Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

62岁男性患者，发现右心室肿物1天。既往有骨肉瘤病史。超声心动图示右心室心腔内及右心室壁占位性病变。2019年2月在全麻低温体外循环下行右心室肿物切除术＋三尖瓣生物瓣膜置换术＋心外膜临时起搏导线缝置术。术后病理检查示间叶源性恶性肿瘤，考虑心脏转移性骨肉瘤。术后随访1年，患者心功能良好，心腔内未见肿瘤复发，右心室壁占位无明显变化。

Objective To investigate the results of the surgical treatment in the patients with Stanford type A aortic dissection.Methods Aretrospective study was performed on 88 cases of patients who were admitted and underwent surgery of the Stanford type A aortic dissection from January 2011 to March 2016.The preoperative data,in vitro circulation data,perioperative blood transfusion volume,mechanical ventilation time,ICU hospitalization time,total hospitalization time and postoperative complications were analyzed.Results In the total 88 cases,16 cases were operated by the means of the none-total arch replacement without the deep hypothermic circulatory arrest (7 cases with the ascending aorta replacement and Bentall surgery in 9 cases),and the rest of the 72 cases were operated by the total arch replacement (ascending aorta replacement + Sun's surgery in 40 cases,Bentall + Sun's surgery in 31 cases,David + Sun's surgery in 1 case).Compared with the patients of non-total arch replacement group,patients of total arch replacement group were with low intraoperative nasopharyngeal temperature and anal temperature,long time of extracorporeal circulation and the ascending aorta blocking,large amount of intraoperative red blood cells,plasma and platelet transfusion,long time of the breathing machine ventilation and ICU length of hospital stay,large amount of postoperative red blood cells,plasma and platelet transfusion,high incidence rate of postoperative neurological complications,and the differences were statistically significant(P ＜ 0.05).The autologous blood transfusion volume,the total length of hospital stay,postoperative acute kidney injury,hypoxemia,the application of continuous renal replacement therapy and secondary tracheal intubation and tracheostomy and mortality rate in the total arch replacement group were higher than those in the non-total arch replacement group,there was no statistically significant difference between the two groups(P ＞ 0.05).During the follow-up,2 patients(12.5％) were re-operated by the means of total arch replacement and descending aorta stent implantation because of the aortic dissection in the aortic arch in the none-total arch replacement group,there was no secondary surgery in the total arch replacement group,and the difference was statistically significant (P ＜ 0.05).Conclusion The surgical treatment effect of the Stanford A type aortic dissection is satisfactory although the disease is complicated,the condition is severe,the operation risk is large and the in-hospital mortality is high.Intraoperative brain protection is of particular importance,and selection of surgical methods should be considered.

Objective To evaluate whether obstructive sleep apnea ( OSA) contributes directly to left ventricular ( LV) dias-tolic and regional systolic dysfunction in newly diagnosed OSA with normal left ventricle ejection fraction . Methods 125 consecutive patients were prospectively enrolled in the study .Control group consisted of 78 asymptomatic age-matched healthy subjects who did not have any cardiovascular and respiratory diseases .All patients had undergone overnight polysomnography and standard transthoracic and tissue Doppler imaging echocardiogram .Results The E/A ratio and the peak E wave at mitral flow were significantly lower and the peak A wave at mitral flow was significantly higher in OSA patients compared with control sub -jects.Left ventricle isovolumetric relaxation time ( IVRT) and mitral valve flow propagation ( MVFP) were significantly longer in OSA patients than in controls.Tissue Doppler derived S' amplitude of lateral part at mitral valve (S'Lm) and E' wave ampli-tudes both at the lateral ( E' Lm) and septal parts of the mitral valve ( S' Sm) were significantly lower in OSA patients compared to controls.Conclusion Newly diagnosed OSA patients with normal global LV function have significantly impaired diastolic func -tion and regional longitudinal systolic function .OSA is independently associated with these changes in LV function .

目的 探讨长疗程体外反搏及短疗程体外反搏对稳定型心绞痛的疗效及炎症因子的影响.方法 将90例稳定型心绞痛患者随机分为Ⅰ组(常规治疗组)、Ⅱ组(短疗程反搏组)及Ⅲ组(长疗程反搏组),每组30例.Ⅰ组接受常规治疗,Ⅱ组接受常规治疗及15 d体外反搏治疗,Ⅲ组接受常规治疗及35 d体外反搏治疗.治疗35 d后对三组的治疗效果进行评价,用免疫比浊法测定治疗前后血中CRP水平.结果 Ⅰ组有效率55.2％,Ⅱ组有效率90.0％,Ⅲ组有效率93.1％.Ⅰ组治疗前后对比,CRP水平无明显变化;与治疗前对比,Ⅱ组、Ⅲ组治疗后CRP水平明显下降,且差异有统计学意义(P＜0.05),但两组组间比较差异无统计学意义(P＞0.05).结论 长疗程体外反搏与短疗程体外反搏在治疗稳定型心绞痛方面疗效相近,均优于单药治疗.

Objective To discuss the curative effect and safety of olmesartan on chronic heart failure (CHF). Methods The CHF patients (n=120, male 50 and female 70) were chosen from the Cardiovascular Hospital affiliated to Qingdao University Medical College from Nov. 2011 to Oct. 2013. All patients were divided into groupⅠand groupⅡ(each n=60) according to random digits table. All groups were treated with routine therapy (individualized administrations of cardiotonics, diuretics, aldosterone receptor antagonist andβ-receptor blockers), and group Ⅰ was additionally given olmesartan, and group Ⅱ, valsartan for 8 w. The changes of LVEDd and LVEF, level of N-terminal pro brain natriuretic peptide (NT-proBNP), blood pressure (BP) and renal function were detected in 2 groups before and 8 w after treatment. Results After treatment, LVEDd decreased in groupⅠ[(58.5 ±6.4) mm vs. (52.2±6.0) mm] and groupⅡ(58.2±5.9) mm vs. (52.8±5.8) mm], and LVEF increased in groupⅠ[(39.2±5.2)%vs. (52.1±3.8)%] and groupⅡ[(39.8±6.0)%vs. (50.6±2.7)%, all P<0.05]. After treatment, NT-proBNP decreased significantly in groupⅠ[(934.0±217.7) pg/ml vs. (184.7±66.6) pg/ml] and groupⅡ[(935.0 ±224.6) pg/ml vs. (191.6±70.2) pg/ml, all P<0.05]. After treatment, BP decreased significantly in groupⅠand groupⅡ(all P<0.01). Conclusion Olmesartan can improve heart function and reduce level of NT-proBNP in CHF patients, and its curative effect is not worse than that of valsartan.

缺血后适应是人体天然的内源性保护机制,作用是减轻引起再灌注损伤的多种起始因素,以减轻缺血组织损伤,减少细胞凋亡,缩小梗死面积.本文对参与缺血后适应信号转导通路的细胞外信号物质、细胞内信号转导酶和信号转导分子等的最新研究进行综述.

Objective To compare the therapeutic effect and safety of Ramipril,Irbesartan and Ramipril combined with Irbesartan for treatment of heart failure and angina pectoris.Methods 90 patients with heart failure and stable angina pectoris treated with conventional therapy were randomly assigned to group A(treated only with Ramipril)、group B(treated only with Irbesartan) and group C(treated with both Ramipril and Irbesartan) for 8 weeks to observe the therapeutic effect and safety.The changes of NYHA class、blood electrolytes、liver and renal function、12-lead electrocardiogram and echocardiography were examined before and after treatment.Results The angina pectoris attacks、Nitroglycerin dosage、ST segment move down、brain natriuretic peptide(BNP)、the indexes of echocardiography were improved more significantly after treatment in group C than the two other groups(P0.05),the frequency of adverse reaction of three groups was similar(P0.05).Conclusions Not only does the therapeutic effect of Ramipril combined with Irbesartan for treatment for heart failure and angina pectoris surpass that of Ramipril or Irbesartan alone,but also it is a safe medicine.

Objective To study the effects of Valsartan combined with Spironolactone on Paroxysmal Atrial Fibrillation(PAF) in patients with mild to moderate Essential Hypertension (EH). Methods Seventy-four patients of mild to moderate EH with PAF were randomized to Valsartan plus Spironolactone group or Valsartan group. All the patients took Amlodipine Besylate per day orally. The patients in Valsartan plus Spironolactone group took Valsartan 80-160mg and Spironolactone 40mg per day orally; The patients in Valsartan group took Valsartan 80-160mg per day orally. The inner diameter of left atrium and the onsets of Atrial Fibrillation (AF) were measured at before and after the therapeutic 3rd day, 6th, and 9th months. Results The inner diameter of left atrium in two groups were not significantly changed at the 9th month, the onsets of AF during the 6th~9th month were decreased compared with pre-treatment in two groups and decreased significantly in Valsartan plus Spironolactone group. Conclusion Valsartan can prevent the enlargement of left atrium of patients with EH complicated with PAF, and reduce the onsets of AF, but the effect of valsartan combined with Spironolactone is wore significant to reduce the onsets of AF.

Objective To study the effects of valsarta combined with atorvastatin on intima-media thickness(IMT)of common carotid artery of patients with mild to moderate essential hypertension. Methods Eighty-six patients with mild to mo-(derate essential) hypertension and normal lipidemia were randomly divided into two groups. Group A was given Valsarta 80 mg qd; Group B, Valsarta 80 mg qd combined with atorvastatin 10 mg qd. Both were treated for 12 weeks. IMT, TC, TG,LDL-C were evaluated before and after the treatment. Results There was no difference in BP, TC,TG, LDL-C or IMT between the two groups before treatment. BP decreased significantly (t=11.10-24.00, P0.01)two weeks after administration and decrease till the end of experiment in both groups. TC, TG, LDL-C, IMT were decreased significantly(t=2.83-14.10,P0.01)in Group B and IMT were decreased significantly (t=2.04,2.65; P0.01) in Group A after 12 weeks. The difference was significant between the two groups (t=2.53-7.34, P0.05). Conclusion Valsarta combined with atorvastatin is more effective than Valsarta alone in IMT of the common carotid artery in the treatment of patients with mild to moderate hypertension.

目的探讨肺心病患者血浆CGRP，ET-1水平与PAI-1基因40／5G多态性的相关性。方法用放免法测定正常组与肺心病组血浆CORP，ET-1水平；PCR技术检测肺心病PAI-1基因40／5G多态性的基因型，并分析不同式因型血浆CGRP。ET-1的水平。结果肺心病组和正常对照组血浆ET-1含量分别为77．4±13．1ngl／L和52．2±15．6ng／L，差异有显著性（P〈O．01）。肺心病组和正常对照组CGRP血浆含量分别为23．6±14．4ng／L和48．3±17．5ng．／L，两者间具有显著性差异（P〈0．01）。4G／4G基因型肺心病患者血浆ET-1水平明显高于40／5G和50／50基因型肺心病患者（P〈0．05）。结论肺心病患者血冰岛CGRP水平与ET-1水平呈负相关，共同参与肺心病病理过程的调节；40／40多态性能影响ET-1的活性，二者在肺心病发生发展中具有协同作用。而CGRP与40／5G多态性无相关性。

Objective To investigate the association of CGRP,ET-1 and plasminogen activator inhibitor1 genetic polymorphism in chronic pulmonary heart disease.Methods The PAI-1 genotype in 40 normal subjects and 60 patients of CPHD was detected by the polymerase chain reaction(PCT): the level of CGRP and ET-1 in plasm of the normal group was assayed by radioimmunity methods.Results The level of ET-1 in plasm of CPHD patients and normal subjects was 77.4±13.1ng/L and 52.2±15.6ng/L: P 0.01.The level of CGRP in plasm of CPHD patients and normal subjects was 23.6±14.4ng/L and 48.3±17.5ng/L: P 0.01.The plasmic ET-1 level in 4G/4g genotype CPHD patients was significantly higher than that of 5G/5G CPHD patients:P 0.05.Conclusion The level of plasm ET-1 in CPHD patients was higher than that in the normal group,but CGRP was lower than that in the normal group.Therefore CGRP and ET-1 may participate in the development of CPHD.The plasmic ET-1 level is correlated with 4G/4G polymorphism,which means that they have synergistic effect in the occurrence and development of CPHD.But the plasmic CGRP level is not correlated with 4G/5G polymorphism

Objective To study the effect of atorvastatin on intima-media thickness(ITM)of the common carotid artery and coagulative system in hyperlipidemic patierts. Methods Thirty five hyperlipidemic patients were received atorvastatin 10 mg qd for 12 weeks. TC,TG,LDL-C,HDL-C,IMT,fibrinogen(FIB),thrombin time (TT),activated partial thromboplastin time(APTT) and prothrombin time (PT) were determind in hyperlipidemic group before and after treatment. The intima-media thickness of carotid artery was measured using echography. Thirty-five normol lipidemic subjects serued as control. Results TC,TG,LDL-C,IMT,FIB were decreased significantly( P 0.01)in hyper-lipidemic group after 12 weeks. HDL-C,PT TT,APTT were increased significantly ( P 0.05). Compared with normal lipidemic group,TC,TG,LDL-C,HDL-C,IMT,FIB and PT were not significantly different( P 0.05),while TT,APTT were significantly increased ( P 0.05). Conclusion Atorvastatin treatment not only regresses the structural changes in IMT of the common carotid artery but also improve disorder of coagulation system in hyperlipidemic patients.

Objective To evaluate the effects of ramipril combined with valsartan on patients with congestive heart failure (CHF). Methods One hundred and fifty patients treated with conventional therapy (digitals, diuretics, β-blocking therapy) are randomly assigned to receive ramipril 1.25～10 mg/d and valsartan 80 mg/d combination (group A n75) or ramipril 1.25～10 mg/d alone (group B n75). The changes of NYHA class, blood electrolytes, liver and renal function, electrocardiogram and echocardiography were examined. Results After eight weeks therapy, although LA atrium diameter, LV end-distolic volume(EDV), LV end-systolic volume(ESV), left ventricular ejection fraction (EF), fraction shortening(FS), cardiac output (CO), cardiac index (CI) were improved significantly in both groups(P0.05); however, LVEDV, LVESV, EF, FS, and NYHA class were ameliorated more substantially in group A than those in group B (P0.05). No significant changes of liver and renal function were found in both groups with little difference in the freguency of adverse reaction between them (P0.05). Conclusion Valsartan combined with ramipril is more effective than ramipril alone in the treatment of the patients with CHF.