越来越多的证据表明,疼痛可普遍发生于慢性心力衰竭患者中,发生率随着心功能恶化而上升.疼痛可以在多方面影响患者生活质量和预后,为慢性心力衰竭治疗加大了难度,但在临床上往往没有引起足够重视.本文就慢性心力衰竭患者疼痛的发生率、常见部位、疼痛的来源、影响因素、疼痛对慢性心力衰竭患者的影响及疼痛的药物治疗进行综述,希望提高临床对慢性心力衰竭患者疼痛的认识和重视,为慢性心力衰竭患者疼痛治疗提供参考.

目的 检测老年射血分数中间值心力衰竭(HFmrEF)患者血清可溶性CD146(sCD146)的水平,探讨其对老年HFmrEF患者的临床诊断价值.方法 选取2020年9月至2021年10月间牡丹江医学院附属红旗医院老年病科和心血管内科就诊射血分数(LVEF:40％～49％)、纽约心功能分级(NYHA分级)Ⅱ级～Ⅳ级的老年心衰患者34例(老年HFmrEF组),非老年心衰患者34例(非老年HFmrEF组),同期健康体检老年者31例(健康老年组)作为研究对象.收集所有患者的年龄、性别、血压、心率、总胆红素、血肌酐、胆固醇等数据,所有患者均常规行超声心动图检查,检测血清N末端前体脑利钠肽(NT-proBNP)、sCD146水平.比较各组患者的一般资料、NT-proBNP、超声心动图相关指标、sCD146水平的差异,分析相关性,受试者工作特征曲线(ROC)评价sCD146对HFmrEF的诊断价值.结果 三组患者收缩压、舒张压、血浆白蛋白、胆固醇、低密度脂蛋白无显著性差异(P>0.05),而心率、总胆红素、同型半胱氨酸、血肌酐有明显差异(P<0.05);三组研究对象左室后壁厚度、每搏输出量无统计学意义(P>0.05),而左心室室间隔厚度、左室舒张末期前后径、左室收缩末期前后径、左室舒张末期容积中有显著差异(P<0.05);三组患者的血清NT-proBNP、sCD146水平有显著性差异(P<0.05),且HFmrEF患者的NT-proBNP、sCD146浓度均显著高于健康老年组患者;老年HFmrEF组与非老年HFmrEF组,sCD146与NT-proBNP、心功能分级呈正相关;sCD146诊断HFmr EF的曲线下面积为:0.945(95％CI:0.894,0.996),最佳截断值:68.459 ng/mL,灵敏度、特异度分别为:85.3％、93.5％.结论 血清sCD146浓度在老年HFmrEF、非老年HfmrEF显著升高,sCD146对老年HFmrEF的诊断和病情评估有意义;老年HFmrEF患者血清sCD146与NT-proBNP、心功能分级具有相关性.

Objective: To analyze the correlation between serum fibulin-3 level and blood lipids, brachial-ankle pulse wave velocity (baPWV), left ventricular posterior wall thickness (LVPWT), and interventricular septal thickness (IVST). Methods: From June 2017 to April 2019, 45 elderly patients with hypertension who were admitted to the Department of Cardiology of our hospital were selected as the observation group, and another 45 healthy people were selected as the control group. We compared the correlation between serum fibulin-3 level and blood lipids (TC, FFA, TG, HDL-C, LDL-C), brachial-ankle pulse wave velocity (baPWV), left ventricular posterior wall thickness (LVPWT), and interventricular septal thickness (IVST). Results: The level of fibulin-3 in the observation group was significantly lower than that in the control group (P<0.01); the level of HDL-C in the observation group was significantly lower than that in the control group (P<0.01); the level of LVPWT and IVST in the observation group was significantly higher than that in the control group (P<0.01); the level of baPWV in the observation group was significantly lower than that in the control group (P<0.01); fibulin-3 and HDL-C were positively correlated with TC, TG and LDL-C. Fibulin-3 was negatively correlated with LVPWT and IVST, and positively correlated with baPWV (P<0.05) . Conclusion: The level of fibulin-3 in the elderly patients with hypertension was lower than that in the healthy control group, which was closely related to LVPWT, IVST, and baPWV, and therefore it can be used as an important index to prevent and judge the disease.

急性心肌梗死(acute myocardial infarction,AMI)是全球发病率及死亡率较高一类疾病之一,当心脏血管闭塞,血流急剧减少或中断,供应区域的心肌细胞,严重的持久性缺血缺氧所导致的心肌细胞坏死,从而引起不可逆性心肌损害,导致患者出现一系列临床症状,甚至诱发患者心源性死亡.现临床上常采用经皮冠状动脉介入治疗(Percutaneous coronary inter-vention,PCI)开通闭塞血管,完成血运重建,快速缩小心脏心肌细胞的梗死面积,但经PCI治疗后,时常出现心肌缺血再灌注损伤(Myocardial ischemia reperfusion injury,MI/RI),出现心肌组织损伤反而加重的现象.其中较为严重是再灌注心律失常(reperfusion arrhythmia,RA)的发生,不仅影响患者的预后及生存质量,还会增加猝死风险,现就急性心肌梗死PCI术后发生心律失常的机制及其药物预防进行综述.