Objective To investigate the early clinical effect of the novel designed domestic transcatheter edge-to-edge repair for mitral regurgitation in the treatment of degenerative mitral regurgitation.Methods A total of 12 patients with severe degenerative mitral regurgitation who underwent intervention therapy procedure using domestic transcatheter edge-to-edge repair system in the First Affiliated Hospital of Zhengzhou University between October 2021 and September 2022 were included in the analysis. The clinical characteristics and echocardiographic indexes of patients during hospitalization were collected, and the changes of cardiac function and echocardiographic indexes of patients were followed up at 3 months.Results There were 12 patients in the whole group, including six females and six males, with age of（69.2±5.76） years. Eleven patients had 4+ mitral regurgitation（MR） and one patients had 3+ MR. Ten patients performed successfully and had MR ≤1+ at immediately after surgery. Two patients failed surgery who had MR ≥3+ at postoperative immediately. The left atrial diameter and left ventricular end-diastolic diameter were increased postoperative immediately. At three months postoperatively, ten patients had MR≤ 2+, and left atrial diameter, left ventricular end-diastolic diameter and pulmonary artery systolic pressure were improved（P＜0.05）. There was no statistically significant difference in left ventricular ejection fraction, mitral valve forward peak flow rate and mean mitral valve cross-valve pressure（P＞0.05）. One patient had acute pericardial effusion intraoperatively, and received pericardial puncture and drainage immediately.Conclusion The novel designed domestic transcatheter edge-to-edge repair showed good safety and efficacy for severe degenerative mitral regurgitation. The early results are satisfactory.

目的:探讨2型糖尿病患者糖化血红蛋白(HbA1c)变异性与经皮冠状动脉(冠脉)介入治疗(PCI)术后支架内再狭窄(ISR)的关系.方法:连续纳入2017年9月-2021年3月在郑州大学第一附属医院心内科行PCI术的326例2型糖尿病患者.根据术后6个月至1年随访的冠脉造影结果分为ISR组和非ISR组.HbA1c变异性以HbA1c测量值的标准差、变异系数和校正后的标准差表示.建立多因素Cox回归模型分析HbA1c变异性与ISR的关系.结果:基线分析表明,两组在胱抑素C、术前HbA1c、平均HbA1c、钙通道阻滞剂、口服降糖药、胰岛素应用、饮酒状态、脑卒中史、支架数量等方面存在差异(均P＜0.05).在多因素分析中,依次校正多个混杂因素后发现高HbA1c变异性与发生ISR的风险增加独立相关,HR(每1-SD增加)分别为1.73(95％CI:1.14～2.62)、1.77(95％CI:1.17～2.68)、1.73(95％CI:1.14～2.61).结论:高 HbA1c 变异性与2型糖尿病患者PCI术后发生ISR的风险增加独立相关.

目的:评价Crush与Culotte策略在真性分叉病变中的安全性和有效性,并从流体力学的角度评价采取两种术式后分叉局部血流动力学的不同改变.方法:连续入选300例真性分叉病变患者并随机分配至Crush治疗组或Culotte治疗组,进行1年的临床和造影随访.主要终点为主要心血管不良事件(包括心源性猝死、心肌梗死、支架内血栓及靶血管再次血运重建等)的发生率,次要终点为支架内再狭窄的发生率.同时,应用计算流体力学的方法分析两组分叉局部的血流动力学变化.结果:术后1年随访结果显示,Crush治疗组和Culotte治疗组主要心血管不良事件发生率分别为6.7％和5.3％,两组间差异无统计学意义(P＞0.05);Crush治疗组的支架内再狭窄的发生率高于Culotte治疗组患者(P＜0.05),分别为12.7％和6.0％.Crush治疗组中分叉区域时间平均壁面剪切力的面积分值显著低于Culotte治疗组[(5.01±0.95)×10-4N vs.(6.08±1.16)×10-4N,P＜0.01].结论:Crush技术及Culotte技术在处理复杂冠状动脉分叉病变中均安全有效.相较于Crush技术,应用Culotte技术治疗的分叉病变患者可能具有更低的支架内再狭窄发生率以及更佳的分叉局部流体力学效果.

目的:伊伐布雷定联合参附强心汤治疗慢性充血性心力衰竭的临床研究.方法:选取2019年7月-2020年7月在我院治疗的慢性充血性心力衰竭患者共60例,随机分为参照组和观察组,各30例.参照组应用伊伐布雷定治疗,观察组在参照组基础上应用参附强心汤治疗.比较两组患者的心功能指标、不良反应发生率.结果:两组心功能指标对比有差异,观察组优于参照组,差异明显(P＜0.05);治疗后观察组GDF-15、hs-TnT、sST2低于参照组,差异有统计学意义(P＜0.05);治疗后观察组PAC-QOL评分高于参照组,差异有统计学意义(P＜0.05);两组不良反应发生率对比无明显差异(P＞0.05).结论:伊伐布雷定联合参附强心汤可改善患者的心功能指标,且不会增加不良反应发生率,值得进一步推广.

目的 分析心衰患者联合使用法舒地尔、标准化抗心衰治疗对其心功能以及BNP、hs-CRP、ET-1、ANP等指标的影响.方法 在2020年10月至2021年1月期间选出62例符合试验要求的心衰患者,采用抽签法将其均分成2组.其对照组仅实施标准化抗心衰治疗,观察组则联合使用法舒地尔、标准化抗心衰治疗,分析各组患者心功能指标、BNP水平、hs-CRP水平、ET-1水平、ANP水平、治疗有效率、不良反应发生率.结果 心功能指标水平,治疗前两组差异无统计学意义(P>0.05),治疗后观察组低于对照组,差异有统计学意义(P<0.05);BNP水平、hs-CRP水平、ET-1水平、ANP水平,治疗前两组差异无统计学意义(P>0.05),治疗后观察组低于对照组,差异有统计学意义(P<0.05);治疗有效率,观察组高于对照组,差异有统计学意义(P<0.05);不良反应发生率,观察组低于对照组,差异有统计学意义(P<0.05).结论 心衰患者联合使用法舒地尔、标准化抗心衰治疗效果显著,不仅能改善病人的心功能,还能有效降低BNP、hs-CRP、ET-1、ANP等水平,值得应用.

Objective:To explore the effects of smart cloud follow-up platform in home care for elderly patients with pacemakers.Methods:Totally 120 elderly patients who received pacemaker implantation in a ClassⅢ Grade A hospital in Henan province between August 2018 and August 2019 were selected by convenient sampling. The 60 patients admitted from August 2018 to February 2019 were included into the control group, while the 60 patients admitted from March to August 2019 were selected into the experimental group. Patients in the experimental group received home care based on the cloud follow-up platform, while patients in the control group received routine continuing care at home. After 3 months of intervention, the complication rate, functional exercise compliance and quality of life were compared between the two groups using χ 2 test and t test. Results:Totally 59 patients in the experimental group and 58 patients in the control group completed the study. After intervention, the complication rate in the experimental group was 32.2% (19/59) , lower than 89.7% (52/58) in the control group, and the difference was statistically significant (χ 2=9.307, P< 0.05) ; the scores of physical exercise compliance after pacemaker implantation, postoperative precautions compliance and compliance of initiative advice seeking in the experimental group were (26.05±3.07) , (15.42±1.24) and (11.85±1.96) , higher than those in the control group (18.53±2.93) , (9.66±2.40) and (6.05±1.58) in the control group, and the differences were statistically significant ( t=13.548, 16.331, 17.558; P< 0.01) ; the total quality of life score in the experimental group was (161.12±9.94) , higher than (132.50±9.20) in the control group, and the difference was statistically significant ( t=16.149, P < 0.01) . Conclusions:The home management model based on the smart cloud follow-up platform improves home follow-up experience of elderly patients with pacemaker, the compliance of home functional exercises, and their quality of life.

目的 设计心血管介入远程支持平台,探讨在跨区域农村行冠状动脉介入手术诊疗中的应用效果.方法 将首次就诊于基层心血管联盟医院,后转诊至上级医院行冠状动脉介入手术的118例农村患者按照诊治时间分为A组与B组各59例.A组按照传统模式实施会诊与转诊;B组通过心血管介入远程支持平台实施会诊与转诊,制定区域协同术后运动康复方案.比较两组患者的救治效率.结果 B组转诊决策时间、冠状动脉介入手术治疗决策时间、术后卧床时间及住院时间显著短于A组,康复锻炼依从性显著高于A组(均P＜0.01).结论 基于心血管介入远程支持平台的应用可规范联盟医院间远程会诊、转诊流程,减少农村冠状动脉介入手术患者治疗决策延迟和转诊决策延迟时间,促进患者早期康复.

目的 观察心悦胶囊联合琥珀酸美托洛尔缓释片治疗冠心病心绞痛的临床疗效.方法 选取2018年4月-2021年2月郑州大学第一附属医院收治的136例冠心病心绞痛患者作为观察对象,根据随机数字表法分为对照组(68例)和治疗组(68例).对照组口服琥珀酸美托洛尔缓释片,1片/次,1次/d.治疗组患者在对照组治疗的基础上口服心悦胶囊,2粒/次,3次/d.两组治疗疗程均为4周.观察两组临床疗效、心电图疗效,比较两组心绞痛症状、心功能指标、心肌损伤指标、血液流变学指标.结果 治疗后,治疗组的临床疗效总有效率为94.12％,高于对照组的80.88％,治疗组的心电图疗效总有效率为92.65％,高于对照组的76.47％,组间对比差异有统计学意义(P＜0.05).治疗后,两组心绞痛发作频率降低、持续时间缩短(P＜0.05),与对照组相比,治疗后治疗组心绞痛发作频率降低、持续时间缩短更显著(P＜0.05).治疗后,两组左心室射血分数(LVEF)、心排血量(CO)较治疗前升高(P＜0.05),与对照组相比,治疗后治疗组的LVEF、CO升高更显著(P＜0.05).治疗后,两组全血低切黏度、全血高切黏度、血浆黏度、纤维蛋白原较治疗前降低(P＜0.05).与对照组相比,治疗后治疗组全血低切黏度、全血高切黏度、血浆黏度、纤维蛋白原降低更显著(P＜0.05).治疗后,两组肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、脑钠肽(BNP)水平较治疗前降低(P＜0.05),与对照组相比,治疗后治疗组CK-MB、cTnI、BNP水平降低更显著(P＜0.05).结论 心悦胶囊联合琥珀酸美托洛尔缓释片治疗冠心病心绞痛具有较好的临床疗效,能够改善血液流变学、心功能,减轻心肌损伤,安全性好.