OBJECTIVE:To describe profiles of collateral arteries of moyamoya disease (MMD) and analyze risk factors of cerebral hemorrhagic events. METHODS:This study retrospectively analyzed 298 patients diagnosed with MMD at Tiantan Hospital in Beijing, who were divided into pediatric and adult groups. Angiographic features were compared between groups. Angiographic outcomes were assessed between hemispheres with and without cerebral hemorrhagic events in adult and pediatric groups separately. Logistic regression analysis was performed to identify relevant risk factors of cerebral hemorrhage. RESULTS:Among 298 patients, there were 20 hemorrhagic hemispheres in the pediatric group and 106 hemorrhagic hemispheres in the adult group. The superficial temporal artery and middle meningeal artery (MMA) were more prominent in the adult group than in the pediatric group. In the pediatric group, the superficial temporal artery, MMA, posterior choroidal artery, and middle cerebral artery were more prominent in hemorrhagic hemispheres than in ischemic hemispheres. In the adult group, the superficial temporal artery, MMA, and middle cerebral artery were more prominent in hemorrhagic hemispheres than in ischemic hemispheres. Logistic regression analysis showed that presence of the posterior choroidal artery was associated with cerebral hemorrhagic events in pediatric patients with MMD. Disappearance of ophthalmic artery, presence of MMA, and presence of MCA were associated with cerebral hemorrhagic events in adult patients with MMD. CONCLUSIONS:Differences in collateral arteries between adult patients with MMD and pediatric patients with MMD were observed, among which MMA acted as a predictor for cerebral hemorrhage in adult patients with MMD.

Background and aims:Emerging evidence indicates a relationship between low-density lipoprotein cholesterol (LDL-C) levels and bleeding. However, data regarding the relationship between LDL-C levels and bleeding events in patients with atrial fibrillation (AF) remain unfilled. This study is aimed to examine the relationship between LDL-C levels and the risk of in-hospital bleeding in patients with AF. Methods and results:In this multi-centered observational study, 25,380 patients with AF were enrolled; 14,071 (55.4%) and 11 309 (44.6%) were men and women, respectively, and the mean age was 69.51 ± 11.88 years. After adjusting for covariates, with LDL-C ≥ 70 mg/dl as the reference, LDL-C < 70 mg/dl was associated with a higher risk of any bleeding event [adjusted odds ratio [aOR]: 1.63, 95% confidence interval [CI]: 1.12-2.35; P = 0.009], major bleeding events (aOR: 1.48, 95% CI: 0.99-2.20; P = 0.05), and gastrointestinal bleeding events (aOR: 2.11, 95% CI: 1.27-3.50; P = 0.004) in the multivariate logistic regression model. The restricted cubic spline model showed an L-shaped relationship for bleeding events, with a higher risk at lower LDL-C levels. The nonlinear relationship between LDL-C levels and the risk of bleeding persisted among the subgroups. Conclusions:This nationwide and multi-centered AF registry study found an L-shaped relationship between LDL-C levels at admission and in-hospital bleeding events, with a greater risk at lower LDL-C levels. Further studies are needed to establish LDL-C as a factor for risk stratification and management of bleeding events in patients with AF. Clinical Trial Registration:[http://www.clinicaltrials.gov], identifier [NCT02309398].

This case report describes a patient in their 50s with 20 minutes of substernal chest pain radiating to the left shoulder and back, which was accompanied by shortness of breath and sweating.

AIMS:The electrocardiographic and electrophysiological characteristics of ventricular arrhythmia (VA) arising from the intramural basal inferior septum (BIS) have not been specifically addressed to date. The aim of the current study was to characterize intramural BIS-VA and distinguish it from those with endocardial origins besides clarifying the anatomical configurations of the pyramidal space. METHODS AND RESULTS:Fifty-five consecutive patients undergoing catheter ablation of VAs from BIS were identified and divided into three groups: the left ventricular (LV)-BIS group (n = 28), right ventricular (RV)-BIS group (n = 8), and intramural group (Intra, n = 19). Compared with the LV-BIS and RV-BIS groups, patients in the Intra group presented with no adequate earliest activation time at the two-sided BIS and epicardial coronary system [right: 7.79 ± 2.38 vs. left: 7.16 ± 2.59 vs. the middle cardiac vein (MCV): 6.26 ± 1.73 ms, P = 0.173] and poor-matched pacing-produced QRS at each site. Under the intracardiac echocardiography view, the pyramidal base was the broadest part of the septum and served as the division of the two-sided BIS. Focal ablation yielded promising acute-term and long-term procedural success in the LV-BIS and RV-BIS groups. But for the Intra group, VAs disappeared only after stepwise ablation successively targeted early preferential exit. After follow-up, three patients in the Intra group had recurrent VA, and all of them were treated well by a redo procedure or drug therapy. CONCLUSION:Intramural VAs were relatively common in the BIS region in our series. Intra-procedural mapping was important to distinguish the intramural VAs from other VAs by comparing the local activation time and pacing mapping. Procedural success could be achieved by stepwise ablation on the counterpart sides of the BIS and within the MCV.

Background Poorly controlled type 2 diabetes mellitus (T2DM) is known to result in left ventricular (LV) dysfunction, myocardial fibrosis, and ischemic/nonischemic dilated cardiomyopathy (ICM/NIDCM). However, less is known about the prognostic value of T2DM on LV longitudinal function and late gadolinium enhancement (LGE) assessed with cardiac MRI in ICM/NIDCM patients. Purpose To measure LV longitudinal function and myocardial scar in ICM/NIDCM patients with T2DM and to determine their prognostic values. Study Type Retrospective cohort. Population Two hundred thirty‐five ICM/NIDCM patients (158 with T2DM and 77 without T2DM). Field Strength/Sequence 3T; steady‐state free precession cine; phase‐sensitive inversion recovery segmented gradient echo LGE sequences. Assessment Global peak longitudinal systolic strain rate (GLPSSR) was evaluated to LV longitudinal function with feature tracking. The predictive value of GLPSSR was determined with ROC curve. Glycated hemoglobin (HbA1c) was measured. The primary adverse cardiovascular endpoint was follow up every 3 months. Statistical Tests Mann–Whitney U test or student's t ‐test; Intra and inter‐observer variabilities; Kaplan–Meier method; Cox proportional hazards analysis (threshold = 5%). Results ICM/NIDCM patients with T2DM exhibited significantly lower absolute value of GLPSSR (0.39 ± 0.14 vs. 0.49 ± 0.18) and higher proportion of LGE positive (+) despite similar LV ejection fraction, compared to without T2DM. LV GLPSSR was able to predict primary endpoint (AUC 0.73) and optimal cutoff point was 0.4. ICM/NIDCM patients with T2DM (GLPSSR < 0.4) had more markedly impaired survival. Importantly, this group (GLPSSR < 0.4, HbA1c ≥ 7.8%, or LGE (+)) exhibited the worst survival. In multivariate analysis, GLPSSR, HbA1c, and LGE (+) significantly predicted primary adverse cardiovascular endpoint in overall ICM/NIDCM and ICM/NIDCM patients with T2DM. Conclusions T2DM has an additive deleterious effect on LV longitudinal function and myocardial fibrosis in ICM/NIDCM patients. Combining GLPSSR, HbA1c, and LGE could be promising markers in predicting outcomes in ICM/NIDCM patients with T2DM. Evidence Level 3 Technical Efficacy 5

目的:研究门诊老年人使用潜在不适当用药(PIM)对患者全因住院时长和住院费用的影响.方法:回顾性分析北京市医保数据库2016年7-9月数据.纳入的患者年龄≥65岁,应用Beers Criteria 2015版识别PIM.暴露PIM的定义为在3个月内被处方至少一个PIM.结局事件定义为患者在暴露于PIM或非PIM 14 d后(≥14 d)发生住院.通过门诊数据中患者ID匹配住院数据的患者ID,抓取发生住院的患者信息,计算这些患者的住院时长和住院药品费用.结果:研究共纳入506214位患者,中位年龄74岁(范围65～105岁),50.10％为女性.门诊老年人服用PIM后发生住院的患者共5 200人(1.03％).服用 PIM=0,PIM=1,PIM=2、PIM≥3 后住院天数分别 10.00 d(7.00,14.00),11.00 d(7.00,15.00),11.00 d(8.00,14.00)和 11.00 d(7.00,14.00),组间差异有统计学意义(P=0.01);服用 PIM=0,PIM=1,PIM=2,PIM≥3 后住院费用分别 13 488.42 元(8 926.00,20 914.36),14 325.67 元(9 484.81,22 626.31),14 201.07 元(9 274.79,21 673.86)和 14214.64元(9 716.09,22 098.23),组间差异无统计学意义(P=0.20).经多因素分析后,PIM暴露数量与住院时长和住院费用无相关性(P＞0.05);年龄≥75岁、胆碱能评分(ARS)≥2、糖尿病、就诊次数5～8次可增加住院时长(P＜0.05);查尔森合并症指数(CCI)≥3分、二级医院就诊、就诊次数5～8次、药品使用种类数5～9种增加住院药品费用(P＜0.05).结论经多因素校正后,本研究发现门诊老年患者暴露于不同数量PIM不增加住院时长和住院药品费用,为评估PIM对住院医疗资源的使用提供参考.

Background There are limited data available on the impact of early (within 24 h of admission) β-blocker therapy on in-hospital outcomes of patients with ST-elevation myocardial infarction (STEMI) and mild-moderate acute heart failure. This study aimed to explore the association between early oral β-blocker therapy and in-hospital outcomes. Methods Inpatients with STEMI and Killip class II or III heart failure from the Improving Care for Cardiovascular Disease in China project (n = 10,239) were enrolled. The primary outcome was a combined endpoint composed of in-hospital all-cause mortality, successful cardiopulmonary resuscitation after cardiac arrest, and cardiogenic shock. Inverse-probability-of-treatment weighting, multivariate Cox regression, and propensity score matching were performed. Results Early oral β-blocker therapy was administered to 56.5% of patients. The incidence of the combined endpoint events was significantly lower in patients with early therapy than in those without (2.7 vs. 5.1%, P < 0.001). Inverse-probability-of-treatment weighting analysis demonstrated that early β-blocker therapy was associated with a low risk of combined endpoint events (HR = 0.641, 95% CI: 0.486–0.844, P = 0.002). Similar results were shown in multivariate Cox regression (HR = 0.665, 95% CI: 0.496–0.894, P = 0.007) and propensity score matching (HR = 0.633, 95% CI: 0.453–0.884, P = 0.007) analyses. A dose-response trend between the first-day β-blocker dosages and adverse outcomes was observed in a subset of participants with available data. No factor could modify the association of early treatment and the primary outcomes among the subgroups analyses. Conclusion Based on nationwide Chinese data, early oral β-blocker therapy is independently associated with a lower risk of poor in-hospital outcome in patients with STEMI and Killip class II or III heart failure.

Objective:To understand the prescription medications that may cause or exacerbate heart failure (HF-CEPMs) in elderly outpatients with HF and analyze its influencing factors.Methods:Prescriptions for elderly patients with HF in clinic of Xuanwu Hospital, Capital Medical University between January 2016 and August 2020 were collected. According to the list of HF-CEPMs published by the American Heart Association in 2016, HF-CEPMs in prescriptions were identified. The patient′s gender, age, disease diagnosis, medical insurance, therapeutic drugs, visiting departments, physician titles, and other information are extracted from the prescription, and the use of HF-CEPMs in the prescription was descriptively analyzed. The patients were divided into HF-CEPMs group and non-HF-CEPMs group according to whether the prescription included at least one drug in the list of HF-CEPMs. The clinical characteristics, number of drugs, medical insurance, visiting departments, and professional titles of prescription physicians in patients in the 2 groups were compared, and the influencing factors of prescription containing HF-CEPMs were analyzed by multivariate logistic regression.Results:A total of 2 418 patients were enrolled, including 1 264 males (52.27%) and 1 154 females (47.73%), with a median age of 80 (65, 99) years and a median number of comorbidities 1 (0, 5). The top 3 comorbidities requiring long-term medication were hypertension (1 233 patients, 50.99%), bronchial asthma (448 patients, 18.53%) and diabetes mellitus (385 patients, 15.92%), and the median number of drugs was 5 (1, 16). Among the 2 418 patients, 254 (10.50%) used HF-CEPMs, including 142 (55.91%) males and 112 (44.09%) females. Two hundred and twenty-four patients (88.19%), 26 patients (10.24%), and 4 patients (1.57%) were treated with 1, 2, and 3 kinds of HF-CEPMs, respectively. The top 5 HF-CEPMs in drug use rates were antihypertensive drugs [4.47% (108/2 418)], pulmonary drugs [2.52% (61/2 418)], antidiabetic drugs [1.99% (48/2 418)], urological drugs [1.12% (27/2 418)], antipyretic and analgesic drugs [1.03% (25/2 418)]. Multiple logistic regression analysis showed that the number of comorbidities ≥1 (1 kind of disease: OR=3.732, 95 %CI: 2.246-6.623, P<0.001; more than 2 kinds of diseases: OR=6.054, 95 %CI: 3.624-10.788, P<0.001) and the number of prescribed drugs ≥5 ( OR=4.003, 95 %CI: 2.874-5.693, P<0.001) were independent influencing factors for prescribing HF-CEPMs. Conclusions:Antihypertensive drugs, pulmonary drugs, antidiabetic drugs, urological drugs, and antipyretic and analgesics drugs were the most common HF-CEPMs in outpatient prescriptions of elderly HF patients. The number of comorbidities and polypharmacy therapy in elderly outpatients with HF were independent influencing factors for prescribing HF-CEPMs.

Objective:To investigate the influence of potentially inappropriate medication (PIM) on emergency treatment or hospitalization events due to heart failure in elderly outpatients.Methods:The data of outpatient, emergency patient, and inpatient above 65 years old collected in Beijing Medical Insurance Affairs Management Center database from July 1, 2016 to September 30, 2016 were retrospectively analyzed. PIM in the outpatient western medicine prescription was identified using the 2015 Beers Criteria ?. PIM exposure was defined as at least one PIM was prescribed within 3 months and patients were divided into the PIM exposure and non-PIM exposure groups accordingly. Clinical outcome events were defined as experiencing emergency treatment or hospitalization events due to heart failure after ≥14 days of PIM exposure. Clinical characteristics in patients between the 2 groups were compared and the exposure of specific PIM (PIM with the 3 highest use frequency) in the PIM exposure group was described. Influencing factors of clinical outcome events were analyzed using logistic regression analysis. Results:A total of 506 214 patients were entered in the study, including 252 604 males (49.90%) and 253 610 females (50.10%), aged from 65 to 105 years with a median age of 74 (68, 80) years. Definition of PIM exposure was met in 192 740 patients (38.07%); clinical outcome events occurred in 249 patients, of which 131 patients (0.03%) received emergency treatment and 118 patients (0.02%) hospitalized due to heart failure. Incidences of emergency treatment and hospitalization due to heart failure in patients of the PIM exposure group were higher than those of the non-PIM exposure group [0.04% (78/192 740) vs. 0.02% (53/313 474), P<0.001; 0.04% (71/192 740) vs. 0.01% (47/313 474), P<0.001]. The 3 PIM that used most frequently were vasodilators, diuretics, and central nervous system drugs. Multivariate analysis showed that PIM exposure and use of vasodilators and central nervous system drugs had no significant effects on the occurrence of emergency treatment and hospitalization events due to heart failure, while age ≥75 years old and use of diuretics had significant effects. Compared with the 65-74 age group, the risk of emergency treatment for heart failure in patients of the 75-84 age group and ≥85 age group increased by 3.00 times ( OR=4.00, 95 %CI: 2.46-6.51) and 7.14 times ( OR=8.14, 95 %CI: 4.64-14.29), respectively, and the risk of hospitalization for heart failure increased by 1.33 times ( OR=2.33, 95 %CI: 1.52-3.57) and 2.59 times ( OR=3.59, 95 %CI: 2.03-6.36), respectively. Compared with patients without diuretics treatment, patients treated with diuretics had a 1.91-fold increase in the risk of emergency treatment and hospitalization events due to heart failure ( OR=2.91, 95 %CI: 1.72-4.93) and 1.72-fold increase ( OR=2.72, 95 %CI: 1.56-4.74), respectively. Conclusions:PIM increases the risk of emergency treatment or hospitalization due to heart failure in elderly outpatients, but it is not an independent influencing factor. Age ≥75 years and diuretics use were independent influencing factors of emergency treatment or hospitalization in elderly patients.

目的:调查门诊患者潜在不适当用药(PIM)发生率,并探究PIM与因骨折、跌倒和低血糖住院和急诊就诊发生率的关系.方法:回顾性分析北京市医保数据库2016年7～9月数据.纳入的患者年龄均≥65岁,应用Beers 2015版识别PIM.暴露PIM的定义为服用PIM≥14d.通过住院和急诊的诊断判定骨折、跌倒和低血糖的临床结局.结果:研究共纳入506214位患者,PIM发生率为38.07％,其中19.69％服用了1种PIM,9.04％服用2种PIM,9.35％服用了≥3种PIM.被处方最多的PIM依次为血管扩张剂、短或中效苯二氮革类药物、非甾体抗炎药、利尿剂和外周α-1阻滞剂.PIM主要由三级医院开具(52.17％).随着服用PIM数量的增加,骨折急诊发生率增加(P＜0.05)、低血糖急诊发生率增加(P＜0.05).然而使用PIM后因骨折、跌倒和低血糖住院的发生率以及跌倒急诊就诊的发生率并未随服用PIM数量的增加而增加(P＞0.05).结论:随着患者服用PIM数量的增加,骨折急诊和低血糖急诊发生率增加.本研究的结论为医疗政策制定者、实施者、研究者全面且合理地评估老年人多重用药提供了的参考依据.

目的 提升医院儿科药房药学服务的质量.方法 采用SWOT分析法从优势、劣势、机遇、威胁4个方面分析医院儿科药房药学服务的开展情况,并提出有针对性的发展策略.结果 医院全面落实用药交代,加强合理用药宣传,普及用药知识,开展药物治疗监测及药物基因检测等,实现了个体化精准用药;增加处方前置审核,运用信息化技术,可为患儿安全用药保驾护航.结论 建议医院应加强对儿科药学服务的重视,建立更完善的儿科药学服务体系;药师应明确自身定位,发扬优势,弥补劣势,积极探索多元的药学服务模式,以促进儿童安全、合理用药.

Aims The prevalence and incidence of atrial fibrillation (AF) significantly increase with age. Catheter ablation is already recommended in the guidelines for this selected elderly population. This study aimed to explore the safety and effectiveness of AF catheter ablation in patients aged >= 80 years. Methods The data were based on the China-AF study. Patients with AF aged >= 80 years who received catheter ablation from August 2011 to December 2020 were selected. Catheter ablation included bilateral circumferential pulmonary vein antrum isolation with or without additional linear ablation. Patients were followed up every 6 months. Arrhythmia-free curves were generated using Kaplan-Meier analysis. Cox proportional hazards regression models were used to analyse the predictors for post-ablation recurrence. Results A total of 270 patients were included in the study. Many patients had comorbidities: 73.7% had hypertension and 29.3% had diabetes mellitus. All patients achieved successful bilateral circumferential pulmonary vein antrum isolation. Total complications were noted in nine of 270 (3.3%) patients and nine of 286 (3.1%) ablation procedures. After the first ablation procedure, 74% of the whole cohort-78% patients with paroxysmal AF, and 66% patients with persistent AF - were free from atrial tachyarrhythmia at follow-up to 12 months. Patients with persistent AF, longer AF duration, and history of ischaemic stroke were more likely to have AF recurrence. Conclusion Patients with AF aged >= 80 years, although with many comorbidities, had low complication rates and favourable outcomes after catheter ablation. Catheter ablation was a safe and effective treatment to achieve sinus rhythm in the selected elderly patients.

目的:调查门诊老年患者潜在不适当用药(PIM)与胃肠道出血住院或急诊发生率的关系,探究老年患者PIM在年龄、性别和医院级别间的分布.方法:回顾性分析北京市医保数据库2016年7～9月年龄≥65岁患者的数据.依据Beers 2015版判断PIM;通过门诊数据中患者ID匹配住院和急诊数据的患者ID,结合住院和急诊诊断名称判定胃肠道出血的临床结局.结果:研究共纳入506214例患者,中位年龄74岁(范围65～105岁),50.10％为女性.共有22例患者在门诊就诊后发生胃肠道出血住院,其中10例为暴露于PIM后发生胃肠道出血住院,12例未暴露于PIM发生胃肠道出血住院,两者差异无统计学意义(P>0.05).导致消化道出血的PIM涉及30例次,其中非甾体抗炎药PIM 2人共3例次(双氯芬酸2例次,布洛芬1例次),其他风险PIM包括心血管系统药物(地高辛)1人共1例次,中枢神经系统药物4人共12例次(艾司唑仑8例次,佐匹克隆4例次),利尿药5人共7例次(吲达帕胺3例次,呋塞米2例次,螺内酯2例次),血管扩张药4人共7例次(单硝酸异山梨酯6例次、硝酸甘油1例次).暴露于PIM的患者在性别、年龄、就诊医院级别分布上差异均无统计学意义(P>0.05).未发现暴露于PIM后导致胃肠道出血急诊就诊事件.结论:PIM未导致患者因胃肠道出血住院的发生率增加.Beers标准中提示胃肠道出血风险的PIM或提示其他风险的PIM均可导致胃肠道出血住院.

目的:探讨不同Trendelenburg角度对腹腔镜直肠癌根治术(Dixon术)术野暴露及患者心肺功能的影响.方法:收集2018年10月至2020年10月收治的111例行Dixon术患者的临床资料,开展回顾性研究,其中37例Trendelenburg角度为20°(A组),37例Trendelenburg角度为15°(B组),37例为10°(C组).对比分析3组手术时间、术中出血量、切除标本长度、肿瘤远端切缘长度、术野暴露情况、不良事件发生率,以及建立气腹时、体位调整后10 min、体位调整后20 min心肺功能(中心静脉压、气道峰压、呼气末二氧化碳分压)、血流动力学指标(心率、平均动脉压)及脑功能(搏动指数、阻力指数).结果:3组手术时间、术中出血量、切除标本长度、肿瘤远端切缘长度差异无统计学意义(P>0.05);A组术野暴露情况优于B组、C组,且B组优于C组(P<0.05);体位调整后10 min、20 min,A组呼吸末二氧化碳分压、气道峰压、中心静脉压、心率高于B组、C组(P<0.05);A组搏动指数、阻力指数大于B组、C组(P<0.05);体位调整后20 min,A组平均动脉压水平高于B组、C组(P<0.05);A组不良事件发生率为13.51％,B组为8.11％,C组为5.41％,3组相比差异无统计学意义(P>0.05).结论:不同Trendelenburg角度对Dixon术野暴露及患者心肺功能的影响存在明显差异,Trendelenburg角度15°整体应用效果更佳.

目的 探讨高年资主治外科医师对原发性腹股沟斜疝行腹腔镜经腹腹膜前疝修补术(TAPP)的学习曲线.方法 回顾性分析2018年6月至2021年2月首都医科大学附属北京同仁医院同一名医师连续进行TAPP手术的55例(64例次)腹股沟斜疝患者的临床资料.按手术日期先后顺序详细记录每例患者的手术时间,使用累积和法得到学习曲线;再通过分析比较学习曲线完成前后患者总手术时间、各分步手术时间、术后住院时间等指标验证学习曲线结果,并寻找影响学习曲线的相关因素.结果 总手术时间的学习曲线在20例次处达到最高点,20～40例次为平台期.度过学习曲线后组总手术、游离腹膜间隙、放置补片、缝合腹膜时间及术后住院时间分别为(64.80±18.53)min、(5.05±1.43)min、(5.52±1.77)min、(9.77±2.35)min、(1.45±0.50)d,均短于度过学习曲线前组[(134.45±30.97)min、(14.20±6.93)min、(12.2±5.42)min、(31.15±13.20)min、(1.90±0.55)d],差异均有统计学意义(P<0.05);而游离疝囊时间[(32.45±16.98)min vs.(64.90±11.95)min]比较,差异无统计学意义(P>0.05).以40例为界点,度过学习曲线后组的手术时间为(22.79±8.04)min,较度过学习曲线前组(54.48±18.29)min显著缩短,差异有统计学意义(P<0.05).结论 有一定腹腔镜经验的高年资主治医师对腹股沟斜疝患者行TAPP的学习曲线为20例次左右,其后有20例次左右的平台期,主要与游离疝囊这一手术步骤有关.

目的 观察心脏移植等待患者间断重复输注左西孟旦治疗心力衰竭的临床疗效.方法 选取2019年6月至2021年1月间首都医科大学附属北京安贞医院37例心脏移植等待患者,接受每月一次输注左西孟旦策略,每次剂量为12.5 mg,输注速度为0.1 ml·kg-1·min-1,时限6个月.研究终点为心衰发作需机械辅助、需紧急心脏移植及死亡.收集基线与终点数据资料,血红蛋白、B型利钠肽(BNP)、N末端B型利钠肽前体(NT-proBNP)、肝功能、肾功能检验,行心电图、心脏超声心动图检查和6分钟步行试验,完成明尼苏达心力衰竭生活质量评分和堪萨斯心肌病评分.结果 1例患者于研究起始3月后在院外猝死;3例患者分别于研究起始1、2、4月后在院内因心力衰竭死亡;7例患者在研究观察期间接受了队列计划的心脏移植.研究前后,患者的血红蛋白、肝功能、肾功能指标数据没有显著性差异;超声心动图测得的左心室舒张末内径分别为(73.3±8.0)mm和(71.7±8.7)mm,差异无显著性;射血分数分别为(21.3±3.7)％和(23.3±5.5)％,差异无显著性;BNP水平显著下降,分别为(2857.0±1003.5)pg/ml和(2205.3±1120.5)pg/ml;但NT-proBNP无显著差异,分别为(3605.3±1254.7)pg/ml和(3325.3±1537.0)pg/ml;6分钟步行试验结果增加,分别为(255±95)m和(294±86)m,差异具有显著性;研究前后,明尼苏达心力衰竭评分与堪萨斯心肌病评分分别为(37±18)、(45±20),(45±23)、(49±22),差异无显著性.结论 间断重复输注左西孟旦治疗终末期心力衰竭心脏移植等待患者,改善了BNP水平和6分钟步行试验结果;在治疗过程中其安全性可接受.

心力衰竭是各种病因心脏病的终末阶段,所涉及的系统、器官多,发生过程复杂,经过数代人的传承发扬,我国心力衰竭研究取得了令人瞩目的成绩,目前的心力衰竭治疗涵盖药物、介入、外科手术及心理与康复等诸多方面,本文对我国心力衰竭内外科治疗进展作简要叙述.