目的 分析起搏器植入术后起搏诱导性心肌病(pacing induced cardiomyopathy,PICM)的临床特征和相关因素.方法 2008年1月至2013年12月温州市人民医院心内科行起搏器植入且术前左心室射血分数(LVEF)>50％的患者204例,根据术后随访心脏超声结果分为PICM组和非PICM组,比较两组起搏器植入前后心脏超声、心电图数据及起搏器程控数据,分析PICM的危险因素及对患者远期预后的影响.结果 204例植入起搏器的患者中,PICM组26例,非PICM组178例,PICM发病率为12.7％.与非PICM组患者比较,PICM组术前左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)和左心室质量指数(LVMI)较大,LVEF较低,术后心电图起搏QRS时间较长,心室起搏比例较高,差异均有统计学意义(均P<0.05).其中起搏QRS时间(>155.5 ms),心室起搏比例(>28.5％)及术前LVMI(>129.1 g/m2)均为PICM的危险因素(均P<0.05).PICM组术后心力衰竭住院率较高(P<0.05).结论 起搏QRS时间、心室起搏比例及LVMI与PICM的发生有关.

在新医改政策下,我国的医疗卫生体系正面临重大改革,医院的医疗卫生事业全方面进入革新和规范阶段,而医院驾驶员的安全驾驶问题也成为医疗体系改革的一个重要环节.因为我国部分医院的驾驶员缺乏足够的安全意识和法律意识,导致救护车在行驶过程中出现了不文明驾驶和危险驾驶现象,必须引起医院的足够重视.

Objective To evaluate the therapeutic efficacy and influence on the prognosis of ticagrelor in acute coronary syndrome (ACS)patients with low on-clopidogrel platelet reactivity,and analyze its loading dose.Methods A total of 328 cases of ACS patients undergoing percutaneous coronary intervention (PCI) and receiving clopidogrel 75 mg/d treatment in our hospital between September,2013 and April,2016 were enrolled into this study.The platelet aggregation was detected by thrombelastography and 110 patients with low on-clopidogrel platelet reactivity were selected.They were randomly assigned into ticagrelor group(n =54)and clopidogrel group (n =56).The clopidogrel group was continually administrated with clopidogrel 75 mg/d,while the ticagrelor group with ticagrelor 90 mg,2 times/d.The incidence of major adverse cardiac and cerebrovascular events,adverse reactions,uric acid levels and platelet aggregation after the treatment were compared between the two groups.Results After the treatment,the platelet aggregation rate on d3,d7 and d30 in ticagrelor group were significantly lower than those in the clopidogrel group,the difference was significant (P ＜ 0.05);The incidence of UAP,AMI,TIA,heart failure and cerebrovascular accidents in the ticagrelor group was significantly lower than those in the clopidogrel group,the difference was significant (P ＜ 0.05);The incidence of cardiogenic mortality,bleeding and stroke in the ticagrelor group were significantly lower than those in the clopidogrel group,the difference was significant (P ＜ 0.05);Three days and 30 days after the discharge,uric acid levels in the clopidogrel group was significantly higher than that in the ticagrelor group,the incidence of gout in the ticagrelor group (3.51％)was lower than that in the clopidogrel group (18.51％),the difference was significant.Conclusion Ticagrelor therapy for ACS patients with low on-clopidogrel platelet reactivity after PCI can improve the platelet aggregation,reduce the incidence of adverse events,the curative effect is significant.

Objective To investigate the effects of low molecular weight heparin on anti-Xa activity in the treatment of patients with acute coronary syndrome (ACS).Methods A total of 59 ACS patients were divided into two groups.The 22 patients who creatinine clearance rate (Ccr) ＜30 mL · min-1 were in treatment group,and 37 patients who Ccr ＞30 mL · min-1 were in control group.The two groups patients were given subcutaneous injection heparin 5000 U,every 12 h injection 1 times,oral aspirin 100 mg · d-1,1 times/day,treatment for 15 d.After treatment for 3 d and 10 d,the anti-Xa activity were detected by chromogenic substrate assay.The activate part plasma prothrombin time (APT r)and international normalized ratio (INR) were detected by solidification method.And the blood platelet count were detected by blood cell analyzer.Results After treatment for 3 d and 10 d,the anti-Xa activity in treatment group with (0.66 ± 0.21),(0.39 ± 0.17) U · mL-1 were higher than in control group with (0.40 ± 0.22),(0.34 ± 0.1) U· mL-1.The APTT in treatment group with (35.23 ± 6.12),(28.14 ± 5.37)s and INR with (1.23 ± 0.25),(1.07 ±0.21) were lower than in control group APTT with (38.97 ± 5.64),(33.76 ± 5.12) s and INR with (1.37 ± 0.27),(1.19 ± 0.23).The blood platelet count in treatment group with(196.52 ± 56.41),(181.25 ±46.31) × 109/L were higher than the control group with (183.47 ±57.38),(167.17 ±45.66) × 109/L.There were all statistical difference (all P ＜ 0.05).Conclusion For ACS patients who creatinine clearance rate were lower in the treatment of low molecular weight heparin therapy,should monitor the anti-Xa activity and pay close attention to patients' risk of bleeding.

Objective To assess the efficacy of radiofrequency catheter ablation ( RFCA) in premature ven-tricular contractions ( PVCs) by electrophysiological mapping.Methods 60 patients with symptomatic PVCs original from the right ventricular outflow tract underwent RFCA guided by pace mapping and activation mapping,ablation was performed by a catheter with temperature control.The patients were divided into 3 groups,20 cases in each group.The first group ( the combination group ) was the combination with pacing mapping and activation mapping underwent RFCA.The second group ( the activation mapping group) was guided by activation mapping underwent RFCA.The third group( the pacing mapping group) was guided by pacing mapping underwent RFCA.Successful ablation immedi-ate end was that PVCs disappeared and could not be induced by isoproterenol.The success rate,time and composition ratio of the three groups were observed.Results The immediate success rate of ablation of either the combination group or the activation mapping group was higher than that of the pacing mapping group.But the ablation time of the combination group was the shortest.There was no statistical difference between the baseline results of each test group. The cardiac arrhythmia originated from the septum was usual (45/60,75.0%),and the arrhythmia originated from the free wall (15/60,25.0%) was less.The success rate of PVCs ablation of right ventricle was high,and the total success rate was 91.7%(55/60).There was no significant difference in the success rate of the combined mapping and the activation mapping (χ2 =0.084,P>0.05),but were significantly higher than those in the pacing mapping group (χ2 =0.032,0.047,all P<0.05).The ablation time of the pacing mapping group and the combination group were significantly lower than that of the activation mapping group(all P<0.05).Conclusion The effect of the com-bination with pacing mapping and activation mapping is the best.Pacing mapping is better than activation mapping during RFCA of PVCs.

目的 探讨抗Xa水平监测对心房颤动合并肾功能不全患者低分子肝素钠抗凝治疗中的指导意义.方法 选取我院于2012年5月～2015年5月收治的心房颤动合并肾功能不全患者96例作为研究对象,依据随机数字表法分为观察组和对照组,各48例.所有患者均给予基础治疗,在此基础上,对照组给予普通肝素钠常规治疗,观察组给予低分子肝素钠抗凝治疗.观察对比两组疗效指标.对所有患者给予抗Xa水平检测,分析其与治疗效果各因子之间的相关性.结果 治疗后观察组TC、LDL、TG、hs-CRP水平均较对照组显著降低(P＜0.05),而HDL、HGB水平显著升高(P＜0.05),且两组出血状况等级比较差异有统计学意义(P＜0.05);抗Xa水平分组中,各项疗效指标差异均具有统计学意义(P＜0.05),抗Xa水平和疗效指标存在相关性,且以抗Xa≥ 0.4 IU/mL且＜1.0 IU/mL时为最佳,既可以保证抗凝效果,又可以减少出血状况.结论 采用低分子肝素钠抗凝治疗对心房颤动合并肾功能不全患者疗效显著,且抗Xa水平和疗效指标具有一定相关性,因此可以对其水平进行监测,以评估和指导低分子肝素钠抗凝治疗.

目的 探讨尿毒症毒素硫酸盐对甲酚(PCS)对人脐静脉内皮细胞(HUVECs)的毒性作用及机制.方法 体外培养HUVECs,不同浓度对甲酚硫酸钠盐作用HUVECs,WST-1法检测细胞增殖;Matrigel法检测细胞成血管能力;特异性荧光探针2',7'-二氯荧光素二乙酸酯(DCFH-DA)检测细胞活性氧自由基(ROS)水平;实时定量聚合酶链反应(Real-time PCR)及免疫印迹法(Western blotting)检测细胞中炎症因子及黏附分子表达情况.结果 硫酸盐对甲酚对HUVECs增殖及成血管能力未有显著影响,分子机制研究发现,其能显著诱导细胞中ROS水平上调并促进其分泌炎症因子白细胞介素(IL)-1β、肿瘤坏死因子-a(TNF-a)及细胞间黏附分子-1(ICAM-1).结论 尿毒症毒素硫酸盐对甲酚可以加剧血管内皮细胞氧化应激及炎症反应状态,提示其可能参与慢性肾病患者动脉粥样硬化的发生发展.

1例室性早搏(简称室早)呈左束支传导阻滞图形,Ⅰ呈R型,Ⅱ、Ⅲ、aVF及V4～6呈R型,RⅡ＞RⅢ,SaVR＞SaVL,V1～2呈rS型,其胸前导联移行区在V2～ V3之间,右室流出道间隔部消融成功.之后出现频发另一种形态的室早,其QRS形态特点如下:Ⅰ呈Rs型,Ⅱ、Ⅲ、aVF及V5～6呈R型,RⅡ＞RⅢ,aVL呈Rs型,V1呈RS型,V2呈Rs型,在右冠窦窦底消融成功.结论:通过体表心电图QRS波的形态、振幅、移行、顿挫可初步判断室早起源部位,但最终仍需腔内精确的标测和消融.

目的 探讨经左、右桡动脉途径同时行选择性冠状动脉、肾动脉和下肢动脉造影的可行性.方法 59 例在我院进行选择性冠状动脉、肾动脉和下肢动脉造影的患者,按照介入径路不同分为左桡动脉组(28 例)和右桡动脉组(31 例),应用加长Judkins造影导管(125cm)依次行选择性冠状动脉造影、双侧肾动脉和下肢动脉造影,比较手术操作时间、对比剂用量、X 线暴露时间、成功率、并发症发生率.结果 左桡动脉组手术操作时间和X 线暴露时间(30.48±5.71)min、(11.05±2.86)min,显著低于右桡动脉组(40.72±8.30)min、(13.51±4.33)min(均P＜0.05),对比剂用量、造影成功率和并发症发生率差异无统计学意义(均P＞0.05).结论 经左桡动脉途径同时行选择性冠状动脉、肾动脉和下肢动脉造影效率高,安全可行,临床上对于需同时行选择性冠状动脉、肾动脉和下肢动脉造影的患者,可作为首选介入径路.

Brugada综合征是离子通道病的一种[1].Brugada波是Brugada综合征最具特征的临床表现,也是诊断的必要条件之一[2].Brugada综合征的流行病学调查多以Brugada心电图征作为评价指标,根据国内外的报道,Brugada综合征尤其是Brugada波在临床上并非罕见.我们通过调查健康体检人群的心电图,旨在初步了解Brugada心电图征的发生率.

目的拟建立野百合碱诱导的肺动脉高压大鼠模型,并观察尾加压素Ⅱ(urotensin-Ⅱ,UⅡ)在野百合碱(monocrotaline,MCT)诱导的肺动脉高压(Sprague-Dawley,SD)大鼠中的表达。方法 30只大鼠随机分成正常对照组(NC)15只和野百合碱组(MCT)15只,MCT组一次性颈背部皮下注射MCT(60mg/kg),NC组皮下注射相同剂量的生理盐水,饲养3周后分别测定两组大鼠平均肺动脉压力(MPAP),之后处死大鼠,测定右心室游离壁(RV)和左心室加室间隔(LV+S)的重量比,同时用放免法测定大鼠血浆中UⅡ的含量,免疫组化法检测大鼠肺细小动脉UⅡ蛋白的表达。结果 MCT组大鼠MPAP、RV/LV+S显著高于NC组(P<0.01),MCT组大鼠血浆中UⅡ的含量显著高于NC组(P<0.01);免疫组化显示随着肺动脉分支下移,UⅡ的水平越来越高(P<0.05和P<0.01)。结论通过野百合碱诱导大鼠建立肺动脉高压模型是一种较为经济方便的方法 ,UⅡ在肺动脉高压中起着一定的作用。

患者女性,47岁,因反复晕厥7年,再发1d入院.患者于入院次日凌晨02:10左右卧床时感剧烈胸痛伴出汗,面色苍白.测血压92/53 mmHg,神志尚清.

2006年4～11月对温州市戒毒所764名接受盐酸美沙酮替代治疗的海洛因依赖者在戒断期的血压水平进行调查,并随机选取同期在温州市体检中心进行健康体检的700名年龄相似的正常人群进行比较分析,现报告如下.

Objective:To study the effects of blood serum in rats treated with MCT on pulmonary artery hypertension in experiment′s rats. Methods:Blood-serum liquid (SB liquid) of rats injected intraperitoneally with single MCT after 14 days. 40 rats in the experimental group (SB group) was injected with 1-2 ml SB liquid through penile vein, while the rats in control group (DB group) was treated with blood-serum liquid of normal rats through the same dosage and method, and the changes of the rats in both groups were observed through pulmonary arterial mean pressure and right ventricular pressure in both groups were measured for 17, 22, 53, 60 days respectively. Results:There was no significant difference in pulmonary arterial mean pressure and right ventricular pressure in DB group and SB group, but a upgrade tendency was observed in SB group.Conclusion:Blood serum in rats treated with Monocrotaline can′t induce to elevation of pulmonary artery hypertension in experiment′s rats during short period.

致心律失常性右心室心肌病(ARVC)较少见,其临床表现、心电图、超声心动图(UCG)及磁共振(MR)等实验室检查均有其独特的特征.现报道1例确诊ARVC患者13年随访资料.