目的:观察苓桂术甘汤加减联合曲美他嗪治疗慢性心力衰竭的临床疗效及对心功能、血清炎性因子水平的影响.方法:选择114例慢性心力衰竭患者,按随机数字表法分为观察组和对照组各57例.对照组接受常规抗心衰及曲美他嗪治疗,观察组在对照组基础上给予苓桂术甘汤加减治疗.比较2组临床疗效及治疗前后心功能指标、炎症因子水平的变化.结果:观察组总有效率为87.72％,高于对照组71.93％,差异有统计学意义(P＜0.05).治疗后,2组N端脑钠肽前体(NT-proBNP)水平较治疗前降低,左室射血分数(LVEF)及6 min步行距离较治疗前升高(P＜0.05),且观察组NT-proBNP水平低于对照组,LVEF及6 min步行距离高于对照组(P＜0.05).治疗后,2组血清超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平较治疗前降低(P＜0.05),且观察组血清hs-CRP、TNF-α、IL-6水平低于对照组(P＜0.05).结论:苓桂术甘汤加减联合曲美他嗪治疗慢性心力衰竭能够有效抑制炎症反应,改善心功能,提高临床疗效.

目的 探讨增强型体外反搏联合曲美他嗪对行经皮冠状动脉介入术(PCI)后冠心病患者心功能的影响.方法 选取2017年6月至2018年6月在温州市中医院和温州医科大学附属第二医院行PCI术后的缺血性心脏病伴左心室射血分数(LVEF)低下患者90例,随机分为对照组、观察组1和观察组2,每组各30例.三组患者均行常规药物治疗,观察组1在对照组治疗基础上加用曲美他嗪进行干预,观察组2在观察组1的治疗基础上,联合增强型体外反搏治疗.比较三组患者治疗前后LVEF、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD),N-末端B型利钠肽前体(NT-proBNP)值及血清肌酸激酶同工酶(CK-MB)、血清心肌肌钙蛋白I(cTnI)浓度,6min步行试验(6MWT)的步行距离及随访半年内的心血管不良事件的发生情况.结果 两组观察组在干预30d后,其EF值、NT-proBNP、6MWT的变化均优于对照组(P<0.05),且观察组2优于观察组1(P<0.05),同时并未升高CK-MB、cTnI(P>0.05),说明并不造成心肌的损伤.随访半年后,观察组2的心血管事件发生率远低于其他两组(P<0.05).结论 增强型体外反搏联合曲美他嗪干预行PCI术后缺血性心脏病患者,可以改善患者的心功能,减少心脏不良事件.

Objective To investigate the effect of Buyang Huanwu Tang combined with distal ischemic preconditioning on the quality of life and prognosis of patients after stent implantation. Methods 120 patients with ischemic heart disease after stent implantation were divided into observation group and control group with 60 cases in each group.On the basis of routine drug treatment,the control group received distal ischemic preconditioning for 30 minutes. The observation group was treated with Buyang Huanwu Tang.The changes of TCM blood stasis syndrome score,clinical efficacy of TCM and Seattle angina score were observed in the two groups,and the occurrence of adverse cardiovascular events such as angina pectoris,myocardial infarction and death were observed after 6 months of follow-up. Results After one month of treatment,the score of blood stasis syndrome in the observation group was significantly lower than that in the control group(P<0.05). The total effective rate of the observation group was significantly higher than that of the control group(P<0.05).On the Seattle Angina Scale,compared with the control group,the observation group had a significant improvement in the degree of physical activity limitation and the frequency of angina pectoris after 1 month and 6 months of treatment(P<0.05). In terms of disease awareness,after 6 months of treatment,the observation group was higher than the control group(P<0.05).At 6 months follow-up, 1 case died in the observation group and 3 cases died in the control group. There was no significant difference between the two groups(P<0.05);3 cases of recurrent myocardial infarction in the observation group and 10 cases in the control group were significantly lower than those in the control group(P<0.05);16 cases of recurrent angina in the observation group were significantly lower than 28 cases in the control group(P<0.05). Conclusion Buyang Huanwu Tang combined with distal ischemic preconditioning can significantly improve the quality of life of patients with ischemic heart disease after stent implantation and reduce cardiovascular endpoint events.

目的 探讨远端缺血预处理对择期行PCI患者的心肌保护作用及远期预后影响.方法 选择择期行PCI的缺血性心脏病患者122例,采用随机对照表法分为观察组和对照组,各61例.2组均常规药物治疗,观察组在PCI术前1h予远端缺血预处理30 min.观察2组患者术后16h高敏肌钙蛋白I(hs-cTnI)＞0.12、＞0.16、＞0.20、＞0.24、＞0.28、＞0.36和＞0.48 μg/L所占比例及4a型心肌梗死发生率,随访6和12个月时再发心绞痛、再发心肌梗死和死亡等主要不良心血管事件发生情况.结果 观察组不同hs-cTnI水平比例均明显低于对照组(＞0.12μg/L,54.1％ vs 78.7％,P=0.004;＞0.16 μg/L,49.2％vs 68.9％,P=0.039),观察组4a型心肌梗死发生率显著低于对照组(41.0％ vs 59.0％,P=0.046).术后6个月随访时,观察组较对照组再发心绞痛和再发心肌梗死发生率虽有下降,但差异无统计学意义(9.8％ vs 21.3％,x 2=3.055,P=0.080;0 vs 3.3％,x2=2.033,P=0.154),术后12个月随访时,观察组较对照组再发心绞痛和再发心肌梗死发生率明显下降(13.1％ vs 32.8％,x2=6.675,P=0.010;1.6％ vs 11.5％,x2 =4.816,P=0.028).2组随访期间均无死亡患者.结论 远端缺血预处理可显著降低择期行PCI患者术后hs-cTnI水平,保护心肌,降低4a型心肌梗死发生率,并改善患者预后.

目的 探讨血清高迁移率族蛋白B1 (high mobility group protein,HMGB1)、超敏C-反应蛋白(high-sensitivityC-reactive protein,hs-CRP)及脂蛋白相关磷脂酶A2(Lipoprotein-associated phospholipase A.2,LP-PLA2)在冠心病患者病情及软斑块形成风险评估中的应用价值.方法 选取120例冠心病患者为观察对象(冠心病组),按冠状动脉病变支数、冠状动脉病变类型、冠状动脉狭窄程度Gensini评分等进行分组,另选取50例同期行冠脉CTA并排除CHD的患者作为对照组.检测比较2组患者的HMGB1、hs-CRP和LP-PLA2水平.结果 冠心病组患者血液中的HMGB1、hs-CRP吸LP-PLA2水平随着患者冠状动脉病变支数增加而增高(P＜0.05);冠心病组血液中的HMGB1、hs-CRP及LP-PLA2水平随着患者冠状动脉病变支数增加而增高(P＜0.05);患者血液中的HMGB1、hs-CRP及LP-PLA2水平越高,冠状动脉狭窄程度越严重(P＜0.05).软斑块组患者血液中的HMGB1、hs-CRP及LP-PLA2水平明显高于纤维斑块组、钙化斑块组和对照组(P＜0.05).Gensini评分与HMGB1、hs-CRP及LP-PLA2呈正相关(P＜0.01).结论 随着颈动脉粥样硬化程度加重,血清LP-PLA2、hs-CRP、HMGB1呈渐进性升高的趋势,并且与斑块的性质和易损性密切相关.

目的 观察自拟祛瘀通脉中药免煎颗粒剂联合静脉溶栓(IVCT)治疗急性心肌梗死(AMI)的疗效.方法 将符合相应标准的86例AMI患者按照就诊顺序,随机分人联合组与基础组各43例,基础组给予IVCT及对症治疗,联合组在除基础组的治疗外,加自拟祛瘀通脉中药免煎颗粒剂治疗;两组均以15d为1个疗程,在治疗前及治疗后3d、7d、15d分别设立1次随访.结果 从心肌损伤标志物水平、心功能、血小板最大凝聚率、中医临床疗效、冠脉再通率、恶性心血管事件发生情况等几方面比较,联合组均优于基础组(P＜0.05).结论 采用自拟祛瘀通脉中药免煎颗粒剂联合IVCT治疗AMI的临床应用疗效显著.

慢性心力衰竭(简称慢性心衰)是多种心血管疾病发展的终末阶段,近年来随着人们物质生活水平的不断提高和人口老龄化进程的演进,各类心血管疾病的患病率呈现出了明显的升高趋势,慢性心衰的患病率也随之升高[1].房颤是慢性心衰患者较常发生的并发症,对于合并房颤的慢性心衰患者,若能及时有效地纠正心室率,提高双心室起搏比例,然后实施心脏再同步化治疗,能够最大限度地保留器官生理功能,获得满意的治疗效果[2].报道如下.

目的 调查分析心血管内科患者对心脏康复的需求,以此为依据改善医院的诊疗服务.方法 选取2015年1月至2018年1月于我院心血管内科接受治疗的60例心脏病患者,使用我院自制的心血管内科患者心脏康复需求调查表进行问卷调查,分析调查结果.结果 大部分心脏病患者在住院时及出院后希望得到科学的心脏康复治疗与护理支持,且希望医护人员能对其进行合理的心脏康复指导.结论 医院心血管内科在对患者进行治疗与护理时应加强心脏康复护理专业团队建设,加强心脏康复支持,以保障身心健康,促进快速康复.

目的 探讨曲美他嗪联合运动康复疗法对冠心病患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心功能及心肌指标的影响.方法 选择2015年5月～2016年8月温州市中医院及温州医科大学附属第二医院收治的120例被确诊为冠心病并行PCI的患者,按照随机数字表法分为对照组、观察组1和观察组2,各40例.对照组采用常规治疗,观察组1在常规治疗基础上给予曲美他嗪治疗,观察组2在曲美他嗪药物治疗的基础上实施康复运动训练.比较PCI术前和术后24h,三组患者心肌损伤标志物血清肌酸激酶同工酶(creatine kinase MB,CK-MB)、血清心肌肌钙蛋白Ⅰ(cardiac troponinⅠ,cTnⅠ)以及炎症因子血清高敏C-反应蛋白(highsensitivity C-reactive protein,hs-CRP)的浓度;术后随访12个月,比较三组患者末次随访时的心功能指标、随访期间心血管事件的发生率以及生活质量.结果 PCI术后24h,三组患者的CK-MB、cTnⅠ、hs-CRP水平均明显高于术前(P＜0.05),且观察组的水平明显低于对照组(P＜0.05),观察组1和观察组2的CK-MB、cTnⅠ、hs-CRP水平之间无明显差异(P＞0.05).末次随访时,观察组左室射血分数(left ventricular ejection fraction,LVEF)明显高于对照组(P＜0.05),且观察组2的LVEF明显高于观察组1(P＜0.05);观察组的左心室收缩末期内径(left ventricular endsystolic dimension,LVESD)、左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)均明显低于对照组(P＜0.05),且观察组2的LVESD、LVEDD明显低于观察组1(P＜0.05).随访期间,观察组患者心血管事件的发生率明显低于对照组(P＜0.05),且观察组2的心血管事件发生率明显低于观察组1(P＜0.05);观察组患者生活质量评分明显高于对照组(P＜0.05),且观察组2的生活质量评分明显高于观察组1 (P＜0.05).结论 曲美他嗪联合运动康复疗法能有效减轻患者PCI术后心肌损伤,显著改善患者左心室功能,降低心血管事件的发生率,提高患者的生活质量.

Objective Acute coronary syndrome belong to clinical common acute cardiovascular disease that is leading causes of deaths.In order to provide a basis for clinical treatment,we investigate the relationship between UA and Hcy,T cell subset and blood lipid in patients with acute coronary syndrome.Methods A total of 84 patients with acute coronary syndrome were divided into UAP group(40 cases) and AMI group(44 cases) from April,2015 to October,2016,and 40 healthy subjects were selected as control group.UA,Hcy,T cell subset and blood lipid were determined and compared in 3 groups,and to investigate the relationship between UA and Hcy,T cell subset and blood lipid in patients with acute coronary syndrome.Results UA and Hcy of UAP and AMI group were significantly higher than those in control group(P ＜ 0.05),and UA and Hcy of AMI group increased more significantly (P ＜ 0.05);CD4 + CD25 + Treg and CD4 + CD25hi~gh Treg of UAP and AMI group were significantly lower than those in control group (P ＜ 0.05),and CD4 + CD25 + Treg and CD4 + CD25 highTreg of AMI group decreased more significantly (P ＜ 0.05);TC、TG、LDL of UAP and AMI group were significantly higher than those in control group (P ＜ 0.05),HDL of UAP and AMI group were significantly lower than those in control group (P ＜ 0.05),and there was no significant difference between UAP and AMI group(P ＞ 0.05);Correlation analysis showed that UA positively correlated with Hcy,TC,TG and LDL in patients with acute coronary syndrome (P ＜ 0.05),UA negatively correlated with HDL in patients with acute coronary syndrome (P ＜ 0.05).Conclusion Acute coronary syndrome patients with UA,unusually high Hcy levels,immune function decline,lipid metabolic disorder,and the UA levels associated with Hcy and lipid levels.

Objective To investigate the effect of trimetazidine combined with remote ischemic preconditioning(RIPC) on myocardial damage and prognosis in elderly ischemic heart disease patients undergoing percutaneous coronary intervention (PCI).Methods A total of 96 elderly ischemic heart disease patients treated with PCI were randomly divided into observation group(48 cases) and control group(48 cases) from January,2016 to September,2016.All the patients of 3 groups received antiplatelet routine drug treatment,etc.The control group received additional trimetazidine therapy,while the observation group received additional trimetazidine and RIPC.The changes of cTnI and CK-MB before and after the treatment and the incidence of adverse cardiovascular events at follow-up of 6 months were observed in both groups.Resuits The levels of cTnI and CK-MB increased significantly in both groups at 24 h after treatment (P ＜ 0.05),the levels of cTnI and CK-MB of the observation group was significantly lower than that at 24 h after the treatment(P ＜ 0.05);6 months follow-up showed that there were 2 cases of recurrent angina in the observation group,with an incidence of 4.17％;there were no myocardial infarction and death cases;while there were 10 cases of recurrent angina in the control group with an incidence of 20.83％,there were 5 case of myocardial infarction with an incidence of 10.42％,there was nodeath case.The incidence of recurrent angina and myocardial infarction of the observation group was significantly lower than that in the control group(P ＜ 0.05).Conclusion Trimetazidine combined with remote ischemic preconditioning in elderly ischemic heart disease patients after PCI can obviously reduce the levels of cTnI and CK-MB,reduce the myocardial damage and incidence of adverse cardiovascular events.

Objective:Explore the effects of Jijitang on the treatment of acute myocardial infarction underwent coronary intervention(PCI) after clinical treatment.Methods:Randomized 104 patients diagnosed with acute myocardial infarction underwent the PCI surgery patients were divided into two groups,the control group(52 cases) after the PCI were given western medicine treatment,the experimental group(52 patients) in the treatment of the control group on the basis were given Ji ji tang.Results:The experimental group after treatment,the cardiac function and plasma inflammatory factors were better than the control group(P0.05),patient outcomes of the two groups were 100%,liver and kidney functions and blood showed no abnormalities,the difference was not statistically significant(P0.05).Conclusion:Patients with acute myocardial infarction after PCI were given Ji ji tang,can significantly improve cardiac function,reduce the level of inflammatory factors improve patients' quality of life and worthy of the application and popularization.

Objective To evaluate the effect of pre-percutaneous coronary intervention(PCI)administration of L-carnitine on myocardial injury in cororary heart disease patients with diabetes.Methods 60 patients with diabetes and suspicious coronary heart disease who were successively recruited and planed to undergo coronary angiography in our hospital from January,2009 to October,2011 were randomly assigned into two groups,which included A group treated with L-carnitine on the basis of standrard therapy prior to intervention and the B group treated with only standrard therapy.Those who hadn't underwent PCI for some reasons were excluded.Finally,46 patients were enrolled in this study,which included the L-carnitine group(26 patients) and the control group(20 patients).In all of the patients,cTnI and hs-CRP level were messured before PCI and also 24 hours and one week after PCI.Results The cTnI and the hs-CRP level in the total patients were significantly increased 24 hours and 1 week after PCI(P0.01);The cTnI and the hs-CRP level 24 hours and 1 week after procedural in the therapy group were significantly lower than those in the control group(P0.05).By using linear correlation analysis,it showed that the cTnI and the hs-CRP levels in both groups 24 hours after PCI were positively correlated significantly(r=0.75,P0.01).Conclusions The inflammation and myocardial necrocytosis are evident in diabetic with CHD patients after PCI;Pre-procedual L-carnitine administration significantly reduces PCI-induced myocardial injury in diabetic with CHD patients;It may be concluded that one of the reasons of myocardial necrocytosis caused by PCI has much to do with the inflammation.

Background: In recent years, catheter ablation has increasingly been used for ablation of idiopathic premature ventricular complexes (PVCs) or ventricular tachycardias (IVTs). However, the mapping and catheter ablation of the arrhythmias originating from the vicinity of tricuspid annulus (TA) may not be fully understood. This study aimed to investigate electrophysiologic characteristics and effects of radiofrequency catheter ablation (RFCA) for patients with symptomatic PVCs and IVTs originating from the vicinity of TA.Methods: Characteristics of body surface electrocardiogram (ECG) and electrophysiologic recordings were analyzed in 35 patients with symptomatic PVCs/IVTs originating from the vicinity of TA. RFCA was performed using pace mapping and activation mapping.Results: Among the 35 patients with PVCs/IVTs arising from the vicinity of TA, complete elimination of PVCs/IVTs could be achieved by RFCA in 32 patients (success rate 91.43%) during a median follow-up period of 21 months. PVCs/IVTs originating from the vicinity of TA had distinctive ECG characteristics that were useful for identifying the precise origin. An rS pattern was recorded in lead V1 in 93.1% of patients with PVCs/IVTs from the free wall of TA, vs 16.7% of patients with PVCs/IVTs from the septal TA, whereas a QS pattern in lead V1 occurred in 83.3% of patients with PVCs/IVTs from the septal TA vs 6.9% of patients with PVCs from the free wall of the TA. The precordial R wave transition occurred by lead V3 or earlier in all patients with PVCs/IVTs originating from the septal portion of the TA, as compared to transition beyond V3 in all patients with PVCs/IVTs from the free wall of the TA.Conclusions: RFCA is an effective curative therapy for symptomatic PVCs/IVTs originating from the vicinity of TA. There are specific characteristics in ECG and the ablation site could be located by ECG analysis.

目的 探讨病态窦房结综合征(SSS)患者分别在右心室流出道间隔部(RVOT)和右心室心尖部(RVA)植入永久性心室起搏导线前后各项心功能指标是否存在差异,比较各项指标的敏感性.方法 选取SSS患者60 例,随机分为RVOT 组和RVA组,均植入DDD永久性起搏器.所有患者术前及术后1、3、6 个月进行心电图检查,测量QRS 时限;超声心动图测量左心室舒张末期内径(LVEDD)、左心室射血分数(EF)、左右室射血前期时间延迟(PETd);实时三维超声心动图(RT-3DE)分别检测左心室16、12 节段达到最小收缩容积时间的标准偏差(Tmsv16-SD、Tmsv12-SD)及心率校正后的Tmsv16-SD/R-R、Tmsv12-SD/R-R 和左心室16 节段达到最小收缩容积时间的最大差值(Tmsv16-Dif)、心率校正后的Tmsv16-Dif/R-R 和左右心室间机械延迟(IVMD);检测血NT-proBNP.结果 与术前比较,RVOT组术后1、3、6个月QRS 及IVMD 均显著升高(P＜0.01);RVA组术后1、3、6 个月QRS、IVMD、Tmsv16-SD、Tmsv12-SD、Tmsv16-SD/R-R、Tmsv12-SD/R-R、Tmsv16-dif、Tmsv16-dif/R-R 均显著升高(P＜0.01),术后3、6 个月PETD 亦显著升高(P＜0.01).与ROVT 组比较,术后1、3、6 个月时RVA 组IVMD、Tmsv16-SD、Tmsv12-SD、Tmsv16-SD/R-R、Tmsv12-SD/R-R Tmsv16-dif、Tmsv16-dif/R-R均明显升高(P＜0.05 或0.01).结论 DDD 起搏后,无论是RVA 起搏还是RVOT起搏,均影响了心室运动的同步性;RVOT起搏对心室收缩同步性影响较RVA 小.实时三维超声心动图评价DDD 起搏术后患者心室运动的同步性优于传统的检测方法.

目的 探讨血尿酸水平与冠状动脉病变严重程度的关系.方法 入选338例经冠状动脉造影检查确诊为冠心病的患者,根据冠状动脉造影结果分为单支病变组100例,双支病变组78例,多支病变组160例.测定3组空腹血尿酸、血脂、血糖等各项指标并进行比较,最后分析血尿酸与冠状动脉病变严重程度的关系.结果 单支病变组、双支病变组、多支病变组血尿酸水平分别为(299.66±50.23)、(368.97±74.49)、(415.01±82.27)μmol/L,3组差异具有统计学意义(P＜0.01);性别、高血压、血尿酸水平、TC、LDL-C与冠心病病变严重程度具有显著相关性(P＜0.01),年龄、吸烟、空腹血糖与冠心病病变程度具有相关性(P＜0.05),而TG、HDL-C与冠心病病变严重程度无相关性(P ＞0.05).进一步采用偏相关分析,剔除性别、年龄、吸烟、高血压、空腹血糖、TC、LDL-C对冠心病病变严重程度的影响后,血尿酸水平与冠心病病变严重程度仍具有显著相关性(P＜0.01);最后进行线性回归分析,得回归方程y=0.104+0.006x.结论 血尿酸水平与冠状动脉病变的严重程度密切相关,检测血尿酸水平有可能成为一项有价值的、能预测冠心病事件的常规检查方法.

吸烟、高血压、糖尿病和高脂血症均是冠心病常见的独立危险因素.近年来研究表明,除上述危险因素外,高尿酸血症也在动脉粥样硬化(AS)的发生、发展中起一定作用.本文探讨血尿酸代谢异常在冠心病发病中的临床意义.

AIM:To study the correlation of two measured values of pulse wave time:PWT1 obtained by catheter and PWT2 obtained by Doppler tissue image(DTI)and the correlation of two measured values:aortic root to a point in the abdominal aorta 2 cm below the septum and length of body surface and to estimate the validity and feasibility of pulse wave velocity measurement using DTI.METHODS:A total 50 patients who had coronary arteriography were included in this study.Length of artery(L)was measured to study the correlation between L and different surface markers.PWV1 was obtained by PWV1=L/PWT1.Electromechanical time(EMT)and left ventricular pre-ejection period(PEP)were measured by DTI,and PWV2 was obtained by PWT2 = EMT-PEP,PWV2=L/PWT2.PWT1 and PWT2,PWV1 and PWV2,and the value of distance from aortic root to a point in the abdominal aorta 2 cm below the septum and the value of length of surface were then statistically compared.RESULTS:PWT1 was(24±9)ms and PWT2 was(24±9)ms,with no significant difference between PWT1 and PWT2.A positive correlation was found between the two(r=0.91,P0.01).PWV1 was(14±5)m/s and PWV2 was(14±5)m/s,with no significant difference between PWV1 and PWV2,but a positive correlation was also found between the two(r=0.92,P0.01).A positive correlation was found between the value of length of artery and the 1 cm+double values of length from angle of sternum to inferior border of sternum(r=0.90,P0.01).CONCLUSION:DTI is a noninvasive approach to measure PWT and PWV.PWV from the estimated value of the length of artery is precise by using 1 cm+double values of length from angle of sternum to inferior border of body of sternum.

Objective:To investigate the buffering function(elasticity)in different segment of aorta in aged patients with essential hypertension(EH).Methods:To measure pulse wave velocity(PWV)in different segment of aorta in 60 aged patients(30 EH patients and 30 patients with normal blood pressure)who were performing coronary arteriography.Results:The PWVs of inferior segment of aorta were more than that of superior segment(P0.01 all)in two groups.The different value of two segment significantly increased in aged EH patients compared with that of aged patients with normal blood pressure[(3.6±1.7)m/s vs.(1.6±1.3)m/s,P0.01].Conclusion:Decrease of buffering function of aorta in aged patients with essential hypertension suggest that there is decrease of aorta elasticity.