自1899年瑞典临床医学家Heschen提出运动员心脏这一概念的百余年来,运动与心脏的研究一直是运动医学界探讨的重要领域,运动引起心脏结构、功能改变与调节机制等方面的研究更是众多学者们研究的热点.

To investigate safety of radiofrequency current ablation(RFCA)of tachycardia in patients with cardiac dysfunction, tachycardias were treated by means of RFCA in 36 patients with different degree of cardiac dysfunction. Results:Having been prepared preoperatively, cardiac function(NYHA) of all patients were improved at least 1～ 2 classes, and recovered to class Ⅱ～Ⅰ.The first RFCA were successful in 33 patients with success rate of 91.7%(33/36). Of 3 patients with failured RFCA, 2 patients,1 with left midseptal accessory atrioventricular pathway(AP) and 1 with right anterior free wall AP , were successfully ablated at second time. Two-time RFCAs were failure in 1 with impured atrial flutter who took amiodarone. Therefore, total success rate was 97.2%(35/36). Of 6 patients with angina pectoris, 4 received percutaneous transluminal coronary angioplasty stenting, 2 had no angina onset following RFCA. Of 2 patients with rheumatic heart diseases, 1 patient received percutaneous mitral balloon valvularoplasty at the same time, 1 patient selective valve replacement. No tachycardia was recurrent in all patients during follow-up of 6.4±2.4(2～10)years. Conclusion: RFCA of tachycardia was also safe in patients with cardiac dysfunction based on excellent perioperative preparations.

Objective: To investigate the characteristcs of histology of atrioventricular junction (AVJ) and seek the histological substrate of dual atrioventricular nodal pathways (DAVNP).Methods: The specimens including atrioventricular node (AVN) were fixed with formalin. Tissue blocks were cut serially in three planes: sagittal plane, coronal plane and frontal plane. Sections were stained either by Masson trichrome procedure or by hematoxylin and eosin. Results: A distinct compact node was found in each of the 17 hearts. 8 hearts had posterior extensions both on the right side and on left side.6 hearts only had a rightward postenor extension. One heart only had a leftward posterior extension, whereas two hearts had no posterior extension. Furthermore, the rightward extension continued to the Ievel of the coronary sinus ostium. Conclusion: The human compact node contains rightward and leftward posterior extension, with the right extension close to tricuspid annulus and coronary sinus ostium. It is speculated that the superficial strata might be the fast pathways and the extensions might be the slow pathways.

预激综合征多旁路是诱发多种形态心动过速尤其诱发心房颤动的常见原因[1].由于其心动过速发作时可通过多种折返径路,与单旁路相比具有更为复杂的电生理特征,故临床诊断及射频消融靶点较困难[1,2,3].1995年以来,我们对12例预激综合征左侧多旁路患者进行射频消融治疗,均获成功.现报告如下.

房室结双径路慢径消融方法的研究缺乏定量指标,尤其Koch三角在X线上投影的变异较大,消融靶点的确定对不同大小Koch三角缺少更多的电生理判定指标.本文对成功消融的27例患者通过X线测定Koch三角大小,并对电生理标测指标进行分析,初步得出慢径消融更多的量化指标.

To investigate radiofrequency current ablation(RFCA) and cautions of atrioventricular nodal reentry tachycardia(AVNRT) in patients with small imaging Koch triangle. The small imaging Koch triangle was defined as that the distance between the site of the largest His potential and coronary sinus ostia(CSo) was not for more than three 8-French big-tip electrodes under X ray fluoroscopy of right anteoblique 30 degree, and the slow pathway were ablated referring to the routine ablating method in 16 AVNRT patients with small imaging Koch triangle. Results: Of 16 patients with small imaging Koch triangle, successful ablating site was located below CSo level in 12 patients, at the same level in 3 and above in 1. The leaping of atrioventricular conduction disappeared in 14 patients, only leaping but no both atrial echo and isoprenaline-induced AVNRT in 2. Among the 12 patients , there was transient atrioventricular block(AVB) during RFCA and type 2 of second degree AVB happened in 1 patient post-procedure 24 hours, which did not improve after 3 months' follow up, thus the patient received cardiac pacemaker. There were no both AVB and AVNRT recurrence in other 15 patients following 3.5±1.2(0.5～5)years. Conclusions: Mapping and ablating of slow pathway could not follow the routine ablating method, mostly, the slow pathway should be mapped and ablated in the ante-inferior field of CS ostia for the patients with small imaging Koch triangle. Meanwhile, it was necessary to regulate ablating parameter instantly according to responses of slow pathway to radiofrequency current.

目的:评价尼卡地平注射液对主动脉瓣返流的影响.方法:主动脉瓣返流的病人20例[男性13例,女性7例,年龄(56±s 12) a],应用尼卡地平注射液20 mg+氯化钠注射液250 mL,iv, gtt,治疗前后进行彩色多普勒超声心动图检查,检测返流指标.结果:在给病人静脉滴注尼卡地平注射液1 h后,主动脉瓣返流束的长度、宽度、面积、返流分数及返流频谱的下降斜率与治疗前比较均显著减小或降低[(6.3±0.8) cm vs (2.6±0.5) cm;(0.80±0.11) cm vs (0.40±0.14) cm;(9.4±0.8) cm2 vs (4.6±0.6) cm2;(0.60±0.23) vs (0.40±0.12);(222±20) cm*s-2 vs (94±5) cm*s-2;均P<0.01)];主动脉瓣返流频谱的压差半降时间显著延长[(241±16) ms vs (380±18) ms,P<0.01)].结论:尼卡地平注射液可以明显减轻主动脉瓣返流的程度.

目的探讨房室多旁道的电生理特点及射频消融方法. 方法 23例患者经电生理检查确定房室多旁道,应用心房和心室刺激诱发室上速,确定每条旁道的电生理特征及与心动过速的关系,按照标测部位对相关旁道逐步消融, 以射频消融成功确定旁道位置. 结果 23例中检出旁道49条, 其中三条旁道3例;左侧多旁道12例,右侧多旁道2例,双侧多旁道9例;左侧多旁道以隐匿性为主;右侧多旁道多为显性;未见心动过速时右侧旁道前传而同侧旁道逆传现象. 结论多旁道患者应首先确定和消融与心动过速相关旁道; 左侧多旁道应以诱发心动过速或快速心室起搏方法标测;右侧多旁道应同步描记12导联体表心电图,旁道消融成功可能仅见于QRS波的变化;双侧多旁道应首先消融左侧旁道.

Objective:To determine the main factors of early renal damage in patients with hypertension.Methods:One hundred patients with hypertension and 50 normotensive subjects were included in this study. They were classified into 3 groups according to urinary albumin excretion rate (UAER). Ultrasound Doppler renal blood flow, 24 hour ambulatory blood pressure, body mass index (BMI) and blood sugar (BS) were assessed in all patients. Stepwise multiple linear regression was carried out using UAER as the dependent variable, and gender, age, history, clinic SBP, clinic DBP, the parameters of renal blood flow measurement and 24 hour ambulatory BP as the independent variables.Results:By stepwise multiple regression analyses, 24 hour mean SBP, BS, BMI and resistance index (RI) of interlobar artery were only the independent determinants of early renal damage and together explained 54.1 % of the variability in the whole population.Conclusion:24 hour mean SBP, BS, BMI and RI of interlobar artery were the important factors affecting early renal damage in patients with hypertension.

Objectives To study the Electrophysiologic characteristics and method of radiofrequency ablation in patients with slow conduction in left free wall. Methods When 5 cases induced tachycardia, using VS2 program stimulation terminated the tachycardia to establish that ventricle is the part of reentry circle. Results No retrograde A waves in 4 cases but only 1 case present A wave in terminating tachycardia. The accessory pathways have decreasing conduction in One case. Successful ablation were located in ventricle sides. Conclusions Ventricular sense and S2 program stimulation to terminate tachycardia is a reliable method to different atrial tachycardia. A wave of successful targets ahead of A wave of any coronary sinus leads is 8 ～22 ms.

房室结折返性心动过速的射频消融,目前多采用慢径消融法.本研究通过对慢径消融成功靶点在Koch三角的分布,观察组成慢径传导的细胞的主要分布区域,指导慢径的消融.

Twenty-seven patients with atrioventricular node reentry tachycardia were performed ablation of slow pathways.The base and top of Koch′s triangle were m arked with catheter electrodes of His bundle and coronary sinus ostium(CSO).The highness of Koch′s triangle were measured in X-ray exposure in left anterior o blique 45 ° and right anterior oblique 30 ° and divided two groups by 20 m m hi gh in order to evaluate the sites of successful and unsuccessful targets.The con ducting time from CSO to His bundle(Acso-H) and from CSO to A wave of target(Ac so-AT) were measured and to calculate the ratio of Acso-H/Acso-AT to observe differences in two groups.The successful targets located below 5 mm in upper mar gin of CSO in small Koch′s triangle group but the targets located up to inferio r 1/3 site of Koch′s triangle in larger triangle group.Acso-AT is more than 5. 78 ms in successful group,suggest that the activity of the targets are later tha n CSO.Acso-H/Acso-AT is more than 10 in successful targets and suggest that it can be reflected the distance from His bundle to CSO.The quantitative parameter of combination of electrophysiology and Koch′s triangle size in x-ray can be useful in ablation of slow pathways.

目的:通过对有效靶点和无效靶点的多参数分析以研究慢径消融靶点的综合判定方法.方法:对80例房室结双径路慢径消融成功患者的634个靶点分为有效靶点组(n＝184)和无效靶点组(n＝450),分别测定冠状静脉窦口A波起始至希氏束H波的间期(Acso-H),希氏束远端A波起始至靶点A波起始的间期(AHIS-At)以及冠状静脉窦口A波起始至靶点A波起始的间期(Acso-At).测定靶点A波和V波振幅以及A/V值.将以上结果行统计学处理.结果:有效靶点组与无效靶点组比较,除Acso-At两组比较无差异之外,其他各值均有显著性差异.结论:本文结果提示Koch三角大小的激动传导时间无明显差异,有效靶点位置A波振幅＜2 mV,V波振幅＞10 mV,A/V值＜0.2,Acso-At≥0 ms是重要的参考量化指标,均提示靶点位于冠状静脉窦口附近三尖瓣环侧.

对30例房室结折返性心动过速(AVNRT)患者行慢径消融术时,采用多角度X线投照,并分别测定冠状窦口至希氏束的距离、心房程序刺激时最长的慢径传导时间(AHmax)和诱发心动过速时的AH间期(AHtach), 分别计算Koch三角大小与两者之间的相关性.结果显示,右前斜30°+足位20°时Koch三角最大,有明显差异;AHmax和AHtach组间亦有显著差异,二者与Koch三角大小均有较高的相关性(P＜0.001).提示Koch三角大小有明显差异,AHmax和AHtach与Koch三角大小呈正相关.

目的:探讨原发性高血压伴胰岛素抵抗与心率变异性的关系及临床干预后的变化.方法:原发性高血压胰岛素抵抗患者60例为胰岛素抵抗组,非胰岛素抵抗患者30例为非胰岛素抵抗组,正常对照30例为正常对照组,行心率变异比较后将胰岛素抵抗组患者随机分成胰岛素抵抗A、B 2组各30例,胰岛素抵抗A组给予钙离子拮抗剂,胰岛素抵抗B组给予血管紧张素转换酶抑制剂分别治疗4周.结果:药物治疗前胰岛素抵抗组与非胰岛素抵抗组和正常对照组心率变异各项指标比较有显著性差异(P＜0.01).治疗后胰岛素抵抗A组胰岛素水平及心率变异指标改善不显著;胰岛素抵抗B组胰岛素水平及心率变异指标明显改善,2组间比较有显著性差异(P＜0.01).结论:血管紧张素转换酶抑制剂贝那普利较好地改善了血胰岛素水平及心率变异各项指标,其效果优于钙离子拮抗剂硝苯地平.

Objective:To measure size of Koch's triangle in the X-radiation and to evaluate the value in ablation of slow pathway.Methods:27 patients with AV nodal reentry tachycardia marked with coronary sinus ostium and His bundle with cardiac catheterization.The high of Koch's triangle were measured by multiangle projection respectively.Results:Koch's triangle is obviously different in these patients.The minimal size show in left anterior oblique(LAO),but the maximal size show in right anterior oblique(RAO) with caudal.Conclusion:Slow pathway locate is below in small Koch's triangle group,RAO with caudal projection can be used in ablation of slow pathway,but slow pathway locate in area of middle-posterior 1/3 of Koch's triangle in larger Koch's triangle group.

Objective:To evaluate the myocardial infarct size and its value according to the dynamic changes of myocardial enzyme in old patients with acute myocardial infarction(AMI). Methods:The infarct sizes were determined by calculatoing activity-time changing curves of serum creatine kinase(CK), creatine kinase isozyme MB (CK-MB), pyruvate kinase (PK), glutamic oxalacetic transaminase (GOT), lactate dehydogenase (LDH) and hydroxybuty-rate debydrogenase(HBDH) in 125 patients with AMI. Results:The myocardial infarct sizes were (44.2 + 19.2)CK-g, (40.2 + 18.6)CK-MB-g, (38.2 + 18.5)PK-g, (46.1 + 21.4)GOT-g, (49.5 +23.4) LDH-g, (44.8 + 20.4) HBDH-g, respectively in 56 old patients, and in the other 69 patients the myocardial infarct sizes were (34.8 + 17.1 )CK-g, (32.9 + 15.7)CK-MB-g, (30.5 + 15.8)PK-g, (38.4 + 17.4)GOT-g,(40.9 + 20.7)LDH-g, (36.5 + 18.8)HBDH-g. The infarct sizes in older patients were increased significantly than those in younger patients(P < 0.05). Conclusion: The infarct size in old patients with AMI can help to judge the tendency of AMI and asses the treatment methods and predict prognosis.

Objective:To evaluate the value of ultrasound Doppler renal blood flow measurement on diagnosing early renal damage of hypertension.Method:Sixty patients with hypertension and twenty normotensive subjects were classified into hypertensive group and control group according to β2-MG contents in blood or urine and urinary albumin excretion rate(UAER).All 80 cases received ultrasound Doppler renal blood flow measurement.Result:The earliest abnormal of renal blood flow in hypertensives was that the end-diastolic velocity(Vd) of interlobar artery decreased and the acceleration time(AT) of segmental and interlobar artery increased.Peak velocity in systole(Vs) and Vd decreased and pulsed index(PI) and resistance index(RI) inceased in segmental and interlobar artery of all hypertensives with early renal damage.UAER was positively correlated with PI (r=0.384,P<0.01) and RI(r=0.381,P<0.01) of interlobar artery.Conclusion:The change of interrenal hemodynamics in essential hypertensives was earlier than that of renal function detected by laboratory test.The increased interrenal artery resistance is associated with early damage of renal function.

应用超声彩色室壁动力(CK)分析技术,根据超声CK图像的变化对冠心病心绞痛进行分层诊断.结果显示:正常心肌超声CK图像由"红-黄-绿-蓝”色组成,色彩分布均匀; 冠心病心绞痛患者根据超声CK图像的变化可分为4组,A组:CK图像"蓝”色轻度减少;B组:C K图像"蓝”色完全消失;C组:CK图像"蓝”色完全消失,并伴有"绿”色轻度减少;D组 :CK图像"蓝”色完全消失,并伴有"绿”色明显减少.研究表明,根据超声CK图像的变化可对冠心病心绞痛进行分层诊断,并筛选高危患者.

目的:运用X线解剖和电生理导管标测相结合的量化指标以指导慢径消融的靶点定位方法.方法:对27例房室结双径路并折返性心动过速病人行慢径消融术时用希氏束和冠状窦导管分别标记Koch三角底部和顶端,X线投照用左前斜45度和右前斜30度分别测量Koch三角的高度并以20mm为界分为大小Koch三角两组,观察成功和不成功靶点的位置,采用测量冠状窦口A波至希氏束H波(Acso -H)传导时间和冠状窦口A波至靶点A波的传导时间(Acso - AT),以及Acso-H/Acso-AT为电生理指标,观察成功和不成功靶点的差异.结果:成功靶点在小Koch三角组多在冠状窦口上缘5mm以内,大Koch三角组可达中下1/3处,其电生理指标以Acso-T和Acso-H/Acso-AT与不成功靶点有显著性差异.结论:X线影象和电生理学的量化指标结合可反映不同Koch三角大小时,靶点与冠状窦口的关系,可作为靶点定位的参考指标.