate of 200-240ms(300-250/min),2 cases recovered spontaneusly.

    1998年04期 167-168页 [查看摘要][在线阅读][下载 115K]
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  • AV JUNCTION ELECTROPHYSIOLOGIC DATA IN PATIENTS HAVING PAROXYSMS OF ATRIAL FIBRILLATION

    S.V.Popov;I.V.Antonchenko;V.V.Aleev;

    <正> The aim of the study was to investigate peculiarities of AV junctionconduction in paroxysmal atrial fibrillation(AF)pts.We retrospectively assessed electrophysiologic investigations data in53 pts having paroxysmal AF.Assessment of the AV junctionconduction was performed during rapid and programmed stimulationin the setting of sinus thythm.Sixteen(30.1%)pts were revealed tohave signs of longitudinal dissociation of AV conduction which wascharacteristic of suddenly increased A_2-H_2 interval by more than 50msThe remaining pts did not reveal dual AV conduction pathways.Tenpts revealed polyfascicular antegrade AV conduction and distallydisturbed conduction which was manifested by the lengthened H_2-V_2interval to 70-150 ms during programmed stimulation performed fromthe sinoatrial zone.These pts had ventricular contractions rate of118±16.4/min in the setting AF both spontaneously induced andinduced by the stimulation which were reliably(p<0.05)lesscompared to other pts(168.6±29.4/min).Thirty three(62.2%)pts whohad no multiple AV conducting pathways revealed distally slowed(to40-60 ms)conductionas well.Thus 92.5% of pts having AF paroxysms revealed concealed AVconduction disturbance and 30.2% revealed polyfascicular one.Wedid not reveal marked tachysystole in pts having multiple AVconduction pathways and distally disturbed conduction which must betaken into account while performing modification of the AVconduction in these pts.

    1998年04期 168页 [查看摘要][在线阅读][下载 62K]
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  • 孤立性房颤的临床特点

    彭雪梅;张学功;

    房颤是临床上常见的心律失常,可以阵发或持续性出现,在人群中发生率为0.4%,而在老年人中发生率可达10%,部分老年患者中,既往常因缺乏缺定的检查手段而诊断为心律失常型冠心病,我院对96年一年来甲状腺及左室结构功能正常的房颤患者进行冠状动脉造影,发现无有意义狭窄病变的10例,诊断为老年性孤立性房颤.我们的观察表明:这类患者的年龄较大,无回顾性心脏病,因临床症状少而轻,故就医时间往往在一年以上,不宜行转复治疗,但同时伴有严重的血液动力学影响的急诊情况应及时行直流电复律.大部分患者多伴有快速心室率,因而控制满意的心室率可以明显减轻患者的症状。主要可以选用作用于房室结的,增加其隐匿性传导的药物,包括洋地黄类制剂、β-阻滞剂及钙通道拮抗剂,如平时有缓慢室性心率的阵发房颤患者,在发作时如无临时心内起搏保持,则不宜用β-阻滞剂及钙拮抗剂,可试用极小量洋地黄类.孤立性房颤的血栓栓塞的并发症的危险度较低,可每日使用 APC 150毫克,而无须抗凝治疗.综上所述,随着心脏介入技术的开展,积极行冠状动脉造影有助于明确患者诊断,判断预后,筛选药物.

    1998年04期 168页 [查看摘要][在线阅读][下载 62K]
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  • MONOPHASIC ACTION POTENTIAL CHANGES OF RIGHT VENTRICULAR MYOCARDIUM INDUCED BY RADIOFREQUENCY CURRENT IN DOGS

    <正> To investigate the monophasic action potential changes of myocardiuminduced by radiofrequency catheter ablation in dogs,the right ventricularepicardium were ablated with radiofrequency(RF)energy(20 w,30 sac)via a 7 Fr.large tip catheter in 8 dogs.Franz catheter was used to record at8 different sites and at 3 different time before and after ablation.Myocsrdial APA,APD90 and Vmax at the ablation site,marginal siteand reference site(20 mm from the ablation site)were measured beforeand after(immediately,30 min)ablation.The interval from stimulationspike(S)(stimulated at right ventricular apex)to the [0] phase of localMAP were also maasured.Results:1.Two to 10 mm from the ablationsite,APA decreased to different degree.There was no change in the APDafter RFCA.2.Vmax of ablation site and marginal zone decreased afterablation(P<0.01);30 min later,Vmax show no change compared with theresult immdietely after ablation(P>0.05).3.S-[0] phase interval increasedfrom ablation site to marginal site after ablation(ablation site 22.50±6.55ms vs 35.63±7.76 ms,P<0.001;marginal site 23.75±7.91 ms vs31.88+9.61 ms,P<0.01).Conclusion:RF energy can destroy or injuremyocardial tissue,and modificate cellular electrophysiology ofperinecrosis myocardium.These findings provide electrophyiologic basisfor sevasal clinincal observations following RFCA. Background:Most AV node reentrant tachycardia are easily induced duringelectrophysiologic studies.However,some could not be induced despite long timestimulation.How to deal with such patients properly is practically important.In thissituation,the radiofrequency ablation may provide a good results,but the experience islimited.The clinical effect need further investigation.Objective:To assess the clinicalefficacy of slow pathway ablation in patients with clinical documented but noninducibleAV node reentrant tachycardia.Methods:The criteria of presumed diagnosis of common-type AV node reentrant tachycardia included tachycardia with pseudo-r' in lead VI,retrograde p wave on the end of QRS,or without retrograde p wave in all leads duringtachycardia,and/or presence of discontinous curve during the baseline electrophysiologicstudy.The stimuli technique included single,double extrastimuli at 2 basic derive cyclelengths and decremental pacing from atrium,ventricle and coronary sinus.If thetachycardia could not be induced,isoproterenol(1 to 8 ug/min)was used,If thetachycardia could not be initiated with isoproterenol,atropine(1 mg)was given 20 minutesafter termination of isoproterenol infusion.The sites of slow pathway ablation wereseptum or around ostium of coronary sinus with a small fragment A wave and large Vwave.The slow junctional rythms which decreased progressly or dispeared were goodindicator for successful ablation.The endpoints of ablation were elimination of slowpathway and /or significant alternation of Wanckebach point and ERP of AVconduction.The patiants were followed up after procedures.Results:Six patients(4female,2 male)were identified as noninducible AV node reentrant tachycardia.Theaverage age were 53±10 years and the history of tachycardia were 14.8±8.8 years.The heart rates of tachycardia were 180±10 beats/min.Four cases had ECGs oftachycardia,three had retrogrede P wave on the end of QRS wave and pesudo-r' in VIlead.The remaining one had no retrograde p wave in all leads,The VA retrogradeWenckebach block were seen on 6 cases.Four had jamp of AV conduction(average 86±62 ms).After ablation,the jamp dispeared in three of them,one still had jamp withetrial echo.The ERP and Wenckebach points of AV or VA conduction were changed.During ablation,the junctional rythms were seen in 6 cases,decreased progressly in onecase and dispeared at last in five cases.None of six patients had recurrence of tachycardiaduring follow-up of 18±8.4 months.Conclusion:In patients with documented butnoninducible AV node reentrant tachycardia,the modification of slow pathway canachieve a satisfactory clinical effect.

    1998年04期 168-169页 [查看摘要][在线阅读][下载 134K]
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  • THE OPERATION AND FEELINGS OF APPLICATION OF TEMPORARY CARDIAC PACING BESIDE BED WITHOUT FLUOROSCOPY

    <正> The endocardial electrodes were placed in endoventriculus beside bed withoutfluoroscopy in 9 patients who required temporary cardiac pacing and theresults were satisfactory.The manipulatory points are below:operatingcarefully with lightly and softly handling,noticing hand's feeling,tryingagain by roling the electrode and/or changing its top's direction whenmeeting with venous valves or branches.Judging the position of electrode'stop according to the right ventricular luminal electrogram.As comparedwith the setting of electrode under X ray,our method is superior in savingtime and requires less instrumente,the patients needn't be moved,bothphysicans and patients are avoided X radiation's injury.

    1998年04期 169页 [查看摘要][在线阅读][下载 71K]
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  • STUDY OF RELATIONSHIP BETWEEN SUPERNORMAL ATRIAL CONDUCTION AND ATRIAL TACHYARRHYTHMIA

    <正> The purpose of this study was to investigate the relationshin between supernormalatrial conduction(SNC)and atrial tachyarrhythmia.To obereve the SNC,supernomal atrial conduction zone(SNCN)and maximum decrease in conduction36,female 39)with tachyanhythmis or polpitation.Their ages ranged from 21 to65 years(41.27±13.29).All patients had no organic heart disease.Result:Atrial tachyarrhythmia(atrial tachycardia,atrial flutter and atrialfibrillation)was induced in 10 patients with history of atrial techarrhythmia(group Ⅰ).18 of 65 patients without history of atrial tachyarrhythmia had theinduced atrial tachyarrhythmia(group Ⅱ),remaining 47 patients had no theinduced atrial tachyarrhythmia(group Ⅲ).Compered with the group Ⅲ,theoccurence rate of SNC incresed significarthy in the group Ⅰ and group Ⅱ(respectively 34.04% vs 70.00% and 72.22%,p<0.01),but the SNCZ andMDCT had no significant difference(p>0.05).Among 36 patients with SNC,20patienta(55.56%)had the induced atrial tachyarrhythmia.But among 39patients without SNC,8 patients(20.51%)had the induced atrialtachyarrhythmia.There was obvious difference in the two groups(p<0.005).Conclusion:There is well conrelation between the SNC and the atrialtachyarrhythmia.

    1998年04期 169页 [查看摘要][在线阅读][下载 71K]
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  • 生理性永久心脏起搏器临床应用分析

    司定然;王恒亮;白广海;

    永久性心脏起搏是治疗缓慢型心律失常最有效的方法.生理性起搏能保持正常的房室收缩顺序,维持正常心脏功能,减少起搏综合征,心力衰竭、脑卒中及心房纤颤的发生率,在临床应用日益广泛.我院自1994年开展人工心脏起搏以来,已为20例患者进行了生理起搏,取得了良好的临床疗效.临床资料与方法:1.病例选择:本组共20例,男性14例,女性6例;年龄20-64岁,平均53.1±11.6岁.病窦综合征:共15例,其中窦缓并阵发性房颤(即慢-快综合征)5例,血管迷走性晕厥1例,冠心病并Ⅱ°Ⅱ型房室阻滞2例,肥厚梗阻型心肌病2例,以上患者均有明显起搏指征.2.起搏方式选择:AAI 起搏4例,其中1例为血管迷走性晕厥(心脏抑制型),余3例为单纯窦性心动过缓,DDD 起搏13例:窦缓6例,慢快综合征5例,HOCM 2例.DR 起搏1例:为窦缓.VDD 起搏2例,均为冠心病致Ⅱ°Ⅱ型 AVB.3.起搏器:AAI 4例分别为 CPI 公司产 ASTRAT6539型1台;VISTAT6445型1台;Medtronic 公司产80842台.DDD 型起搏器13台,分别为 CPI 公司产 DelTA 937与941备1台:Modtronic 公司产 Prodigy D 7864型11台,Prodigy DR 各1台,VDD 型起搏器2台均为 Medtronic Prodigy VDD 8168型.全部18根心房电极均为 J 型电极.4.电极植入方法:静脉选择:首选头静脉切开法(其中9例通过头静脉顺利进入2根电极),失败后改颈外静脉切开或锁骨下静脉穿刺植入电极;采取锁骨下斜切开设置囊袋,植入起搏器.结果及随访1.结果:全部20例患者安装生理起搏器后临床症状消失,生活质量明显提高.无1例发生早期并发站,其中3例发生起搏器介导性心动过速(PMT),经及时程控改变起搏方式(DVI)后终止,后经调整心室后心房不应期,未再发生 PMT.5例慢-快综合征患者经 DDD 起搏治疗未再发生房颤.2例肥厚梗阻型心肌病患者术后晕厥及心绞痛均消失.2.随访:经随访期3-16个月,全部起搏器功能正常,无1例发生起搏器综合征、脑卒中、栓塞及心力衰竭,房颤.结论:AAI、DDD、DR、VDD 型起搏器均为生理性起搏器,对于治疗缓慢型心律失常有良好的疗效,且较少发生起搏器综合征,脑卒中,心力衰竭等并发症,且对慢-快综合征心房纤颤有良好的治疗作用,应在临床上广泛应用.

    1998年04期 169页 [查看摘要][在线阅读][下载 71K]
    [阅读次数:14 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:22 ]
  • EXTRACTION OF LEAD VIA LEAD WITH DRINKJHG TUBE

    <正> With drinking tube,we extraot peranent pacemaker lead through theleft subclavian route successfully.The following report is a case ofdoing it.A 87-year-old man was admitted to hospital.He had symptom of anginspector is and blackout again and again for six months.His heart ratevaried from forty-four to seventy per minute.ECG showed second degreeartrloventrioular block(Mobiz Ⅱ)and right-bundle branch blockads.This illness was diagnosed as sick sinus syndrome.So he was referredfor placement of a permanent pecewaker(WI)),pacemaker model:Medtrinic8801.On the ninth day,the suboutaneous generator pocket was infected.Two days later,we displaced the pacemker.No consent was obtainedfrom his relatives,we didn't extract the pacing lead.Although wetried our best.the out remained disunion.After a month,we decided toextract the lead.The operation was performed in a elcetrophyslologylaboratory,we disinfacted the part of the lead exposed to the airand clipped the end.First we made the dilstor sheath(10.5Fr)which fitthe lead packaged with drinking tube(12Fr).So it was easy to push thedrinking tube through the lead.Second,advanced it into the leftautolavian.NOW it was time to pull the dilator sheath(10.5Fr)out.Third,we inserted the stylet which provided additional stiffness andcontrolled flexibililty into the lead.Satisfactory position wasachieved when the stylet was lodged in the spex of right ventriclewhere the lead distal end lay.In other words,imparted the stylet tothe distal end.Tightening the drinking tube with left hand,we rotatedthe lead clockwise with right hand untill the distal and was partedfrog heart eusule,then extracted the lead via vein.There air little previons dootrmen tation about extraction of permanentpacemaker lead with drinking tube and this approach spend less time andless nosey then other methods.Norsover,it has little complication.While,in other methods,a special instrument is essential to extractthe lead.So it's expensive to do it.The indication of the method withdrinking tube is that the operation should be performed less than threemonths after implantation,no lead fracture was found.The drinkingtube trade mark is Wahaha.Clip the end and grind it,then disinfect itwith othylene oxide.Next step,use it as provided before.

    1998年04期 170页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:8 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • MANAGEMENT OF SOME SPECIAL PROBLEMS IN RADIOFREQUENCY ABLATION

    <正> At present,radiofrequency abtation has being the first method for treatment of WPWsyndrome and dual AVN pathway with reentrant supraventricular tachycardia.Review 110cases in our hospital,there are some special problems.Reported here:1.Patient with DDO permanent pacemaker.The function of pacemanker was interfered byradiofrequency cunrrent and changed to DOO.It recurvered Immedlally after discharge.Longtimes follow up there is no desfunction of the pacemaker.2:WPW with paroxysmal atrial fibrMation:Two weeks before ablation,oral amiodaron(200-400mg a day)can effective prevent the occurmence of atrial fibrMation.3.D not appear accessory pathway reterograde:During precedure,when accessorypathway reterograde do not appear,Intravenous lsoptin drip can prolong the refractoryperiod of AVN.It can cause reappearance of the accessory pathway reterograde.4:"Slow conduction"In accessory pathway.As discharge repeatedly at target,conduction ofaccessory pathway was slower.But SVT can still be induced.The YA(or AV)of tapget is notmiscible.Distinguish of the earlist A(or V)is the key of successful abtation.5.Accessory pathway with dual AVN pathway:Phttents with accessory pathway can withdual AVN pathway.Most of them are no clinical significance.Weather ablation or not,atsame time,is decided by the induction of AVNRT.6.Dual AVN pathway with AV block:Dual AVN pathway with AH prolonged slightly is not acontraindication of abletion.But the target should be far from the bundle of His.Lower powerand shorter time should be given and closely observe the change of AV interval.

    1998年04期 170页 [查看摘要][在线阅读][下载 57K]
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  • FIVE CASES FOLLOW-UP SURVEY IN PATIENTS WITH TACHYCARDIOMYOPATHY AFTER SUCCESSFUL RADIOFREQUENCY CATHETER ABLATION

    <正> Left ventricular disfunction may be due to long lastiog tachycardia.This syndrome presenting with cardiac hypertrophy and lowerfunction was definited as tachycardiomyopathy(TCMP).Theobservation of ejection fraction ratio after radiofrequency catheterablation(RFCA)was a good method to help to evaluate the value ofRFCA in TCMP treatment.Five cases were selected as a patient group.RFCA was administeredon them.Left ventricular ejection fraction(EF)was measured on the1st and the 8th month reapectively.As a result,EF value was foundto increase remarkably after RFCA(from 39.4±3.1% pre.RFCA to46.5±6.2%,51.0±8.4% post-RFCA respectively,p<0.01).Onecase was not conform to the priniciple.RFCA was a very successful method in TCMP therapy.It must beused as soon as TCMP was determined and he selected very beforethe presence of TCMP,otherwise the myocardiol injury due totachycardia may come to an unreversible period.

    1998年04期 170页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • RADIOFREQUENCY CATHTER ABLATION IN MANAGEMENT OF A GERONTAL PATIENT WITH PERMANENT JUNCTION RECIPROCATING TACHYCARDIA

    <正>Pettamna lintta Rfdpraittal Tuhyortk <fAt) iwdy ion of urtylin* H nut or onij thnpr k X opdml, k am ou* oudbmyopuhy. b iko <albd ubyculk aritonDopMiy In dfab.IUdlolteqD.ier Ckteto Ablujm (RFCA) i> one of uk bot my to ml USa. A mUl rub* tb PJKT M DM npoiud Ihm Tie me ii lUty-one ><ui oU nu, Etettophytlolotj Study (EPS) dmoMMri Ital a mlbonlc th u|b iBtemOtaiu Dodd lad UDtonfc duoufh <tow piUmy 1C iko toned dow pithoy Lotmlbl kft poitaiiqxd, Wbm PJRT lpp<ub| the usnoiy puhwy mi ibkttd by RFCA to fee Id) pMooiqttl bcutoi. no mi pom 20Wx I30S

    1998年04期 170页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:8 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • DELAYED Ⅲ°AVB AFTER CATHETER ABLATION OF ATRIOVENTRICULARNODAL REENTRANT TACHYCARDIA

    <正> Thirty-six patients received radiofrequency ablation of slow pathway totreat atrioventricular nodal reentrant tachycardia.One of them(1/36)hadoccured delayed 111° AVB.The patient was 65-years-old woman andsuffered from coronary heart disease.Initial selection of radiofrequencyenergy was 25-30 W During the operation fast AV junctive rhythmappeased for a time.Delayed 111° AVB ocuured at 72 hours after ablationsuccess.We consider that fast junctive rhythm can predict appearence of111° AVB in the further.Otherwise catheter ablation of slow pathwaystarted from low energy.

    1998年04期 171页 [查看摘要][在线阅读][下载 61K]
    [阅读次数:6 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • Intravenous sotalol in the suppression of inducible sustained ventricular tachycardia and its electrophysiologic effects

    Anne Powell ;Michael Davis;

    <正> Sotatol is a nonselective β sympathetic antagonist with additional class Ⅲantiarrhythmic drug activity.In this study,we reported intravenous sotalol inthe suppression of inducible sustained ventricular techycardia guided byelectrophysiologic study and its alectrophysiologic effects.Patients withdocumented sustained ventricular tachycardia or had been resuscitated fromhaemodynamically unstable VT or VF were considered eligible forelectrophysiologic study.Only 21 patients who had sustained ventriculartachycardia induced by programmed ventricular stimulation receivedintravenous sotalol 1.5mg/kg within 15-20 mins after termination oftachycardia.16 patients has coronary artery disease and 5 had dilatedcardiomyopathy.The mean induced VT cycle length was 276±54ms.Repeatprogrammed ventricular stimulation was then performed.Of 21 patients,9(43%)had their sustained ventricular arrhythmia non-inducible and 11 hadtheir VT still inducible.Among the 11 patients who were inducible VT,5was difficult for induction and mean VT cycle length was prolongedsignificantly by sotalol compared with baseline.Sotalol prolonged markedlyright ventricular effective refractory periods(RVERP),sinus cycle length,QT interval,atrial ventricular nodal and intraventricular conduction time.There were no significant differences of the electrophysiologic parametersbetween the group of patients in whom the arrhythmia were suppressed andthe group of patients in whom the arrhythmias were not suppressed.Conclusion Sotalol is an effective drug for the suppression of ventriculartachycardia as judged by programmed electrical stimulation.It prolongedsignificantly RVERP and inhibited cardiac conductive system.

    1998年04期 171页 [查看摘要][在线阅读][下载 61K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:7 ]
  • 80例阵发性房颤患者的 Holter 记录临床分析

    吴剑萍;

    阵发性房颤因其常是急性发病,病人多自觉症状明显,并常诱发心衰,而在治疗除尽快控制心室率上,临床上还尽量使其恢复正常窦性心律,且部分阵发性房颤可因正确处理而复律,由于其在病情及治疗上与慢性房颤不同的特殊性,笔者近来特别收集了从1992年至1998年4月共80例有阵发性房颤发作Holter 记录的资料进行了一些分析,其中主要是对患者的病因及其伴随的心律失常情况进行了一些分析,以期能够通过对房颤的病因、发生病理等方面做些总结及分析,对临床工作者对房颤病人的病情评估及治疗能够有所帮助.通过对本资料统计的80例阵发性房颤患者的 Holter 记录资料,对阵发性房颤发作的病因,是否有心脏扩大,发作前后心率变化等方面分别进行统计分析.1.通过本资料的统计,笔者认为:以往房颤最常见的病因风心病已为冠心病所取代,临床上对有瓣膜病变的房颤病人应注意其是否同时还有其他心脏或全身性疾病的损害.2.从本资料分析的情况看,笔者认为:心脏扩大者,不论是何病因:冠心病、高心、肺心、心肌炎、心脏病,凡引起心脏扩大者其房颤的发生率增高,且有以心脏扩大的房颤病人更易见到心脏损伤,窦房结或结间纤维化,因而临床上可同时伴有其他各种复杂心律失常同时发生.3、本统计资料可见低龄组中迷走型房颤发生率较高,而高龄组则交感型房颤发生率增高.据文献资料报导,部分阵发性房颤的发作可与自主神经失有关.借 Holter 检查识别病人房颤的发作者有无自主神经的介导对于治疗,判断预后是非上必要的,应引起临床医生的充分重视.

    1998年04期 171页 [查看摘要][在线阅读][下载 61K]
    [阅读次数:12 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:22 ]
  • 射频消融改良房室结术后残留慢径者房室结传导功能

    叶行舟;黄玉;冯毅;胡大一;杨新春;商丽华;

    150例房室结折返性心动过速(AVNRT)行 RFCA 房室结改良术获得成功后38例残留慢径.其中4例于术后六月内AVNRT 复发.所有38例中消融后的快径有效不应期及传导时间无改变,慢径传导时间变化较大.高右房 S1S2刺激出现A1-A2,A2-H2曲线连续中断时 A2-H2跳跃幅度多数(79%)较消融前有明显差别(延长或减少≥30ms).4例6月内复发者消融后较消融前 A2-H2跳跃幅度仅增加10-20ms,18例术后仍有心房回波产生,但无一例复发 AVNRT.文章认为房室结折返性心动过速 RFCA 房室结改良术残留慢径并不意味术后复发(复发机率仅5%),判断可能复发的指标是消融前后跳跃幅度的变化程度,变化愈大,愈不易复发,反之,复发就高,残留慢径者的心房回波不能预测复发机率.

    1998年04期 171页 [查看摘要][在线阅读][下载 61K]
    [阅读次数:24 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:16 ]
  • 特发性右室室性心动过速的射频消融治疗

    张家明;于世龙;曾秋棠;陈志坚;

    本文报道7例特发性右室室性心动过速的射频消融治疗.男2例,女5例;年龄14-47岁,右心房、右室心尖部及流出道分级递增和程序刺激,静滴异丙肾上腺素后重复电生理检查,诱发持续性单形室速2例,短阵室速2例(其中1例呈多形室早单形室速),LAD45、RAO30体位 X 线投照.采用起搏标测法,以室速周长起搏,体表心电图至少11导联 QRS 形态与室速相同的起搏部位,作为射频消融靶点,流出道间隔部室速先根据室速 I、V3导联的 QRS 形态,在 X 线影象指导下进行解剖定位,再精细标测起源灶.I 导联呈 R 波,大头电极在间隔部中后方标测,呈 Q 波在前方标测;V3导联有 r 波在上方,呈 Q 波在前下方标测.试放电20W×30S,如室早消失或减少,巩固放电35W×120S,重复前述电生理检查,不能诱发室速和室早认为射频消融成功.结果:4例流出道间隔部前上方、1例游离壁室速消融成功,1例间隔中后部及流入道室速未能成功.5例病人随访2-31月无室速复发.提示右室流出道室速射频消融成功率较高(5/6,83.3%),室速起源灶多数位于流出道间隔部前上方,影像学指导下解剖定位起搏标测是寻找消融靶点的有效方法.

    1998年04期 172页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:20 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:39 ]
  • ANALYSIS OF THE POSTOPERATIVE OMPLICATIONS IN 415 CASES WITH PACIMAkER IMPLANTATION

    <正> 415 cases of permanent pacemaker implantation had be per-formed from 1980 to 1997 among them 86 cases of poatopertivecomplications occured(20.7%),which predominated by lnfetion(3.9%)and electrode diaplacement(3.9%).The maincause of electrode displacement was hypoperis.No infectionoccured among the 35 cases with the catheters and pacemakersimplanted at the identical incision after 1992.Complete AVBoccured in 2 cases while Radiaofrequency catheter ablationwere performed for postoperative atrial fibrillation accom-partied by cardiac failure,but their cardiac function recoveredafter repeating.No undesirable impact on pacemakers and ca-theters caused by Radiofrequency catheter ablation was found.The results remind that Radiofrequency catheter ablation is asafe and effective method in high-speed arrhythmia treatmentwith pacemake implantation.

    1998年04期 172页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:5 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • EXPERIENCE ON RADIOFREQUENCY CATHETER ABLATION OF SEPTAL ACCESSORY PATHWAYS 45 CASES

    <正> Results of rediofrequency ablation in 45 patients with septedaccessory pathway(AP)were analyzed in order to improvesuccess rate and decrease complications.There wre 47 septalAP in 45 casas.In which existed 16 dominant AP and 31concealed AP(imcluding 1 slow AP).Position of AP:There were16 dominant AP and 24 concealed AP in posteroseptal region.in which,29 AP located in left posteroseptal region,11 APlocated in right posteroseptal region;2 concealed leftmidseptal AP;2 dominant AP and 3 concealed AP located inanterioseptal region.Analyze electronhyslologic features and the radiofrequencyablation methodology of 45 cases of septal AP.46 AP wereablated suceessfully in the first procedures.Successory rate97.8%.Short term complete atrioventricular block occurred inone patient.In the other patient,happend perimant AVB,HR>50′bps,no make paecemark,following up 3 years.Tae patlent'sfeeling is Ok.Conclusion:The rediofrequency catheter ablation is saft andeffective method for curative therapy of septal accessorypathvay.

    1998年04期 172页 [查看摘要][在线阅读][下载 64K]
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  • RELATION BETWEEN TRANSESOPHAGEAL ATRIAL PACING AND CORONARY LESIONS

    <正>we performed Transeeophageal Atrial racing{IEAP) en 60 cases with Coronary stenosis and 20 with normal coronary. Hie diagnostic value of TCAP for coronary heart disease (QQJ) was evaluated by coronary arteriograpby( GAG) standards.Material and aetbod: Hie patients ere divided into two groups: treated group diagnosed by GAG, included 60 cases (4Baalea, 12 females, mean age 61.2 yrs) with conmry stenosis (one-vessel, two-vessel, three-vessel), control group included 20 cases (16 Bales, 4 feaales, nan age 49yrs) with nornal coronary Standard of coronary lesion extant was judged by GAG. The coronary me divided into one Bain trunk (pain left trunk) and three nun branches {LGS, U&, RCA). Hie lesions were classified into one-vessel lesion, two- vessel lesion, three-vessel lesion by Jodkift's tocb&icpw. H bipolar eecfhageal pacing electrode as pushed into esophagea] through nose, fixed at the place where we could record the biphasic r wam, Then, we selected the right pacing voltage and vent on nth programa stinulos. The amount of exercise was checked by pacing heart rate Btandards. Ihe rhytba was SOour1 then increased by lOoiif4. Brary rbytha Luted for 2tin, 12 lead HO} was recorded before the end Continuous pacingwBj deployed until uk objective heart rate (200-age un'^was reached B03 Knitoring was deployed during the whole process, fe recorded BOO after pacing at 2,4,6,8 mn, Hie positive standard of HUP oeeaed to trewkill rest (Bruce prograooe). the Bcnsitivity, specificity and positive prediction were calculated separately. Results: Tbere were 14 positive and 8 negative in 22 one-vessel cases, 21 positive and 3 negative in two-vessel cases, 14 positive in three- vessel caaea.1b0 sensitivity a 14/22x100^ 2L/24xlOOX 100X respettively. The specificity was 18/20x1001 ^"> positive prediction was 49/51 xlOOX inclusion: HV? is highly positive for coronary lesions. Hie positive result and the extent of lesions have shown a positive- correlation. HUP has high diagnostic value in <5Di HUP is safety, convenient Wf has aore advantages for old patients, the patients with tboracopathy and pulnonary disease, and the patients with moving difficulties. Wf has a clear BOG record. So, we regard HUP as a practical Method in diagnosing CBH

    1998年04期 172页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:5 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • PACING THERAPY OF BRADYCARDIA IN 213 CASES/TIMES

    <正>Artificial pacemaker has been used in bradycardia for 116 cases (213 times pacing) at our hospital since 1983. In these paticms.ihere arc 92 males and 84 femalei, mean age 57.1±12 yean (8—87).Thc basic heart disease was myocarditis (69),coronary heart dtseaie(37},hYpertcnsion(26),myocardosis(15).valvular heart disease* (ft) and ventricular icpial dcfecup). The type of arrhythmia respectively was third degree AVB(102cases).sinus bradycardia and sino -airial conduction block (3B).sccond degree second type AVB and high degree AVB(37),bibundlc uud iribundlc block(9). 6 of (hem were paced by epicurdium lead via thoracoccntcsis due to cardiacrcjuJCJtaiion.3 were paced via right ventricular myocardium lead due tn Ihirddcgrec AVB at resuscitation of heari during ventricular scptal defects mending. Other Ifi7 vscrc uH paced by endocardium lead via venae The type of pacemaker respectively was VVl(VVIR) 147 cases,AAI(AAIR)l5 cases, ODO(DDDR)U cases.VDD 3 cas - There were .19 citsci of temporary pacing ynd IH7 cases of permanent pacemaker implanting at ihc first lime The temporary piitcmiiker wysAXQ - Z(madc in Shanghai medical dctlnc fucioryjirnd Tc\cclronic\ 5(H2 lypc.Pcniiiinqnl piiccmnkor loliilqd H4 (including Icmponiry changed over tfl |ierimntcnl .mil replaced iincsj.miitlc in cliinn 72 (projjr;irturi;(rilc 2'J,Notl 41).iinpor.tcd UI2(Pro6 VH.Non 4) The pnting threshold wiis 11.7— 2 5V m icmporary and 0.5~- 1.2V in permancnl.The wearing (imc of pacemaker wai I hour to 69 days in temporary and 1 — 182 months in permanent the path of lead putting in was incision of venae taphcna magna at early and puncture via venae fcmoralisrcccnlly in mod temporary pacing, and was incision of venae ccphalica(137 cases) or puncture via venae subcl vii>(3l discs).via venae jugulari* cxicrna(6 cases) in permanent pacing. The pacing lend totaled IS] (including the rcsctonc at replacing new pacemaker)in 137 cases of permanent one. The site of pacemaker implanted was mainly in the right upper chest. The complication included infection 5 cascs( temporary 4.Permanent 1),el tetrode displacement 7 cases (Temp 5,Perm 2),pactm kcr syndrome 5 cascs.pulse run away 3 cases and prcexhaustion of battery 27 caset(thc early Chinese pacemaker). Results and coocltodonKThe pacing luccestAil rale was l72/l7bThc 4 unsuccessful patients were all temporary pacing during cardiacrcsuscitation.there arc ulive 129 cases now in 137 cases of permanent pacing.The S died ones were due 10 cerebral h;icmorrhilgc(l),rcn!il fHilurc(2),BCUlC myouirdutl inriirclion{2).niyociirdosii concomitant m(hliear(iiLitiirc(l). The I'irsi case of'pcimancni piiccjualicrtinpladiiiuiM!-u 51 years female.in our hospital has been ulivc 182 monilis,changed 1 pacemaltcr In * word.ihe results of pucing (hcrapy for bradvcurdia was wtisfied

    1998年04期 173页 [查看摘要][在线阅读][下载 57K]
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  • 射频消融治疗心律失常242例报告

    郑绍芬;蒲晓群;李传昶;陈凡;欧淑其;

    1995年起射频消融治疗心律失常242例,男性138例,女性104例,年龄12-71岁.患者均有反复发作心动过速史,室上速236例;其中 AVRT 139例,消融旁路164条:左侧旁路109条,成功107条(98.2%);失败2例,1例为左前壁,逆行法失败,择日穿房间隔再消融成功,另1条为左后间隔旁路;1例复发,再消融成功.右侧旁路55条,成功51条(92.7%),其中1例合并 Ebstein 畸行;失败4例,其中1例显性预激并发作顺向型室上速,再消融,旁路逆传阻断,前传保留,随访26月未再发室上速.1例复发,第二次消融成功.AVNRT 93例,成功92例(98.9%);失败1例,再次消融成功.复发1例,第一次消融时 A_1A_2刺激房室传导跳跃现象消失,复发室上速再次手术时跳跃现象再现,再消融成功,随访24月未再发.右房房速4例,成功3例,特发性室速6例:左室间隔1例,成功;右室流出道5例,成功4例.并发症:左侧旁路消融并发 TIA 1例;AVNRT慢径改良发生Ⅱ°Ⅱ型 AVB 1例,后植入起搏器.讨论:射频消融治疗心律失常成功率与经验有关,本组失败病例多在开展该工作早期时,几例再次消融获成功,1例Ⅱ°Ⅱ型 AVB 也发生在早期阶段;1例AVNRT 患者术后房室传导跳跃现泉再现,推测第1次消融时仅致慢径纤维肿胀,后肿胀消退,慢径传导恢复致 AVNRT 复发.

    1998年04期 173页 [查看摘要][在线阅读][下载 57K]
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  • 室性心律失常56例临床分析

    郑民安;刘尚斌;黄晓雁;

    我们分析了56例临床上诊断为慢性心肌炎的病人的一般资料,包括临床表现.心脏 B 超、X 线表现、心电图、动态心电图、血脂、心肌酶改变等情况.这些室性心律失常主要表现为频发室性早搏,病人临床常有心慌、气短、乏力等表现,常诊断为心肌炎.我们的分析发现:所有这此病人,心脏 B 超,X 线未发现心脏有器质性改变,动态心电图提示这些心律失常多发生于安静或睡眠状态之中.血清酶学、血脂与正常对照组相比也无显著性差异.我们的分析提示,因室性心律失常就诊而诊断为心肌炎者不在少数,而这些心律失常并非心肌炎的必然后果,而是与交感、迷走神经张力有显著关系.

    1998年04期 173页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:20 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:12 ]
  • 经皮球囊二尖瓣成形术的并发症及防治体会

    程晓曙;罗伟;吴清华;吴延庆;程应樟;岳晓军;李菊香;苏海;

    经皮球囊二尖瓣成型术治疗二失瓣狭窄见有疗效较好、痛苦小、较安全及康复快等优点,但有一定并发症.我院自1991年12月以来,用国产橡皮尼龙球囊导管为204倒风心病二尖瓣狭窄患者施行经皮二尖瓣球囊成形术,术中出现短暂心律失常58例,球囊破裂2例,急性心包填塞1例,失血性休克1例,术后经彩超发现房中隔过隔血流3例,以上除房中隔过隔血流,均经相应处理痊愈出院.为减少并发症,我们认为围手术期整体处理极为重要.(1)严格掌握手术适应症.(2)做好术前准备.(3)术中严密观察血压、心率及患者一般情况,注意心影变化,一旦生现心尖搏动位于心影内侧,常提示心包积血量较大,应立即停止操作,行外科手术治疗.(4)股静脉穿刺应尽量避免损伤股动脉.(5)房中隔穿刺点定位以左房高结合房中隔电图法最为简章可靠.(6)14F血管扩张器扩张房中隔足以使球囊导管顺利通过,可避免过分扩张造成创伤性房缺及迷走神经牵拉反射.(7)尽量减少手术程序,避免不必要插管.

    1998年04期 174页 [查看摘要][在线阅读][下载 56K]
    [阅读次数:22 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:7 ]
  • RADIOFREQUENCY CATHETER ABLATION FOR TREATMENT OF ATRIAL ARRHYTHMIAS

    <正> In this paper,electrophysiologic study and RFCA were attempted in 3 patientswho had clinical episodes of atrial arrhythmias with multiple ECG recordings.Diagnoses were automatic atrial tachycardia in one,reentrant atrialtachycardia in one,and typical atrial flutter in one.Site for atrial flutterablation was based on anatomic barriers in the floor of the right atrinm.Forautomatic atrial tachycardia,the site of earliest activation before the pwave was sought and for reentrant atrial tachycardia,our goal was to identifya site of early activation in a zone of slow conduction.At target sites,20 to40w of radiofrequency energy were delivered during tachycardia.Procedureend point was inability to reinduce tachycardia by atrial pacing and infusionof isoproterenol,Acute success was achieved in all of three patients.Fortachycardia involves reentry(reentrant atrial tachycardia and atrial flutter),successful ablation required severing an isthmus of slow conduction.Foratrial flutter,this was between the tricuspid annulus and the coronary sinus osor between the inferior vena cava and the tricuspid annulus.Abla-tioo ofautomatic and reentrant atrial tachycardia and atrial flutter had a highsuccess rate and caused no complications.Repeat procedures may be requiredfor long-term success,especially in patient with atrial flutter.

    1998年04期 174页 [查看摘要][在线阅读][下载 56K]
    [阅读次数:6 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • SIGNIFICANCE OF VENTRICULOATRIAL CONDUCTION IN PATHOGENESIS OF PACEMAKER SYNDROME AND THE INTERVENIENT STUDY OF AMIODARONE

    <正> The present study is to search the significance of ventriculoa1trialconduction(VAC)in pathogenesis of pacemaker syndrome(PMS)anddetermined the act of Amiodarone on VAC,thereby looking methods forcure PMS.The twelve patients with VVI pacemaker complicated byPMS,as well as showed VAC on their electrocardingram(ECG),weresetected into our study.We measured pulmonary capillary wedge pressure(PCMP)and cardiac output(CO)by Swan-Ganz catheter before and afterAmiodaronn's intravenous injection(300rag i.v.)in the four patients of themand prescribed Amiodarone(0.2 tid;after a week,0.2q.d)for the othereight patients.The PMSpatients with VAC have a higher PCWP(mean:3.06+0.31Kpa)and a lower CO(3.13+0.19L/min).however,their PCWPsgo down 2.18+0.36 Kpa)and their COs go up(3.90+0.12 L/min)after Amiodarone's intravenous injection:The patients'symptoms disappearmainly or completely,tugather with the VACs on ECG disappear afterusing Amiodarone.The present study suggested that VAC play a key rolein pathogenesis of PMS and Amiodarone maybe applied to treat PMS bystopping VAC.Theortically,Amiodarone also maybe applied to treatpacemaker-mediated tachycardia(PMT)which result from VAC in thepatients with DDD pacemaker.

    1998年04期 174页 [查看摘要][在线阅读][下载 56K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • 风心病二尖瓣狭窄房颤并发左房活动性血栓及经皮球囊二尖瓣扩张术治疗的研究

    戴铁鸣;牟令勤;邢淑珍;杨旭;李佳峰;

    目的对9例风心病二尖瓣狭窄心房纤颤并发左房内活动性血栓患者,采用小剂量尿激酶加用蝮蛇抗栓酶治疗成功,顺利地施行了经皮球囊二尖瓣扩张术.方法选择9例经过心脏彩超证实二尖瓣口面积0.78cm~2—1.15cm~2,附壁血栓为2.2cm~2×2.0cm~2—2.6cm~2×3.2cm~2,球形成椭圆形等回声,边缘清楚,内部疏松,可随心搏活动并轻度变形.治疗采用每日尿激酶10—20万单位加入葡萄溶液200ml 中静滴,蝮蛇抗栓酶0.5加入盐水200ml 中静滴,连续治疗10—15天(视血栓缩小至消失而定),溶栓成功后继续口肠溶阿斯匹林100mg 巩固疗效,一个月后行政良的经皮球囊二尖瓣扩张术治疗.结果 7例于治疗10天,2例于治疗15天经彩超显示左房内球团消失,溶栓全程无任何部位发生出血.后经皮球襄二尖瓣扩张术治疗,9例均取得理想效果,无并发症发生.结论风心病二尖瓣狭窄房颤并发左房内活动血栓是经皮球囊二尖瓣扩张术的禁忌证,常需要手术摘除血栓,我们采用小剂量尿激酶反复溶栓,蝮蛇抗栓酶抗凝治疗,全面激活了患者的纤溶系统,无发生出血并发症.由于本组血栓内部疏松尚未机化,药物易于渗入,加上血栓悬于血液中运动接触药液更为充分,溶栓达到了理想效果,为皮球囊扩张术提供了有利条件.

    1998年04期 174页 [查看摘要][在线阅读][下载 56K]
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  • A PROSPECTIVE STUDY OF PATIENT-RELATED FACTORE INFLUENCING THE EFFICACY OF PERCUTANEOUS BALLOON CATHETER MTRAL VALVULOPLASTY BY A SET OF MODIFIED ECHOCARDIOGRAPHIC SCORE IN 115 SUBJECTS

    <正> The goal of the present study was to determine whether the patient-relatedfactors such as mitral valve morphological features influence the efficacyof percutaneous balloon catheter mitral valvuloplasty(PBMV)with Inoueballoon catheter,A set of modified echocardiographic total score(ETS),in which each score was assigned for each mitral valve morphologicalfeature such as valvular mobility,thickening,calcification or subvalvularthickening on a scare ranging from 1 to 4,used for a prospective cohortstudy of different fiTS in 115 subjects with mitral stenosis hut withoutsignificant mitral regurgitation.It was found that the efficacy of PBMVafter the procedure was significantly better in the low ETS(≤8 points)group(n=61,included 43 women;ages 18 to 57 years,mean 39)than inthe high ETS(>8 points) group(n=54,included 37 women;ages 17 to 58years,mean 40)in mitral valve area (2.32+0.46 cm~2vs 1.87±0.37cm~2,p<0.01),mean left atrial pressure(12±5 mmHg vs 18±7 mmHg,p<0.01),mean mitral valve pressure gradient(4±1 mmHg vs 10±2 mmHg,p<0.01),and left atrial dimension(34.9±5.2mm vs 41.2±6.9 mm,p<0,01).In the low ETS group,mitral valve area was 2.30±0.45 cm~2(NS)and leftatrial dimension was 35.2±5.5mm(NS)at 12-30(24±7)monthsfollow-up.In contrast,in the high ETS group,mitral valve areadecreased to 1.58±0.36 cm~2(p<0.01)and left atrial dimension incresed to45.2±7.4mm(p<0.05) at 12-36 months follow-up.In addition,restenosiswas demonstrated in 12 of 54 patients(22%)with a high ETS but only in2 of 61 patients(3%.p<0.01) with a low ETS at follow-up.Thus,thepatients with a morphological suitable valve for PBMV or a low ETS mayget a better efficacy from PBMV,and ETS mey be very useful in selectingpatient for the procedure.

    1998年04期 175页 [查看摘要][在线阅读][下载 39K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • OVERCOME THE OPERATING DIFFICULTIES OF THE PERCUTANEOUS BALLOON MITRIL COMMISSURO TOMY

    <正> Porcutaneous balloon mitral commissurotomy(PBMC)has become a widelyacceptod operation for the patients with mitral atenosis.Though muchaccepted operation for the patients with mitral atenosis.Thoush muchexperiece has been accumulntad for the past decade some difficulties havealways been faced during the operation,for example,the tip of transseplalturning the other direction and unable to curve clockwise essily,the ballooncatheter difficult to enter the left vantricle(LV,and easily floating backdifficulties,simplify the procedure,shorten the duration of operasion.reduceinanipulated easlly ② Specially designed transseptal cathcter.withcurvature on the head part,was used inssend of the routine cuthetes in 46left and curve clockwise.③When the balloon on:ering LV become difficultin 8 patients.instead of repeatedly manipulation with mitral stylet,wc usedmitral suide'wire,which can out of the balloon uatheter,and move into thestyler,the mitral stylet fixed upon a tbroe way switch,make it possible thatpressure can be messured successively while the mitral valvuloplusty isunderway without witbdrawing the mitral stylet,which can not affect theresult of the operation,Conclusion;①"orientation needle"can make thecatheter tip fasten on fossa ovale and assure the puncture for patients withshallow Cossu ovalc at the right point,②Spceially designed transseptalcatheter prevent the guide wire from turing the other direction.③Mitralguide wire is a new method for overcoming the dirficulty of batloon enteringthe LV,④The manomertric mitral styler can uvoid the balloon floatingback from the LV.simplify the procedure aud reduce the complication.

    1998年04期 175页 [查看摘要][在线阅读][下载 39K]
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  • THE EFFECTS OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY ON PULMONARY FUNCTION OF RHEUMATIC HEART DISEASE

    <正> Many papers have demonstrated that perctaneous transvenous nitralcolnmissurotomy(PTMC)can improve patterns' heart function.The aim of thisresearch is to confirm the effect of PTMC on pulmonary function of rheumaticheart disease.PTMC was performed in 40 mitral stenosis patients according toInoue's method.Left atrium mean pressure(LAMP),left ventricular diastolicend pressure(LVDEP),mean pressure gradient across the mitral valve(MVG)and right ventricular systolic prossure(RVSP)were measured immediatelybefore and after dilatation ofmitral valve,Pulmonary function,including VCFEV_(10)/FVC、TLC、RV/TLC/、V_(50)、V_(25) as percent predicted valuerespectively(VC%、FEV_(10)/FVC%、TLC%、RV/TLC%、V_(50)%,、V_(25)%)were also dtermined in one week before and after PTMC,All cardiac pressureindexes and mitral valve area(MVA)were improved(P<0.01)and dates ofVC%,V_(50)% were higher(from 76.54、79.59 to 84.33.93.29)andRV/TLC% was lower(from 147.12 to 129.82)dramstically(P<0.01)after PTMCFEV_(10)/FVC%、TLC% and V_(25)% were normal before PTMC and did notchange clearly.From this datas,we concluded that the patients suffered fromrheumatic mitral stenosis had clear decrease in pulmonary function and PTMCcould improve it obviously.

    1998年04期 175页 [查看摘要][在线阅读][下载 39K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY:EXPRIENCE OF 182 CASES

    <正> Objective:To evaluate the clinical results of pcrcutancous balloon mitratvalvuloplasty(PBMV)in patient with rheumatic nlitral stenosis.Materials andMethods:one hundred and eighty-two patients with rheumatic mitral stenosis(MS)have been Irented by PBMV since 1995.There were 30 males and 152females,aged 38.6+8.0 years.Atrial fibrillation occurred in 42 paticnts andsinus rhythm in 140 patients,including 18 patients wilh restenosis closedcommissurotomy and 8 patients with thrombus in the left atrial appendage bylaking a small dose of Warfarin(3mg/d)for 4-6 months.63 patients hadminimal mitral regurgitation,26 patients had minimal aortic valve stenosis onregurgitation.The balloon diameter was from 25mm to 28mm.PBMV wasperformed using tbe single balloon Inoue technique.Results:PBMV for 179 patients with MS were successfully performde AfienPBMV the mean Ien atrial pressure decreased from 36+11 mmllg to 12+4mmHg(P<0.001),the mean mitral value gradie(MVG)decreased from 32+6 mmHg to 9+5mmHg(P<0.001).the mean mitral valoe area incrensed from0.89±0.32 cm~2 lo 1.92±0.43 cm~2(P<0.001)the mean pulinonary arterypressure dropped from 54±26 mmHg to 32±14 mmHg(P<0.001).the mcanIen atrial diameler decreased(LAD) from 48 mm to 43 mm(P<0.001).symptomatic improvement occurred in 178 patients with severecolnplicatins.including one palient wilh.severe regurgitation of mitral valvedue to valve lear.another potienl with acute endovarditis there were no deatlor thronlhoembolic complications in all paticnts.Conclusion:The results suggest that PBMV is effective therapy for thepatients with mitral stenosis,the method is also of first choice for thealing MSwith cxcellent results,the procedure is very safely with high success rele and afew complications.

    1998年04期 175页 [查看摘要][在线阅读][下载 39K]
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  • CLINICAL APPLICATION OF PERCUTANEOUS BALLOON MITRAL VALVALOPASTY

    <正> The operation of PBMV is popular and considecl highlybeacuso of advantages of satisfactory effects andlittle lesion.But there are many difficulties inpractices,such as the balloon can't be passedthrough the mitral valve eesily.We operated 64patients by the method of big curve in front part ofthe catheter during PBMV and all of the catheterswere passed through the mitral valve in short time,the stenosis valves vere dilated successfully.In myopinion,in order to made a big curve in front partof the catheter,it is vital to change the curve infront part of left ventricular wire according to thesize of left atrium,which can make the catheter havea proper curve to pass the mitral valve.In addition,it is not suitable to puncture the artial ssptum inhigher position,if so,the front part of the catheterin left atrium is parallel or almost parallel to theaitral valve,not in the right angle,so the cathetercan't be easy to pass through the mitral valve.During the puncturing,the angle of the punctureneedle must be settled properly to reduce thecomplications.We suggest that the degrees of arrowin the puncture needle be set to 45°.60 and 75°separately when the size of left atrium are 4.0cm,5.0cm and 6.0cm.When pueeturing in such degree,thecatheter could be in right angle with the mitralvalve and passed through the valve easily.

    1998年04期 176页 [查看摘要][在线阅读][下载 73K]
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  • 有关拓宽球囊二尖瓣成形术适应症的探讨

    刘玲;黄兴华;王鹏飞;蔡琦;

    经皮球囊二尖瓣成形术(PBMV)已成为较成熟的治疗二尖瓣狭窄的外科替代疗法.我院已施行115例,95%手术成功,随着技术不断成熟,使我们掌握PBMV 的适应症有扩展.1.老龄:老龄患者行闭式二尖瓣分离术病死率可高达7-8%以上,国内外报导老年二尖瓣狭窄行 PBMV 有50-75%得以改善,并有较好的即刻和长期疗效,本组115例中60岁以上老年人12例,PBMV 全部安全成功,术后临床改善,认为选择合适病材,进行分级递增法进行 PBMV,也是老年二尖瓣狭窄安全有效的治疗措施.2.心房纤颤:风心二尖瓣狭窄伴房颤者,为预防脑栓塞一般要求 PBMV 前先行抗凝治疗2-4周,本组房颠51例,占44.3%,我们在术前多未按规定时间给以抗凝治疗,而是在术后开始或继续应用华法令抗凝2-4周,结果51例中仅有1例术后次日发生轻症脑梗塞,以上结果似提示:房颤患者行 PBMV 前虽未进行充分抗凝,术后脑梗塞似乎并不多见.3.左房血栓:左房血栓一般视为 PBMV 禁忌证,可使外周动脉栓塞率增加,马长生报导31例左房血栓患者应用小剂量华法令抗凝治疗,除3例失访外,余28例均在2至12月内血栓消失,本组对10例符合 PBMV 瓣膜条件的二尖瓣狭窄并发左房血栓给以口服华法令1.5-3.75 mg/d,结果10例患者左房血栓于3月内消失8例,4月内消失2例,另1例左房血栓已5年,经口服华法令3mg/d共三年,血栓自原来3.5×4.5cm 大小逐渐缩小至完全消失,以上10例均于血栓消失后安全完成 PBMV,仅1例因穿隔失败而未成功.华法令治疗使血栓消失机制,可能在抑制新的血栓形成前提下,原有血栓受自身纤溶系统作用而溶解消失.4.咯血:本组4例咯血是自200至600毫升,药物治疗咯血不止,PBMV后4例均于1至3日咯血终止,故认为 PBMV 是治疗二尖瓣狭窄大咯血快速有效的措施.5.肺动脉高压:器质性肺动脉高压的重度二尖瓣狭窄常为外科开胸手术反指征.本组12例重度肺动脉高压行 PBMV,除2例手术未成功外,显示10例在术后虽有部分患者右心衰竭体征改善不理想,但大部分患者心功能改善,一般情况好转.我们认为:在充分积累技术经验的基础上,对一些急需治疗、内科药物疗效不佳而又不能承受外科手术者,适当拓宽 PBMV 适应症对多数患者可能有利.

    1998年04期 176页 [查看摘要][在线阅读][下载 73K]
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  • 二尖瓣狭窄合并房颤球囊扩张成形术16例疗效分析

    廖旭东;刘晶;刘同库;

    自1995年4月起至1998年1月,我科应用经皮房间隔穿刺二尖瓣球囊扩张成形术治疗风湿性心脏病二尖瓣狭窄共25例。其中合并心房纤颤者16例,术后疗效显著。16例中男性3例,女性13例,年龄最小31岁,最大64岁,平均42.2±9.5岁,合并轻度二尖瓣关闭不全者8例,合并主动脉瓣病变者3例。经超声检查左房发现血栓者3例.所有病人均服华法令3个月.术前超声检查发现左房血栓。采用 Inoue 球囊经股静脉及房间隔穿刺途径,将球囊导入二尖瓣口进行扩张.术后有12例杂音消失,4例杂音减至极弱程度,9倒合并二尖瓣关闭不全者杂音未增强,2例杂音反而减弱.无1例发生栓塞。扩张后瓣口面积 MS(cm~2)从1.04±0.23增至4.8±0.38(P<0.001)。左房压 LAP(Kpa)从扩张前的3.30±1.31降至1.75±0.74(P<0.001)。心率 HR(次/分)从86.3±12.5降至79.4±15.2(P<0.05).血压 BP(Kpa)从13.8±0.78降至15.4±2.9(P<0.05).术前测左房内径为5.1±1.2(cm),术后3个月为3.8±0.45(cm)(P<0.001)。术前12人曾用药物转复房颤,转复成功者9例,成功率75%,但均未维持超过3个月。术后3个月,16人中有14人经药物转复,2人经电转复,15例转复成功,成功率93.8%,14例维持超过3个月。目前,经皮心房间隔穿刺球囊扩张成形术及直视二尖瓣狭窄分离术均为治疗单纯二尖瓣狭窄最有效的方法.但前者具有对病人损伤小,痛苦轻,易为病人接受,不需全麻,在神志清醒状态下进行,住院时间短,术后1-3天后既可出院参加日常工作的优点;且疗效与后者相同.本组扩张后 MS、LAP、HR、BP 及左房内径均明显改善。只要操作正确,选择好适当的球囊直径,可减少二尖瓣返流的发生。扩张前应充分抗凝,我们的体会一般抗凝3个月最安全,本组无1例发生栓塞.有资料报道远期疗效与直视分离术相同,平均10年可发生再狭窄,而再狭窄时仍可再次行球囊扩张成形术.因此,经皮房间隔穿刺二尖瓣狭窄球囊扩张成形术是一种安全、疗效显著、并可重复的治疗二尖瓣狭窄最有效的方法。

    1998年04期 176页 [查看摘要][在线阅读][下载 73K]
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  • CLINICAL TRIAL OF PERCUTANEOUS BALLOON MITRAL VOLVULOPLASTY IN PATIENTS WITH RESTENOSIS AFTER TREATING WITH MITRAL VALVE COMMISSUROTOMY

    <正> Sixteen cases patients with restenosis after treatment with mitralvalve commissurotomy(CMV)were treated by percutaneoas bal-loon mitral volvaloplasty(PBMV)in this study.The result shownthat the area of mitral valve(MVA)was significantly inceased(p<0.001).The mean pressure of left atrium(LAMP)and thetransmitral valve pressure grade(MVPG)was decreased(p<0.001).Of them,3 cases of patients complicated with atrialfibrillation,there were no any thrembus in left atrium which wasconfirmed by ultrasound,after taking warfarin 3mg/day for twomonths,were successfully performed PBMV,and achived a goodresult and less complication.Follow up(10.2±3.6months)datashown that the MVA was still significantly larger than pre-opera-tion(p<0.001),LAMP、MVPG was lower thsn pre-operation,thedifference after operation was not significant(p>0.1).

    1998年04期 176页 [查看摘要][在线阅读][下载 73K]
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  • PBMV IN TREATING MITRAL STENOSIS WITH LEFT ATRIAL THROMBUS

    <正> We have performed 348 canes of PBMV(pereutsneous Balloon Mitralvalvhloplssty)since April 1989,in which there are 4 Patients(13.8%)diagnosed as mitral stenosis with left atrial thrombus.To keepprothrombin time 1.5-2 times as normal,two kiods of thrombolytictherapy was qiven to these 48 patients,one was using 2 weeks ofurokinase(20 theusand units/d intravaneously)for early 18 cases,theother was using 4 weeks of warlarin(3-10mg/d.po)for other 30cases.PBMV was perlormed after thrombolytic therapy.In those 48cases,PBMV of 47 cases were successful,none of them had thecomplication,such as cerebral,limb and systemic emboesm.Though 1ease of PBMV was failed because balloon couldn't be sent to mitralorifice owing to thrombus just adjacent to mitral orifice,which wasverified by intraesophagesl echocardiogram after operation,butseveral times of touching between balloon and thrombus hadn'tresulted in other organ's embolism.Above data revealled that it's safeto take PBMV after 4 weeks of thrombolytic therapy of warfarin inpatients of mitral stenosis with left atrial thrombus.The mechanismperhaps is,we think,that thrombolylic therapy can make freshthrombua dissolute and make old ones organize to prevent thrombusfrom dropping.So the patients of mitral stenosis with left atrialthrombus can take PBMV after strict thrombolytic therapy.

    1998年04期 177页 [查看摘要][在线阅读][下载 53K]
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  • HEMODYNAMIC AND ELECTROPHYSIOLOGIC EFFECTS OF SOTALOL IN PATIENTS WITH LIFE-THRAETENING VENTRICULAR TA CHYARRHYTHMIAS

    <正> Aim To evaluate the hemodynamic and electrophysiologic effects ofintravenous and oral sotalol and its tolerance of long-term oral therapy in pts.with Life-Threatening Vantricular tachyarrhythmias.Methods twenty-throe pts.,17 with sustained ventricular tachycardias,6 with ventricularfibrilation were studied.16 pts.were postmyocardial infarction,4 were rightvuntricolar dispiasia and 3 were dilated cardiomyopathy.Results Sotalotprevented the induction of arrhythmias in 34.3% with bolus intravenousinjection(1mg/kg body weight)and 60.8% with oral(160mg twice daily for10 to 14 days).Intravenous and oral sotalol each induce a comparablereduction in heart rate(78±6 vs 68±6,60±6min~(-1) p<0.01),decrease incardiac index(3.2±0.4 vs 2.8±0.3,2.4±0.3L/min.m~(-2);p<0.01),increase inleft vantrinular filling pressure(1.2±0.4 vs 1.5±0.4,1.9±0.7kPa;p<0.01),as well as in systemic vascular resistanca(1255±153 vs 1446±176,p<0.05;1537±160,p<0.01),The stroke volume increased significantly after sotalolintravanoas(72±11 vs 80±10ml,p<0.05),but not changed at peak actionafter oral sotalol(79±11,p>0.05).Neither intravenous nor oral sotalol had asignificant effect on systemic and pulmonary arterial pressures,as well asstroke work indexes.During a follow-up of 3 to 6 months,oral sotalolprevented the recurrent of arrhythmias in 12 of 16 pts.who were responsedto electrophysiology testing.Congestive heart failure associated with amarked bradycardia developed in one patient.This patient was managedwith a reduction in the dosage and with a regimen of digoxin andfurosemide.Conclusion Sotalol provided effective prophylaxis againstlife-threatening Ventricular tachyarrhythmias.It exerted significant negativehemodynamics effects but with quite good clinical tolerance,even in pts.with compromised heart function.

    1998年04期 177页 [查看摘要][在线阅读][下载 53K]
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  • EXPERIENCE OF PERCUTANEOUS BALLOON MITRAL VALVULPLASTY(PBMV)IN 35 PATIENTS

    <正> Since 1991,we have performed PBMV on 35 mitral stenosis patients(pts).Clinical data:35 pts(10males,25 females)Mad 39.5(23-59)yrs,were diagnosed asmitral stenosis by ecbocardiogram.The course of disease was 9(1-39)yrs exceptactive stage of rheumatic fever.The mitral valve thiclmess was 4-8mm.TheMitral Valve Area(MVA)was 1.05(0.7-1.4)cm~2.The pts without atrial thronbusipcluded light aortic regurgitstion(AR)in3,light mitral regurgitation(MR)in5,atrial fibrillation in11I,NYHA cardiac function Ⅱ-Ⅲ°.Single-ballcontochniqus was applied on them,6 with Japan-amde balloon,29 with China-madebelloon.The balloon diameter was 2A-28mm.Besults:32 pts were successful in PBMV.Acute cardiac tamponade occurred toone case.The thoracotomy bemostasis and the mitral commissurotomy wereperformed in time.2 Cases failed in Interatrial septal punctura.Rapid atrialfibrillation occured to 1 cese.Aftor electrical conversion.sinus rhythmresumsed,and the operation accomplished.The symptom was obviously improvedin the successful 32 pts.Diastolic murisur in apical region of heart decreasedor disappeared.MVA increased 0.91cm~2(p<0.01).Left atrial pressure andtransmitral pressure gradient decreased 20 and 2.2 Kp(p<0.01).Conclusion:PSMV was successful in 5 pts with light MR and 3 pts with light ARSubjective symptom was improved and MR did not increase.So that PBMV iseffective in Mitral atenosis pts with light MR or light AR 11 atrialfibrillation pta(no atrial thrombus)without anticoagulant before PBMV bad noembolism.The results indicate that anticongulant before operation isusslesseful,but left atrial thrombus must be excluded under ecbocardiogram.The main complication in artial septum punturs is perforation of heart.Cardiac tampomads occurred to 1 case bucauss the cannula entered too deeplyand broke the left pulmonary veins.The followings should be done to decressethe perforation of heart:1)Before operation the anatomical position variationof atrial septum must be detected completely to clear the point of puncture.2)When the needle break the atrial septum,the cannula must be pushed afterthe needle is just in the left atrium.depending on the bemospasia,thecontrast examination and left atrial pressure determination.3) The canmulamay not be pushed too deeply to break the left atrium or the pulmonary veins.4) After taking out the needle,the contrast exnmination and left atrialpressure determination must be done again to decide the next step.

    1998年04期 177页 [查看摘要][在线阅读][下载 53K]
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  • THE STUDY OF CLINICAL EFFICACY OF TRAPIDIL IN TREATMENT OF DISLIPIDEMIA

    <正> Trapidil.a platelet-derived growth factor antagonist.has a beneficial effect onatherosclerosis and restenosis after PTCA.This study was to evaluste its clini-cal therapeutic efficacy for dislipidemia.62 consecutive patients with primarydislipidemia were randomly divided into two groups.Group A(n=32)receivedtrapidil 300 mg daily and group B(n=30)with lovastatin 20 mg daily for 6 we-eks.After 6-week treatment,the results were showed in table 1.With trapidil,plasma TC and LDL significantly decreased by 12.5% and 11%,HDL signi-ficantly increased by 11.7%(P<0.05).The former effects were inferior to lov-astatin(P<0.001).Trapidil has a beneficial effect on lipid metabolism whichsignificantly decreased TC,LDL and increased HDL,but the effects were in-ferior to lovastatin.Table 1.Lipid and lipoprotein Valuca after Treatment(x±s)Compared with pretreatment.*P>0.05,**P<0.05.***P<0,01,****P<0.001Compared aronp A with B,a P>0.05,b P<0 05,c P<0.01,d P<0.001.

    1998年04期 177页 [查看摘要][在线阅读][下载 53K]
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  • DILTIAZEM IS SAFE AND EFFECTIVE IN RATE CONTROL OF ATRIAL FIBRILLATION ASSOCIATED WITH HEART FAILURE:RESULTS FROM 280 PATIENTS

    <正> The safe and efficacy of diltiazem in ventricular rate control of atrialfibrillation are the major concern to most clinicians in patients with heartfailure.We tested the performance of acute application of diltiazem inpatients with heart failure and atrial fibrillation or flutter.A total of 280patients were grouped according to the New York heart failureclassification,with class IV in 48 patients.All the patients receiveddiltiazem 10-20mg intravenous injection and/or 10mg/h intravenousinfusion during arrhythmia.After the drag injection or infusion,theventricular rate decreased from 142.09±17.61 to 100.24±17.74 beatper minute(P<0.0001),the systolic blood pressure dropped from135.44+28.14 to 123.52±19.18 mmHg(P<0.001),the diastolic bloodpressure dropped from 84.52±16.04 to 77.26±12.02mmHg(P<0.01).Despite the decrease in blood pressure,no deteriorate symptom wasnoted in all the groups of patients.Our results suggest that the diltiazemis a safe and effective drug to control the ventricular rate during atrialfibrillation or flutter associated with heart failure.

    1998年04期 178页 [查看摘要][在线阅读][下载 54K]
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  • EFFECTS OF ENALAPRIL AND SPIRONOLACTONE REFRACTORY CONGESTIVE HEART FAILURE

    <正> The 5-year-survival rate for patients with severe congestive beart failure(CHF)isapproximately 50% for those judsed to be in New Yock Heart Associstion(NYHA)class Ⅲ;for patients in classⅣ;the 5-year-survial rate decilimes to about 20%,fatal of136-impstients(89 men and 47 women)were enrolled,mean age was 68 years(range39-84 year)and the mean duration of heart faihure was 26 months(range 3-32months).the primary etiologic factor was ischemic heart disease in 92patients,hypertension in 26.dilated cardiomyopathy in 14,and mitral insufficiency in4.short and long-term clinical effects of the anglotensin-converting enzyme(ACE)inhibtor enalapril in severe congesttive heat failure(CHF)were evaluated during a 2-year open study of 136 inpatients with New York Heart Association(NRHA)funtional class Ⅲ or Ⅳ CHF refractory to treatment with cardial glycosides andhigh doses of loop dluretics,Enalapr was added to each petients reglmen,whichcomprised combinations of urosomide(136patients),digitalis(102patients),andspironolactone(89pstients),By the end of the first month of Enalapriladrninistration,improvement in NRHA functional class was seen in 89 patients(72%).During the first year of Enalapril treatment,the number of hospital admissionsand hospital days delined signiflcantly(p<0.001)and functional class improvedsigniflcantly(p<0.001).Although most patients to lerated Enalapric well..44%experiencde hypotension,which in 10% of patients necessited termination ofEnalapril therapy.Although mean serum potassium levels traded to increase,serioushyperkalemia did not occur,After 1 year,a subset of 30 patients who had not initiallyrecelved spironolactone detersted clinically and manfested inreasing urinaryaldosterone leveis.Hypotension precluded increasing the Enalapril dose,butintroduction of spiroonolsctone improve dclinical status in this cohort.The resuitssaggest that rational therapy for severe CHF.In cludss,addition of the aldosteroneantagonist spironactone to low doses of Enalapril(or abother ACE inhibitor)andhigh doses of loop dluretlcs provided rebal function is adequate.

    1998年04期 178页 [查看摘要][在线阅读][下载 54K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:8 ]
  • OBSERVATION OF QUINIDINE ON THE CARDIOVERSION TREATMENT IN PATIENTS WITH RHEUMATIC MITRAL STENOSIS AND ATRIAL FIBRILLATION AFTER PERCUTANEOUS BALLON MITRAL VALVULOPLASTY

    <正> Background:Pharmacologic therapy has been advocated for bothcardioversion and prevention of recurrent atrial fibrillation.Quinidine is thetherapeutic mainstay for both purpose.Method:Twelve patients withrheumatic mitral stenosis and persistent atrial fibrillation recieved quinidineafter percutaneoas ballon mitral valvuloplasty within 3-6 weeks.If heart rate>100bpm,it was decreased with intravenous or oral digoxin,wbereafter 200mgof oral quinidine was given maximally 5 times,each dose 2 hours apart.Afterconversion of atrial fibrillation to sinus rhythm.All patients recieved 200mg oforal quinidine once or twice a day for prevention of recurrence.Result:Allpatients were converted to sinus rhythm and two of patients had recurrence ofatrial fibrllation within three months after cardioversion treatment.The sideeffect included diarrhea,vomit and bleeding tendency.Conclusion:Quinidineis effective in conversion of atrial fibrillation to sinus rhythm and is associatedwith an acceptable efficacy rate in preventing recurrence of atrial fibrillation.It shows that proper supply of drug,careful observation of side effects andpatient psychological nursing is also important to quinidine cardioversiontreatment.

    1998年04期 178页 [查看摘要][在线阅读][下载 54K]
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  • THE STUDY FOR CORONARY REOPENING

    <正> PERPOSE:it is very beneficial for the treatment of coronary heart disease toreopen the infarct coronary,especially in acute myocardial infarction(AMI).The coronary reopening is very important to rescue the dying cardiolmuscle and recover the heart fountion early.The following is the report that wehad treated the patients with AMI in different interving manners from 1988 toMay of 1998.METHOD:The whole cases should be under the criteria of WHOfor diagnosis of AMI,and should be fit for the following:①Chest pain in 6hours,②The time of chest pain above 30 minutes and ST segment elevateabove 0.2 my,③No prohibition to thrombosis.They are derided into fourgroups:Group 1-a small dose of urokinase(0.9 million IU)introvenous thrombosis group(21 cases):Group Ⅱ-a large dose ofurokinase(1.5 million IU)introveaous thrombosis group(52cases);Group Ⅲ-50mg rt-pA introvenous thrombosis group(43 cases);Group Ⅳ-primary percutaneous transluminal coronary angioplasty(PPTCA)group(55 cases).RESULT:The reopening rate,hemorrhagerate,metality rate(in one month)were 47.6%(10/21),0%,9.5%(2/21)for Group Ⅰ,respectively;59.6%(31/52),3.8%(2/52),7.7%(4/52)forGroup Ⅱ,respectively:69.7%(30/43),11.6%(5/43),7%(3/43)for GroupⅢ,respectively:94,5%(52/55),0%,10.9(6/55)for GroupⅣ,respectively.CONCLUSION:We got the result that the reopeningrate of PPTCA for infarct related coronary was higher than that ofintrovenous administration of 50 mg rt-pA,then higher than that ofintrovenous thrombosis of 1.5 million urokinase and then higher thanthat of 0.9 million urokinase.There had no apparent difference inone month morality(after AMI)between every two groups.Thehomorrhage rate of rt-pa in introvenous administration was morehigher.

    1998年04期 178页 [查看摘要][在线阅读][下载 54K]
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  • COMPLICATIONS OF IMPROPER ANTITHROMBOTIC THERAPY IN THREE PATIENTS WITH STENT IMPLANTATION

    <正> The clinical benefit of coronary-artery steating performed inconjunction with coronary angioplasty is limited by the risk of thromboticocclusion of the stant as well as hemorrhagic and vascular complications ofintensive anticoaguistion.We analysed complications of three patientscaused by improper antithrombotic therapy after coronary artery stanting.Method and Result:Case 1,male,52 years old.The diagnosis is old myocardial infarction(OMI),unstable angina pectoris(UAP).Gianturco-Roubin stent was successfullyimplanted into right coronary artery(RCA).Balloon angioplasty wasperformed in left circumflex artary(LCX).Angiography showed optimal resultafter the procedure.The patient bad acute inferior myocardial infarction onthe same day,and died from ventricular fibrillation on the third day afterthe stenting.Case 2,male,53 years old.The diagnosis is UAP.Two Gianturco-RoubinStents were implanted into left anterior descending artery(LAD)and RCArespectively,angioplasty was done in LCX On the tenth day atfer theprocedure,bloody urine happened.By reducing warfarin dosage be bloodyurine disappeared.Case 3.female.71 years old.the diagnosis is acute anterior myocardialinfarction,UAP.Multilink stent was implanted into LAD,balloon dilatationwas done in RCA.On the day of the stenting,groin regional bleeding andshock happendod.Afterwards.acute anterior,Supralataral MI and acute heartfailure happended.Finally the patient was discharged.DiscussionRecently the success rate of the stent implantation reach at 95%.However,the main complications are stent thrombosis as well as bleeding,vascular access complicalions caused by intensive antithrombotic agent.Inthese three patients,the death of the first case is due to acute stentthrombosis resulted from insufficient antithrombotic therapy.The bloodyurine of second case is caused by too much intensive anticoagulation.Thecomplications of the third case is due to too much intensive antithrombosisat beginning and insufficient antithrombosis at latter.The antithrombosisafter stenting should be monitored by ACT,CT or PTT The antipisteletherapy can largely reduce the stent thrombosis and the incidence of theleeding.

    1998年04期 179页 [查看摘要][在线阅读][下载 60K]
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  • THE RESULTS OF HEART RHYTHM DISTURBANDCES TREATMENT USING SELENIUM

    Prukin A.F ;Voschenko A.V.Chita,Russia;

    <正> Selenium concentration in patients with heart rhythm disturbances and the part ofselenium in treatment of this pathology were studied.50 patients(age 16-67)were studied.The check group consisted of 23 healthypatients(age 21-44).Selenium concentration in patients' blood was measured.Thencorrection of selenium concentration was done.With the daily dose of 450mkg,selenium concentration in blood was managed to increase up to 60-70%.In compaison with the check group selenium decrease up to 43 and 78.4mkg(standard 90-120mkg/l)was discovered.The most marked decrease of seleniumconcentration was noticed in patients with idiopathic transverse blocks 34.4mkg/land paroxysmal supraventricular tachycardias(SVT)not caused by ischemic heartdisease(ICHD)-39.5mkg/l.Thee patients with ICHD(tachy-and bradycardia)hadthe selenium decrease up to 55.8mkg/l.After selenium therapy during 2 weeks thefollowing results were obtained:in cases of SVT the beneficial result was reached in75%;in cases of the tachycardias caused by ICHD-25%.In cases of idiopathictraverse blocks the heart conduction restoring after selenium recovery was noticedin half of patients.In case this pathology is caused by ICHD no beneficial effect wasnoticed.

    1998年04期 179页 [查看摘要][在线阅读][下载 60K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • UROKINASE THROMBOLYSIS IN ARTERY FOR TREATMENT OF PERIPHERAL ARTERIAL OCCLUSION

    <正> Purpose:To evaluate the clinical efficacyof thrombolysis injecting urokinase inperipheral artery for treatment of arterialocclusion.Materials and methods:12 patientswere treated with injecting urokinase inartery.Results:The mean dose of urokinase was500000U,the mean time of thrombolysis was200 minutes.The rate of clinic efficacy was83%.Conclusion:The indication of urokinasethrombolysis in artery is for those patientswith arterial occlusion in whom catheteriza-tion is feasible and clinical course is inone month.This operation is simple and conv-enient,it does not require special equipment.The method can be used safely and effectivelyin patients with arterial occlusion.

    1998年04期 179页 [查看摘要][在线阅读][下载 60K]
    [阅读次数:5 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • Effcet of Pravastatin to Reduce the Onset of Transient Myocardial lschemia in Patients with Stable Angina of Coronary Heart Disease

    <正> One of the major pathogenesis of coronary heart disease is hyperchoresterolemiaAlthough choresterol reducing therapy can decrease the morbidity and mortality ofcoronary heart disease,what is less certain is the portential antimyocardial ischemiaeffect of it.Besides the conventional therapy,the application of choresterol reducingtherapy can decrease the onset of transient myocardial ischemia in patients withunstable angina in this trial,we initiated the application of 3-hydroxy-3-methylglutaryl coenzyme A(HMG-CoA) reductase inhibitor pravastatin to reduce thelevel of serum total choresterol and LDL-C(low-density lipoprotein choresterol) andto decrease the onset of transient myocardial ischemia in pationts with stable angina ofcoronary heart disease.Patient selection.There were 368 patients aged 45-80 years,with stable angina of coronary heart discase and hyperlipidemia,randomized intopravastatin group and placebo group besides the convientional antiangina therapy in12 months,with 266 male and 102 female.Serum total choresterol was 4-8mmol/L(155-310mg/dL).All patients received 48 hours Hoter monitoring pre andpost the trial.The definition of the onset of transient myocardial ischemia isdownsloping or horizontal ST segment depression≥0.1mv from 80msec after the Jpoint with duration≥60secends.I.In pravastatin group,the level of serum totalchoresterol and LDL--C reduced significantly(total choresterol from 6.08 mmol/L to4.80mmol/L,LDL-C from 4.20 mmol/L to 1.46 mmol/L),high-density lipoproteinchoresterol raised markedly(from 0.9 mmol/L to 1.02 mmol/L),p<0.001.Nosignificant change was noted in placebo group.2.Inpravastatin group,the onset oftransient myocardial ischemia was 26% before the trial.and was 19% after the trial.While in placebo group,the rate was 19% to 22% reapectively.There were significantdifference between the two groups.3.Duration of the episode of transient myocardialisohemis was shortened from 80±12 seconds to 42±10 seconds in pravastatin groupand was shortened from 60±13 seconds to 51±9 seonds in placebo group.In patientswith stable angina of coronary heart disease,the application of HMG-CoA reductaseinhibitor reduced blood lipids.hindered the growth of atherosclerotic plaque,improved myocardial blood supply and decreased the onset of transient myocardialischemia.

    1998年04期 179页 [查看摘要][在线阅读][下载 60K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:9 ]
  • THE RATIONAL DRUGS THERPY IN PERI-OPERATION PERIOD OF CORONARY INTERVETION

    <正> It is very important that rational drug therapy in pen-operation for asuccessful coroary intervention.This article reported our experienceof drugs used in 195 patients undergoing coronary intervetion.Patientsof angina take nitroglycerin,calcium antagonist or β-Blockers,aspirin,persentin,ticlopidine before operation.Patients of UA is usedintravenous nitroglycerin,heparin.PTCA is done after two weeks ofstable angina.Simple PTCA do not use heparin after the operation,intravenous heparin(1000u/h) continue 24h after pull sheath.ComplexPTCA and DCA use intravenous heparin at once after the operation.Moniter ACT(200-250s),pull sheath 24h after the operation,intravenous heparin(1000u/h) continua 24-48h.In 63 case stunt,10case use wafarin at operation day,and intravenous heparin till PTremind 1-1.5 times of normal countrol.41 case use faxi 04ml/d×10days.All patients take aspirin,persentin,ticlopidine 3-6 months.No bleeding,and thrombotic complications.The results showed thatanticoguinfion was necessary in preventing coronary thrombosis andacute vessel closure,no anticoagulatien in stunting patients may notincrease the risk of thrombotis.

    1998年04期 180页 [查看摘要][在线阅读][下载 70K]
    [阅读次数:8 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:9 ]
  • 经皮冠状动脉腔内成形术与静脉溶栓治疗急性心肌梗塞再通成功率的比较

    伍海安;陈国俊;梁明;关卫;

    急诊经皮冠状动脉腔内成形术(PTCA)和静脉溶栓是两种治疗急性心肌梗塞的有效方法.自97年9月至98年3月,我院收治的急性心肌梗塞患者中的51例,随机分为 PTCA 组和静脉溶栓组.PTCA 组27例,静脉溶栓组24例,两组病人治疗前后均给与相同的一般治疗,治疗后静点肝素,保持 ACT 在160-180秒之间,持续72小时.PTCA 组成功率96.3%.成功的靶血管术前平均狭窄率94.2±4.3%,术后残余狭窄15.3±8.9%.静脉溶栓组成功率79.1%,梗塞相关血管残余狭窄率56.4±18.3%.未成功的5例中1例死于心源性体克,4例行补救 PTCA,3例溶栓后残余狭窄>75%者,做了择期 PTCA.两级血管再通率和残余狭窄存在明显差异(P<0.01).PTCA 可使闭塞血管迅速恢复血运,对血管的结构起到即时修复作用.溶栓的疗效受诸多因素的影响,使其作用降低.即使溶栓成功,也常遗留高度的残余狭窄.残余狭窄可导致梗塞后的缺血和梗塞复发.本文溶栓治疗组中1例死亡,4例失败者做了补救 PTCSA,另有3例患者因残余狭窄>75%,做了择期PTCA,说明两种方法在血运重建方面的差别.文献报道急诊 PTCA 可明显降低急性心肌梗塞并发心源性休克的病死率,而溶栓治疗并不能显著提高心源性休克的存活率.本文2例心源性休克患者急诊PTCA 成功后休克纠正.溶栓组1全心源性休克患者死亡,考虑休克未能纠正的原因可能是梗塞相关血管未再通,或可能再通,但存在高度残余狭窄或为多支血管病变.静脉溶栓治疗失败,可能增加早期死亡率,补救 PTCA 可能使溶栓失败的梗塞相关血管获得再通,以挽救濒死的心肌.多个临床试验结果表明:溶栓后立即 PTCA 较溶栓后1-7天的择期 PTCA死亡率,出血发生率及急诊 CABG 需要率均增高,因此冠脉造影最好在溶栓后1-7天进行.如需做 PTCA,选择这段时间较为安全,亦可提高成功率.TIMI-2B 及 SWIFT 试验比较了静脉溶栓后择期 PTCA 与保守治疗的观察结果,两组的EF、再梗发生率及死亡率相同.所以溶栓后残余狭窄<75%、TIMI Ⅲ级的病变血管并非是择期 PTCA 的适应症.

    1998年04期 180页 [查看摘要][在线阅读][下载 70K]
    [阅读次数:23 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:15 ]
  • STUDIES RELATED TO COAGULATION ACTIVATION AFTER THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL INFARCTION

    <正> Objective:Thrombolytic therapy is an established modality in the management ofacute myocardial infarction(AMI).But early reocclusion of 5-15% limits its effectsand modifies the prognosis of involved patients,To identify the coagulation-relatedfactors predisposing to rethrombosis and consequent reocclusion after thrombolytictherapy,this study was designed to dynamically observe the changes of plasmacoagulation activities before and after thrombolytic therapy.Materials and methods:Consecutive 37 patients presenting with AMI were included,28 of which matched with the inclusion criteria for thrombolysis,Either 1500 000U ofurokinase or 1 500 000U of streptokinase was infused intravenously within 30min.0.3g of aspirin was taken sublingually by all the patients before the start ofthrombolysis and maintained 150mg once daily.Subcutaneous calcium heparan,7500U twice daily was administered 12 hours after the initiation of thrombolytic therapyand sustained for 4-10 days.Upon the diagnosis of the AMI established,blcodsampling was performed periodically and plasma ATM(antithrombin Ⅲ modified)and D-D(D-Dimer) determined by ELISA.Changes of these two parameters within andbetween different subgroups were analyzed.Results:Plasma ATM and D-D increased significantly 2 hours after thrombolysisinitiation.Plasma ATM levels peaked 4 hours later,sustained for at least 3 days,Plasma D-D peaked in 2 hours and returned progressively to normal 12 hours afterthrombolysis In patients without thrombolysis,no significant changes were found inplasma ATM and D-D levels during the whole monitoring period.A positivecorrelation was present between plasma ATM and D-D levels in thrombolytic patients.By subgroup analysis,coagulation activation occurred upon infusion of thromnbolytics.no matter whether the infarct-related vessels were reperfused or not,or which kind ofthromboiytics we chosen,Conclusion:1)Thrombolytic therapy activates coagulation system,which is positivelyrelated to clot lysis.2)Burst of coagulation cascade is only related to thrombolyticsinfusion.3)The anticoagulant regimen we now used could net sufficiently suppress theactivation of coagulation.Earlier or simultancous administration of intensiveanticoagulation may benefit more from thrombolytic therapy for patients with AMI.

    1998年04期 180页 [查看摘要][在线阅读][下载 70K]
    [阅读次数:13 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:8 ]
  • THE CLINICAL STUDY OF RECOMBINANT TISSUE-TYPE PLASMIOGEN ACTIVATOR IN 53 PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

    <正> The purpose of this study is to evaluate efficacy and safety of intravenousrecombinant tissue-type plasminogen activator(rt-PA) in treatment of acutemyocardial infarction(AMI).Fifty-three patients with AMI admitted to ourhospital from April 1995 to December 1997 were confumed to the inclusion andexertion criteria of thrombolytic therapy.The patients in Group B and to receivert-PA intravenous(i.v.) blous 0mg in five rain followed by an 40mg i.v.infusion over 55 min.or over 85 min.The clinical criteria of reperfusion wereevaluated.The reperfusion rate of Group A was 67.86% and 92.0% of Group B.The total reperfusion rate was 79.25% in 53 patients who treated with rt-PA.Hypotension,mild bleeding rigor occurred respectively in 11.32%.13.20% and1.87% of patients with rt-PA,rt-PA is a safe and effective thrombolytic agent.Total dose of 50mg of rt-PA is suitable to use among Chinese.

    1998年04期 180页 [查看摘要][在线阅读][下载 70K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • CIINIC VALUE OF DETECTING VIABLE MYOCARDIUM BY SUBLINGUAL NITITROGLYCERIN(NTG)ADMINISRATION BETORE REAT~(99m)Tc-MIBIMYOCARDIL TOMOGRAPRY IMAGING

    <正> To evaluate the clinic value of comb-ination of rest 99mTc-MIBI myocardial tomograaphy with mitroglycerin(NTG)sublingual administration in assessing myocardial stabilityRoutine rest 99mTc-MIBI myocardial tomography imaging wasperformed for 36 patients with coronary heart disease(12)with old eyocardral infarction,12 with unstable angina and12 with stable anginal,and 48 hours later NTG wasadministrated aublinggually(0.5mg)5 minutes before thetrace ingection,and then rest mycoardial imaging wasperformde again Showed 36 patients gad 111 segments ofhyperfusion in rest imaging,46 patients had improvement ofperfusion after NTG administration(41.4%).7 segments wereindentified as irreversible perfusion defects inpatients with UA.and without in SAConclusions:The administration of NTG before rest 99mTCMIBI SPECT may be a useful approach for predictingmyocardial viability be helpful for assessing patients'condition and direct treatment,The results require furtherstudy.

    1998年04期 181页 [查看摘要][在线阅读][下载 52K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • STUDIES OF ASSESSMENT OF MYOCARDIAL VIABILITY BY TC-99M SESTAMIBI MYOCARDIAL SCINTIGRAPHY AND APPLICATION IN CORONARY REVASCULARIZATION

    <正> The purpose of the studies were to explore the effective ways to enhance theability of routine rest Tc-99m-sestamibi(MIBI)myocardial scintigraphy toassess myocardial viability and to evaluate value of eletrocardiographic(ECG)changes during the percutaneous transluminal coronary angioplasty(PTCA)In assessing viable myocardium,Four methods,(1)rest-nitroglycerinaugment,(2)rest-gated,and(4)meaaurement of ECG changes in ST-T,QRSelectric axis were used in 20,30,10 and 15 patients with coronary artery d.s-ease treated with coronary revascularization.The results showed that in eval-uating viable myocardium,the positive predictive values for methods(1)-(4)were 95.9%,68.5%.84.1% and 88.9%,respectively,the negative predic.tive values were 68.2%.90.1%,90.0% and 83.30%.respectively:the predic-tire accuracy rates were 82.5%,77.3%,87.2% and 86.7%,respectively,The results indicate that identification of viable myocardium with ~(99m)Tc-MIBI can be effectively enhanced with methods(1)-(3);the method(4) isgood one to assess myocardial viability,the ~(99m)Tc-MIBI myocardial scintig-rephy can provide objective data for evaluating treatment effects by coromaryrevascularization.

    1998年04期 181页 [查看摘要][在线阅读][下载 52K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • THE ASSESSMENT OF INTRACORONARY ULTRASOUND (ICUS) IN CORONARY HEART DISEASE WITH INTERVENTIONAL THERAPY

    <正> 20 patients of coronary heart disease were consecutivelyexamined before and immediately after balloon angiopiasty anddeployment of stent with a 3.2F,30 MHz rotational tip intravascularultrasound system.Minimal luminal diameters,vessel diameters,crosssection area and vessel area were measured before and after balloonangioplasty and deployment of stent.All of the patients had severestenosis in the target vessel of interventional therapy and plaques ofeccentric were determined in 16 patients before interventional therapy.The minimal luminal diameters and vessel diameters were 2.19±0.13 mm Vs 3.09±0.09 mm and 4.59±0.11mm Vs 4.58±0.09 mmbefore and after therapy.The cross section area and vessel area wereseparately 4.29±0.46 mm~2 Vs 6.75±0.67.mm~2 and 16.18±1.11mm~2Vs 16.60±0.74 mm~2 before and after therapy.The minimal luminaldiameter and cross section area were significantly different(p<0.001).ICUS was an useful modality for evaluating the morphologicmechanism of dilatation after balloon angioplasty and deployment ofstent.

    1998年04期 181页 [查看摘要][在线阅读][下载 52K]
    [阅读次数:6 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • ~(99m)TC-MIBI心肌灌注断层显像与冠状动脉造影在诊断冠心病中对比分析

    刘可权;蔡凯;夏明凯;蒋祖勋;

    为比较冠状动脉造影和~(99m)TC-MIBI 心肌灌注断层显像在诊断冠心病中的作用.147例可疑冠心痛均行冠状动脉造影和~(99m)TC-MIBI 心肌灌注断层显像.最终诊断:冠心病115例,其它心脏病23例,无器质性心脏病9例.在115例冠心病中,有112例核素心肌显像呈阳性,9例无器质性心脏病患者7例核素心肌显像阴性.结论:在冠心病诊断中,心肌灌注单光子发射计算机断层显像(SPECT)的敏感性和特异性分别为97.4%和77.8%,两项检查阳性者,冠心病可确诊;均阴性者,可否定;单纯一项检查阳性者,必须结合临床分析.

    1998年04期 181页 [查看摘要][在线阅读][下载 52K]
    [阅读次数:31 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:9 ]
  • Application of intravascular ultrasound in coronary atent implantation

    <正> Objetive To determine the evalustion of intravascular ultrasoumd(IVUS) incoronary stent implantation.Bacloground.Until 1992,the success of stent deployment was assessed byangiographic criteris only,but in 1993 the procedure was expanded to includepostprocsdural IVUS imaging.It demonstrated that incomplete apposition of thestent struts to the vessel wall was strill present in 88% of the cases with an optimalangiographic result.Methods.We used mechanical 3.5F 30 MHz monorail intravascularultrasound catheters.Ultrasound criteria for successful stent deployment were(1)symmetry (2)minimal lumen diameter>3mm (3)no echo-free spaces betweenthe stent and the vessel and(4)no uncovered dissections.The events,includingacute thrombosis,revascularization,cardiac death and angina pectoris wereobserved at six months of following up.Results.81 cases with stent implantation were studied.Postprocedural IVUSwas performed in 44 cases(Group A)and without IVUS in 37 cases(Group B).The diameter of stents was measured from IVUS imaging and it was 2.72±0.40mm×2.68±0.37 mm.Nine cases(20.5%) needed twice or more to repeat stentdilatation.The pressure of balloon dilatation was 12-15 ATM.A 7.1% reductionin events was observed in the ultrasound group(21.6% event in Group B vs 4.5%in Group A).No acute thrombosis,revascularization,and death happened in theultrasound group.Conclusions.IVUS has an essential role in developing an optimal strategyfor stent deployment.

    1998年04期 182页 [查看摘要][在线阅读][下载 435K]
    [阅读次数:6 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • The Effects of The Angiotensin Ⅱ Receptor in Neointima Hyperplasia After Vascular Balloon Injury

    <正> Objective:To investigate the role of angiotensin Ⅱ receptor(ATR) inneointima hyperplasia after vascular balloon injury.Methods:The tissueATR and ATR subtype was measured by the radioligand binding essay.Inorder to understard the proliferous procesa of vascular smooth muscle cells(VSMC),the proliferation cellular nuclear antigen(PCNA) was observedby means of immunohistochemistry techniqu in the rats model aftervascular balloon injury.Results:The ATR increased significantly at day 3(P<0.05),the maximal binding capacity of receptor in injury artery was 3times as those in the control group at day 14 and recovered at day 28 aftervascular balloon injury.However,its equilibrium dissociation contantwas not significantly change(P>0.05).The ATR in normal andproliferating iliac artery was exclusively angiotensin Ⅱ type 1 receptor(ATIR).Irbesattan,a non-peptide ATIR antagonist,inhibited significantlythe proliferation of VSMC and attenuated neointima area However,CGP42112A,a non-peptide angiotensin Ⅱ type 2 receptor(AT2R)antagonist,had no effect on neointima hyperplasia.Conclusions:ATRupregulates,and ATIR is involved in neointima hyperplasia aftervascular balloon injury.

    1998年04期 182页 [查看摘要][在线阅读][下载 435K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • 冠状动脉病变程度及病变支与QTc离散度关系的探讨(摘要)

    陈烯明;胡方斌;陈次滨;吴沃栋;劳绮云;卢雄;

    本文在冠脉造影基础上对47例冠脉正常,82例冠脉病变(狭窄≥50%)患者12导联心电图 QTcd 进行分析以探讨 QTcd 与冠脉病变程度及冠脉病变支之间关系。1 资料与方法:1994年12月至1998年5月临床谚断或疑诊冠心病而行冠脉造影且心电图资料完善者129例进入本研究。根据冠脉造影结果分组,冠脉正常组47例,男性27例,女性20例,平均年龄45.3±12.2岁,冠脉病变组(指左或右冠或其主要分支任何一支或一支以上狭窄≥50%)82例,男51例.女31例,平均年龄58,8±13.2岁.再根据冠脉造影结果将冠脉病变组分成:冠脉狭窄≥75%组33例,冠脉狭窄≥50%≤75%49例。单支病变组34例,双支病变组27例。三支病变组21例.左冠变组48例,右冠病变组84例。收集上述组别患者12导联心电图进行分析,测量 QT 间期.各导联连续测3个 QT 间期取其平均值 QTcd=(QTmax-QTmix)/(RR)~(1/2)。所有数据用 X±S表示.组间比较采用 t 检验。2 结果:冠脉病变组 QTcd 较冠脉正常组 QTcd 明显增大,两组比较有显著差异(p<0.01).冠脉狭窄≥75%组 QTcd 较冠脉狭窄≥50%(75组 QTcd 显著增大,两组比较有显著差异.(P<0.05)。双支病变组 QTcd 较单支病变组 QTcd,三支病变组 QTcd 较双支病变组 QTcd 显著增大,且均有显著差异(p<0.05),左冠变组 QTcd 与右冠病变组 QTcd 均增大,两组比较无差异(p>0.05)。3 讨论:冠状动脉病变者由于冠脉储备下降.心肌缺血,缺氧。细胞膜 Ha-K 泵能源不足。导致复极过程廷迟。所心冠脉病变者 QTcd 增大,本文 82 例经冠脉造影证实的冠状动脉病变患者 QTcd 明显增大,与冠脉正常组比较有显著差异。且冠脉狭窄程度越重.QTcd 增大越明显,冠脉病支越多 QTcd 增大亦越明显,表明 QTcd 增大对评价冠脉狭窄程度、冠脉病变受累支数有一定价值,但本研究未发现冠脉的不同病变支对 QTcd 增大有明显影响。

    1998年04期 182页 [查看摘要][在线阅读][下载 435K]
    [阅读次数:17 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:18 ]
  • THE CARDIOTOXICITY OF TRICYCUC ANTIDEPRESSANT OVERDOSE AND EFFECTS OF PHYSOSTIGMINE ON IT

    <正> Tricyclic antidepressant overdose(TCAs-OD)is now recognized as one of the most commonforms of acute life threatening self-poisoning,The major features of TCAs-OD includecardiac,neurologic and anticholinergic complications.However,the measures andantidotes recommended for the management of the cardiac complications have unfortunatelybeen based in large part on anecdotal reports and have been toplcs of considerablecontroversy,especially In the use of physostigmine(Phys).The purpose of our experiment isto study the effects of TCAs-OD on the cardio-vascular of rats and the factors that contributeto the lethality of it.The l.v.infusion of AMI in rats under artificial respiration produced deathdue to cardiovascular collapse.it Was characlerized by hypotension,bradycardia,depression of myocardial contractile force and intraventricular conduction delay.Studies onanesthetized spontaneously ventilated rat models given AMI(l.v.infusion)showed that afteran initial hypotensive response,pronounced respiratory depression invariably occurredpreceding critical changes in the heart with the incressing doses,respiration changed fromintercostal to abdominal,reducing both in rate and amplitude prior to amhythmlas and heartblock.The cardiac effects were followed by apnea.Supportive mechanical respirationdramatically reversed the toxic syndrome.Heart action toward normal and blood pressurewas restored.From the recovery and reversible nature of the cardiotoioxic signs,It appearsthat respiratory depression plays an important role in the toxicity of TCAs on the heart.Theeffects of Phys on TCAs-OD was also studied.it was found that Phys potentiates thetoxicity and lethality of two TCAs.AMI and clomipramine in mice.The LD50 of both thesedrugs was reduced 7.4% and 17.3% respectively when administered in conjunction with low,subtoxic dose of Phys(0.15mg/kg).Moreover,the influence of Phys in the treatment ofcardiotoxicity and respiratory amest caused by AMI,has been investigated in order toestablish its possible usefulcess in clinical practics.In experiment on rats.Phys wasineffective against the cardiovasular to further reduction of heart rate.the influence onrespiration was also unpredictable.We suggest that it is doubtful that Phys has any piace inthe routine management of TCAs-OD.

    1998年04期 182页 [查看摘要][在线阅读][下载 435K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • CHANGES AND SIGNIFICATION OF SERUM CPK BEFORE AND AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN PATIENTS WITH CORONARY HEART DISEASES

    <正> To study the damage effect of percutaneous transfuminalcoronary angioplasty(PTCA)on myocardium,wedetermined the serum CPK and CPK-MB level in 35 casesof patients with coronary henrt disease(CHD)beforePTCA and at 6th,12th,24th hour,2nd,3rd day afterPTCA.The results showed that after PTCA,the serumCPK and CPK-MB in 21 of 35 case of patients wised at12th hour.2nd day reached the peak level.But comparedwith others,it has no significant different(P>0.05).TheCPK and CPK-MB decreased to normal level at 3rd day.Itis suggested that PTCA has no significant damage effect onmyocardium.

    1998年04期 183页 [查看摘要][在线阅读][下载 431K]
    [阅读次数:13 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • STUDIES ON TILT TABLE TESTING IN SYNCOPAL PATIENTS WITH PAROXYMAL SUPRAVENTRICULAR TACHYCARDIA

    <正> The commonly proposed mechamism of syncope in patients(pts)withparoxymal supraventricular tachycardia(PSVT)is a more rapid tachycardiarate.Nevertheless,the probability of a coesxistent vasovagal syncope(VS)component has not bees adequatelly investigated in these patients.Westudied 3 groups:group 1(G1):20 syucopal patients(age:37±9 years,M/F:11/9)with supraventricular tachycardia,group 2(G2):40 Syncopalpatients(age:37±13 year,M/F:19/21)without supraventriculartachycardia,these syncopal patients with syncope of unknown etiology andgroup 3(G3):22 healthy controls(age:39±10 years,M/F:10/12).Thesame tilt table test(TTT)protocol was used(25min in 80 degreesUpright followed by two 10 min stages in the same postion undergraded isoproternol(iso)intravebiys infusion at 2ug/min and 5ug/min).The tilt table test was considered positive(pos)if induced syncope dueto hypocension with of without bradycardia.Results:A positive tilttable test result was observed in 13 patients of G1(65%)and 30 patientsof group 2(75%)(pNS).In contrast,only 5 of the healthy controls group(22.7%)developed syncope(p<0.05).We conclude that syncopalsupraventricular tachycardia patients commonly demonstrate a positivetilt table test.Tilt table test is a useful test for investigatingsyncope in patients with supraventricular tachycardia.Tilt table testis also a safe,simple and effective test for nonivasive identifyingvasovagal syncope.Tilt table test shoule be used widely.

    1998年04期 183页 [查看摘要][在线阅读][下载 431K]
    [阅读次数:5 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • REDUCTION IN QT INTERVAL DISPERSION BY SUCCESSFUL CORONARY ANGIOPLASTY IN UNSTABLE ANGINA OR MYOCARDIAL INFACTION

    <正> Increases of QTc interval diapersion has been reported to be amarker for ischemia.The effects of coronary artery revascularizationon QTc dispersion have not been previously reported.We studiedOTcd in 34 patients with a mean age of 55 years(range 31-72)withcoronary artery disease who underwent successful,uncomplicatedcoronary angioplasty(PTCA).We analysed 12-lead ECGs recordedbefore,1 day and a week after the PTCA.QT intervals were mea-sured by an observer who was blinded to the time the ECG wasrecorded,and to all other clinical information.QT intervals were cor-rected using Bazett's formula.QTc interval dispersion was calculatedas the difference between the maximum and minimum of the 12-lead EKG QTc interval.The QTc dispersion in a day(35±13)and(34±13)a week after PTCA was significant less reductive than theQTc dispersion(64±16),before PTCA(P<0.05).Successful reves-cularization by PTCA results in a significant reduction in QTc inter-val dispersion which persists over time.It may be a mechanism ofbenefit of PTCA therapy.Whether this measurement would predictrestenosis in such patients requires further study.

    1998年04期 183页 [查看摘要][在线阅读][下载 431K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • PTCA对心肌梗塞恢复期患者QT离散度的近期影响

    刘黎明;张永浩;

    目的:探讨经皮穿刺冠脉成型术(PTCA)对急性心肌梗塞(AMI)恢复期患者近期 QT 高散度(QTd)的影响及其影响因素。方法:对我院 AMI 恢复期成功地进行 PTCA 的14例病人手术前后的常规12导联心电图进行 QTd 的分析,然后根据 QTd 的降低或增大再进行比较分析。本组病例 PTCA 后平均住院<30天,结果:1、PDCA 前后 RR 间期、QTmax、QTd、QTcmax、QTcd 分别为893±127ms、879±70,431±24、411±23.40±18、38±23.456±21、445±21,56±30、42±24.2、14例患者中,6例PTCA 前后 QTcd 分别为77±10ms,30±22ms,PTCA 后 QTcd 平均下降47±26ms(P<0.01)。6例 PTCA 前后 QTcd 分别为40±20ms.63±23ms,PTCA 后 QTcd 平均增大20±13ms(P<0.05),2例在 PTCA后 QTcd 无变化,对比分析发现,平均年龄下降组58.7±6.5岁,增大组41.3±10.5岁(P<0.01),选择性冠脉造影侧支循环阳性例数为5∶1(P<0.05).其余在高血压、糖尿病、高血脂、吸烟、饮酒史方面,PTCA 后平均住院天数,入院后服β阻滞剂及治疗、溶栓成功例数,梗塞部位、梗塞面积,选择性冠脉造影病变血管数量,心脏超声发现的心肌肥厚,心脏扩大,室壁运动异常,LVEF 下降等方面两组间均无显差异。结论:高龄患者,病程较长,心肌有较充足的时间形成侧支循环,侧支循环的建立有助于 AMI 恢复期患者行 PTCA 后近期 QTd 的改善。

    1998年04期 183页 [查看摘要][在线阅读][下载 431K]
    [阅读次数:19 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:11 ]
  • Correlation of Coronary Angiographic Morphology and Clinical Presentation in Unstable angina

    <正> Objective:To seek the relation between clinical presentation(Braunwaldclassification)or electrocardiogram(ECG)and angiographic morphology inpatients with unstable angma(UA),and to determine which clitoral markerscould reliably predict unstable lesions and cardiac eventsMethods:120 hospdalized patients with a clinical diagnosis of UA and anabonrmal angiograms(≥50% diameter stenosis)were selected The lesionmorphology included sunple lesion,complex lesion and inracoronarythrombus(ICT)In-hospital events included acute myocardialinfarction,cardiac death and prompt revasculan-zation Logistic regressionwas used to evaluate the ability of clinical markers to predict unstable lesionsand cardiac events.Results:There were more complex lesion in class Ⅲ group(61%,or 20 of33)than in class 1 group(30%,or 13 of 43,P<0.05)and more ICT in class Ⅲgroup(18%.or 6 of 33)than in class Ⅱ group(2%,or 1 of 44,P<0.05)Thetare of cardiac events was higher m class Ⅲ patients(58%,or 19 of 33)thanin class 1 patients(19%,or 8 of 43,P=0.01)or in class Ⅱ patients(25%,or Ⅱof 44,P<0.01)Logistic regrassion analysis demonstrated that an abnormalST segment of ECG or Braunwald class Ⅲ were highly predictive of thepresence of complex lesion morphology(P<0.01,OR 4.9,P<001,OR3.3,respectively)An abnormal ECG was the single predictive clintcalindicator of triple coronary disease(P<0.01.OR 3.9)and cardiacevents(P<0.001,OR 4.8).Conclusion:Complex lesion can be best identified by the clinical featureof recent onset refractory angina at rest and abnormal ECG Patients withabnormal ST segment represents a high rate of triple coronary disease anda high risk of cardiac events.

    1998年04期 184页 [查看摘要][在线阅读][下载 69K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • THE CORRELATION BETWEEN QT DISPERSION AND THE DISPERSION OF DEPOLARIZATION AND REPOLARIZATION IN CANINE EPICARDIUM

    <正> The QT dispersion(QTd)is the difference between the longest and theshortest QT interval in the 12-lead body surface electrocardiogram(ECG)and may play an important role to predict ventricular arrhythmias and sud-den cardiac death.This study test the relationship between the QTd and thedispersion of depolarization and repolarization directly from epicardium incanines.Methods:ECG in body surface and monophasic action potentl(MAP)at21 different epicardial sites were recorded in 16 canines.The QTd was com-pared with the dispersion of MAP duration at 90% repolarization(MAPD90d),recovery time(RTd)and activity time(ATd).Results,The QTd,ATd,MAPD90d and RTd are respectively 27±12,16±4,38±11,38±12ms.It was showed a signiflcant correlation of QTd withATd,RTd,and MAPD90d(respectively r=0.98,0.79,and 0.78,P<0.05).Also a good correlation of ATd with MAPD90d and RTd(r=0.81 and 0.74,P<0.05).Conclusion:The QTd correlate significantly with ATd,MAPD90d andRTd.Therefore,QTd could be a reltable way to reflect the inhomogeneity ofrepolarization.

    1998年04期 184页 [查看摘要][在线阅读][下载 69K]
    [阅读次数:6 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • DELAYED CARDIOPROTECTION OF AGED RAT MYOCYTES IS ASSOCIATED WITH ACTIVATION OF MITOGEN-ACTIVATED PROTEIN KINASE

    <正> The delayed cardicprotection of ischemic preconditioning(IPC)has beendemonstrated in heart in vivo and myocytes in vitro in different animal species.However,the cellular mechanism underlying delayed protection of IPC are not fullyunderstood at present.In the model of hypoxia/reoxygenation(H/R)of isolatedventricular myocytes of aged rat,effects of bypoxic preconditiong(HPC)onaged rat ventricular myocytes against lethal H/R simulated ischemia/reperfusion(I/R)injury 24 hours late and the changes of mitogen-activated protein kinase(MAPK)system were observed in the present study.The results showed that HPC attemuatedthe LDH release(72.9±11.4 vs 268.3±29.5,p<0.01)and ATP depletion(19.8±3.4vs 12,2±2.2,p<0.01)in myocytes and increased the visbility(66.0±4.0 vs 52.0±6.0,p<0.05).HPC induced activation of MAPK in myocytes at 5 min up to highpeak(83.2±10.1 vs control 11.0±1.8 pmol/min,mg pr~(-1),p<0.01),The MAPKactivity of aged myocytes were lower than that of neonatal myocytes and had astatistical significance(p<0.05).At 30 min after HPC.the MAPK activity of agedand neonatal rat myocytes were still at high level,and retumed to basic levels at 1h,then maintained to 24 h at that level.preincubation of the myocytes with PD_(098059)prevented the activation of MAPK both in aged end neonatal myocytes(p<0.01).The activation of S6 kinase-the down-stream kinase of MAPK was also observedafter HPC.The results suggest that there is delayed cardioprotection in aged ratcardiac myocytes and the cellular mechanism umderlying might involved theactivation of MAPK system.

    1998年04期 184页 [查看摘要][在线阅读][下载 69K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • QRS Prolongation as an Indicator of Risk of lschemic Ventricular Arrhythmia in Treadmill Exercise Test

    <正> Objective:The clinical value of QRS prolngation as a indicator of risk ofischemic ventricular arthythmia induced by exercise in the patient withischemic heart disease.Methods:17 case patients with ventricular arthythmias were studiedbefore and after myocardial revascularization.These results werecompared with 19 control patients with no ventricular arrhythmia.Theresting and peak exercise electrocardiogram were examined with respectto QRS duration,ST-segment depression,and JT intervals.Result:The QRS duration at rest was similar in case and control patientsand increased significantly with exercise in both groups.However,theQRS prolongation was larger in the case group.In both groups,the QRSprolongation was associated with significant ST-segment depression.TheQRS prolongation>15msec predicted ischimia-related ventriculararrhythmia in 73% of the patients.After myocardial revascularization,there were no QRS prolongation with exercise in either group.Conclusion:QRS prolongation>14msec may be a useful indicator of riskof ischemic ventricular arrhythmia related to exercise in the patients withtschemie heart disease.

    1998年04期 184页 [查看摘要][在线阅读][下载 69K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:10 ]
  • THE RELATIONSHIP OF QTC DISPERSION WITH MYOCARDIAL ISCHEMIA AND SEVERITY OF CORONARY ARTERY STENOSIS

    <正> To assess the relationship of QTc dispersion(QTcd)with myocardialischemia and severity of coronary artery stenosis,QTcd on 12 leadECG was measured in 85 patients and controls,The results showed thatQTcd in patients with coronary artery disease was significantlyincreased than that of controls(46.7+12.6ms vs.26.3+10.9ms,P<0.01);QTcd was longer in patients with unstable angina than that in patientswith stable engina(54.6+13.7ms vs 42.3+14.1ms,p<0.05).Comparedwith single vessel disease group,QTcd was prolonged significantly intwo-vessel disease group(48.7+13.3 ms vs,35.7+11.9ms,P<0.05).QTcd in three-vessel disease group was increased significantly then thatin two-vessel disease group(59.6+15.1ms vs. 48.7+13.2 ms,P<0.05).The results suggest that QTcd have a predictive value for the presenceof myocardisl ischemia and severity of coronary artery stanosis.

    1998年04期 185页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • THE PROTECTIVE EFFECT OF LIMB ISCHEMIC PRECONDITIONING ON IN VIVO HEART SUBJECTED TO ISCHEMIC REPERFUSION

    <正> In the model of m vivo rabbit heart subjected to ischemia/reperfusion(I/R),the effect of limb ischemic preconditioning(LIPC)on I/R injury ofrabbit heart was observed,in order to investigate the phenomenon oforgan crossed preconditioning.The esults found that both of limb andheart preconditioning limited myocardial infarct size(21.3±6.5 in limbIPC group and 19.5±6.3 in heart IPC group vs.36.7±7.2 in I/R group,p<0.05).reduced leakage of lactate dehydrogenase(LDH)frommyocardium(1895±164 in limb IPC group,1758±176 in heart IPCgroup vs.2792±189 U/L in I/R group,p<0.01).It is suggested tha limbIPC has a protective effect on limiting myocardial infarct size induced byI/R injury.The protective degress is similar to that of ischemicpreconditioning on heart

    1998年04期 185页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • CHANGES OF QTe DISPERSION BEFORE AND AFTER RIGHT VENTRICULAR PACINO AND ITS CLINICAL SIGNIFICANCE

    <正> QTc dispersion(QTcd)was studied in 60 patienta with right ventricular pacing.The results show that:(1)QTcd after pacing was significantly Jess than thatbefore pacing(35.72±29.75ms vs 73.78±46.10ms,p<0.001).The changes ofQTcd in patients with Ⅲ~* atrial-ventricular block(from 88.81±49.47ms to36.90±35.80ms)was significantly larger than that in those with sick sinussyndrome(from 58.75±34.87ms to 33.54±13.39ms),p<0.001.(2)The QTcdof syncope patients before pacing was larger then the average value(119.02±36.33ms vs 73.78±46.10ms,p<0.001).The mortality of the patients withQTcd≥60ms after pacing was higher than that of those with QTcd<60ms.p<0.005.The results suggest flint QTcd may be decreased significantly by rightventricular pacing,especially in pationts with Ⅲ~* atrial ventricular block.QTcd before and after pacing may be correlated with seriousness of illness andprognosis respectively.

    1998年04期 185页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • TO STUDY PHYSIOLOGY IN THE CARDIOLOGYTHE EMERGING OF CLINICAL CARDIOPHYSIOLOGY

    <正> Definition A new subspecialty to study the physiological function of heartdisease in the course of etiology,development,treatment and rehabilitationhas emerged as Clinical Cardiophvsiology.Scope and aims To assess the functional changes(such as pumpfunction,electrophysiology and endocrinology)of heart disease in order tounmask the clinical enigma.Methods1.Examinations:(a)Invasive:coronary angiography,ventriculography,intravascular ultrasound(IVUS)and Doppler,angioscopy,intracardiacelectrophysiology,etc.;(b)Non-invasive:ECG,echocardiography,nuclear cardiology,MRI,PET,etc..2.Testings:treadmill or bicycle stress testing,and the following drugscould be used:acetylcholine,ergonovine,adenosine,papaverine,ornitroglycerine under the angiography and/or ICUS or Doppler imagingsor ECG or echocardiography monitoring.3.Treatments:(a)drug therapy:lowering serum lipid drugs,anti-hypertensive drugs(B-blocker,calcium ion antagonists,ACEinhibitors),anti-arrhythmic drugs,anticoagulation agents,thrombolyticagents,etc.;(b)non-drug therapy:interventional procedures(PTCA,stenting,rotablator,etc.),radiofrequency ablation,pacemakerimplantation,maze procedure,CABG,etc..4.Rehabilitations:scheduled recovery procedures,such as nutrients,nursing,exercises,and risk factors modification.Conclusion The advent of Clinical Cardiophysiology may make itpossible that the thinking of doctors changes from the"clinic-patholy"to"clinic-physiology"correlation in the clinical practice.

    1998年04期 185页 [查看摘要][在线阅读][下载 57K]
    [阅读次数:6 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:9 ]
  • Effects of Metoprolol on QT Dispersion and Heart Rate Variability in Patients with Coronary Artery Disease

    <正> Objective:To investigate the Effects of Metoprolol on QTDispersion(QTd)and Heart Rate Variability(HRV)in Patientswith Coronary Artery Disease(CAD).Methods:The changes of QTd and HRV were investigatedbefore and after administrating Metoprolol(93.75±22.8mg/d)for two weeks in the 24 patients with CAD.Results:Compared with healthy adults,the QTd,QTcd andQTmax were significantly higher(p<0.05)in the patients withCAD,and the QTmin lengthened and the QTd shortened whentaking Valsalva s respiration,the SDNNindex,rMSSD,PNN50and HF increased significantly(p<0.01),and LF/HF ratiodecreased,but the SDNN,SDANN and LF did not change afteradministrating Metoprolol.In addition,the QTmin shortened,the QTd,QTcd lengthened significantly(p<0.05),but the QTmaxhad no significant change after administratingMetoprolol(p>0.05).Condusions:The results suggest that the sympathetic nervecould regulate the repolarization speed of the normalventricular myocardium,and change the QTd in the patientswith CAD,Metoprolol relieve not only angina pectoris byincreasing efficiently the blood supply,and decreasing theoxygen demand of the myocardium,but also shorten markedlythe QTd.

    1998年04期 186页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH NORMAL CORONARY ANGIOGRAM BUT POSITIVE TREADMILL TEST

    <正> To investigate the relationship between left ventricularmass index(LVMI),left ventricular end-diastolic volume(EDV)andmyocardial ischemia induced with treadmill exercise test in patientswith normal coronary angiogram.Method:Sixty-one male patientswith normal coronary angiogram were divided into two groupsaccording to treadmill test:positive(23 cases)and negative group(38 cases).Left ventricular end-diastolic diameter(EDD),interventricular septum thickness(IVST),posterior wall thickness(PWT),EDV,LVMI,etc.were measured or calculated withechocardiography.Results:LVMI in positive treadmill test group(114.2±35.8 g/m~2)was markedly larger than that in negative group(90.7±16.1,p=0.0009).IVST and PWT in positive group weresignificantly thicker than those in negative group(p=0.00002,0.00003).EDD and EDV were not different between the groups.Conclusions:The left ventricular mass increased markedly inpatients with normal coronary angiogram but positive treadmillexercise test.Left ventricular hypertrophy or hypertrophy-relatedchanges,e.g.reduction of coronary reserve,may be the cause ofischemia at exercise.The end-diastolic size of left ventricle was notrelated to ischemia induced by exercise in patients with normalcoronary angiogram.

    1998年04期 186页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:5 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • Recent concepta regarding“Mahaim”accessory pathway;Implication for catheter ablation.

    Kaoru Okishige;

    <正> Mahaim accessory pathway has generally been regarded as an accessorypathway which originates from the atrioventricular node and is inserted at,or adjacent to the right bundle branch or ventricle.Recently.severalreportes have demonstrated that these pathways originate from the atrialfree wall distant from the atrioventriculer node.Electrophysiologicalcharacteristics of Mahaim fiber have also been investigated particularlyconcerning its decremental property by examining electrophysiologicalbehavior of the so-called Mahaim potential.We also tried.to delineate thefanctional and anatomical characteristics along the Mahaim fiber with thedetailed electrophysiological study.In my presentation 1 would like todemonstrate that there is electrophysiological evidence Of functionallongitudinal dissociation or supernormality in the Mahaim fiberextrapolated from the discontinuity or the resumption of the antegradeconduction over the Mahaim fiber.1 also demonstrate the exact procedureto eliminate conduction over the Mahaim pathways using radiofrequanencycatheter ablation targeted at the tricuspid annulus.An inter esting case,which under wenr catheter ablation for its wide QRS complex tachycardiaassciated with Mahaim pathway,will be presented for your reference.

    1998年04期 186页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:8 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:8 ]
  • RELATIONSHIP OF CHANGES OF QT DISPERSION AND PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY ON SHORT TIME

    <正> To study the changes of QT dispersion after percutaneous transluminalcoronary angioplasty(PTCA)on short time,We hypothesized wether that the QTinterval dispersion would reduce after successful revascularization.QT intervalanalysis on 12-iced electrocardiograms in twenty male patients with coronaryartery diseases was performed before pTCA,12 hours after PTCA,and beforedischarged(18-21d).Mean QTd and QTcd before PTCA was 71±18ms,73±22ms;immediately after PTCA 44±13ms,48±12ms(p<0.05 vs beforePTCA);and before discharged 47±12ms,50±15ms(p<0.05 vs before PTCA).The reduction in precordial QT interval dispersion after successful PTCA wasdue to shorten of the maximal QT interval.Therefore,QT interval dispersionmay be a marker of successful revascularization.

    1998年04期 186页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:8 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • Clinical analysis of heart rate variability in 32 cases with Unstable angina pectoris

    <正> Abstract Heart rate variability was evaluated in 32 patients with unstable angapectons and 32 control subjects using 24 hour ambulatory ECG.The resuitsshowed that indexes of time-ranged analysis and frequency-ranged analysisin angina pectoris group were significantly different,compared with the controlgroup(p<0.01)This indicates disturbance in autonomic nervous activity inpatients with unstable angina pectoris

    1998年04期 187页 [查看摘要][在线阅读][下载 52K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • The effects of coronary arterial reperfusion on Kechanical parameters of cardiac Functions in Patients with Myocardial Infarction

    <正> IS this study,by use of sscreen demons-tration of echorardiography,phonocarediography andelectrocadiography and monitoring blood pressure(BP)skillsat the samtime.the values of QC,A_2E,LV end- systolic andend-diastolic long-and short-axis dimensions,wall thicknessesand area sizes and synchronous right arm Bp were measured inpost-Ml patients within 3 months.before and aftersublingual isosorbide dinitrate and nitroglycerin respectivelyto reduce blood pressure 0.93-1.86Kpa and 1.86-3.72Kpn.Themechanical parameters of LV end-diastolic and end-Systolicpressure volume and stress-strain relations(Pad.Ved.Pes.Ves,Vop,Emax,Dom,maxEav.Es.σed.σafand pumpingx(EF)were calculated through computer programmed process.Emax is sensitive to ventricular contractility,anxEav issensitive to myocardial contractility;Es is sensitive to thedegree of resistance to ventricular filling;σed and σaft arerespectively called as stress-prelond and stress-afterload.Theresults showed that there were moe significant decrense inVed and Yes;more increase in Vop and Emax;more reduction inEs and σed.therefore.It iS considered that the coronaryatery reperfusion by thrombolysis or PTCA can rescure dyingmyocardium.limit the ventricular remodelling and improveventricular contractility and passive fulling state andrelatively reduce proload.This study has established aretatively convenient,reliable,practical and noninvasivemination method,by which the mechanical parameters ofeardial functions can play a very important role in clinicallyassessing the condition of diseases,guiding trentment.evaluating effectiveness and predicting prognoses.This methodhas important values in clinical practice.

    1998年04期 187页 [查看摘要][在线阅读][下载 52K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • AN ANALYSIS OF FACTORS INFLUENCE ELECTROCARDIOGRAM STRESS TESTING FOR DETECTING CORONARY HEART DISEASE

    <正> Although exercise-induced ST segment depression is thought to be a reliabièmarker of myocerdinl ischemia in most patients,the diagnostic accuracy ofST segment response was influenced by many factors.Objective:Factors influence electrocardiogram(ECG)stress testing were evaluated inthis study.Methods:The treadmill stress test and coronary angiogramrecords were reviewed retrospactively in 453 consecutive patients from1991-1997.There were 44 cases with normal coronary angiogram butpositive exercise stress test results(false-positive,group A),and 33 cases withboth negative angiogram and exercise test(true-negntive,group B).Wecompared the effects of baseline ECG、echocardiogram、abnormalsystolic blood pressure and diabetes mellitus in the two groups.Results:1.There were no difference in age and gender between group A(42men and2 women,age 49±11 years)end B(27 men end 5 women,age 48±10 years).2.There were no significant differences in the two group by baseline ECG inbundle branch block(7 Vs 1)and ST segment depression(9 Vs 4).3.Patientswith left ventricular(LV)hypertrophy by ECG(11 Vs 1,p<0.05)or byechocardiogram(16 Vs 4,p<0.05)were more easy to have false-positivestress test results.4.Abnormal postexercise systolic blood pressure responsedid not influence exercise test results(7vs 1,p>0.05).5.Patients with diabetesmellitus had higher incidence of false-positive stress test results(7 Vs0,p<0.05).Conclusion:Our results suggest that consideration of LVhypertrophy and diabetes mellitus,in combinations with ST depression,mayimprove the accuracy of ECG stress tasting for detecting CHD.

    1998年04期 187页 [查看摘要][在线阅读][下载 52K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:7 ]
  • CLINICAL ANALYSIS OF EARLY POSTINFARCTION ISCHEMIA BY AMBULATORY ELECTROCARDIOGRAPHIC MONITORING

    <正> Objective:To study clinical significance of early postinfarctionischemia by ambulatory electrocardiographic monitoring(AEM).Methods:There were 64 petients with acute myocardial infarction(AMI).43 males,21 females,with a mean age of 61 years.Among of them,31 were anteriormyocardial infarction(MI),26 were inferior HI,7 were HI with botbanterior and inferior,All patlents were contintinueouslyonitored for5-12 days,The judging criteria were①ST segment depressed≥0.1andlasted for≥1 minute②The time interval between two ischemia attacks>1 minute.Results:Of all patients,46 showed postinfarction ischemia(PII)(72%),17 of them with symptom of postinfarction angina(PIA)(37%),29 of them without any symptom(63%).The incidence of PII within a weekafter infarction is 83%.These patients'incidence of arrhythimia,heartfallure,and cardiogenic shock are 90.24%,68.29%,and 19.51% respective-ly,which are much higher than that of those without PII attack.Discussion:The occurrence of PIA indicates relapsing myocardialischemia,and coronary angiography has confirmed a great degree ofstenosis with coronary artery.The exist of PII is one of theIndependent dan factors of bad prognosis of coronary heartdisease.It has been confirmed by other articles that ischemis mayexist whether PIA occurs or not,and the ircidence of ischemia withoutsymptom is higher,having the same result with this one.The depressionof ST segment can sensltively show ischemia So we must pay attentionto the change of ST segment in early stage of AMI.By AEM,we can findthat PII has different appearances and incidence with differentinfarction position and infarction range,and its occurrence has timedistribution,part of them are related to the activities of patients.Ischemia occurs more frequently in patients with anterior HI thanthose with inferior MI.The more extensive infarction,the higherincidence of ischemia,and the incidence of all kinds of complicationsand the mortality rate are higher in those with PII than those withoutit.Weiner D.A etc.also had similar reports.So we must strengthen themonitoring to the patients with PII to lay out individual cure planaccording to different attack characteristics,when necessary,we shouldtake coronary angiography to make PTCA or CABG.

    1998年04期 187页 [查看摘要][在线阅读][下载 52K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:3 ]
  • 保守法治疗永久性起搏器人术后囊袋肿胀

    何仲海;

    笔者就二例植入时间分别为8天和2个月的囊袋肿胀患者采用穿刺或局部引流附加抗生素的保守方法治疗,获得成功。对此常规治疗的方法是将作为异物的起搏器,甚至整个起搏器系统取出体外.笔者认为,肿胀原因是多方面的.如例1,尽管囊液细菌培养阴性,也不能除外术中或术后囊腔出血、积血引起的毒力较低的细菌的继发感染,另外手术所致淋巴管损伤、断裂,导致局部淋巴回流.吸收障碍,组织液滞留,引起局部肿胀尤其在例2.无局部红、热、痛,抽得液体色清,细菌培养阴性,考虑局部淋巴回流不畅所致.保守疗法治疗成功的关键、在于1)局部引流要通畅.引流切口应在囊袋下方,离囊袋要有一段距离.2)局部抗感染,彻底清除血块及坏死组织。3)局部压迫不松懈,但压迫不宜过度.防止困此影响局部血供。加压的目的在于机械性消除渗出,形不成囊腔。

    1998年04期 188页 [查看摘要][在线阅读][下载 71K]
    [阅读次数:16 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:14 ]
  • 非离子型造影剂引起威胁生命的休克反应1例报道

    李震一;黄岚;

    在心血管造影越来越广泛的今天,造影剂引起的严重反应及其处理也应得到足够的重视.对有心血管危险因素的病人,提倡使用非离子型碘造影剂.尽管用这种渗透压低、不离解,不带电荷的非离子型造影剂,我们仍然碰到1例出现威胁生命的休克反应.特报道如下:患者男性62岁,有高血压史及典型心绞痛症状.心电图及24小时动态心电图有缺血性 ST 段改变.作冠状动脉造影的当天,患者没有不良症状,但动脉直接测压血压为80/40mmHg.术中只对左、右冠状动脉分别作1次造影,非离子造影剂 Optiray 320用量不足50ml.证实左冠开口明显钙化,主干几乎完全闭塞,右冠狭窄约85%.术后80分钟患者胸闷、大汗、血压为零.虽经积极抢救,血压为零或不清楚持续7小时,血压回升后需升压药维持达5天之久.输液量每日4000ml 或2000ml,第三天中心静脉压仅6cmH_2O,用低右扩容后血压才逐渐稳定.讨论:造影剂引起的低血压及休克可能是险峻的和灾难性的.对非离子型造影剂也不能掉以轻心.文献中也有低血压持续4天引起死亡的报道.术前静脉注射小量造影剂预测严重反应,通过大组评价预测价值很低。对造影剂所致的低血压,早先按处理过敏性休克的方法以用肾上腺素肌肉或静脉注射,不但没有作用.还可能产生不良反应.Sonnenberg 氏等指出,造影剂引起的非心源性低血压,最有效及应最先使用的治疗是快速静脉辅液.用等渗盐水或林格氏液.Sonnenberg 氏等发现患者静脉压明显减低,甚至为零,表明有效血容量减少在发病中起着重要作用.本例输液量不算少,但中心静脉压仍然低,经加强扩容后血压才稳定。Sonnenberg 氏等认为.这种病例用液体治疗来发现有并发症.也容易为听诊肺部所监护。对疑有早期心衰及需多量补液者,必要时可监测中心静脉压.

    1998年04期 188页 [查看摘要][在线阅读][下载 71K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:18 ]
  • 经皮腔内肾动脉成形术大出血一例

    张薇;郭玉军;余保瑞;

    男性,59岁,高血压病二十年,近一月血压突然明显升高,肾功能减退,药物效差,超声提示:双臂动脉狭窄,双臂墙小.左肾明显。行选择性肾动脉造影(股动脉穿刺三次),右臂动脉近段狭窄90%,压差12KPa,左肾动脉中段狭窄80%.压差8KPa.行经皮腔内肾动脉成形术后造影,右侧残余狭窄10%,压差0.8KPa。左侧残余狭窄80%,压差2.6KPa,术后3小时出现脑缺氧症状.血压为零,应用多巴胺无效,改用肾上腺素后血压不稳定.10小时后查血色素明显降低,超声见腹后血肿、腹腔积液,腹穿抽出少许不血,经输血2200ml,补液等治疗48小时,血压稳定,但血色素不升.考虑(1)穿刺部位出血;(2)肾脏出血。由外科探查穿刺部位,术中见腹股沟韧带后、股动脉前一直径的1.5 mm小动脉听断增活动性出血,,即予结扎,股动脉穿刺口已无法辩认,腹腔留置引流管后返回病房,术中、术后共输血800ml,血色素由42g/L 升到65g/L,四周后出院,随访3个月血压正常.肾功接近正常.讨论:本例肾动脉成形术后腹膜后.腹腔同时出血.以肾脏损伤出血无法解释.穿刺部位出血可能性最大-出血进入腹腔原因则与股动脉穿刺破腹膜(穿刺点偏上)有关,同时穿刺针进入股动脉切听一小动脉,由于为动脉断增,压追不能止血,出血在流向腹膜后同时流入腹腔,而由于局部加压包扎及平卧放未形成血肿。提示股动脉穿刺点应谨防偏上,最好一次成功,术后要严密监测生命体征。

    1998年04期 188页 [查看摘要][在线阅读][下载 71K]
    [阅读次数:17 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:13 ]
  • PERCUTANEOUS MANIPULATION OF INTRACARDIAC CATHETERS:RETRIEVAL,UNKNOTTING,REPOSITIONING,AND STRIPPING

    Jaime Tisnado;Uma Prasad;Janice Newsome;Michael Ko;

    <正> Puroose:Intracardiac embolization of catheter fragments,andiatrogenic,and other foreign bodies,such as stents,intracardiacformation of knots in catheters,malpositioning of intracardiaccatheters,and thrombi formation in intracardiac catheters arc seriouscomplications of catbeterization techniques,associated with highmorbidity and mortality.Material and Metbods:We performed percutaneous retrieval ofintracardiac catheters and iatrogenic foreign bodies(n=40),unknottingof catheter knots(n=4),repositioning of malpositioned catheters(n=31),and stripping of catheters(n=25),in 100 adults and children.Interveotional equipment used included:retrieval baskets,retrievalwire loops,deflector wires,retrieval forceps,and differentangiographic catheters,alone or in combination.Results:Retrieval of catheter fragments and iatrogenic foreign bodieswas successful in 38 patients.There were 3 failures:an IVC filter,acatheter,ans a Wallstent,lodged in the right atrium.Unknotting ofcatheter knots,repositioning of misplaced catheters,and stripping ofcatheters was successful in all patients.There were no majorcomplications.Minor complications were infrequent.Cinclusions:These procedures are quick,safe,and effective tomanage potentially serious complications of percutaneouscatheterization techniques.Dialysis and other central catheters andports can be functional for longer periods.A major operation to solvethese problems,which may include open heart surgery,is avoided.

    1998年04期 188页 [查看摘要][在线阅读][下载 71K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • ELECTROPHYSIOLOGICAL EFFECTS OF CALCITONIN GENE-RELATED PEPTIDE ON NORMAL AND ISCHEMIC MYOCRDIUM

    <正> Calcitonin gene-related peptide(CGRP)has the effect of antiarrhyth-mic,expectally to ischemtc arrhythmia.But up to now,it's electro-physiological mechanism is not known very clearly.In this study,theaction potential and resting membrane potential(RP)in rabbit my-ocardial were recorded with standard glass microelectrodes tech-nique,the electrophysiotogical effects of CGRP on normal and simu-lated ischemtc condition were observed.The results showed that:(1)In normal condition,after afflication of CGRP(the concentration ofCGRP was 1×10~(-8)M,CGRP was purchased from sigma chemicalCo),RP and action potential amplltude(APA)increased significantly(P<0.01),the action potential duration(APD_(30),APD_(50))were notchanged obviously,but the APD_(90)was shorted obviously(P<0.05).(2)In simulated ischemic condition,CGRP had the same effects onRP and APA as normal condition.It prolonged the APD_(30)and APD_(50)obviously(P<0.05)and shorted the APD_(90)signficantly.This indicat-ed that CGRP could reverse the abnormal changes caused by ischemi-a.These results demonstrated that CGRP had stabilizing and protec-tive effects on ischemical myocardial.

    1998年04期 189页 [查看摘要][在线阅读][下载 59K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:8 ]
  • EXPRESSION OF CALCITONING GENE-RELATED PEPTIDE IN VASCULAR SMOOTH MUSCLE CELLS BY RETROVIRUS-MEDIATED GENE TRANSFER

    <正> Background:The contemporary treatment of coronary athero-occlusive disease bypercutaneous transluminal coronary angioplasty is hampered by maladaptive woundhealing,resulting in significant failure rates.Morbid sequelae include smooth musclecell(SMC)hyperplesia and restenosis due to vascular neointimal formation.Calcitoningene-related peptide(CGRP)has been proposed as a potential therapeutic neuopeptide forintimal hyperplastic vascular disease.Methods and Results:In this study,we investigated CGRP gene expression in culturedrat thoracic arterial smooth muscle cells(SMCs)A replication-defective,recombinantretrovirus containing human α-CGRP cDNA(termed pRCGRP)was constructed and usedto infect SMCs in culture.Following selection with G418,cells traneduced by pRCGRPwere found to express CGRP and stable transfer of CGRP in SMCs was achieved withretroviral vector.CGRP gene expression was observed only when cultured SMCs weretransduced with vectors containing the CGRP cDNA No evidence of similar geneexpression was observed in nontranfected or empty vector transfected SMCs CGRPexpressed in the transduced SMCs was secreted into culture medium and was detected byradioimmunoassay(RIA).The highest level of CGRP gene product reached 18.2±0.6pM,whereas that of normal and control group were undectable.Conclusions:The fact that a recombinant gene can be readily inserted and efficientlyexpressed in vascular smooth muscle cells suggests that CGRP gene may be served as apromising candidate gene for gene therapy in atharosclerosis and restenosis.Retroviralmediated CGRP gene transfer may he used to treat atherosclerosis and restenosis.

    1998年04期 189页 [查看摘要][在线阅读][下载 59K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • INTERVENTIONAL THERAPY OF BUDD-CHIARI SYNDROME(CASE REPORT AND REVIEW OF THE LITERATURE)

    <正> A 54-year-old man had ascites,hepatomegaly,abdominal pain and wasmistaken for cirrhosis for two years.This time,MRI and infericrvena cavography showed segmental stances of proximal portion ofinferior vena cava(IVC).The diameter of segmental stenosis ofIVC was 8 mm.He was diagnosed as suffering from Budd-chiarisyndrome(BCS).After 23 mm diameter balloon dilatation catheterhad been used to dilate the proximal caval narrowing for fivetimes,a Gianturco expandable metallic stent(EMS)was implanted,The diameter of segmental stenosis of IVC has gone up from 8 mmto 14 mm.The preasure gradient disappeard after the operation.Followed up for 5 months,the main symptoms and physical signsdisappeared.Review of 20 pieces of literature revealed 165 priorcases of balloon dilatation of the hepatic venous system.Therewere 116 males and 49 famalas with the age ranging from 8-58years,The success rate of operations was 97%.The mean bloodpressure in the IVC dropped from 2.83±0.81 kpa to 0.98±0.59kpa immediately after dilating.Complication:one died withpulmonary embolism and one died with DIC.No other seriouscomplications were reported,133 cases were followed up for anaverage of 20.5 months(range 0.5-120 months).The main symptomsand physical signs improved or disappeared.Reocclusion occurredin 24 patierts,sixteen of whom underwent repeated angioplastyand one of whom was treated with EMS.Review of 7 pieces ofliterature revealed 59 prior cases of patients with the BCS whowere treated with EMS.There were 45 malta and 14 females withthe age ranging from 20-74 years.Technical success rate ofoperation was 100%.No serious complications were reported.Followed up for 0.8-30 months,the main symptoms and signsdisappeared or almost disappeared in all patiens but 7 whosuffered from the cancer of liver.It is concluded thatpercutaneous transluminal angioplasty and EMS placement are safeand effective modes of therapy in the patiente with BCS.

    1998年04期 189页 [查看摘要][在线阅读][下载 59K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:8 ]
  • TRANSDUCTION OF CALCITONING GENE-RELA TED PEPTIDE GENE INTO HUMAN UMBILICAL VEIN ENDOTHELIAL CELLS MEDIATED WITH RETROVIRUS

    <正> BACKGROUND:Several lines of evidence indicate that the process of atherosclerosisand lurninal narrowing after PTCA of atherosclerotic lesions is largely due to endothelialinjury and smooth muscle cells hyperplasia Calcitoning gene-related peptide(CGRP)wasreported to stimulate the proliferation of human umbilical vein endothelial cells(HUVECs)and inhibit the growth of vascular smooth muscle cells.This study was to define thepotential for gene transfer to facilitate endothelial cell regeneration and promote recoveryof endothelial dysfunction.METHODS AND RESULTS:Recombinant retrovirus comtaining human α-CGRPcDNA(termed pRCGRP)was constructed and used to infect HUVECs in culture.Thelevel of CGRP gene expression and the mitogenic effects of CGRP on cultured HUVECswere determined by RT-PCR,radioimmunoassay(RIA)and cell proliferative activity.CGRP gere expression was observed only when cultured HUVECs were transduced withvectors containing the CGRP cDNA.No evidence of aimilar gene expression wasobserved in nontransfected or empty vector transfected HUVECs.Twelve days aftertransduction,CGRP level in the supernatant of CGRP vectors tranduced cells wasdetected at 12.4±0.5pM,whereas that of normal and control group were undectableTransduction of HUVECs with vectors bearing CGRP cDNA construct showed a markedincrease in the number of viable cells observed at 24~120 hours after transductioncompared with transduced cultures containing the empty(control)vector CGRP vectorsenhanced cell cycle progression,as determined by the MTT metabolic assay and FlowCytometry.CONCLUSIONS:These primary results represent the first demonstration of theproliferative effects of CGRP retroviral vector on HUVEC.The CGRP gene cam beeffectively transfered into HUVEC and stably expressed with retroviral vector.CGRPvectors containing the leading sequence enabled mature CGRP to be secreted from thecells.Taken together,these data indicate the potential utility of CGRP constructs in thedevelopment of a novel gene therapy spproach to vascular restenosis and atherosclerosisand may lay solid foundations for in vivo gene transfer next.

    1998年04期 189页 [查看摘要][在线阅读][下载 59K]
    [阅读次数:12 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • The Study of M cell's Characteristics of Action Potential and Its Transient Outward Current

    <正> Introduction:Some studles have described the M cells in the deepsubeploardial to midmyooardial layers of the canine ventricle.Transient outward current of potasium(ito)initiate the repolarization ofaction potentials,and has an important effect on the configuration ofaction potential of epicardium and endocardium.So.it is necessary tostudy further about the contribution of ito in M cells.Methods:Standard glass microelectrode was used to observe actionpotential properties of M cell in canine ventricular tissue allce.The whotecell patch clamp was used to investigate the effect of M cell's ito oh itsaction potential.Results:(1)configuration of action potential:M cell and epicardialpossess prominent spike and dome configuration at early repolarization,but lucks of it in endocardium.(2)Characteristics of action potential:resting potential in M cell was more negtive than of apicardium andendocardium(respectively-88.,-66.5 and -85.9mv),but no statistic'ssignificance.Vmax in M cell possessed much greater than inendocardium and epicardium(299.0,197.6 and 160.4V/s).APD90 in Mcell was longer thin In eplcardium and endocardium(304,227 and211ms when BCL-1000ms);(3)M cell had more rate dependence ofaction potential duration than endocardium and endocardinm when BCLwas 500-5000ms;(4)ito in M cell and epicardium are aignifcantly greaterthan that in endocardium;(5)ito has obvious rate dependence,whenBCL lengthened,ito became strong.Conclutions:M cell possesses special characterlatics of actionpotential,such as obvious spike and dome configuration,much greaterVmax,longer action potential duration and more rate dependence,ito inM cell is one of the ionic busis of its having spike and dome morphologyand obvious rate dependence.vious rite dependence.

    1998年04期 190页 [查看摘要][在线阅读][下载 58K]
    [阅读次数:8 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:7 ]
  • The Improvement of Coil Closure Patent Ductus Arteriosus

    <正> Purpose To improve the method of PDA closuremanipulation for occluding larger PDAs with the diameter>5mm Method:For 3 patients after perforating the femoral artery,a guiding wire wasintroduced into the aortic atery and past through the PDA.Along the wirea balloon catheter was adopted to explore the real internal eiameter and thedistensibility of the PDA.Using a multi-usable catheter which remade fromthe coronary angiographic catheter and had a relative larger cavity was easyto push the coil.Result:The diameters of 3 patients were 6.0,6.3 and40 minutes.A small shunt existed in only one case and disappeared onemonth late.Conclusion:The improved method is safe and valuable forclmical application.

    1998年04期 190页 [查看摘要][在线阅读][下载 58K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • Levels of Soluble P-Selectin in Patients With Unstable Angina

    Jianting Doug;Xiaofei Jiang;Huayu Huang;Ganxiong Liang MD;

    <正> Background Unstable angina occurs when atherosclerotic plaquerupture.Recent evidence suggests a role for inflammation in this process.Leukocyte-endothelial cell interactions are important in inflammationand are regulated by cell adhesion melecules.As a kind of cell adhesionmelecules,P-selectin in platelets and endothelial cells mediates adhesiveinteraction with leukocytes to form thrombi.The purpuru of this studywar to invvstigate plasma levels of soluble P-selectin in patients withunstable angina and in health volunteers.Methods and Results Plasma P-selectin levels were determinedby a monoclonal antibody-bared enzyme immunoassay on plasma samplestaken from 27 patients with unstable angina,46 healthy volunteers.Patientswith unstable angina had angina at rest associated with ECG changes.Blood sample(2ml)was collected within 3 hours after the attack .Inpatiants with unstable angina,plasma P-seleatin levels(23.2±7.5ng/ml)were significently(P<0.005)higher than those in volunteers(10.12±7.61ng/ml)Conclusions our data indicate that soluble P-selectin released intothe blood after the attack of unstable angina and the levels of P-selectin inpatients with unstable angina were increased significantly.Our data indicatethat measur-ements of plasma P-selectin may help us to understandthe pathophysiology of unstable angina and may be clinically usefulas a new molecular marker of platelet aggregation and thrombus fomationin acute coronary syndrom.

    1998年04期 190页 [查看摘要][在线阅读][下载 58K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:10 ]
  • MYOCARDIAL INFARCTION IN YOUNG ADULTS:RISK FACTORS AND CORONARY ANGIOGRAPHY

    <正> 26 cases of an initial AMI who Were admitted to our hospital and who wereunder or 40 years of age(Group A)were compared to 29 patients over 60admitted during the same time because of die same reason(Group B).Group Ahad significant fewer patients with hypertention and diabetes mellitus,and morewith positive family history.Smoking was the most common risk factor in bothgroups,but there was no statistical difference between them as well ashyperlipidamia.But cigarette consumption per day in group A was much morethen that in group B.Location of infarction was most common in anterior wallin group A.In group B it was similar to inferior wall.Coronary angiographywas performed in 17 patients in group A.Most of them had single-vessel diseaseand of the left anterior descending was most commonly involved.Three of themwere found with normal coronary arteries in angiography.In group B there weremore than half of multiple vessel disease.

    1998年04期 190页 [查看摘要][在线阅读][下载 58K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:8 ]
  • The Clinical Significance of the Variation of Plasma Endothelin in Angocardiopathy

    <正> ObJective:To study the clinical significance ofthe plasma endothelin(ET)variation in thecardiovascular disease.Method:To determine the peripheral blood ETlevels by means of radlo-immunlty for 34 cases ofnormal control(BC),34 cases of acute myocardiacinfarction(AMI),43 cases of coronary disease(CHD),25cases of hypertension(HT)and 21 cases ofcongestive heart failure(CHF).Result:the plasma ET levels of AMI,HT andCHF groups are much higher than that of thenormal control(P∠0.01),but the levels of CHD groupand normal group have no obvious difference.Theplasma ET level of AMI and CHF groups indifferent heart classify and the ET level of HTgroups are tend to go up as the disease isexacerbation(P∠0.01).Conclution:The plasma ET density has a closerelationship with the physiopathologic progress ofangiocardiopathy.

    1998年04期 191页 [查看摘要][在线阅读][下载 55K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • The association between coronary angiouraphy and ST-T changes in 81 patients with angina

    Gang noizhl;Tring wel;

    <正> Objective To assess the assoiation betwesn coronary angingraphic(CAG)finding and ordinary electrocardiogram(ECG).Method CAG and ECGwere assessed,and the association between the findings were determined.Results There were 26 patiants(32.1%) with 1-vessel disease;16 patients(19.7%)with 2-vessel disease;19 patients(23.4%)with 3-vessel disease;20patients(24.7%)with no obvious vessel disease in 81 patients with angina.Inpatients with 1-vessel disease,there were 12 cases with a stenosis in proximalleft anterior descending(p-LAD),and with a ECG manitestation of a flattedor inverted T wave in lead V_2~V_4,Ⅰ、Ⅱ、Ⅲ、avE;there were 5 cases withstenosis in m-LAD,end with a ECG manifestation of depressed ST segmentsand of flared or inverted T wave in precordial lead V_3~V_6.and of STsegments 0.4my elevation in precordial leads in one case;there were 4 caseswith stanosis in left conflx(LCX).and with a ECG menifestation ofdepressed ST segments and T wave changes in lead Ⅱ、Ⅲ、avF:and there wasone case with a stanosis in proximal right coronary anery(p-RCA),and witha ECG menifestation of inverted T waves in lead V_1~V_;there were 4 caseswith stanosis in middle and distal of RCA,and with a ECG manifeststion ofdepressed ST segments and T wave changes in lead Ⅱ、Ⅲ、avF.In patientswith 2-versel disease,there were 12 cases with LAD and LCX stenosis,and10 of them had the major stenosis in LAD,and had a ECG manifestation ofST segment depression and T wave changes in lead V_3~V_5,there were noother regularities.In 19 patients with 3-veasel diseases,there were 7 caseswith normal ECG,and most of them had coronary stanosis in p-LAD、m-LCX,m,d-RCA,the degree of stanosis of LAD in 6 of them was slighter thanthe two others,and there were 12 cases with manifestation of ST segmentdepression and T wave changes in lead V_3~V_5,end some of them had ST-Tchanges in leads Ⅱ、Ⅲ、avF.and the coronary stanosis major in LAD.Conclusloa In patients with 1-vessel disease,most of them had stenosismajor in m,d-LAD,and with a ECG manifestation of ST-T changes in leadV_3~V_5,and in patients whose stenosis not major in LAD usually had normalECG.

    1998年04期 191页 [查看摘要][在线阅读][下载 55K]
    [阅读次数:6 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • REVIEW OF EXPERIENCE WITH THE NEWER GENERATION IMPLANTABLE CARDIOVERTER-DEFIBRLLATOR 1998

    Hon-Wah Chan;Wal-Kwong Chan;Stephen Lee;Llnda Lam;Ching-Wah Lam;Chiu-Sun Yue;Taan-Fal Chan;Man-Hong Jim;

    <正>Introduction Thltreport review*ourrecentexperienceofImplentatlon of me newer generation Implentsble cerdloverter-deflbrlllator (ICD) in two (ooal cardiology oantnis.Pram January 1998, 11 patients (0 mete, maan aga 80.8 yeira) received iCOe. 6 had dilated cardtomyopathy, 4 feohamic heart disease and 2 hypertrophlc cardlomyopathy. The presentations war* palpitations with documented ventricular tachycardia or ventricular flfriflatfon (VT/VF) (n fl). non-sustained VT (N 3) and history of unexplained recurrent syncope (n*1). All patlenta had etoctrophyvloloQtcal atudles (ventrlculer tachycardia tndudble In 8. ventricular flutter In 2. One patient who presented with non- utta(ned vT and recurrent synoopa and Indudble ventricular flutter wa treated directly with ICD Implant without prior madteatlonr Tha r malnln0 10 oetei had felled medloal treatment Tha prooadure w § carriad out In the cardiac catheterizatlen laboratory under con*cloir tadatlon and local anaestheele. All patlentt tolerated the prooadura wall. &ubmu cuiar Impfantatlon was performed In a and aubcuteneout In 3. Slnplo lead ICD wltti algorithm for supraventrioulerteohycardle discrimination were used In 10 patients end duet chamber ICO was Implanted in 1. The precedura was uncomplicated In all petlents. All patients had a deflbrillatlon threshold testing (DFT) of more then 10J safety margin. All patlenta ware re-examined one day liter the procedure on their recapitulation of the procedure and assessment with coring system over prosanoo of mnolB, recall of the procedure and the severity of pain during dft testing. Upon a mean follow-up of 1 to 8 months, there was appropriate shocks In 4, recognition of atrial arrhythmia In 1 {with the dual chamber ICD) wtth no therapy given. There were 2 Inappropriate shocks but upon reprognsmmlng or the SVT dliorlm'naBon algorithm, thera was no recurrence,Conclusion : Newer generation pectoral (CDs with its smalter alee end SVT discrimination algorithm have significant adventage over the older generations ICD In that they could be Implanted under local anaesthesia with less patient discomfort and have a low Incidence of Inappropriate ahooke.

    1998年04期 191页 [查看摘要][在线阅读][下载 55K]
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  • SERIOUS SIDE EFFECTS OF ULTRAVIST IN TIIREE PATIENTS

    <正> As a non-ionic X-ray contrast media,Ultravist had been used widely on ctinic.Serious side effects occurred during or after coronary artery angiography or PTCA in3 patients(2 male,1 female)caused by Ultravist in past three yenrs.All puticnts hadbeen tested by Meglumini Diatrizoas(Cardiografin)first,the results were nagative.Then Ultravist was used in angiography and PTCA.Reverse reaction occurred duringangiography in one patient and 30 to 60 minutes sfter engiography in two patients.These include:serious hypotension,pale,sick,vomitting,profuse sweating.bradycardia or tachycardia.The blood pressure decreased to 50/30 mmHg or couldn'tbe measured and the heart rate reached to 20-30 bpm.Emergent treatments includingintravenous injection or infusion with Atropine,Dopamine.Aramine anddexsmethasone were adapted.The blood pressure and heart rhythm returned tonormal gradually.10 to 20 days after englography,these 3 patients undergone PTCAor coronary stentlng.The same adverse reaction occurred again.During PTCA,ventricular fibrillation happened suddanly on the female patient after 5 minuteshypotension while no distinct evidences of coronary artery complication.Afteremergent treatment similar to above measures,all the three patients returned tonormal agsin in one hour to three days.Instant restenosis presented in one malepatient 3 months later,In-stent PTCA was done again and the same adverse reactionshappened again.We included that:Ultravist can cause serious side effacts,if emergentmeasures not be taken may led the patient to death;If side effects related to Ultravistoccurred during angiography,the same side effects may occur gain during or afterPTCA,and the treatment may be more difflcult;If the result of testing using loniccontrast media prlorly Is negative don't mean that side effects related to Ultrvfst willnot happen dusing or sfter coronary nngiography and PTCA.

    1998年04期 191页 [查看摘要][在线阅读][下载 55K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:7 ]
  • High Thoracic Epidural Analgesia for Cornary Heart Discase Treatment snd Perioperative Cardiac Protection

    <正> Objective:To assess the therapeutic effects of cardiac sympathelicblockade in coronary heart disease(CHD),acute myocardial infarction(AMI),andperioperative cardisc protection.Material and Method:In a series or CHD and AMIpatients treated in this hospital,thoracic epidural ansigesin(TEA)at T1-5 wasperformed by epidural bolus injection of 5-8 ml of 0.5-0.75% lidocaire every 2 to 4houra,with the duration and number of TEA trastment course suited to patient'scondition.Result:In 48 cases of angina pectoris with a score of 95—100 and in 12cnses of angina pectoris with a score of 80~94.the post-TEA scorc becamezero(completely painless);other pre-and post-TEA data ineluded NST-T3.1±1.0.p<0.01).∑ ST-T(2.89±0.9 vs.1.8±0.8,p<0.01),le ventricular(I.V)diastolic performance(E/A 0.89±0.4 vs.1.04±0.37,p<0.02;E penk 57.41±15.18 vs.66.35±13.73,p<0.02),LV systolic performance(SV 48.79±19.42 vs.67.2±15.8.p<0.01;CO 3.97±1.3 vs.5.4±0.86,p<0.05;EF 58.04±10.28 vs 69.7±8.92.p 0.02).Inpatlienls with angina pectcris and head failure,pre-and post-TEA compnrisonsincluded ANP(324.57±227.6 vs.104.67±107,46.p<0.02)and Q-T cd(63.7±30.8 vs.45.6±25.7,p<0.05).In patients with AMI.the serum free fatty acids(FFA)levellowered from 1310±233(wEq/L)on admission to 456±72 at 12h after TEA,inomparison(p<0.05)with 1491±524 to 1383±532 in the control group without use ofTEA;pump failure incidence of the TEA and control groups was in a ratio of 1 to 9;and arrhythmia incidence of the TEA and control grouns was in a ratio of 2 to 11.Ahundred perioperative patienta with CHD used TEA.and among them no deathoccurred,ventricular arrhythmias and atrial prernalure heals disappeared.Conclusion:Thocic epidural anslgesin(TEA)at T1~5 is significantly effective for:preventionand treatment of angina pectoris;emergency prevention of AMJ by combined use ofTEA and heparin;improvement of diastolic and systolic functions in CHD;prevtionof pump failurc and atrhythmias in AMI;and perioperative cardiac protion ofpatients with CHD.

    1998年04期 192页 [查看摘要][在线阅读][下载 48K]
    [阅读次数:14 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:20 ]
  • STUDY OF OCCURING MECHANISM OF ATRIAL FIBRILLATION IN WOLFF-PARKINSON-WHITE SYNDROME

    <正> We selected 231 petients with WPW syndrome that was concomitant withhistory of tachycardia and 200 patients with history of AVNRT.The inci-dence of atrial fibrillation in WPW group was 46.3 % That in AVNRTgroup was 2.5%.Comparison of two groups showed significantly different.Af(+)patients in WPW group were significantly shorter than Af(-)in sameGroup and atrial refractory stage in AVNRT group.Relative smaller wave-length of atrial impulse(FRPA/PA)also showed significantly decreased.The maximal value DI/D2 of prolonsed degrce of persistant time by righttrial wave in high siie was obtained by early stimulating in right atrial highsite.D2/D1 was sited above 1.5 in non-contimal strial active area that con-duced delay ares below 20 ms of persistant time prolonged of atrial waveand area of fast atrial fibrillation.The incidence of these indexes in Af(+)group and RAF(+)was significantlyInased.The results suggested that atrial fibrillation in WPW syndromehas an important relation with pathway existed end atrial characters.

    1998年04期 192页 [查看摘要][在线阅读][下载 48K]
    [阅读次数:8 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • Feasibility of Using lohexol Instead of Meglumine Diatrizoate to Do a Test of Sensitivity to Iodum

    <正> BACKGROUND:Coronary angiogram and percutaneous coronaryangioplasty are becoming important techniques to make diagnosisand relieve symptoms for the patients with CAD.But higherincidence of hypersensitivity when meglumine diatrizoateas as a agent todo iodum sensitivity test will make some difficuties in practice of CAGand PTCA.PURPOSE:Using iohexol instead of meglumine diatrizoateas a agent to take sensitivity test may be helpful to promote theprevalance the CAG and PTCA in clinical.METHODS ANDPATIENTS:850 patients were enrolled into this study.Patients withpositive reaction when meglumine diatrizoate as a agent to do sensitivitytest accepted the second test using Iohexol.RESULTS:21 Patientaccepted the second test in this study,of the patients,only 1 patient had asame complaints during the 1st and 2nd test.then was rejected to give herCAG and PTCA procedures.The others with positive reaction during 1sttest showed negative reaction during 2nd test,then accepted CAG andPTCA procedure.All the 20 patients underwent CAG and PTCA had noallergic reaction during the procedure.CONCLUSION:Using iohexolinstead of meglumine diatrizoate as a agent to do iodum-sensitivity testmay be helpful to reduce incidence of the false hypersensitive to iodumand promote the practice of CAG and PTCA in clinical.

    1998年04期 192页 [查看摘要][在线阅读][下载 48K]
    [阅读次数:6 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:12 ]
  • EFFECT OF THE GENE POLYMORPHISM OF LOW DENSITY LIPOPROTEIN RECEPTOR ON THE EFFICACIES OF THE LIPIDS REGULATION OF MICRONIZED FENOBRITE

    <正> Objective:To observe effect of the gene polymorphism of low density tipoproteinreceptor on the efficacies of the lipids regulation of micronized fenobrite.Methods:Fifty two patients with hyperlipidemin(serum total cholesterol level exceeded or equalto 5.20mmol/L,and/or triglycoride level was in the range 2.00-5.65 mmol/L)wererandomly allocated into Fenobrite group and placebo group (30 and 22 cases,respectively).The low density lipuprotein receptor HineⅡ polymorphism weremeasured by polymerase chain reaction technology.Results:Comparing theefficacaes of regulation of lipids of Fenobrite and placebo among the subgroups withH1H1,H1H2,or H2H2 genotype of low density lipoprotein receptor HincⅡpolymorphism,we did not find that the efficacy rates(10 % fall in total cholesterol andin low density lipoprotein cholesterol,20% fell in triglyceride,and increase more than0.1 mmol/L in high density lipoprotein cholesterol respectively)of patients witlH1H1,H1H2 or H2H2 genotypes were significantly different amaong the differengenotytes of Fenobrite and control groups.The lowered ranges of total cholesterollow density lipoprotein cholesterol,and triglyceride were neither marked differenamong the patients with H1H1,H1H2,and H2H2 genotypes,average reductionpercent of total cholesterol were in sequence 30.3,30.2,and 33.4%(P>0.05),lowdensity lipoprotein cholesterol were 28.0,29.1,and 31.8%(p>0.05),triglyceridwere 55.2,53.9,and 53.2%(P>0.05)Responsiveness were less different betweenpetients with h1 allele and h2 allele in Fenobrite and placebo group.ConcluslonThe result of present study suggested that low dansity lipoprotein receptor Hinealleles do not took part in the key processes of the cholesterol or triglyceride regulationof Fenobrite.

    1998年04期 192页 [查看摘要][在线阅读][下载 48K]
    [阅读次数:8 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • Angiographical and histopathologic study of atherosclerotic plaques in acute myocardial infarction

    石怀银;王士雯;谭端军;

    <正> Objective Compare the morphology of atherosclerotic plaquesmgiographically and histopathologically in acute myocardialmfarction m order to accumulate experience in recognizing plaquerupture and thrombus by angiogrames.Material and methods 16postmortem cases of acute myocardial infarction were studied.The coronary arteries were romoved en block,filled with barium the lumen and ridiographed.Then the arteries wereontinuously insetted and routin HE sections were made.Results 16 cases had plaque ruptures and thrombi.Among the total98 blocks,21 had plaque ruptures on which 20 thrombiccur(95.23%).while the other 777 unrupured blocks had only 2hrombi(0.25%).The difference was significant(p<0.001).Therupture mostly occur on unstable plaques.The ruptured plaqueswith thrombi had different angiographical morphology withunruptured plaques.The former had irregular borders andunraluminal lucencies;while the Iatter had smooth borders and nointraluminal lucencies.Conclusions Plaque ruprure withthrumbus was the major cause of acute myocardial infarction andthe ruptured plaques with thrombus had different angiographicalapperances with unruptured plaques.

    1998年04期 193页 [查看摘要][在线阅读][下载 60K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:5 ]
  • A STUDY OF PLASMA BIOACTIVE SUBSTANCE IN PATIENTS WITH CORONARY HEART DISEASE

    <正> The purpose of this study is to evaluate the relation between the plasma ofnitric oxide(NO),endothelin(ET),interleukin-2(IL-2),tunmor necrosisfactor(TNF)and the severity of the coronary atherosclerosis,as well asto measure above-mentioned plasma bioactive substances before and aftertreadmill exercise testing in patients with coronary heart disease(CHD)and normal subjects.Materials and Methods,30 patients diagnosed bycoronary angiograph(CAG)had single-vessel stenosis at least and morethan 50% reduction in luminal diameter.The blood sample was withdrawnbefore exercise and at the moment when the patients complained of chestpain and upon observation of≥1mm ST-segment depression with ahorizontal during treadmill exercise testing.Normsl control groupconsisted of 10 subjects,The blood sample was withdrawn before exerciseand at the end of exercise.Plasma ET,IL-2 sad TNF were measured byradioimmunoassary,and plasma NO was measured by indirect calorimeter.Results,After exercise the plasma NO levels reduced from 4.45±2.28 to3.55±2.28μg/ml(P<0.01),ET increased from 8.48±4.97 to 12.3±7.65 pg/ml(P<0.05),IL-2 increased from 10.76±3.70 to 16.19±5.62ng/ml (P<0.0001),TNF increased from 13.33±6.32 to 17.45±6.40(P<0.05)in patients with exerclse-induced angina of coronary heartdisease.There were significant positive correlation between the score ofcoronary artery atenosis and plasma levels of ET and IL-2 before exercise,In comparison with plasma levels of normal control group,ET and TNFwere significantly high but NO and IL-Z had no much change.DiscussionThe study showed that coronary atherosclerosis patients presentendothelial dysfunction.At the same time,it also suggests that aninflammatory response and immunization may mediate the formation ofatherosclerosis.There were significant high level of NO and no significantchanges of ET、IL-g and TNF levels of plasma after exercise in normalcontrol group,and the plasma levels at IL-2,ET as well as TNF weresignificantly high after exercise in patients with atherosclerosis,but theplasma level of NO had no much change.All above-mentioned resultsindicate further that endothelium-dependent relaxation response may beimpaired and endothelial cells may be defective to secrete NO.

    1998年04期 193页 [查看摘要][在线阅读][下载 60K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • Advancing age and heart failure:the Influencing factors of prognosis in patients with acute myocardial infarction

    谭端军;王士雯;刘玲玲; 高凯 ;

    <正> The purpose of this study is to determine whether advancing age andheart failure are independent predictors of increased mortality afrer acutemyocardial infarction(AMI)We reviewed the clinical data of 1068 in-patients(344 senile/724 nonsenile)with AMI.The results showed atypicalpresentations of infarction-related symptoms in the elderly are common,with consequent delay in the diagnosis and treatment The elderly patientshad a high proportion of systemic hypertension(43.9%),non Q wave AM/(36%)and heart failure(35.5%),On the contrast,the proportion of that innonsenile patients were 33%,8Vo and 16.4% respectively.In elderlypatients,several complications:of AMI are more common,asinterventricular septum perforation(2%),cardiogenic shock(19.8%),arthythmia(61.9%).Heart failure was more frequent in patients with leftventricular ejection fraction(LVEF)≤35%,previous heart failure ormyocardial infarction,and anterior location infarction.Those with severecongestive heart failure had a mortality of 33.2% compared with 24.5% forthose with moderate heart failure and 13.51% for those with no heart failurein the first eight weeks.The following factors were associated with anincreased risk of death:older age,longer delay before admission to hospital,no prescription of beta-blaekers and a previous history of infarctionOur data suggested that the prognosis after AMI was directly related toadvaneeing age and the severity of congestive heart failure.Thedevelopment of congestive heart failure was an independent predictor ofdeath.The increasing incidence and mortality were closely related toimpaired myocardial reserve.The present benefits,as pointed out by therecent progress in AMI therapy,must be employed in the treatment of olderinfarcted patients More aggressive management in elderly patients shouldoe evaluated for its potential to reduce mortality.

    1998年04期 193页 [查看摘要][在线阅读][下载 60K]
    [阅读次数:18 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:8 ]
  • BACTERIAL ENDOCARDITIS:NATURAL HISTORY AND VALVULAR INVOLVEMENT

    Nguyen Quoc Thai;Do Doan Loi;Nguyen Lan Viet;Nguyen Ngoc Tuoc;Pham Gia Khai;

    <正> A total of 92 patients with baetenal endocarditis (BE) were treatedduring 1/1995-5/1998.48 patients were intravenous drug addicts (ID)(52.2%).The averase age of ID patients was 30.48+/-6.06 years.Themajority had been using drugs for more than 6 months (79.3%).Thevegetations were located mainly in the left heart (90.9%).All the casesof BE in ID patients occured in native valves.Differences were foundbetween non-ID (NID) and ID with regard to heart failure in ID (62.5%versus 16%) and to cerebral vascular accidents (25% versus 13%).Positive blood cultures were significantly more frequent in ID (95.5%)versus NID (44.4%).Streptoccocal D infections were predominant in ID(56.8%) and Streptococcal alpha infections in NID patients (44.4%),thedifference being statistically significant.The hospital mortality rate wassimilar in both groups,18.7% and 18.2% in ID and NID patientsrespectively.There were no surgical interventions in the ID group.Conclusions:In an area with high prevalence of rheumatic valvular diseasethe incidence of bacterial endocarditis in ID and NID showed difference inpresentations.Even there were no surgery in the ID group,the short termmortality was similar.There is a need to investigate the clinical benefit ofvalvular replacement end the survival of the ID and NID patients,in an areawhere resources are limited.

    1998年04期 193页 [查看摘要][在线阅读][下载 60K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • Prophylactic captopril reduces perioperative myocardial ischemia in dogs

    王士雯;陈鸣和;谭端军;

    <正> Perioperative myocardial ischemia(PMI) is mainly caused by increasesin sympathetic nervous system activity due to stress,which results incoronary endothelial dysfunction,hence that it is hypothesized thatcaptopril may improve PMI.In our study,twenty mongrel dogs wererandomized for four groups;group Ⅰ:control,group Ⅱ:myocardialinfarction (MI) model,Group Ⅲ:MI+partial gastrectomy,group Ⅳ:MI+captopril+partial gastrectomy.Myocardial infarction wasproduced by ligation of left anterior descending coronary artery exceptthe group Ⅰ.In the group Ⅲ and Ⅳ,the hemodynamics,plasmaendothelin (ET) and nitric oxide (NO) on baseline,pre-andpostoperation were investigated two weeks after MI All animals werekilled by overdose anesthetic and their cardiac samples of non-infarction area taken for examining nitric oxide synthase (NOS)mRNA expression levels in vascular endothelial cells.Results:ingroup Ⅲ,the operation decreased the maximal rate of left ventricularpressure rise (LV+dP/dtmax),cardiac index (CI) and plasma No level,and increased left ventricular end diastolic pressure (LVEDP),time-course of isovolumic pressure fall (T constant),total peripheralresistance (TPR) and the levels of ET.In group Ⅳ,40 minutes afteradminstration of captopril,the TPR was decresed,and the t constantwas incresed significantly.The operation attenuated the TPR and Tconstant,but didn't affect the other values.In situ hybridization it wasshowed that the expression levels of NOS mRNA was the highest ingroup Ⅰ,lower in groups Ⅱ and Ⅳ,and the lowest in group Ⅲ.Conclusions:1.Partial gastrectomy performed after myocardialinfarction may induce left ventricular systolic and diastolic dysfunction,and may produce coronary endothelial dysfunction;2.captopril canimprove left ventricular dysfuction and endothelial dysfunctioninduced by noncardiac operation.

    1998年04期 194页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:6 ]
  • CARDIAC RUPTURE FOLLOWING ACUTE MYOCARDIAL INFARCTION

    <正> Cardiac rupture(CR)is a very severe complication and major lethal factor of acutemyocardial infarction(AMI),included free wall rupture,ventricular septal ruptureand papillary muscular rupture.In addition to the general clinical symptoms therewere some differences.The patients of ventricular septal rupture had cardiogenicshock,severe right ventricular failure and the murmur as the same as gencricventricular septal defect,papillary muscular rupture resulted severe mitralregurgitation,circulation failure and pulmunary-edima,there were rough systolicmurmur locatied in mitrai region,while free wall rupture occured,theconsciousness,breathless and Beau'disease syndrome were presented suddenly,inthe electrocrdiogram showed sinus rhythm,atrioventricular junctional rhythm,ventricilar rhythm,that was electricity-machine disconnection Treatment of cadacrupture is more diffcult prevention is eimportant The patients of acutemyocardial infarction especially initial pass through wall and no angina,no heartfailure in histry must be take care of carefully,inhibit myocadial systole in noinfarction region suitably,by lying in bed,preventing defecate dry,reducing bloodpressure,using β-blacker.Benefit of thrombolysis on following myocardialinfarction was doubtful in reducing cardiac rupture

    1998年04期 194页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:10 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:16 ]
  • Effect of bFGF on expression of MMPs mRNA on the rat thoracic aorta after ballon injury and cultured VSMCS

    <正> Background:Extracellular matrix (ECM) plays a very important role in the development ofrestenosis after PTCA The MMPs,enymes specialized in degradation of ECM,probably partciptesin extracelular matrix remodeling after balloon injury,but the factors that regulates MMPs activity arenot completely understood Basic fibroblast growth factor (bFGF),as a mitogen for a variety of cellstypes,influences metabolism of ECM.However,if effects on MMPs are not known.Methodsand Results:24 male Wistar rats were divided randomly into control group,balloon-injuried group andbFGF-treated group.The rats of control group were not treated.The rats in balloon-injuried group weredamaged by balloon and the thoracic aortas were harvested after two weeks.In the bFGF-treated grorp,balloon injury and the injuried vessels were collected after two weeks.The northern blot was used toinvestigate the MMP1,MMP2 and MMP9 mRNA expression of vesss.At the same time,the effectsof differet dose bFGF (0ng/ml,40ng/ml,80ng/ml and 120ng/ml) on the MMPs expression of culturedVSMCs were examined The results showed the bFGF can selectively increase the expression ofMMP1 and MMP9 mRNA without effect on the MMP2 on the injuried rat thoracic aorta,and dosedependently increase the MMP1 mRNA expression of cultured VSMCs without MMP2 and MMP9expression Conclusion:bFGF selectively increased MMPs mRNA expression on both injuried ratthoracic aorta and cultured VSMCs.This effect may be related to the degradation of ECM,remodelingof vessel after injuty.

    1998年04期 194页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:9 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:8 ]
  • 内科医生要警惕主动脉事件

    王庆国;管镜耀;王莉珍;刘希增;

    本文报告了4例由于主动脉事件导致的心脏性猝死,其中主动脉瘤破裂死亡2例,主动脉夹层破裂死亡1例,急性主动脉瓣关闭不全死亡1例,3例主动脉瘤(主动脉夹层)生前1例考虑冠心病,1例考虑胃炎、腹痛待查,1例虽考虑到主动脉瘤可能,但由于医院条件有限而转院,1例急性主动脉瓣关闭不全,由于错过瓣膜置换手术时间而未能得到及时治疗,以致猝死。主动脉破裂所引起的主动脉事件生前多数病人不易确诊,往往因医疗纠纷,尸体解剖得以诊断。部分病人在院外猝死,确诊更加困难。本文提示内科医生在临床工作中要提高对主动脉事件的警惕性,遇有下列情况之一者应考虑主动脉瘤或主动脉夹层的可能需作进一步详细检查,如心脏彩超、CT、核磁共振、心脏 ECT 等,以防漏诊或误诊:①中老年男性既往有高血压病史、糖尿病史、吸烟史、突然发生胸背部、腰部、腹部疼痛,排除胆道疾患,泌尿系结石、腰椎间盘突出、急性心肌梗塞、心绞痛、急性胸膜炎、食管裂孔疝等疾病。②突然发生胸腹部剧烈疼痛,应用扩张冠状动脉药物及解痉止痛药物不能缓解.③剧烈胸腹部疼痛病人 X 线片发现主动脉影增宽,B 超检查发现主动脉增宽并伴有搏动减弱。④胸腹部剧烈疼痛伴有低热、白细胞轻度升高,用其它疾病不能解释.⑤体型瘦长伴有突然胸痛,用其它疾病不能解释.急性主动脉瓣关闭不全均有多年慢性风湿性心脏病病史,对于心脏明显扩大者,要认真进行主动脉瓣功能评价.如脉压差明显增大,主动脉瓣第二听诊区舒张期杂音明显,应尽早行瓣膜置换术,以防急性主动脉瓣关闭不全引起猝死。

    1998年04期 194页 [查看摘要][在线阅读][下载 64K]
    [阅读次数:8 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:13 ]
  • 细胞凋亡与心肌梗塞后心力衰竭

    张钧华;齐丽彤;

    细胞的死亡有两种形式,即坏死和凋亡,近年研究发现细胞凋亡是心肌梗塞过程中心肌细胞死亡的机制之一,心肌细胞的凋亡不仅发生于心梗急性期,在陈旧心梗病例中在梗塞区周围仍可以观察到,因此心梗后心力衰竭的发生除了与梗塞面积有关外还可能与心肌细胞的凋亡有关.RAS 参与心肌梗塞的病理生理过程.在合并心功能不全的心梗病例中 RAS 的变化更为明显,血管紧张素Ⅱ不仅影响血流动力学,还可能参与心肌细胞的损伤,以往研究表明 ACE 抑制剂对梗塞心功能县有保护作用。我们观察到血管紧张素Ⅱ可在体外诱导乳鼠心肌细胞凋亡,其作用可被血管紧张素ⅡⅠ型受体阻断剂 Losartan 抑制;Losartan 还可减少缺氧-复氧条件下乳鼠心肌细胞的凋亡,并可减少大鼠心肌缺血-再灌注模型心肌细胞的凋亡;Losartan 抑制抑癌基因 P53在心肌细胞中的表达。以上结果表明血管紧张素Ⅱ可能是心肌梗塞过程中心肌细胞凋亡的诱导因素之一,阻断血管紧张素Ⅱ的Ⅰ型受体可以减少心肌细胞凋亡的数量,对心肌起到保护作用。进一步我们将观察血管紧张素Ⅱ,心肌细胞凋亡与心梗后心功能三者的关系,以探讨心梗后心力衰竭的机制。

    1998年04期 195页 [查看摘要][在线阅读][下载 417K]
    [阅读次数:18 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:43 ]
  • 氧化修饰低密度脂蛋白的受体和内皮功能损伤

    张钧华;徐雅琴;

    氧化修饰低密度脂蛋白(OX-LDL)诱发的内皮功能障碍加速了动脉粥样硬化(AS)的形成,增加了心肌缺血再灌注损伤和急性心机梗塞,成为目前心血管领域的一个研究热点.OX-LDL 存在于体内,但其生成的途径尚不清楚。研究显示 LDL 的氧化修饰与活性氧.15-脂加氧酶及 heam 蛋白髓过氧化酶有关。LDL 经氧化修饰后,最主要的变化有两点:一是卵鳞脂转化为溶血卵鳞脂,二是产生新的受体结合位点,被清道夫或其它受体识别。识别 OX-LDL 的受体有多种,主要有清道夫受体(SR),SR 又分为 A、B,C 三类,A 类 SR 主要存在于巨嗜细胞上,其可能与宿主的自身防卫及 AS 的形成有关。B 类 SR 包括 CD36和 SR-BI,CD36存在于多种细胞表面,可能介导了 AS 形成中 OX-LDL 对单核细胞和血小板的趋化作用;SR-BI 可与多种配体结合,研究认为其在清除体内过多脂质中起重要作用。C 类 SR 只在胚胎发育期间的巨嗜细胞和红细胞上表达,目前认为其与心血管疾病关系不大。除 SR 外,还发现多种识别 OX-LDL 的受体,如:存在于鼠肝 kuppffer 细胞和内皮细胞上的两种 OX-LDL 受体,分子量分别为95kDa 和320kDa;FcyRII(CD32)血管内皮细胞上的 LOX1等.其中 LOX1与 OX-LDL 结合特异性最强,在结构上属于 C 型血凝素家族,分子量约30872Da.但其具体的病生理功能尚不清楚,有研究显示 LOX1参与了自发性高血压大鼠内皮依赖舒张功能(EDVR)的损害,但作用机制不明.OX-LDL 对内皮细胞有多种损伤作用。首先可引起内皮细胞凋亡及坏死,LOX1可能参与了这一过程:其次可造成 EDVR损害,研究认为这主要与 OX-LDL 干扰 NO 生成和增加内皮素(ET)分泌有关.并且发现SR 可能介导了这一过程:另外还可损伤内皮的抗凝和纤溶功能,降低内皮细胞的抗聚集性,促进血栓形成,限制血栓溶解,且研究认为这可能与 OX-LDL 提高内皮组织因子表达有关,但 OX-LDL 受体在其中的作用还不清楚。

    1998年04期 195页 [查看摘要][在线阅读][下载 417K]
    [阅读次数:21 ] |[引用频次:1 ] |[网刊下载次数:0 ] |[下载次数:33 ]
  • The Relatlonahlp Between Pleame Calcltonin Gane-Rslated Peptlds Leval and Early Cardlac Dyafunetion In Patianta with Coronary Artery Dlsease

    <正> To identify whether plasma Calcitonin gene-related peptide (CGRP) level isindexe for evaluating early cardiac dysfunction in patients with coronaryartery disease.Normal and coronary artery disease total sixty cases werechosen at random,which were diagnosed by coronary arteriography,foursubgroups (0,1,2,3 lesion branch group) were divided basing on coronaryartery lesion branch,each having fifteen cases.hemodynamic parameters weremeasured by left cardiac cather and left ventricular cineangiography,plasmaCGRP concentration was msaured by radioimmunoassay.results reveal:LVEFdecressed as coronary artery lesion branch increased,but there were nosignificantly difference between subgroups (only P_(sio)<0.05);there weresignificantly difference of diastolic function parameters between subgroups,especially T,bad positive relativity to stenosis score (r=0.72,P<0.01).Plasma CGRP level had positive relativity to stenosis score,time constant(r=0.37~0.38,P<0.05);bad negative relativity to LVEF (r=-0,46,P<0.01).in brief,Coronary artery disease imparies diastolic function prior tosystolic function;CGRP is a important index for evaluating early cardiacdysfunction in patients with coronary artery disease.

    1998年04期 195页 [查看摘要][在线阅读][下载 417K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • Decrease of Mortality of AMI in the Hospitalized Patients

    <正> there were 167 patient of AMI hospitalized in ourhospital during Jan 1995to Sep.1997.A significant decreasein the mortality of AMI in 1997 is found of 3.7%,comparingwith the same time in 1995 and 1996 (p<0.01).We extendour antistreplase therapy to a higher limitation of age.Acurrante care is taken to the early stage of heart failurearrhythmia and fall of blood pressure.ACEI,B-blocker andAspring is as a routine use.We found a significant decreaseof mortality comparing with recent report both domestic andabroad report both domestic and abroad.

    1998年04期 195页 [查看摘要][在线阅读][下载 417K]
    [阅读次数:5 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
  • Early Assessment of Infarct Size by CK,CK-MB and TnT after Reperfusion in Acute Myocardial Infarction

    <正> Primary PTCA is an effective performance to reopen the infarct-relatedartery,so as to limit infarct size and maintain left ventricular function.It is veryimportant to estimate infarct size for the management and prognosis after AMI.Infarct size can be assessed by serum creatinc phosphokinase (CK).CK isoenzymeMB (CK-MB) or troponin T (TnT),but reperfusion therapy such as primary PTCAhas a washout effect on these biochemical indexes.Whether or not thesebiochemical indexes are still useful in estimating infarct size after reperfusion isconfused.Objective:To detect the possibility of serum CK,CK-MB and TnT forassessing the infarct size after early successful reperfusion in acute myocardialinfarction (AMI),and find a better method of these biochemical indexes toestimate infarct size.Methods:This study consisted of 29 AMI patients aftersuccessful primary PTCA.Serum CK,CK-MB and TnT were measuredsequentially within 72 hours after primary PTCA,and ~(99m)Tc-MIBI myocardialsingle photon emission computed tomography was performed within 30 days afterpermission to calculate the myocardial infarction score (ISI).The peak,sum totaland area under curve within 16 hours of these biochemical indexes were comparedwith ISI with linear regression analysis and multiple stepwise regression analysis.Finally,the result were correlated with ISI to find its assessed value.sensitivity andspecificity.Results:Serum CK,CK-MB and TnT increased rapidly after primaryPTCA (p<0.05);CK,CK-MB and TnT release curves were about monophasicwithin 24 hours;The peak,sum total and area under curve within 16 hours of CK,CK-MB and TnT correlated well with ISI;The area under curve within 16 hours ofTnT correlated best with ISI (r=0.58,p<0.01),its regression equation was Y=1.39×10~(-4)X+0.20.While patients were grouped by ISl as 30%.there wasobvious difference on the ISI between the 2 groups (p<0.01).The assessing valueof TnT area under curve within 16 hours to infarct size was 85.2% (ISI=30%.TnTAUC=688μg.h/l),the sensitivity was 100%,specificity was 84%.Two of thesepatients studied had a relative normal ~(99m)Tc-MIBI myocardial perfusion as healthypeople.Conclusion:The area under curve within 16 hours after primary PTCAcan be used to assess infarct size in AMI.Primary PTCA can reopen the infarct-related artery in time,and rescue the dying myocardium obviously.

    1998年04期 196页 [查看摘要][在线阅读][下载 422K]
    [阅读次数:12 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:9 ]
  • THE ANALYSIS ON RELATIONSHIP BETWEEN THE LIVING HABIT AND HYPERTENSION INCIDENCE RATES

    <正> the relationship between the living babit and hypertension incidencerates was analyzed in population of Dingxi prefecture of Gansu provinceby epidemic investigation.The result was as following:In populationwith high salt diet (≥12 g per day),hypertension relative risk (RR),attributive risk (AR),and popular AR (ARP) were 7.77,27.28,57.23%,res-pectively.In population with high body mass index(BMI>24),RR were 3.66,AR 16.89,ARP 37.23%,In fat type population with hypertension,RR was4.29,AR 26.64,ARP 19.74%,In population liking greasy foods,RR was 1.70,AR 6.09,ARP 8.78%;In those smoking cigarettes,RR 1.36,AR 3.33,ARp 8.78%,And is those drinking spirits,RR was 1.35,AR 3.26,ARP 6.69%,resbectively,there were high significant differences between populations with and wi-thout above risk factors.Themultiple liner regression on risk factorswith hypertension incidencerate showed that correlation coefficient was0.8517-0.3215(P<0.05) and the partial correlation coefficient 0.3775-0.0809(P<0.001,the multiple correlation coefficient 0.9535).According tosize of effect on the hypertension incidence rate,the risk factors werein turn,salt amount>the time and numbers to smoke cigarette>amount andtime to drink spirits>BMI>fat time>greasy food time.The concurrent hyp-ertension of wife and her husband living together for 20-30years andwithout obvious risk factors was also discovered in 15 couples.It isconcluded that having a good living habit is of importance in reducingthe incidence rate of hypertension in population.

    1998年04期 196页 [查看摘要][在线阅读][下载 422K]
    [阅读次数:7 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:10 ]
  • 关于基层医院冠心病诊断中存在问题的初步探讨

    张学功;彭雪梅;

    冠状动脉粥样硬化性心脏病是心血管内科常见的疾病.过去由于客观条件的限制,使得许多冠心病的诊断是臆测性的.近年来,随着介入技术的发展为冠心病的明确诊断提供了可靠的证据.为总结经验提供教训,我院对30例过去收治并诊断为冠心病的病例进行回顾性分析,并行冠状动脉造影发现,30例中可确诊冠心病者25例,诊断符合率83.3%,以心肌梗死诊断符合率最高100%,9例患者冠造全部符合,其余诊断符合率为诊为心绞痛型83.3%,12例符合10例:隐匿型75%,诊断4例,符合3例;心衰及心律失常误诊率最高80%,5例符合1例.以上结果说明,冠心病的发生虽然受多因素的影响,但对于每个具体病例,只提示发生冠心病的相对危险度,并不构成冠心病诊断的主要或次要条件,偏倚这些危险因素是造成误诊的主要原因。冠心病在不同发展阶段的临床表现多种多样,特别是老年人临床表现差异大,本组隐匿性冠心病3例均为老年人,临床上无症状,冠造提示双支或三支病变,2例行 PTCA 和 CABG,1例于自动出院一月后猝死,故对老年患者应足够认识以防不幸.本组心绞痛患者中不稳定心绞痛6例,2例累及左主干,其中1例先后11次入院并好转出院,本次虽经冠造确诊仍未引起临床医师足够重视,于两周后猝死。故提示一旦确诊应积极确定进一步治疗方案,减少类似事件的发生.总之,介入技术的发展,的确提高了基层医院的冠心病诊断及治疗水平。

    1998年04期 196页 [查看摘要][在线阅读][下载 422K]
    [阅读次数:16 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:25 ]
  • 左向右分流型先心病肺动脉高压患者呼吸道感染与肺循环血流动力学关系的对照研究

    周敬群;曹林生;李欲舒;

    为探讨左向右分流型先心病合并肺动脉高压患者易反复呼吸道感染的病因,我们调查了107例左向右分流型先心病患者易反复呼吸道感染的发生率,并结合右心导管检查获得的血流动力学参数以及实验室结果,进行了临床对照研究。结果显示1.肺动脉高压组或高阻力组易反复呼吸道感染的发生率显著高于肺动脉压正常组成低阻力组;2.高分流量组与低分流量组易反复呼吸道感染的发生率无显著差别3.易反复呼吸道感染的高发生率组其肺动脉平均压、肺循环总阻力、血浆 TXA_2浓度均显著高于低发生率组;而两组间左向右分流量无显著性差异。我们认为1.左向右分流量的大小,并不是导致呼吸道易反复感染的根本原因,2.呼吸道症状的产生与血浆 TXA_2浓度升高有关。

    1998年04期 196页 [查看摘要][在线阅读][下载 422K]
    [阅读次数:13 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:17 ]
  • 列题

    <正> Comparative Study of ECG in Patients with AMI and Convalesccent Coronary AngiographyCao Yange,Li Yingrong.WISCO First Workers Hospital,Wuhan 430080,ChinaAn Analysis of 42 Cases Coronary Angiography with Risk Factors of Coronary Heart DiseaseFan Guanghong.Qingdao Third People’s Hospital,Qingdao 266041,China冠状动脉内支架植入术与5例报告江西省人民医院(南昌 330006)洪浪盛国太尹秋林龙恭铭Coronary Stenting for Complex Lesions:A Single Center Clinical ExperienceHou Yuqing,Huang Zheng,Jia Maning,Liu Yili.Nanfang Hospital,First Miltary Medical University,Guangzhou 510515,China

    1998年04期 197-200页 [查看摘要][在线阅读][下载 195K]
    [阅读次数:11 ] |[引用频次:0 ] |[网刊下载次数:0 ] |[下载次数:4 ]
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