The β-receptor blocker is used to treat heart failure (HF), and its role in the occurrence of atrial fibrillation (AF) is unclear in patients with HF. This study aimed to investigate the relationship between β-receptor blocker use and AF in patients with HF. All data was collected from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The relationship between β-receptor blocker and AF was analyzed by univariate logistic regression, multivariate logistic regression, and subgroup analysis. The machine learning algorithm including logistic and Random forest was used to analyze the importance of variables in AF. The interaction analysis was conducted to determine whether other factors influence the relationship between β-receptor blocker and AF. A total of 953 participants were involved. We found that the use of beta-blockers increased the risk of AF this result was not affected by confounding factors (OR (95

Objective: This study aimed to assess the rotation and torsion in the endocardial, epicardial, and global myocardium using two-dimensional speckle tracking imaging(2D-STI) in patients with rheumatic heart disease who underwent aortic valve replacement (AVR). Methods: This study included 42 AVR patients [(23 F/19 M, aged (62.7±11.2) years] and 25 normal control [(16 F/9 M, aged (63.3±10.5) years]. 2D-STI was performed in five consecutive heart beats, and data were stored for offline analysis using Q-Lab. The peak systolic rotation of the endocardial, epicardial, and global myocardium in the left ventricular basal and apical walls were measured using 2D-STI. The torsion and twisting angles of the sub-endocardial, sub-epicardial, and global myocardium were calculated. Results: Rotation at the left ventricular basal level of the study group was not significantly reduced compared with that in the normal control group. However, at the apical level, rotation was significantly reduced (p=0.03, 0.003, 0.004). The torsion angle of the study group was significantly reduced compared with that of the normal control group (p=0.006, 0.003, 0.003). Furthermore, patients with different left ventricular ejection function after AVR showed differences in torsion of the endocardial, epicardial, and global myocardium. Conclusions: The systolic rotation and twist of the subendocardial, sub-epicardial, and global myocardium in the left ventricle were reduced, whereas those at the basal level remained unchanged. After AVR, old patients have an almost complete recovery of left ventricular rotational motion at the basal level. 2D-STI is a useful non-invasive tool for evaluation of the left ventricular regional function.

目的 探讨残余胆固醇(Remnant-C)对冠状动脉支架再狭窄(ISR)的影响.方法 选择2015年6月至2021年12月在宁波市医疗中心李惠利医院心内科住院的冠状动脉支架植入术后的患者1 980例,均行冠状动脉造影术,术后1年根据冠状动脉ISR的诊断标准采用简单随机抽样法选取再狭窄组100例和未狭窄组100例,收集两组患者的临床资料及冠状动脉造影结果.采用单因素分析和多因素logistic回归分析冠状动脉ISR的危险因素.结果 再狭窄组的Remnant-C水平为(0.48±0.23)mmol/L,高于未狭窄组的(0.31±0.23)mmol/L(P＜0.01),再狭窄组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白a[LP(a)]、载脂蛋白B(ApoB)、糖化血红蛋白(HbA1c)及SYNTAX评分均高于未狭窄组,差异均有统计学意义(均P＜0.01),logistic回归分析结果提示Remnant-C和LP(a)是冠状动脉ISR的危险因素(均P＜0.05).结论 Remnant-C可为PCI术后患者的临床管理提供有价值的数据,避免ISR及其他心血管事件的发生,值得临床推广应用.

目的 评估经导管主动脉瓣置换术(TAVR)治疗重度主动脉瓣狭窄的疗效.方法 35例重度主动脉瓣狭窄患者行TAVR治疗,分析手术即刻和术后1年的临床效果.结果 所有患者均成功置入自膨式瓣膜.35例患者主动脉瓣跨瓣压差均明显下降,术中经食道超声心动图验证无主动脉瓣狭窄,其中1例患者有瓣周瘘,即刻给予瓣中瓣治疗,术中球囊预扩张时采用双侧颈动脉按压保护,未出现脑梗死等并发症.与术前相比,患者1年后随访的主动脉瓣狭窄明显改善,平均跨瓣压差下降,氨基末端B型利钠肽前体下降,纽约心功能分级减少,明尼苏达生活质量评分下降,左室舒张末期内径缩小,左室射血分数和6min步行试验明显提高(均P＜0.05).结论 TAVR治疗高龄、重度主动脉瓣狭窄的疗效显著,可显著改善患者临床症状,但中远期效果有待进一步随访.

目的 全面评估起搏器术后早期康复运动证据临床应用的现状,分析其障碍因素,为证据的临床转化提供参考.方法 以JBI循证卫生保健模式为理论框架,确定临床护理问题,进行文献检索、评价并汇总证据,制定审查指标及审查方法;根据基线审查结果进行障碍因素分析,制定对策.结果 本研究共纳入18条最佳证据,制定15条审查指标,其中仅3条指标依从率为100％;采用i-PARIHS概念框架对审查结果进行分析后得出主要障碍因素:起搏器术后早期康复制度及流程缺乏、医护人员对于循证知识及起搏器术后早期康复知识培训不足、缺乏相应的激励机制、变革造成工作量增加但人员配备不足.主要促进因素:国家政策及医院政策支持,领导者们变革理念强、患者及家属对医护人员信任度较高、团队协作能力好及护理人员的基础知识扎实、学习能力强等.实施相应对策后,15条审查指标中13条依从率为100％.结论 起搏器术后早期康复运动证据与临床实践尚存在较大差距,科学、全面评估实践中的障碍与促进因素,并给予相应的对策,可以有效促进证据在临床中的应用.

目的 探讨脂蛋白a[Lp(a)]和同型半胱氨酸(Hcy)对经皮冠状动脉介入治疗(PCI)后支架内再狭窄(ISR)的影响.方法 回顾性分析2016年6月至2021年6月在宁波市医疗中心李惠利医院接受PCI术并随访冠状动脉造影患者临床资料.根据ISR诊断标准随机选取ISR患者102例(ISR组),未发生ISR患者101例(无ISR组).采用单因素和多因素logistic回归分析Lp(a)和Hcy是否为PCI术后ISR的危险因素.结果 ISR组、无ISR组术后随访时Lp(a)分别为(0.28±0.23)g/L、(0.15±0.08)g/L,差异有统计学意义(t=5.62,P<0.01);Hcy分别为(16.35±11.12)μmol/L、(10.37±3.33)μmol/L,差异有统计学意义(t=5.20,P<0.01),表明Lp(a)和Hcy水平与PCI术后ISR呈正相关.多因素logistic回归分析结果显示,血浆Lp(a)(OR=842.679,95％CI=31.117～22820.459,P<0.01)和Hcy(OR=1.248,95％CI=1.130～1.379,P<0.01)是PCI术后ISR的危险因素.结论 Lp(a)和Hcy是PCI术后ISR的危险因素.

In the present study,we aimed to explore the protective effect of spironolactone on cardiac function in patients undergoing coronary stent implantation by determining the serum levels of GATA4 and hypoxia-inducible factor-1α(HIF-1α)proteins before and after the coronary stent implantation.A total of 134 patients undergoing coronary stent implantation in our hospital from March 2019 to March 2020 were retrospectively selected using the propensity score matching(PSM)method.Of the 134 patients,67 patients taking spironolactone were used as a test group,and the other 67 patients without taking spironolactone were used as a control group.In all patients,the levels of serum GATA4,HIF-1α,and troponin Ⅰ proteins were determined before as well as 24 h and 6 months after the coronary stent implantation.Left ventricular ejection fraction(LVEF)and left ventricular systolic global longitudinal strain(GLS)were determined before and 6 months after the coronary stent implantation.There were no significant differences in the HIF-1α level between the two groups before and 6 months after the operation,while the HIF-1αlevel was significantly lower in the test group compared with the control group at 24 h after the operation(P＜0.01).There were no significant differences in the GATA4 protein level between the two groups before and 24 h after the operation,while the GATA4 protein level was significantly lower in the test group compared with the control group at 6 months after the operation(P＜0.01).There was no significant difference in LVEF between the two groups before and 6 months after the operation.GLS was significantly improved at 6 months after the operation compared with that before the operation in both groups,while GLS was significantly better in the test group compared with the control group at 6 months after the operation(P＜0.01).Collectively,spironolactone could protect cardiac function probably by improving myocardial hypoxia and inhibiting myocardial remodeling.

目的 检索并评价心脏起搏器术后患者早期运动康复的相关证据,对其所获取证据进行总结,为临床实践提供参考.方法 通过护理循证方法确立问题,按照循证检索数据库的"6S"分类模型,检索与"心脏起搏器术后早期运动康复"相关证据,证据包括临床指南、系统评价、专家共识和证据总结,并由2名完成循证护理培训的研究员对纳入文献独立评价,同时对遴选出符合质量标准的文献进行证据提取.结果 共纳入证据文献6篇,包括临床指南1篇,专家共识4篇、系统评价1篇,并对证据进行汇总,最终总结了16条最佳证据.证据内容包括运动前评估、运动计划、运动开始指征、运动监督、运动方式及强度、出院指导6个主题.结论 心脏起搏器术后患者开展早期运动康复,需要专业康复团队进行全面的综合评估:包括临床综合症状的评估和起搏器功能的评估,同时借助专业的辅助工具,对康复过程进行安全监测,采用渐进方式逐步增加锻炼强度以期降低术后并发症,确保早期运动康复的安全性,从而提升患者舒适度.

目的 探讨冠状动脉介入术者下肢暴露部位射线剂量与部位高度、术者位置、造影体位及射线防护强度之间的关系.方法 用仿真人体模型代替患者进行曝光,桡动脉途径下采集2位模拟术者左足、左小腿在不同防护下的体表入射剂量率.采用独立样本t检验对无防护时左足和左小腿间及2位模拟术者间的体表入射剂量率进行比较;采用单因素方差分析对无防护时各体位间的体表入射剂量率以及不同防护条件间的体表入射剂量率进行比较;计算不同防护下的射线屏蔽率.结果 无防护时,2位模拟术者下肢的体表入射剂量率均较高,左小腿的体表入射剂量率高于左足(P<0.05),第1术者下肢在多数体位的体表入射剂量率高于第2术者(P<0.05).防护越强,下肢体表入射剂量率越低(P<0.05).单纯床旁防护时在多数体位,左小腿的射线屏蔽率高于左足,第2术者下肢的射线屏蔽率高于第1术者.床旁防护配合射线防护靴时,射线屏蔽率较单纯床旁防护明显升高.结论 冠状动脉介入术者下肢暴露部位的射线剂量受部位高度、术者位置、造影体位及防护强度等多种因素综合影响,单纯床旁防护对小腿和第2术者下肢的防护效果更好,射线防护靴弥补了单纯床旁防护的不足.

目的 探究银杏叶片联合辛伐他汀治疗颈动脉粥样硬化的临床疗效,并对治疗后血脂水平以及斑块面积影响.方法 回顾性纳入医院2018年6月-2019年6月收治颈动脉粥样硬化患者96例作为研究对象,根据数字随机法分为联合组和常规组,每组48例.联合组给予银杏叶片联合辛伐他汀治疗,常规组给予辛伐他汀治疗,评估两组患者治疗前及治疗后3个月血脂水平及斑块面积,并应用统计方式对两组临床疗效进行分析.结果 联合组性别、平均年龄、收缩压、体质量指数、空腹血糖以及吸烟史与常规组相比差异无统计学意义(P＞0.05);治疗前,联合组与常规组TC、TG、LDL-C、HDL-C及颈动脉斑块面积水平比较显示无统计学意义(P＞0.05);治疗后联合组TC、TG、LDL-C、HDL-C及颈动脉斑块面积优于常规组,比较显示差异有统计学意义(P＜0.05).结论 辛伐他汀及银杏叶片治疗颈动脉粥样硬化可有效改善血脂代谢异常,缩小动脉粥样硬化斑块,是一种较为理想的中西医结合方式.

目的 探讨冠脉介入诊疗中术者上肢暴露部位射线剂量与部位高度、术者站位、造影体位及物理防护强度之间的关系.方法 通过对仿真人体模型进行造影曝光,采集桡动脉途径时2位模拟术者左手、左上臂在不同防护条件、不同造影体位下的体表入射剂量率.采用T检验比较仅穿无袖铅衣时左手和左上臂间的体表入射剂量率及同一部位在两位术者间的体表入射剂量率,比较左手在床旁防护前后的体表入射剂量率;采用单因素方差分析比较仅穿无袖铅衣时同一部位在各体位间的体表入射剂量率,比较左上臂在不同防护条件间的体表入射剂量率;并计算左手、左上臂在不同防护措施下的射线屏蔽率.结果 仅穿无袖铅衣时,第一术者上肢的体表入射剂量率均高于第二术者(左手t=38.9～86.5,左上臂t=13.0～83.8,P<0.05);两位术者左上臂大多数体位的体表入射剂量率高于左手(第一术者t=7.1～55.3,第二术者t=9.2～78.8,P<0.05).左手给予床旁防护后体表入射剂量率明显较低(第一术者左手t=49.4～181.6,第二术者左手t=5.1～47.3,P<0.05);左上臂给予的防护越强,体表入射剂量率越低(第一术者左上臂F=84.6～531.3,第二术者左上臂F=7.0～326.3,P<0.05).单纯床旁防护时,第一术者左手、左上臂的射线屏蔽率分别为22.46％～52.93％、23.83％～72.12％,第二术者左手、左上臂的射线屏蔽率分别为2.28％～17.39％、3.45％～50.62％,第一术者上肢的射线屏蔽率均高于第二术者,左上臂的射线屏蔽率在多数体位高于左手.半袖铅衣+床旁防护时第一、第二术者左上臂的射线屏蔽率升至73.32％～89.48％、63.97％～89.55％,两术者之间及各体位之间的射线屏蔽率差值较单纯床旁防护时明显缩小.结论 经桡动脉冠脉介入诊疗中,术者上肢暴露部位的射线剂量受部位高度、术者站位、造影体位、物理防护强度等多种因素综合影响,单纯床旁防护对第一术者上肢尤其上臂的防护效果更好,而半袖铅衣弥补了单纯床旁防护的不足,应充分利用床旁防护及穿戴强化的射线防护用品以减少介入术者的辐射危害.

目的 分析经皮冠脉介入过程术者头颈部所受辐射剂量和强化头颈部防护效果.方法 用仿真人体模型进行曝光,采集两位术者左眼、左腮腺颌下腺、甲状腺在不同投照位和不同防护条件下的体表入射剂量率,计算不同防护下的射线屏蔽率.结果 无防护时,两位术者头颈部的体表入射剂量率均较高,多数投照位下,第一术者左眼、左腮腺、左颌下腺和甲状腺部位体表入射剂量率均高于第二术者,差异均有统计学意义(均P<0.05).第一术者最高为(5833.1±23.1)μGy/h(左眼、左足位),第二术者最高为(4826.8±27.2)μGy/h(甲状腺、左足位).给予的防护措施越强,体表入射剂量率越低(P<0.05),射线屏蔽率越高.结论 经皮冠脉介入诊疗中,术者头颈部的辐射剂量受站位及造影投照位影响,应加强头颈部防护.

目的 评估经桡动脉入路经皮冠状动脉介入治疗(PCI)术中患者头部和性腺的辐射剂量,并评价物理辐射防护的效果.方法 采用仿真人体模型代替患者,采集经桡动脉入路PCI术中模拟患者头部和性腺在物理辐射防护前后的体表入射剂量率,采用配对t检验和单因素方差分析进行统计分析并计算射线屏蔽率.结果 模拟患者头部和性腺在有防护时的体表入射剂量率显著低于无防护时,差异均有统计学意义(头部:t=243.541～738.728,性腺:t=277.934～901.467,均P<0.001).无论有无防护,在相同造影体位下头部和性腺的体表入射剂量率差异均有统计学意义(无防护:t=4.704～172.484,有防护:t=38.281～181.942,均P<0.001).无防护时,头部各造影体位之间体表入射剂量率差异有统计学意义(F=3835.427,P<0.001);性腺各造影体位之间体表入射剂量率差异有统计学意义(F=4572.454,P<0.001).有防护时,头部各造影体位之间体表入射剂量率差异有统计学意义(F=4269.812,P<0.001);性腺各造影体位之间体表入射剂量率差异有统计学意义(F=8107.038,P<0.001).有防护时模拟患者头部射线屏蔽率为65.85％(左足位)～85.60％(正头位),性腺射线屏蔽率为54.53％(左头位)～79.00％(右侧位).在正足位、左足位和右足位,头部射线屏蔽率低于性腺,其余5个体位,头部射线屏蔽率均高于性腺.结论 在经桡动脉入路PCI术中,无防护时患者头部和性腺受到较高剂量的辐射,辐射强度与造影体位有关,使用物理辐射防护可以大大降低辐射剂量.

目的 分析心电图aVR ST段抬高的患者临床表现及冠状动脉影像学检查结果,总结特点.方法 回顾性分析13例aVR ST段抬高心电图患者的临床表现及冠状动脉影像学检查结果.结果 13例患者中主诉严重胸痛5例,冠状动脉存在严重病变6例,未完成冠状动脉造影检查抢救无效死亡2例,未发现严重冠状动脉狭窄病变2例.结论 一般认为aVR ST段抬高的心电图表现提示病情紧急危重,需要临床医师引起足够重视.另有少数患者仅有心电图异常而无冠状动脉严重狭窄,值得进一步研究.

Objective To explore the relationship between the plasma level of homocysteine (Hcy) and the severity of coronary artery disease (CAD). Methods 380 patients underwent coronary angiography and measurement of plasma Hcy for chest pain. The severity of coronary artery lesions was evaluated based on Gensini score system. The correlation between plasma Hcy and Gensini score was analyzed. Results Of 380 patients, 270 cases was diagnosed as CAD (140 stable angina pectoris and 130 non-ST-segment elevation myocardial infarction) and 110 non-CAD. The level of Hcy increased (＞10μmol/L) in 265 cases and was normal in 115 cases. The level of Hcy was significantly higher in CAD patients than in non-CAD patients (P＜0.01). Gensini score was significantly higher in patients with Hcy increased than with normal Hcy, and significantly higher in CAD patients with two-or three-vessel lesions than with only one-vessel lesion (all P＜0.01). Spearsman correlation analysis showed that Hcy level was positively correlated with the Gensini score. Conclusion Plasma Hcy levels is related to the severity of coronary artery lesions.

目的 评估急性冠脉综合征介入治疗中的经刺破球囊局部给药治疗慢血流情况的效果及安全性.方法 诊断为急性冠脉综合征进行冠状动脉介入治疗,支架植入后出现慢血流的患者3例,进行刺破球囊局部给药.结果 3例患者局部用药后血流较用药前均出现明显改善,恢复TIMI3级.结论 经刺破球囊局部给药可能对急性冠脉综合征进行冠状动脉介入治疗支架植入后出现慢血流的患者有治疗效果,但需进一步进行相关的临床研究,与经导引导管或微导管给药对比以得出明确结论.

目的 评估两种不同透视模式下冠状动脉造影及介入操作的X线剂量差异.方法 收集301例冠状动脉造影及冠状动脉介入治疗患者,分为儿科模式组和心脏模式组,记录在操作中接受的累积空气比释动能、累积剂量面积乘积及透视时间,并估算患者接受剂量.结果 与普通剂量模式相比,儿科剂量模式下空气比释动能率更低,差异有统计学意义(P＜0.05),而透视时间、累积空气比释动能、累积剂量面积乘积(DAP)及估算患者有效剂量差异均无统计学意义(均P＞0.05).两种模式下冠状动脉介入治疗时,透视时间、DAP及估算患者有效剂量差异均无统计学意义(均P＞0.05),而儿科剂量模式下累计空气比释动能、空气比释动能率更低,差异均有统计学意义(均P＜0.05).两种模式下冠状动脉造影时,透视时间、累积空气比释动能、空气比释动能率、DAP及估算患者有效剂量差异均无统计学意义(均P＞0.05).结论 儿科模式有利于降低冠状动脉介入治疗操作中的X线剂量,而对于冠状动脉造影无影响.

Long QT (LQT) type 2 (LQT2) is caused by HERG mutation. L539fs/47 encodes a truncated protein, and its mechanisms in HERG mutation are unknown. HERG mutation plasmids were overexpressed in HEK293T cells, respectively, followed by analyzing lysates with Western blot. Transfected HEK293T cells were treated with or without N-acetyl-l-leucyl-l-leucyl-l-norleucinal (ALLN) and Propranolol (Prop) at 24 or 48 h. HERG-WT, HERG-A561V, WT/A561V, HERG-L539fs/47, WT/L539fs/47, and Calnexin (CNX)/Calreticulin (CRT) protein expression and their interactions were detected by Western blot and immunoprecipitation. Each group with HERG currents (Ikr) were detected by Patch-clamp technique. Treated with ALLN, the expression of mature HERG protein and the CNX/CRT protein increased. The interaction of HERG-A561V and WT/A561V protein with the chaperone CNX/CRT increased significantly. The maximum peak currents and tail currents density increased by 70% and 73%, respectively, while maximal peak currents density (24%) and tail currents density (19%) were slight increased in WT-HERG cells. Treated with Prop, the expression and interaction of mature HERG and chaperones CNX/CRT had no difference in each group. The maximal currents and tail currents density were slight increased. CNX/CRT might play a crucial role in the trafficking-deficient process and degradation of HERG-A561V mutant protein, however they had no effect on L539fs/47 HERG due to protein transport deletion. ALLN can restore HERG-A561V mutant protein trafficking process and rescue the dominant negative suppression of WT-HERG.

目的 探讨急性ST段抬高型心肌梗死(STEMI)患者血尿酸(UA)、C反应蛋白(CRP)、B型脑钠肽(BNP)水平变化的临床意义.方法 选择150例STEMI患者作为观察组,男86例,女64例,年龄38~79岁.依据患者预后情况,将观察组分为存活亚组和死亡亚组.另选择120例稳定型心绞痛为对照组.比较观察组与对照组血清UA、CRP、BNP水平以及入院第1、3、7、9天存活亚组与死亡亚组的UA、CRP和BNP水平变化.结果 观察组患者发病第1天UA为(401.41±83.92)μmoI/L,CRP为(42.92±9.73)mg/L,BNP为(379.40±85.47)ng/L,均显著高于对照组[(300.16±56.93)μmoI/L、(2.45±0.97)mg/L、(33.76±12.83)ng/L],差异均有统计学意义(均P<0.05),观察组患者血清UA与CRP、BNP呈正相关(r=0.522、0.403,均P<0.05),CRP与BNP呈正相关(r=0.416,P<0.05).存活亚组入院第1、3、7、9天血UA、CRP、BNP水平均低于死亡亚组,差异均有统计学意义(均P<0.01).结论 血清UA、CRP和BNP水平与STEMI的严重性相关.

Objective To study the correlation of serum uric acid,C-reactive protein,IL-6,BNP and the severity of coronary heart disease (CHD). Methods The survey group consisted of 200 patients whose CHD diagnosis was confirmed by positive CAG results and 100 patients were taken to the control group.In the survey group,they were divided into AMI group,UAP group,SAP group.The CHD patients were also divided into groups according to the CAG results,single-artery lesion,two-artery lesion,three-artery lesion. The score of coronary lesion were calculated. Classification of cardiac function.The serum levels of UA,CRP,IL-6,BNP and the LVEF were measured;and the correlation between the levels of UA,CRP,IL-6,BNP and the severity of coronary lesion,cardiac function were analyzed. Results AMI group,UAP group,SAP group and control group,the serum levels of UA,CRP,IL-6 and BNP were decreased(P<0.05). At the same time,UA,CRP,IL-6 and BNP levels increased with the increase of the number of lesions and the increase of Gensini score (P<0.05). The number of coronary lesions,coronary lesion score and cardiac function level were positively correlated with UA,CRP,IL-6,BNP(P<0.05). Conclusion Serum levels of UA,CRP,IL-6 and BNP were correlated with CHD,and could be used as indicators of cardiac function,coronary artery disease and risk stratification.