Objective:This study investigated the efficacy and safety of intracardiac echocardiography (ICE) on radiofrequency ablation of arrhythmias.Methods:From May 2020 to February 2021, a total of 200 patients (60.40±12.14 years old, male 126) with arrhythmia were treated with radiofrequency ablation in our center. They were divided into ICE group and control group according to whether ICE was used during operation. The intraoperative fluoroscopy time, complications and operation success rate were compared between the two groups. ResultsConclusion:ICE can significantly improve the safety of radiofrequency ablation of arrhythmias.

目的:探讨阵发性心房颤动(PAF)导管射频消融术(RFCA)后复发的相关独立危险因素以及多指标联合评估模型在预测RFCA后PAF复发中的价值.方法:回顾性分析于2017年1月—2018年10月在苏州大学附属第一医院心内科行首次RFCA的PAF患者186例,收集患者的一般临床资料、血清学资料、超声心动图资料、消融方式及口服药物资料等,并构建3种指标左心房内径(LAD)、中性粒细胞与淋巴细胞比值(NLR)及术后早期复发(ERAF)]联合的新评估模型,术后随访12个月,记录复发情况.采用二元Logistic回归分析建立预测模型,用受试者工作特性(ROC)曲线和曲线下面积(AUC)评估预测效率,最后用MedCalc软件的Z检验比较不同指标的AUC.结果:38例(20.43％)复发(复发组),148例(79.57％)无复发(未复发组).两组LAD、NLR、ERAF、红细胞分布宽度(RDW)、总胆固醇(TC)、甲状腺素(T4)以及白细胞(WBC)差异有统计学意义(P＜0.05).多因素分析显示:LAD(OR = 1.227,95％CI:1.090～1.382,P = 0.001)、NLR(OR = 2.020,95％CI:1.295～3.151,P=0.002)、ERAF(OR = 16.886,95％CI:5.698～50.037,P＜0.001)是PAF术后复发的独立危险因素.LAD、NLR及ERAF预测PAF术后复发的AUC分别为0.773、0.758和0.767.LAD、NLR及ERAF预测PAF复发的敏感度和特异度分别为0.730和0.741、0.865和0.585、0.595和0.939.LAD+NLR+ERAF联合评估模型预测PAF术后复发的AUC为0.902,敏感度为0.865,特异度为0.837.结论:本研究显示,LAD、NLR和ERAF是RFCA后PAF复发的独立危险因素,LAD+NLR+ERAF联合评估模型对RFCA后PAF复发风险的评估效能高于任何单一指标,其对PAF术后复发的预测更可靠.

心房颤动是临床最常见的心律失常,近年来射频消融已成为治疗心房颤动最重要、最有效的手段,但与此同时各种并发症也随之而来.肺静脉狭窄是心房颤动射频消融术后的并发症之一,严重的肺静脉狭窄可出现患侧肺淤血及血流灌注异常,晚期可发生进展性肺循环高压.由于它是一种相对罕见的医学问题,且不具有特异性表现,因此很容易被误诊、漏诊.结合上述现状,现针对心房颤动射频消融术后肺静脉狭窄的流行病学、形成及影响因素、病理生理、临床症状、诊治及相关进展做以下综述.

目的 探讨特发性室性早搏(室早)的发生与自主神经机制之间的关系.方法 采用单中心回顾性研究方法,选择24 h动态心电图记录到频发室早(≥10000次/d或室早负荷≥10％)的156例特发性室早患者(室早组)和同期健康体检者84例(对照组)为研究对象.根据24 h动态心电图检查结果,计算心率变异性指标rMSSD、pNN50、高频功率(HF)、标准化的高频功率(HFnorm)、低频功率(LF)与HF的比值(LF/HF).比较两组自主神经张力间的差异,并分析室早负荷与自主神经张力变化的关系.结果 与对照组相比,室早组患者rMSSD、pNN50、HF和HFnorm均明显增加(P<0.01),LF/HF显著降低(P<0.01).室早组患者24 h室早负荷与rMSSD、pNN50和HF呈正相关(相关系数分别为0.492、0.425、0.372,P<0.01),而与LF/HF呈负相关(相关系数为-0.206,P<0.05);其中28.8％(45/156)的患者每小时室早负荷与每小时HFnorm呈正相关,16.0％(25/156)的患者与每小时LF/HF呈正相关,53.8％(84/156)的患者与每小时HFnorm和每小时LF/HF均无相关性.结论 部分特发性室早的发生与交感和(或)迷走神经张力变化相关.

Obesity is often accompanied by dyslipidemia, high blood glucose, hypertension, atherosclerosis, and myocardial dysfunction. Selenate is a vital antioxidant in the cardiovascular system. The beneficial effects of selenate on obesity-associated cardiac dysfunction and potential molecular mechanism were identified in both H9C2 cells and C57BL/6J mice hearts. The cardiac histological preformation in C57BL/6J mice were evaluated by cross-sectional area (CSA) of cardiomyocytes and percent area of fibrosis in the left ventricles. The cardiac autophagy flux in H9C2 cells and C57BL/6J mice hearts was analyzed by Western blots and the number of autophagosomes and autolysosome in H9C2 cells. In the present study, we found that lipid overload caused increases in serum lipid, CSA, and percent area of fibrosis. We further found that lipid-induced accumulation of autophagosomes was due to depressed autophagy degradation, which was not restored in the pretreatment with 3-methyladenine and chloroquine, whereas, it was improved by rapamycin. Moreover, we demonstrated that increased levels of serum lipid, CSA, percent area of fibrosis and mRNA expression related to cardiomyocytes hypertrophy and fibrosis were significantly reduced after selenate treatments of mice. We also found selenate treatment significantly down-regulated activity of the Akt pathway, which was activated in response to lipid-overload. Furthermore, selenate dramatically improved cardiac autophagic degradation which was suppressed after exposure to lipid-overload in both H9C2 cells and C57BL/6J mice hearts. Taken together, selenate offers therapeutic intervention in lipid-related metabolic disorders, and protection against cardiac remodeling, likely through regulation of the activity of autophagic degradation and Akt pathway.

目的 观察冷冻消融和射频消融环肺静脉电隔离后对阵发性心房颤动(PAF)患者心肌肌钙蛋白I(cTnI)和C反应蛋白(CRP)的影响.方法 选取PAF患者102例,冷冻组有42例,射频组有60例,所有患者均于术前、术后3～4 h测定血清cTnI和CRP并对其进行比较.术后随访3个月,比较早期复发与未复发患者的cTnI和CRP水平.结果 所有患者术前cTnI和CRP均在正常范围.两组患者术后cTnI和CRP均升高,与术前相比差异有显著性(P<0.001).与射频组相比,冷冻组术后cTnI和CRP水平升高幅度更大(P<0.05).术后3个月随访,共复发31例(30.4％),其中冷冻组15例(35.7％),射频组16例(26.7％),两者复发率无明显差异(P>0.05).射频组术后复发的患者CRP水平明显高于未复发的患者(P<0.05).结论 冷冻消融较射频消融对心肌损伤程度更大;射频消融术后CRP较高可能与早期复发相关.

目的：探讨心肌淀粉样变性的临床特点及其诊治方法。方法对确诊的4例心肌淀粉样变性患者的临床资料进行回顾性分析。结果4例临床表现均以充血性心衰、心律失常、低血压为主；均出现血清N末端B型利钠肽原水平增高，3例出现肝肾功能异常，1例行血尿轻链水平检查出现增高。4例心电图均为低电压表现，心脏超声均表现为左室壁增厚。4例腹壁脂肪组织活检刚果红染色均为阳性。1例行硼替佐米及地塞米松化疗者第1疗程结束后复查血轻链水平降至正常，其余3例未行化疗者均于就诊后4～8个月死亡。结论心肌淀粉样变性具有特征性的心电图和心脏超声表现，脂肪组织病理检查可确诊。应主要针对淀粉样变性进行治疗。

Objective Increased mean platelet volume (MPV) is associated with poor clinical outcome in patients with acute coronary syndrome. We evaluated the predictive role of MPV in young patients with acute myocardial infarction (AMI). Methods This study includes 265 patients who were hospitalized in the First Affiliated Hospital of Soochow University with AMI (group 1 : 118 young patients,males aged<45 years and females aged<55 years;group 2:147 older patients) and 102 adults with normal coronary angiography as a control group (group3). Results In group 1,the proportion of smokers was higher than that in groups 2 an d 3(P1=0.01,P2<0.001);In group 1,the proportion of male patients was higher than that in group 3(P2<0.001);In group 1,the levels of Platelet count,MPV,Hemoglobin,Creatinine,Total cholesterol, LDL-C were higher than that in group 3(P2<0.05). Conclusion After multivariate analysis,MPV,age,Gender,Platelet count and Creatinine were independent predictors of AMI in young patients .

目的 总结本院射频消融治疗局灶性房性心动过速(简称房速)的消融点、方法及疗效.方法 分析5年间40例行射频消融治疗的房速患者的临床资料,探究消融靶点的分布、消融术的成功率和特殊起源点的消融方法,随访复发情况.结果 ①起源于右房的房速多于左房(60％ vs 40％).右房常见消融点依次为右房间隔、界嵴、三尖瓣环、冠状窦口、上腔静脉和右心耳.左房常见消融点依次为肺静脉、左房间隔和左心耳.②射频消融治疗的成功率为85％ (34/40).85％的患者在EnSite 3000三维标测指引下消融.③起源于右房间隔His束旁的6例房速通过无冠窦消融成功治愈4例,另2例于His束周围低功率消融失败.结论 三维标测系统指引下行射频消融治疗局灶性房速效果肯定.His束旁起源的房速可通过主动脉无冠窦内消融.

目的 探讨老年高血压患者自我感知老化对服药依从性的影响.方法 对苏州市350例社区老年高血压患者进行问卷调查,采用Morisky服药依从性量表评估服药依从性,分析自我感知老化总分及其8个维度得分对服药依从性的影响.结果 350例中,服药依从性不良(＜6分)者222例(63.4％).服药依从性良好(≥6分)组自我感知老化总分低于不良组[(80.10±39.03)分vs.(91.64±28.83)分](P＜0.01).周期时间性维度、情感表征维度、积极控制维度、消极控制维度、积极结果维度及认同维度的高、中、低不同得分组之间患者服药依从性也有明显差异(P＜0.05).血压控制良好、积极控制维度与积极结果维度高得分是患者服药依从性的保护因素,周期时间性维度高得分与认同维度中、高得分是其危险因素.结论 老年高血压患者的服药依从性水平较低,自我感知老化是影响其服药依从性的重要因素.

目的：探讨醒脑静联合高压氧在中暑昏迷患者脑神经康复中的临床疗效。方法选取2013年1月—2014年8月我院神经内科收治的中暑昏迷患者60例，按入院先后顺序随机分为对照组和试验组，每组30例。对照组给予常规内科治疗及高压氧治疗，试验组在此基础之上给予醒脑静注射液治疗。观察两组患者治疗前后的临床疗效，格拉斯哥昏迷(GCS)评分，体温恢复时间，清醒时间及清醒率。结果试验组治疗总有效率显著高于对照组，差异有统计学意义(P<0.05)；试验组的 GCS评分、清醒率明显高于对照组(P<0.01)；试验组体温恢复时间，清醒时间明显短于对照组，差异有统计学意义(P<0.01)。结论醒脑静联合高压氧可快速降低中暑昏迷患者的体温，明显缩短中暑昏迷患者的昏迷时间，对中暑昏迷患者有退热及促醒作用，有利于中暑昏迷患者脑功能的康复。

目的：探究椎－基底动脉缺血性眩晕患者应用中西医结合方案对其血流动力学及症状改善情况的影响。方法选取63例椎－基底动脉缺血性眩晕患者设为对照组，给予盐酸倍他司汀治疗；59例椎－基底动脉缺血性眩晕患者设为研究组，在对照组给药基础上加用加味半夏白术天麻汤治疗。2组于治疗前后均接受DARS及DHI量表测评，同时行径颅多普勒超声检查评估椎基底动脉血液峰流速，并比较2组临床总有效率。结果2组总有效率相比差异有统计学意义（P＜0．05）。2组治疗前DARS及DHI评分比较差异均无统计学意义（P均＞0．05）；研究组治疗后的DARS及DHI评分较对照组低（ P均＜0．05）。2组治疗前左、右侧椎动脉及基底动脉峰流速比较差异均无统计学意义（P均＞0．05）；研究组治疗后左、右侧椎动脉及基底动脉峰流速均高于对照组（P均＜0．05）。结论相较于单纯应用盐酸倍他司汀治疗椎－基底动脉缺血性眩晕患者，实施加味半夏白术天麻汤联合治疗，能有效改善患者眩晕症状，并提高颅脑血液流变学的稳定性，值得在临床上进一步推广。

Objective To study the cardioprotective effects of ischemic postconditioning on rabbit heart injuried by ischemia/reperfusion in vivo .Methods Thirty-six New Zealand rabbits were randomly allocated to three groups: ①Control group ( ischemia/reperfusion group ); ②Ischemic postconditioning group ( IPostC group ); ③Sham operation group ( sham group ) . Models were established by the method of left anterior descending artery occlusion .Electrocardiogram ( ECG ) were performed during the experiment .Blood was drawn from femoral vein to evaluate cardiac troponin I ( cTnI ) by enzyme -linked immunosorbent assay ( ELISA ) before operation and 120 min after reperfusion .Myocardial infarct size of each group was determined by staining with triphenyltetrazolium chloride dye.Morphology of cardiac muscle tissues in each group was examined by transmission electron microscope .Bad expressions in the cardiac muscle tissues were detected by Western blot before and after reperfusion .All experiment data were statistically analyzed by the SPSS 17.0 software.Results ①One hundred and twenty minutes after reperfusion sixty -seven percent of rabbits in control group and eighty-three percent of rabbits in IPostC group had ST -segment resolution ≥50%.But there was no significant difference between two groups (P>0.05).The cardiac arrhythmia score of control group increased significantly than that of IPostC group (2.5 ±1.0 vs 1.4 ±1.0, P<0.05).②One hundred and twenty minutes after reperfusion cTnI value of control group was higher than that of IPostC group (6.63 ±2.32 vs 3.04 ±1.10, P<0.05).③Compared to IPostC group the infarct size of control group increased by 54%(P<0.05).④Morphologic examination indicated that the cardiomyocytes of control rabbits had more significant apoptosis characteristics compared with those of IPostC rabbits .Control group was associated with a significant increase in the expression of Bad compared with IPostC group (P<0.05).Conclusion Ischemic postconditioning at onset of reperfusion can obviously reduce myocardial reperfusion injury .

Objective To investigate the relationship between the levels of mean platelet volume(MPV)and the formation of coronary collateral circulation(CCC)in patients with acute coronary syndrome.Methods The study population included 132patients with acute coronary syndrome who were hospitalized in the First Affiliated Hospital of Soochow University.Totally 132patients with at least the stenosis of one vessel≥90% among three main vessels of coronary artery were enrolled in the study according to angiographic estimation.Development of CCC was classified by Rentrop method.According to the collateral degree,the patients were divided into two groups:non-CCC formation group,79patients with CCC grade 0;CCC formation group,53patients with CCC grade 1-3.CCC grade 1had 14 patients,CCC grade 2had 28patients,CCC grade 3had 11patients.Results Compared with the CCC formation group(11.01±1.61)fl,the levels of MPV in non-CCC formation group(10.32±1.08)fl were decreased significantly(P 0.01).After Spearman correlation analysis,MPV levels were positively correlated with CCC grade(r=0.990,P 0.05).Conclusion Among the patients with acute coronary syndrome,the levels of MPV in patients of CCC formation are significantly higher than those of non-CCC,MPV increase may promote the formation of CCC.

目的:探讨围生期心肌病的临床特点、诊断和治疗.方法:结合相关文献回顾性总结21例围生期心肌病患者的临床资料.结果:21例患者平均年龄29岁,初产妇3例.8例于产前发病,均经剖宫产终止妊娠;13例于产后3月内发病.所有患者左心室射血分数均＜45％.按照心衰指南结合孕妇特点给予治疗,经治疗后除1例因严重左心衰死亡外,余20例患者症状均明显缓解并带药出院.结论:诊断围生期心肌病必须具备左心室射血分数＜45％,发病时间范围适当放宽可提高诊断率.孕妇生产的时机和方式由母婴情况决定.患者的预后与左心室功能的恢复情况有关.

近年来,随着经皮冠状动脉支架植入术(PCI)、经皮冠状动脉成形术(PTCA)和冠状动脉搭桥术(CABG)技术的完善,我们清楚的认识到某些因心肌缺血发生功能和代谢改变的心肌仍是存活心肌.当急性的心肌缺血导致氧供不能满足心肌代谢需要时,心脏早期的缺血适应表现为心肌顿抑(myocardial stunning)[1].正确的认识心肌顿抑对于理解急性心肌梗死的患者一些临床特点,指导治疗以及判断预后有重要意义.

1959 年，Prinzmetal ［1］等首先报道将冠状动脉痉挛引起的缺血性心绞痛命名为“变异性心绞痛”，指出此心绞痛的发作与活动无关，多发生在安静时，发作时相关导联出现ST 段一过性抬高，发作过后ST 段恢复正常，不出现病理Q波。本文通过回顾性分析变异性心绞痛患者的相关临床资料、治疗及回访现状，指导临床及时诊断、治疗提供依据。报道如下。

BACKGROUND:Although cardiac troponin I gives excellent accuracy in the identification of myocardial necrosis, it can also be elevated in a series of diseases other than acute coronary syndromes.CASE PRESENTATION:We present two cases of Chinese patients with a high serum troponin I level after an acute episode of paroxysmal supraventricular tachycardia with normal coronary arteries via angiography.CONCLUSION:Abnormal troponin elevations can be seen in patients presenting with paroxysmal supraventricular tachycardia and angiographically-normal coronary arteries. Caution is advised with the use of invasive assessments such as coronary angiography in the differential diagnosis of patients with paroxysmal supraventricular tachycardia and elevated troponin levels.

高血压心脏病是由于高血压长期控制不良，压力负荷增加，儿茶酚胺与血管紧张素域等生长因子刺激心肌细胞肥大和间质纤维化，导致左心室肥厚、扩张[1]。高血压心脏病是心脏长期处于高阻力、高负荷状态下引起的并发症，有研究指出高血压心脏病患者其病情危险程度是正常高血压患者的3~4倍[2]。大多数高血压心脏病患者若未经有效治疗，病情逐渐加重，心肌纤维增粗肥大，严重损害心脏功能，可随时发生恶性心律失常、心功能衰竭甚至猝死可能。目前临床诊断高血压心脏病除存在高血压病史及临床症状、体征外，还需进行X线胸片、心电图、超声心动图等检查。随着二维超声心动图的应用，发现心电图诊断左心室肥大存在一定的偏差[3]，超声心动图成为早期诊断心脏疾病的一个操作方便、重复性高、廉价、可评价心脏结构和功能的可靠的检查工具，现将我院高血压心脏病患者的超声心动图结果分析如下。

目的：探讨心肌淀粉样变性的临床诊疗特点以便提高该病的诊断率；