心率,即心脏每分钟跳动的次数,在安静状态下为每分钟60～100次,可因年龄、性别或其他因素而产生个体差异.一般来说,超过正常值即为心动过速,会出现心慌胸闷、呼吸困难、乏力、头晕等症状.相关研究显示,心率每分钟增加2.6次,全因死亡率就会升高.因此,莫名的心跳加快一定要引起重视.

目的 探讨当归四逆汤联合西药治疗冠心病稳定性心绞痛的疗效.方法 选择2020年1月至6月冠心病心绞痛患者50例,随机分为2组,对照组予冠心病心绞痛常规药物治疗,观察组在对照组基础上加用当归四逆汤,两组患者均服药3个月后,比较总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、西雅图心绞痛量表(SAQ)评分、中医证候疗效评估、主要心血管不良事件发生情况.结果 观察组治疗后TC、TG、LDL-C水平与对照组比较,差异有统计学意义(P<0.05);观察组SAQ中躯体活动受限程度、心绞痛稳定状态和心绞痛发作情况与对照组比较,差异有统计学意义(P<0.05);观察组总有效率和MACE事件发生率与对照组比较,差异有统计学意义(P<0.05).结论 当归四逆汤联合常规抗心绞痛西药治疗冠心病稳定性心绞痛临床效果较好,值得推广.

大量证据表明,利用经导管主动脉瓣置换术(TAVR)治疗重度主动脉狭窄(AS)的效果与外科主动脉瓣置换术相当.随着TAVR的适应证转向低风险甚至无症状患者,TAVR围术期并发症必然成为医疗团队关注的热点问题.急性冠状动脉闭塞(ACO)是其罕见但致死率极高的并发症之一,直接关乎TAVR的成败.超声心动图是TAVR术前、术中及术后最常用的影像学检查手段之一,具有实时监测、无对比剂、零辐射等优势,在术前评估ACO危险因素以及术中、术后精准监测和及早识别中具有重要作用.本文对超声心动图在TAVR引发的ACO预防与诊断中的应用进展作一述评,以期为TAVR手术团队提供参考.

目的 分析急性心力衰竭(AHF)患者再住院危险因素.方法 选取浙江省人民医院2019年1月至2020年1月收治的AHF患者189例,根据入院次数分为单次住院组116例、再住院组73例,比较两组患者临床资料,采用多因素logistic回归分析AHF患者再住院的影响因素.结果 AHF患者再住院率为38.6％,再住院原因均为AHF发作.再住院组1年内死亡率明显高于单次住院组(P<0.05).再住院组患者收缩压、舒张压、心率及血清D-二聚体水平均明显低于单次住院组(均P<0.05),院外规律复诊用药比例、合并糖尿病比例、抗血小板治疗比例、抗凝治疗比例、口服降糖药物比例、使用β受体阻滞剂比例、使用血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂比例、使用利尿剂比例、使用钙离子通道阻滞剂比例及血清肌钙蛋白I、低密度脂蛋白、同型半胱氨酸水平均明显高于单次住院组(均P<0.05).多因素logistic回归分析显示,抗血小板治疗、抗凝治疗以及使用利尿剂、钙离子通道阻滞剂是影响AHF患者再住院的独立危险因素(OR=13.08、5.08、230.81、11.11,均P<0.05).结论 再住院的AHF患者死亡风险增加,对于抗血小板治疗、抗凝治疗以及使用利尿剂、钙离子通道阻滞剂的初次住院患者,应高度警惕再住院可能.

心房颤动(房颤)是临床上最常见的心律失常,可导致严重的并发症及死亡.导管消融(下称消融)治疗在维持窦性心律方面优于抗心律失常药物治疗.因此现有房颤指南推荐,对于药物治疗无效或不耐受的房颤,消融为一线治疗措施.然而,持续性房颤患者消融治疗复发率仍然较高.近年来涌现出很多房颤消融新技术,并在临床试验中取得良好的疗效.本文旨在论述持续性房颤消融技术的相关研究进展.

目的 探索和评估基于思维导图软件的动态可视化临床病例教学方法.方法 选取2017年10月至2019年8月在浙江省人民医院心血管内科规范培训的76位住院医师作为研究对象.使用XMind 8思维导图软件进行临床病例教学:先设计导图框架,由带教老师引导学生开展思考和讨论,不断完善病例相关知识点,形成知识地图,并模拟临床病例的分析思考过程,引导和训练学生的临床病例分析能力;教学结束后对学生进行问卷调查,针对传统基于问题为基础的学习(PBL)临床病例教学进行比较评分,并评估改教学法的优势和劣势.结果 新型教学法在易于理解、条理清晰、互动性强、有利于临床思维培养及方便复习等五个维度上较传统教学法有明显优势(P＜0.05);但在内容全面维度比较,差异无统计学意义(P＞0.05).新型教学法的主要优势为条理清晰(66/76)、有利于培养临床思维(62/76)及方便理解(34/76),主要劣势为需要软硬件(57/76)、有学习门槛(33/76)及不方便记录(19/76).结论 基于思维导图软件的动态可视化临床病例教学法有利于医学生更好地拓展思维、理解知识点,能更有效地训练临床思维能力.

目的 探讨心血管内科住院患者医院感染的情况,为医院感染的防治提供参考.方法 回顾性分析2016年1～12月浙江省人民医院心血管内科住院患者医院感染的送检标本1881例,明确培养出病原菌的标本148例.统计感染标本来源分布、病原体种类分布、药敏结果.结果 感染标本以痰液、血液、尿液为主,分别占60.1％、17.6％、9.5％,排名前7位的病原体依次为白色念珠菌(40.5％)、大肠埃希菌(8.8％)、肺炎克雷伯菌(7.4％)、热带念珠菌(7.4％)、铜绿假单胞菌(6.1％)、鲍曼不动杆菌(4.7％)、表皮葡萄球菌(4.1％),白色念珠菌对主要抗真菌药物均敏感,敏感率在66％以上,革兰阴性杆菌对庆大霉素、妥布霉素较敏感,敏感率在69％以上,表皮葡萄球菌对庆大霉素、利奈唑胺、万古霉素等较敏感,敏感率为100.0％.结论 心血管内科住院患者医院感染有其特殊性,提高临床操作的规范性、合理使用抗生素、积极治疗原发病、加强营养支持治疗及考虑发生医院感染时尽早进行病原学检查并根据结果制定治疗方案十分重要.

目的 探讨磷酸肌酸钠对心力衰竭(HF)大鼠心脏功能和交感神经活动的影响.方法 将SD大鼠心肌细胞分为对照组、HF组和磷酸肌酸钠组,对照组进行常规培养,HF组用高糖培养建立心肌细胞HF模型,磷酸肌酸钠组在HF组的基础上给予磷酸肌酸钠处理.在处理后36、72 h,采用MTT法检测心肌细胞存活率,流式细胞术检测心肌细胞凋亡率,生化分析仪检测LDH、SOD含量,Westem blot法检测caspase-3蛋白水平.结果 不同时间点的磷酸肌酸钠组心肌细胞存活率均高于HF组(均P＜0.05),细胞凋亡率、caspase-3蛋白相对表达量低于HF组(均P＜ 0.05),SOD值高于HF组(均P＜0.05),LDH值低于HF组(均P＜0.05),与对照组差异均无统计学意义(均P＞ 0.05).结论 磷酸肌酸钠能降低心肌细胞caspase-3蛋白的表达,抑制细胞凋亡,提高细胞存活率,促进提高细胞SOD含量,降低LDH含量,从而改善心脏功能和交感神经活动.

目的 了解ST段抬高型心肌梗死(STEMI)患者急诊血运重建后的胸腔积液发生情况及原因.方法 回顾性分析2017年1月至12月行急诊经皮冠状动脉介入治疗(PCI)术的STEMI患者的基础情况、罪犯血管、术后生化、脑钠肽(BNP)、超声心动图及胸腔积液发生情况,分析胸腔积液发生的相关危险因素.结果 113例患者行急诊血运重建,发生胸腔积液50例(44.2％),logistic回归分析表明,积液发生与BNP(OR=1.002,95％CI:1.000-1.004,P=0.040)、左心室舒张末内径(LVEDd)(OR=1.140,95％CI:1.037-1.253;P=0.006)以及高血压病史(OR=0.272;95％CI:0.096-0.773;P=0.015)相关.结论 STEMI患者血运重建后胸腔积液常见,与BNP水平、LVEDd及高血压病史相关.

Objective To investigate efficacy of operation and non-operation treatment for hip fractures patients complicated with pulmonary embolism.Methods A retrospective case control study was conducted to analyze the clinical data of 18 hip fracture patients complicated with pulmonary embolism admitted to Dongyang People's Hospital from May 2017 to January 2019.There were 11 males and seven females,aged 59 to 96 years[(80.0 ± 9.3)years].There were 10 patients with intertrochanteric fractures,one with femoral subtrochanteric fracture and seven with femoral neck fractures.After diagnosis of pulmonary embolism,the patients were given anticoagulant therapy with low molecular weight heparin for at least one week.The re-examination showed that pulmonary embolism absorption improved and D-dimer did not increase.Eleven patients chose surgical treatment (operation group) with intramedullary nail internal fixation or artificial hip replacement.Seven patients chose non-surgical treatment (non-operation group) with skin traction.The Harris score of hip function was compared between the two groups.Visual analogue scale (VAS) was used to evaluate hip joint pain.At the last follow-up,fracture healing,prognosis of pulmonary embolism and mortality within 3 months were recorded.Results All the patients were followed up for 3-22 months [(11.2 ± 6.0) months].At last follow-up,the Harris score was (92.1 ± 2.2) points in the operation group and (28.8 ± 18.8) points in the non-operation group (P＜0.01);the VAS was 0 point (0-1 point) in the operation group and 3 points (1-3 points) in the non-operation group (P ＜ 0.01).At the last follow-up in the operation group,five patients obtained fracture healing after internal fixation,and among the six patients receiving artificial joint replacement,five patients recovered well except for one deceased patient.At the last follow-up,pulmonary embolism was absorbed and no recurrence of pulmonary embolism was found.None of the patients died within 3 months in operation group,while 14％ of the patients (1/7) in the non-operation group died within 3 months.Conclusions For hip fracture patients complicated with pulmonary embolism,compared with non-operation treatment,operation treatment is more beneficial to restore hip function and relieve pain,with lower mortality rate within 3 months.Operation treatment is feasible for patients who showed improved absorption of pulmonary embolism and no secondary increase of D-dimer after one to two weeks of full anticoagulation treatment before operation.

心房颤动是临床上最常见的慢性心律失常,其主要治疗方法涉及心脏复律并维持窦性心律、控制心室率以及抗凝预防脑卒中等方面.然而,单纯的心房颤动射频导管消融治疗可以改善患者症状,提高患者生活质量,但不能有效预防脑卒中.新兴的左心耳封堵术可替代抗凝治疗,成为心房颤动脑卒中预防的重要治疗手段,但不能改善心房颤动患者症状.因此将射频导管消融与左心耳封堵联合实施的"一站式"治疗就是一种较为理想的心房颤动综合管理方法.

[目的]探讨中药"心肌一号"在动员干细胞治疗心肌损伤过程中干预炎症反应的可能机制.[方法]采用异丙基肾上腺素建立急性心肌缺血大鼠模型,并分为治疗组和对照组,治疗组连续以"心肌一号"灌胃28d,对照组以0.9％氯化钠溶液代替,在第7、28天以酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)、免疫组化检测两组炎症因子肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-6(interleukin-6,IL-6)、白介素-4(interleukin-4,IL-4)、白介素-10(interleukin-10,IL-10)及趋化因子基质细胞衍生因子-1(stromal cell derived factor-1,SDF-1)、C-X-C基序趋化因子受体4(C-X-C motif chemokine receptor 4,CXCR4)水平,第28天以HE染色观察毛细血管密度,Masson染色观察纤维化面积.[结果]第7天和第28天两组大鼠外周血炎症因子TNF-α、IL-6、IL-4、IL-10水平部分太低无法测出,未进行统计;第7天两组大鼠外周血趋化因子SDF-1、CXCR4水平差异无统计学意义(P>0.05),第28天治疗组外周血SDF-1水平显著低于对照组(P<0.05),CXCR4水平显著高于对照组(P<0.01);第28天两组大鼠毛细血管密度差异无统计学意义(P>0.05),治疗组纤维化面积显著小于对照组(P<0.05),心肌SDF-1、CXCR4、IL-10水平显著高于对照组(P<0.01),TNF-α水平显著低于对照组(P<0.01).[结论]"心肌一号"能减弱炎症反应,使心肌纤维化范围相对缩小,同时增强趋化作用,促进干细胞在受损心肌定植,且并不影响心肌新生血管的形成,最终将心肌损伤后炎症反应调控于一个合理的、有利于恢复的水平.

Objective To explore the effects of Panax notoginseng sapo-nins (PNS) on the oxidized low -density lipoprotein ( oxLDL) uptake, mRNA and protein expression of Toll -like receptor 4 ( TLR-4),Sca-venger receptor class B type I ( SR -BI) and ATP -binding cassette transporter A1 ( ABCA1) of macrophages cultured under hyperglycemic condition. Methods Human acute monocyte leukaemia cell line (THP-1) was induced into macrophages with Phorbol ester (PMA). Macrophages were then divided into six groups as follows : normal control group (5.5 mmol· L-1glucose),hyperglycemia group (15 mmol· L-1glucose),hyperglycemia plus oxLDL group (15 mmol· L-1glucose+100 mg· L-1oxLDL),hyperglycemia plus atorvastatin group(15 mmol· L-1glucose+atorvasta-tin 10 μmol· L-1),hyperglycemia plus PNS groups(15 mmol· L-1glucose +20,60 μg· mL-1PNS,respectively). The content of lipid in macrophages was evaluated with oil red O staining .The mRNA levels of TLR-4, SR-BI and ABCA1 were measured by reverse transcription -quantitative polymerase chain reaction , and the protein concentrations of TLR-4, SR-BI and ABCA1 were evaluated by Western blot.Results The lipid contents of hyperglycemia plus oxLDL group and normal control group were (36 ±1)%,(17 ±1)%,the difference was significant (P<0.01).The relative mRNA levels of TLR -4, SR -BI and ABCA1 in hyperglycemia plus oxLDL group were 2.82 ±0.22 , 0.40 ±0.02 and 0.38 ±0.06 , respectively; which in normal control group were 1.00 ±0.09 , 1.00 ±0.01 and 1.00 ±0.06 , respectively; comparison between the 2 groups, the difference of the three factors were significant ( all P<0.01).The relative protein grey values of TLR -4, SR-BI and ABCA1 in hyperglycemia plus oxLDL group were 0.96 ±0.02 ,0.24 ±0.02 and 0.27 ±0.01 , respectively; while in normal control group they were 0.34 ±0.01 , 0.87 ±0.02 and 0.82 ±0.02,respectively;the difference of the three factors between the 2 groups were significant (all P<0.01).After intervation with high dose PNS ,the lipid content in high dose hyperglycemia plus PNS group was de-creased to(29 ±1)%, compared with hyperglycemia plus oxLDL group ,the difference was significant(P<0.01).The mRNA expressions of TLR-4,SR-BI and ABCA1 in high dose hyperglycemia plus PNS group were 1.55 ±0.34 , 0.82 ±0.08 and 0.84 ±0.04, which in high dose hyperglycemia plus PNS group were 0.55 ±0.02 , 0.70 ±0.01 and 0.67 ±0.02 ; compared with those in the hyperglycemia plus oxLDL group, the difference were significant ( all P<0.01).Conclusion PNS decreased the lipid content of macrophages via up -regulating the levels of SR-BI and ABCA1 and down-regulating TLR-4 expression.

房颤导管消融术后复发临床上时有发生,很多研究表明房颤术后复发和相关生物标志物有关.探究这些生物标志物,能揭示房颤术后复发的机制,并对房颤术后早期干预治疗有意义.本研究主要总结比较确切的标志物,以及根据6篇文献对所选的新型标志物进行综合分析.

Objective To study the effect of circadian rhythm on the incidence of nosocomial cardiovascular events in patients with acute ST segment elevation myocardial infarction (STEMI). Methods Totally 212 patients with STEMI from January 2016 to December 2017 were divided into the morning group (84 cases), afternoon group (64 cases) and night group (64 cases) accroding to the onset of disease. The incidences of major cardiovascular adverse events (MACE) and minor cardiovascular adverse events during hospitalization were compared among three groups. The relative risk of MACE in STEMI patients was analyzed by Logistic regression. Results The incidences of MACE [20.0% (13/64), 6.0% (5/84), 7.8% (5/64)] and malignant arrhythmia [18.8% (12/64), 2.4% (2/84), 4.7% (3/64)] in the night group were much higher than those in the morning group and afternoon group (all P<0.017), while no difference was noted between the morning group and afternoon group (all P＞0.017). However, there were no significant differences in the incidences of cardiac insufficiency, arrhythmia and hemorrhage among three groups ( χ2=0.696, 1.601, 2.555; P=0.706, 0.449, 0.279). The multivariate Logistic regression model showed that the nocturnal onset [OR=3.736, 95%CI (1.172, 11.902), P=0.028] was a risk factor for MACE during hospitalization in STEMI patients. Conclusion The nocturnal onset will increase the risk of MACE during hospitalization in STEMI patients.

目的 探讨银杏提取物对急性冠脉综合征(ACS)介入治疗后患者血小板活化因子(PAF)的影响.方法2015年6月至2016年8月行择期经皮冠状动脉介入(PCI)治疗的ACS患者40例,术后随机分为观察组和对照组,每组20例.两组均于PCI术后常规双联抗血小板以及他汀调脂治疗.观察组加用天保宁(银杏叶提取物,19.2mg/片,36片/盒)1片/次,3次/d口服.术前、术后24h,术后2周检测PAF水平、超敏C反应蛋白(hs-CRP)和血小板聚集率.术前及术后2周进行心脏超声检查,术后2周观察主要心血管不良事件(MACE).结果两组患者PCI术后24h的PAF水平,hs-CRP,血小板聚集率均较PCI术前升高,差异均有统计学意义(均P<0.05).PCI术后2周,观察组PAF水平、hs-CRP[(1667.46±390.98)pg/mI、(4.34±2.01)mg/L]均低于对照组[(1823.46±434.76)pg/mI、(7.09±4.78)mg/L],差异有统计学意义(均P<0.05).PCI术后2周,观察组LVEF值与对照组及自身术前比较,差异有统计学意义(P<0.05),心绞痛发作观察组显著低于对照组(P<0.05).结论银杏提取物可降低PCI术后PAF与hs-CRP表达,同时减少临床心绞痛的发生.

本研究根据老年阴寒凝滞型稳定性心绞痛的病证特点,在常规治疗基础上以当归四逆汤加味内服治疗,取得显著疗效,现将结果总结如下.

在动脉粥样硬化多种族研究(multi-ethnic study of atherosclerosis,MESA)中,阵发性室上性心动过速在人群中的患病率是2.25/1 000人,房室结折返性心动过速(AVNRT)是室上性心动过速中常见的一类心律失常,占20~30%[1].导管射频消融术(RFCA)因能起根治作用成为其Ⅰ类治疗方式[2].传统的射频消融术需要在射线透视下进行,随着标测系统的发明完善,射频消融术中射线量逐渐减少.本中心开展三维电场导航系统Ensite NavX(美国圣尤达公司)引导下的射频消融术,术中标测心内膜希氏束的分布区域,现将其在房室结折返性心动过速的射频消融术中的应用总结如下.

Objective To explore the expression of platelet activating factor (PAF) and lipoprotein- associated phospholipase A2(Lp- PLA2)at different time points after acute ST elevation myocardial infarction(STEMI). Methods 50 cases of patients with STEMI were enrol ed. Levels of PAF, Lp- PLA2 as wel as hsCRP, blood biochemical parameters and routine blood examination were measured at admission and 24hours, 72hours, one week and two weeks after AMI and compared to that of patients with stable coronary heart disease(CAD group)(n=30)and healthy people(control group)(n=30). Results The counts of leucocyte, the percent of neutral granulocyte and fast blood glucose at admission in STEMI group were significantly higher than that in CAD group and control group(al P<0.05). LDL- C was significantly lower in CAD group than in control group(P<0.05). PAF levels at admission was significantly higher than that of other time points in STEMI group (al P<0.05) and that of CAD group and control group (all P<0.05). Lp- PLA2 levels were not significantly different among different time points in STEMI group and between different groups. hsCRP was significantly higher at 72 hour than other time points in STEMI group and than other group (al P<0.05) . The percentage of neutral granulocyte was correlated with PAF at admission in STEMI group. Conclusion PAF level increases in STEMI patients with the highest at admission, while Lp- PLA2 does not change.

Ventricular arrhythmias (VAs) that arise from the left posterior fascicle (LPF) and the left anterior fascicle (LAF) are usually considered to have a reentry circuit mechanism that involves the Purkinje fiber network and the local myocardium [ 1 Ouyang F. Cappato R. Ernst S. et al. Electroanatomic substrate of idiopathic left ventricular tachycardia. Circulation. 2002; 105: 462-469 Crossref PubMed Scopus (180) Google Scholar , 2 Metzner A. Ouyang F. Winssner E. Kuck K.H. Monomorphic and polymorphic ventricular tachycardias arising from the His–Prukinje system: what do we know?. Futur. Cardiol. 2011; 7: 835-846 Crossref PubMed Scopus (10) Google Scholar ]. A successful ablation of these arrhythmias could always be achieved by delivering the radiofrequency energy to a target site of the earliest ventricular activation or with the recording of diastolic and presystolic Purkinje potentials simultaneously during ventricular tachycardia [ 2 Metzner A. Ouyang F. Winssner E. Kuck K.H. Monomorphic and polymorphic ventricular tachycardias arising from the His–Prukinje system: what do we know?. Futur. Cardiol. 2011; 7: 835-846 Crossref PubMed Scopus (10) Google Scholar , 3 Yamada T. Kay G.N. Optimal ablation strategies for different types of ventricular tachycardias. Nat. Rev. Cardiol. 2012; 9: 512-525 Crossref PubMed Scopus (35) Google Scholar , 4 Nakagawa H. Beckmann K.J. McClelland J.H. et al. Radiofrequency catheter ablation of idiopathic left ventricular tachycardia guided by a Purkinje potential. Circulation. 1993; 88: 2607-2617 Crossref PubMed Scopus (402) Google Scholar , 5 Nogami A. Naito S. Tada H. et al. Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia. J. Am. Coll. Cardiol. 2000; 36: 811-823 Abstract Full Text Full Text PDF PubMed Scopus (221) Google Scholar ]. To date, ablation of the premature ventricular contraction (PVC) arising from LAF (PVC-LAF) is rarely reported. In recent years, a total of three patients with PVC-LAF underwent catheter ablation in our hospital and all of the PVCs were successfully terminated with a method of the earliest presystolic Purkinje potential mapping.