目的 观察心房肌纤维化延迟钆增强-心脏磁共振成像(LGE-CMR)检测与CARTO-3三维标测左心房纤维化区域相关性和房颤患者射频消融术后复发情况.方法 入选接受射频消融术阵发性房颤患者38例,全部给予心房LGE-CMR检测,根据LGE-CMR检查结果,将左房纤维化定量/左房壁提及百分比分两组,A组为轻度心房肌纤维化,左房纤维化定量/左房壁提及百分比<25％;B组为重度心房肌纤维化,左房纤维化定量/左房壁提及百分比≥25％.检测结束后全部患者给予环肺静脉隔离+二尖瓣峡部线/房顶线隔离(CPVI+MI/ROOF)射频消融术.术后随访1年,观察房颤复发率.结果 38例患者全部成功行射频消融术,并完成1年随访.LGE-CMR和CARTO系统重建图像的心肌纤维化区域以及分级情况相符合,具有一致性,诊断准确率为92.11％(35/38).无论是LGE-CMR检测,还是CARTO系统重建图像评价,左心房心肌纤维化轻的患者室早射频消融术后1年复发率均较左心房心肌纤维化严重的患者低(P<0.001).结论 心房LGE-CMR检测与CARTO-3三维标测左心房纤维化区域相关性强,且心肌纤维化严重患者房颤射频消融术后复发率高.

目的 观察磷酸肌酸钠联合尼可地尔治疗急性ST段抬高型心肌梗死(STEMI)的临床疗效.方法 选择医院2014年5月至2017年5月收治的STEMI患者91例,随机分为对照组(45例)和治疗组(46例).两组患者均于行经皮冠状动脉介入(PCI)手术后给予常规治疗,对照组患者给予尼可地尔治疗,治疗组患者给予磷酸肌酸钠联合尼可地尔治疗,两组均连续治疗14 d.结果 治疗组总有效率为95.65%,明显高于对照组的82.22%(χ2=4.194,P=0.041);治疗后,两组患者心脏指数(CI)、左心室射血分数(LVEF)均增大,室壁运动积分指数(WMSI)均减小,且治疗组变化均明显优于对照组(P<0.05);治疗后,两组患者血清肌酸激酶同工酶MB(CK-MB)、心肌肌钙蛋白I(cTnI)、基质金属蛋白酶-9(MMP-9)、脑钠肽(BNP)水平均降低,超氧化物歧化酶(SOD)水平均升高,且治疗组变化均明显优于对照组(P<0.05).结论 磷酸肌酸钠联合尼可地尔治疗STEMI的临床疗效显著,能明显减轻心功能损伤,促进心功能恢复,且安全性较好,值得临床推广.

Objective To investigate the expression serum type B natriuretic peptide(BNP),vascular endotheli-al growth factor (VEGF) and transforming growth factor-β 1(TGF-β 1) levels in patients with congenital heart disease complicated with pulmonary hypertension and its clinical significance.Methods A total of 86 patients with left to right shunt congenital heart disease,who were treated in Shenzhen People's Hospital from January 2014 to June 2017,were se-lected as the study group and according to the pulmonary artery systolic pressure(PASP)divided into the group A(PASP<30 mmHg,n=20),group B(30 mmHg≤PASP<50 mmHg,n=42),group C(PASP≥50 mmHg,n=24).Another 80 healthy people in the same period were selected as the control group.The levels of serum BNP,VEGF and TGF-β1between the study group and the control group and different PASP groups were compared,and the correlation between them and PASP was analyzed.Results The serum levels of BNP,VEGF and TGF-β1in the study group were(236.76±75.43)pg/mL, (403.32 ± 89.87) pg/mL, (837.53 ± 102.25) pg/mL, respectively, which were significantly higher than corresponding (88.36±26.73)pg/mL,(86.73±22.45)pg/mL,(128.81±32.13)pg/mL in the control group(P<0.05).With the increase of PASP,the serum levels of BNP,VEGF and TGF-β1increased,and the levels of serum BNP,VEGF and TGF-β1in pa-tients with different PASP groups were statistically different(P<0.05).Pearson correlation analysis showed that the lev-els of serum BNP, VEGF and TGF-β 1were positively correlated with PASP in patients with congenital heart disease complicated with pulmonary hypertension(r=0.684,0.572,0.521,all P<0.05),and the serum BNP,VEGF were positive-ly correlated with TGF-β1in patients with congenital heart disease complicated with pulmonary hypertension(r=0.512, 0.554,all P<0.05).Conclusion The serum levels of BNP,VEGF and TGF-β1are increased in left to right shunt con-genital heart disease,and the three of them are positively correlated with PASP.

Objective To investigate the correlation between left atrial diameter (LAD), serum uric acid (UA) level and atrial fibrillation (AF). Methods 239 patients with AF (case group) and 60 patients without AF (control group) were recruited from Jan 2016 to Jun 2016 in department of cardiology, Shenzhen People's Hospital. The medical records and laboratory results were collected. The left ventricular end systolic LAD, left ventricular end diastolic diameter (LVDD) and left ventricular ejection fraction (LVEF) were measured by using an ultrasonic diagnostic instrument. Logistic regression was used to analyze the risk factors of atrial fibrillation. Results The TC, TG and LEVF of the patients in the case group were significantly lower than those in the control group (all P<0.05). The UA and LAD in the case group were significantly higher than those in the control group (all P<0.05). Logistic regression analysis showed that age, UA and LAD were risk factors of atrial fibrillation. The levels of UA and LAD in patients with paroxysmal AF and persistent AF were significantly higher than those in control group (all P<0.05), and the levels of UA and LAD in patients with persistent AF were higher than those with paroxysmal AF (all P<0.05). Conclusion Left atrial diameter and serum uric acid level are independent risk factors of atrial fibrillation, and may be related to the progress of atrial fibrillation, the mechanism needs to be further studied and confirmed.

目的 研究动态心电图检查法在诊断冠心病性心律失常方面的价值.方法 选取深圳市人民医院2013-01-2016-01间收治的92例冠心病患者为研究对象.所有患者均接受动态心电图与常规心电图检查,比较两种检查方法的冠心病心律失常诊断结果与冠心病心律失常症状检出结果.结果 动态心电图诊断冠心病心律失常的阳性检出率为70.7%,显著高于常规心电图的57.6%(P<0.05).动态心电图检查对室性早搏二三联律、室性早搏成对、房性早搏二三联律、成对房性早搏、短阵室上速、房室传导阻滞的阳性检出率分别为48.9%、31.5%、44.6%、42.4%、45.7%、18.5%,显著高于常规心电图检查的18.5%、8.7%、21.7%、17.4%、16.3%、4.3%(P<0.05).结论 动态心电图检查法具有准确率高、操作简便、无创等优点,可以准确反映冠心病性心律失常状况,对预防冠心病性心律失常患者心脏性猝死具有重要意义.

Objective To understand the treatment circumstance of ST-elevation myocardial Infarction (STEMI) patients at public hospitals in Shenzhen.Methods Directed by Public Hospital Administration at Shenzhen Municipality (PHASM) and led by Chest Pain Treatment Quality Control Center at Shenzhen People's Hospital (CPTQCC-SZ),25 public hospitals in Shenzhen, including 15 PCI-capable hospitals and 10 non-PCI-capable hospitals,we investigated on the overall treatment conditions and the STEMI patient treatment situations from October to December 2015 in these hospitals. A regression analysis was performed between a few factors and the success rate of STEMI treatment was reviewed. Results 383 STEMI cases twere registered between October to December 2015 in the 25 public hospitals in Shenzhen,with 324 case treated in PCI-capable hospitals and 59 cases in non-PCI-capable hospitals. There were statistical differences between the PCI-capable hospitals and non-PCI-capable hospital in fields of total number of senior cardiologists (work year ≥ 3 year),total number of beds in general cardiology beds and number of beds in cccu(all P<0.01). There was no difference in the time of obtaining the first ECG at patient arrival between hospitals(P=0.052).Time for laboratory results availability for troporin was significantly shorter in PCI-capable hospital[(25.0±4.2)min vs.(58.0±2.8)min,P=0.002] .Among the PCI-capable hospitals,the mean D-to-B time was 320 minutes, and mean F-to-B time was 380 minutes. In non-PCI-capable hospitals,D-to-N time ranged from 20 to 350 minutes and F-to-N time ranged from 25 to 380 minutes. Conclusions There are gaps among the overall conditions of the public hospitals in Shenzhen. The overall conditions and chest pain treatment conditions of non-PCI-capable hospitals had bigger gaps with PCI-capable hospitals.

目的 更进一步对房颤射频消融术患者围手术期的护理对策及临床体会进行探究.方法 对2015年4月~2017年3月在我院行房颤射频消融术治疗的104例房颤患者进行回顾分析.依据随机数字表法及对每位房颤射频消融术患者所行护理方案的不同将其均分至行传统护理的对照组与行围手术期护理的观察组,房颤射频消融术的围手术期护理包括术前护理干预与相关准备、术中辅助护理与同医生的全面配合以及术后的心理、饮食、运动以及出院指导等全方位护理对策.对比分析不同护理对策对房颤射频消融术患者临床疗效的影响,并总结分析围手术期护理对策的最佳方案,进而有效提升房颤射频消融术的临床疗效.结果 无论在行房颤射频消融术患者的临床总有效率方面,还是在其并发症发生率以及临床满意度方面,行围手术期全方位护理的观察组均明显优于单纯常规护理的对照组,差异有统计学意义(P<0.05).结论 对于行射频消融术的房颤患者,行全面的围手术期护理不仅临床效果显著,而且手术成功率高、安全性佳,患者满意度高,值得推广.

Objective To explore the effect of amlodipine combined with hydrochlorothiazide on steady reduction of blood pressure and protection of target organ in elderly patients with hypertension.Methods Totally 134 elderly patients with hypertension from January 2013 to October 2014 were randomly divided into observation group (67 cases) and control group (67 cases).Control group was given hydrochlorothiazide (12.5 mg daily) and observation group was given amlodipine (5 mg daily) combined with hydrochlorothiazide (12.5 mg daily) after washout period.The blood pressure,parameters of ultrasound,renal function indicators before and after treatment were compared between the two groups.Results The 24 h average blood pressure,24 h blood pressure variety ratio and 24 h blood pressure load were significantly lower,the 24 h trough/peak blood pressure ratio and nighttime blood pressure drop rate were significantly higher in observation group than those in control group [systolic blood pressure/diastolic blood pressure:(125 ± 13) / (82 ± 8) mmHg vs (138 ± 14) / (91 ± 9) mmHg,(10.1 ±1.2)％/(8.3±1.1)％ vs (15.3±1.4)％/(10.6±1.3)％,(10.3 ±1.3)/(10.5±1.1) mmHgvs (15.6±1.7)/(14.8±1.5) mmHg,(76.2 ±7.7)％/(74.8 ±7.5)％ vs (67.2 ±6.8)％/(71.4 ±7.2)％,(12.1±1.4)％/(11.6±1.2)％ vs (10.0±1.4)％/(9.8±1.3)％] (P＜0.05).After treatment,the left ventricular mass (LVMI),intima-media thickness (IMT),plaque Crouse score were significantly lower than before treatment,the left ventricular ejection fraction (LVEF) was higher than before treatment [observation group:(107±8)g/m2 vs (119 ±9)g/m2,(0.65 ±0.03)mm vs (0.82±0.07)mm,(3.2±0.4)scores vs (4.9 ± 0.5) scores,(66 ± 9) ％ vs (54 ± 8) ％;control group:(113 ± 9) g/m2 vs (118 ± 9) g/m2,(0.77 ± 0.09)mm vs (0.83 ± 0.05) mm,(3.3 ± 0.5) scores vs (4.7 ± 0.4) scores,(59 ± 7) ％ vs (53 ± 8) ％];the LVMI,IMT,Crouse score were significantly lower,the LVEF was significantly higber in observation group than those in control group (P ＜ 0.05).In two groups,the microalbuminuria (MAU),MAU/creatinine ratio after treatment were significantly lower than before treatment;the endogenous creatinine clearance rate (Ccr) was significantly higher than before treatment [observation group:(38 ± 12) mg/L vs (55 ± 14) mg/L,(1.34 ± 0.26) mg/μmol vs (3.99 ± 0.24) mg/μmol,(86 ± 16) ml/min vs (69 ± 15) ml/min;control group:(48 ± 13)mg/L vs (56 ± 14)mg/L,(2.15 ±0.39)mg/μ mol vs (4.01 ±0.26)mg/μmol,(75 ± 14) ml/min vs (68 ± 15) ml/min],and the MAU,MAU/creatinine in observation group were significantly lower,Ccr was significantly higher than control group (P ＜ 0.05).Conclusion Amlodipine combination with hydrochlorothiazide can steadly reduce blood pressure and improve the subclinical lesions of target organs.

目的：探讨心肌梗死甲状腺激素水平与冠脉狭窄严重程度的相关性。方法：选取甲状腺功能无异常的急性心肌梗死患者231例，其中210例冠心病。根据病变累及的血管数和狭窄程度分为单支病变（n＝66）和多支病变（n ＝144）。所有患者均进行 TSH 、FT 3、FT4等甲状腺激素水平检查，根据 FT3的含量再分为三个不同的组别：A 组77例，FT 3含量（1．16～2．25）pg ／ml ；B 组78例，FT3含量（2．26～2．81）pg／ml ；C 组76例，FT 3含量（2．81～4．02）pg／ml 。结果：三组性别、年龄、体质指数、高血压、糖尿病、吸烟、TC 、TG 、LDL-C 、HDL-C 和病死率方面比较差异均无统计学意义，而 C 反应蛋白和不良事件发生率方面比较差异有统计学意义，C 组显著低于 A 组。多支病变的 FT 3和 C 反应蛋白水平显著高于单支病变；多支病变 TSH 和 FT4水平低于单支病变，但差异无统计学意义。冠脉狭窄严重程度多因素分析采用 Logistic 回归分析，以冠心病的严重程度为因变量，以年龄、吸烟、高血压、LDL-C 、C 反应蛋白和 FT3为自变量，FT3水平降低与冠心病的严重程度密切相关，是冠心病的危险因素 。结论：急性心肌梗死甲状腺功能正常的患者机体内甲状腺激素水平与冠心病严重程度存在相关性。

目的：观察对心房颤动（简称房颤）患者行射频消融术后给予利伐沙班或华法林抗凝治疗，比较两药的不良反应。方法入选非瓣膜性持续性或阵发性房颤患者74例、采用导管射频消融治疗，随机分成利伐沙班组36例和华法林组38例，术后利伐沙班组每天给予利伐沙班片（10 mg/d），华法林组每天给予华法林片（2.5 mg/d），术后的第1、3个月行常规的实验室检查，统计脑卒中发生率和其他不良事件发生率。结果用药前后及两组间实验室指标血红蛋白、血小板、尿常规、大便隐血、尿素氮、谷丙转氨酶、低密度脂蛋白、凝血指标国际标准化比率INR和房颤复发率，比较均没有统计学差异（P＞0.05）。个别指标异常与观察药物无关。试验结果显示两组患者无死亡病例，利伐沙班组短暂性脑缺血发作1例，无缺血性脑卒中，外周动脉栓塞1例；华法林组缺血性脑卒中1例，无外周动脉栓塞。两组患者牙龈出血各1例；华法林组患者皮肤出血1例，利伐沙班组出现血尿1例，患者停药后出血症状消失，两组患者均未出现严重出血患者。结果显示无论在卒中风险和出血风险上，两组差别无统计学意义（P＞0.05）。结论利伐沙班具有强效抗凝作用，无需监测出凝血指标，可以安全有效地减少房颤患者射频消融术后卒中和栓塞出血风险。

目的:探讨细小型成年动脉导管未闭(PDA)患者的造影、介入治疗特点,观察应用室间隔缺损(VSD)封堵器关闭此类动脉导管未闭的疗效、安全性和意义.方法:选择成年PDA患者25例,造影观察PDA的形态、大小,将其分为长管型10例(A组),迂曲不规则型9例(B组),动脉瘤型6例(C组).UCG显示直径1.2～2.8 mm,造影显示最小直径1.2 mm,最大直径4.3 mm.PDA长度7.9～11.9 mm,平均(9.9±1.3)mm.结果:选择对称型室间隔封堵器和肌部室间隔封堵器进行介入封堵治疗,治疗前后肺动脉压力无明显差异,但造影与TTE测量最窄处直径差异有统计学意义(P＜0.05).总体成功率100％.随访无明显降主动脉缩窄、左肺动脉狭窄及其他并发症.结论:室间隔封堵器关闭细小型PDA疗效肯定、安全.

妊娠相关血浆蛋白A(pregnancy-associated plasma protein-A,PAPP-A),是一种与胰岛素样生长因子1(insulin-like growth factor,IGF-1)相关的金属螯合蛋白酶,与慢性炎症反应关系密切,在冠心病的诊断和预后方面具有较大的应用价值.炎症应答时多种炎症因子可以上调基质金属蛋白酶9(matrixmetalloproteinase-9,MMP-9)的水平[1],而在同样具有慢性炎症反应特性的高血压病患者中,PAPP-A及MMP-9水平是否较血压正常者高,是否随血压水平的升高而升高?目前国内外这方面的报道较少.我们就此研究报道如下.

特发性室性期前收缩是最常见的心律失常,大部分患者预后良好,可无需处理.但仍有许多患者临床症状非常明显,因此反复就诊给患者生活质量带来很大的影响.目前来说,治疗方法主要有药物和射频消融(RFCA)手术,其中RFCA是治疗室性期前收缩最安全有效的治疗措施.常规消融方法是采用双大头标测定位,或用4极电极辅助单大头电极定位,但手术时间相对较长.近年来,我们采用Lasso电极标测对17例右心室流出道室性期前收缩患者进行RFCA治疗,取得了满意效果,随访表明,这是一种安全有效的治疗措施.

Objective To evaluate the efficacy of saline irrigation radiofrequency(RF)ablation for premature contractions originating from the left ventricle. Methods 38 patients with premature contractions originating from the left ventricle were divided into two groups,: underwent saline irrigation RF ablation and normal RF ablation,and the effectiveness were compared. Results Saline irrigation RF ablation has lower electrode temperature and higher RF power than normal RF ablation.There was no difference in the ablation duration.Saline irrigation RF ablation is more efficiency than normal RF ablation. Conclusion Saline irrigation RF ablation has more advantages for premature contractions originating from the left ventricle.