目的：评价心理干预治疗对冠心病慢性心力衰竭合并焦虑、抑郁症患者的疗效,评估心理干预治疗对焦虑、抑郁状态及心功能改善的影响。方法选择合并焦虑抑郁症的冠心病慢性心力衰竭300例患者,随机分为干预组和对照组各150例,对照组给予常规抗心衰治疗+抗焦虑抑郁药物治疗,干预组给予常规抗心衰治疗+抗焦虑抑郁药物+心理干预治疗。比较两组患者治疗前后心功能分级、抑郁自评量表( self -rating depression scale,SDS)、焦虑自评量表( self-rating anxiety scale,SAS)评分结果。结果干预组改善心功能的疗效优于对照组,差异有显著性(P<0.001),与治疗前比较,两组治疗后焦虑抑郁状态均得到明显改善,差异有显著性(P<O.05)；干预组治疗后焦虑和抑郁状态改善程度与对照组比较,差异有显著性(P<0.001)。结论对冠心病慢性心力衰竭合并焦虑、抑郁患者,在常规抗心力衰竭、抗焦虑抑郁治疗基础上联合心理干预治疗,能有效改善患者的心功能,改善焦虑、抑郁状态。

Objective To investigate efficacy of psychotherapy on chronic heart failure with anxiety and depression in patients with coronary heart disease .Methods A total of 200 cases were divided into intervention group or control group by random digits table , with 100 cases in each group.The control group was given conventional heart failure treatment ,antidepressant,and anxiolytic medication treatment,on this bases,the intervention group received psychological intervention treatment .The treatment lasted for 4 weeks.Score of Self-Rating Anxiety Scale(SAS),score of Self-Rating Depression Scale(SDS),left ventricular ejection fraction(LEVF),and curative effect were compared between the two groups before and after treatment .Results There was no statistically significant difference between the two groups in SAS or SDS scores before treatment (P>0.05),but both score decreased in each group after treatment (P<0.05),and the decreases were more obvious in intervention group than in the control group after treatment(P<0.05).There was no statistically significant difference between the two groups in LEVF before treatment(P>0.05),but it significantly increased after treatment in each group(P<0.05), and the increase was more obvious in intervention group than in the control group (P<0.05).The curative effect of intervention group was superior to that of control group(P<0.05).Conclusion Psychotherapy can improve the anxiety ,depression state and cardiac function , thus enhance the quality of life in patients with chronic heart disease .

Objective To observe the effects of different loading doses of atorvastatin calcium on the outcomes of percutaneous coronary intervention (PCI) in elderly patients with coronary heart disease (CHD). Methods A total of 120 CHD patients aged over 80 years were randomly assigned into 3 equal groups to receive intensive pretreatment with statin at the doses of 20, 40, or 60 mg prior to PCI performed within 48 to 72 h after admission. The changes of postoperative cardiac biochemical markers including creatine kinase isoenzyme (CKMB), troponin I (cTNI) and high-sensitivity c-reactive protein (hs-CRP) were observed and the incidence of major adverse cardiac events (MACE, including cardiac death, myocardial infarction, and target vessel revascularization) were recorded within 30 days after PCI. Results Thirty-four patients in 20 mg statin group, 40 in 40 mg statin group, and 38 in 60 mg statin group completed this study. In all the 3 groups, hs-CRP level significantly increased at 12 and 24 h after PCI compared with the preoperative levels (P<0.05). The patients in 60 mg statin group showed significantly lower levels of CKMB, cTNI, and hs-CRP at 24 h after PCI than those in 20 mg statin group (P<0.05), and had also a significantly lower incidence of total MACE within 30 days after PCI (2.6% vs 26.5%, P=0.003) resulting primarily from significantly reduced myocardial infarction associated with PCI (2.6% vs 20.6%, P=0.016). The adverse drug reactions were comparable among the 3 groups (P>0.05). Conclusions Intensive pretreatment with 60 mg/day atorvastatin calcium can significantly reduce myocardial infarction related to PCI with good safety in elderly patients with CHD.

目的:研究C反应蛋白、脂蛋白(a)及血清尿酸的检测对冠心病的临床诊断价值.方法:取我院2012年以来收治的经冠状动脉造影后确诊为冠心病的100例患者作为观察组,同时取100位同年龄段健康体检志愿者作为对照组,两组全部进行C反应蛋白、脂蛋白(a)及血清尿酸的检测并对比化验结果.结果:观察组患者C反应蛋白、脂蛋白(a)及血清尿酸化验结果明显高于对照组志愿者,且化验结果与患者冠状动脉病变范围关系成正相关,观察组患者异常率较高.结论:C反应蛋白、脂蛋白(a)及血清尿酸的检测对冠心病的诊断具有十分重要的意义.

目的：观察术前应用不同负荷剂量阿托伐他汀钙对稳定型心绞痛患者经皮冠状动脉介入治疗（ PCI）术后心肌损伤的保护作用。方法将210例择期PCI的冠心病患者分为两组，强化他汀组100例术前1周使用阿托伐他汀钙60 mg／d，对照组110例术前1周使用阿托伐他汀钙20 mg／d，观察两组患者治疗前后血脂、肝功能，PCI术前、术后心脏生化标志物、高敏C反应蛋白（ hsCRP）等指标变化及PCI术后30 d内主要不良心脏事件（ MACE，包括心源性死亡、心肌梗死和靶血管血运重建）的发生率。结果强化他汀组治疗1周后总胆固醇较对照组显著降低[-1.05±0.84）mmol／L vs（-0.26±0.52）mmol／L，P＝0.015]，PCI术后24 h肌酸激酶同工酶、肌钙蛋白I、hsCRP均较对照组显著降低（P＜0.01），PCI术后30 d内强化他汀组MACE明显少于对照组（10.0％ vs 22.7％，P＝0.013），主要源于与PCI相关的心肌梗死明显少于对照组（10.0％vs 20.9％，P＝0.030）。结论选择性PCI术前1周使用大剂量阿托伐他汀钙60 mg／d与常规剂量20 mg／d比较能更有效地减少与手术相关的心肌损伤及术后30 d MACE。

目的 观察不稳定型心绞痛(UAP)患者经皮冠状动脉介入治疗(PCI)术前不同负荷剂量阿托伐他汀钙对患者预后的影响.方法 将UAP患者90例随机分为3组,每组30例.低剂量组:入院后口服阿托伐他汀钙每天20 mg,术前2～4h口服阿托伐他汀钙20 mg;中剂量组:入院后口服阿托伐他汀钙每天40 mg,术前2～4h口服阿托伐他汀钙40 mg;高剂量组:入院后口服阿托伐他汀钙每天60 mg,术前2～4h口服阿托伐他汀钙60 mg.所有患者均在入院后48 ～72 h内接受PCI,观察各组PCI术前、术后肌酸激酶同工酶、心肌肌钙蛋白I、高敏C反应蛋白的变化及PCI术后30天内主要不良心脏事件的差异.结果 高剂量组术后24h心肌肌钙蛋白Ⅰ及高敏C反应蛋白显著低于低剂量组(P＜0.05).低剂量组、中剂量组及高剂量组患者与PCI相关的心肌梗死的发生率分别为23％、13％、O％,有显著性差异(P＜0.01).高剂量组主要不良心脏事件发生率显著低于低剂量组(0％比23％,P=0.005).PCI术后随访30天,3组均无死亡及靶血管血运重建事件发生.结论 UAP患者择期PCI术前短期负荷阿托伐他汀钙每天60 mg可以显著降低与PCI相关的心肌梗死.

目的:观察合并完全性右束支传导阻滞(CRBBB)的急性前壁心肌梗死(AAMI)的临床特点.方法:回顾性分析316例AAMI患者,将合并新发CRBBB患者43例作为观察组,50例不合并束支传导阻滞的AAMI患者作为对照组,分析两组患者一般资料、冠状动脉造影、心脏彩超、Killip分级以及血液生化指标的差异.结果:两组患者一般情况及并发症比较无明显差异(P>0.05),平均Killip分级观察组为1.63±0.93,对照组为1.22±0.62(P=0.013).左室射血分数(LVEF)观察组为(41.6±4.2)%,对照组为(48.2±4.4)%(P=0.001).肌酸激酶同工酶(CKMB)峰值观察组为(276.6±63.5)U/L,对照组为(171.5±29.4)U/L(P<0.001).肌钙蛋白I峰值(TNI)观察组为(11.01±2.39)μg/L,对照组为(6.03±1.52)μg/L(P<0.001).冠脉造影结果观察组前降支近段病变(26/43,60.5%),对照组前降支近段病变(15/50,30%)(P=0.003).结论:合并CRBBB的AAMI患者多为前降支近段病变,心肌梗死面积更大、心功能更差,应对这些患者尽早采取再灌注治疗以改善预后.

目的探讨急性心肌梗死(AMI)患者合并泵衰竭的影响因素。方法以98例AMI患者为研究对象,对比分析泵衰竭组(41例)与对照组(57例无泵衰竭)的病史、危险因素、临床表现、并发症、病死率等特点。结果泵衰竭组有陈旧心肌梗死(OMI)病史、前壁或多部位AMI、收缩压(SBP)低、脉压(PBP)低、左室射血分数(LVEF)<50%、酸肌酶(CK)峰值高,心率(HR)>80次/min、WBC>10×109/L、房颤、肺部感染等与对照组差异有统计学意义(P<0.05~0.001)。Logistic多因素回归分析表明,肺部感染(OR=7.661,95%CI:2.228~26.336)、LVEF<50%(OR=4.902,95%CI:1.484~16.194)、前壁或多部位AMI(OR=4.417,95%CI:0.803~24.309)、HR>80次/min(OR=4.098,95%CI:1.259~13.335)、WBC>10×109/L(OR 3.651,95%CI 1.169~11.403)是AMI并发泵衰竭的独立危险因素。结论AMI患者发生泵衰竭与多种因素有关,AMI患者合并肺部感染、LVEF<50%、前壁或多部位AMI、HR>80次/min,WBC>10×109/L是并发泵衰竭的独立危险因素。

目的探讨风湿性心脏病(RHD)患者发生动脉栓塞的危险因素,以寻找预防对策。方法将114例RHD患者分为病例组和对照组进行对照研究。结果本组栓塞发生率为20.2%,2组年龄、性别、心功能、二尖瓣口面积(MVA)及左房室大小方面无明显差异。病例组心房颤动(Af)、瓣膜病史>10 a及左房内血栓发生率较对照组高,且无明显二尖瓣反流(MR),2组比较有显著性差异。结论Af、瓣膜病史>10 a及左房内血栓是RHD患者发生动脉栓塞的危险因素,而显著MR是RHD患者避免形成栓塞的保护性因素。

感染性心内膜炎(infective endocarditis, IE)是一种心脏内膜表面发生的微生物感染状态,感染可发生在间隔缺损部位、腱索或心内膜壁,有极强的破坏性、致残性.笔者就IE的易患因素及诊断、治疗进展综述如下.

目的探讨扩张型心肌病(DCM)的心脏结构、心律失常与预后的关系.方法将43例DCM患者分为存活组(33例)与死亡组(10例),回顾分析其超声心动图、心电图(ECG)、24小时动态心电图(Holter)等资料,比较两组的临床特点.结果与存活组对比,死亡组的左房内径(LAD)、左室舒张末内径(LVEDd)扩大(P＜0.05),左心室射血分数(LVEF)、左心室短轴缩短分数(LVFS)降低(P＜0.01);严重室性心律失常(Lown氏Ⅲ级以上室性心律失常)的发生率明显升高(P＜0.005);NYHA标准心功能Ⅳ级患病率高(P＜0.01);QT离散度(QTd)及校正QT离散度(QTcd)明显延长(P＜0.01).结论DCM的左房左室明显扩大、左心功能严重损害、严重室性心律失常的发生率增高以及QTd、QTcd明显延长是DCM患者死亡的高危因素.

目的探讨急性心肌梗死(AMI)的鉴别诊断方法.方法对16例心电图(ECG)误诊为AMI的病历进行回顾性分析.结果16例患者均有胸闷或胸痛症状,其中ST段抬高8例(50.0%),ST段抬高伴异常Q波6例(37.5%),心前导联R波递增不良2例(12.5%).结论对ECG表现与AMI相似的患者,需仔细询问病史,重视体格检查,密切观察ECG的动态演变,结合心肌酶、TNI、心脏超声、胸片、冠脉造影等资料可予鉴别.

目的分析院内老年人心脏性猝死(SCD)高危因素,提高预防及救治水平.方法对93例60岁以上老年人SCD的临床资料进行回顾性分析.结果冠心病(CHD)占66.7%,12～2月死亡例数最多占38.7%,6:00～11:59是一天中猝死最高时段(33.3%).临终前心电图(ECG)室性心律失常占75.3%,其中室颤(VF)占62.4%.SCD合并心力衰竭(HF)占73.1%,其中急性左心衰占38.7%.合并电解质异常占21.5%.结论院内老年人SCD以CHD为最常见病因,SCD的发生有较明显的昼夜节律,室性心律失常、HF、电解质异常是老年人SCD的高危因素.

病态窦房结综合征(SSS)是指窦房结及其邻近组织病变,引起起搏功能和/或冲动传出障碍而致的一系列心律失常,表现为持续性与生理状况不相适应的窦性心动过缓、窦房传导阻滞、窦性停搏及心动过缓-心动过速综合征(慢-快综合征).笔者对我院7年来收治的52例SSS患者进行了回顾性分析,现将其临床特点报道如下.

病毒性心肌炎是嗜心肌性病毒感染引起的,以心肌非特异性间质性炎症为主要病变的心肌炎.为了提高对本病的认识,本文选出我院近 6年来收治的病毒性心肌炎 84例,总结分析如下.

目的:探讨急性心肌梗死(AMI)死亡的高危因素.方法:回顾分析我院1994年～2001年52例AMI死亡患者的临床特征,资料分析包括发病年龄、时间、症状、梗死部位、并发症、心电图.结果:本组70～79岁年龄组死亡人数最多;多数患者死于冬春季节、凌晨至午间.合并心源性恶心呕吐梗死面积较大;前壁梗死、大面积梗死、合并传导阻滞(CB)、房颤(Af)、急性左心衰、心源性休克者预后差;本组P波异常者占73.1%,非梗死部位导联ST段压低占86.5%;AMI早期QTc间期延长易引起恶性心律失常.结论:高龄、心源性恶心呕吐、前壁梗死、大面积梗死、合并CB、Af、急性左心衰、心源性休克、QTc间期延长可作为AMI预示危险的信号,应高度重视.