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三維射頻消融治療心房顫動的圍手術期護理

【摘要】　目的　總結心房顫動患者行三維射頻消的融治療的護理要點和經驗。　方法　對2010年11月-2011年5月收治的62例行三維射頻消融治療心房顫動患者臨床資料進行回顧性分析。　結果　62例手術均消融成功，術后發生并發癥5例，其中心包壓塞1例，迷走神經反射3例，下肢靜脈血栓形成1例，經積極治療和護理均好轉出院。　結論　圍手術期實施正確有效的護理措施是保證手術和治療效果的重要因素。

經橈動脈穿刺行冠狀動脈介入治療圍手術期護理

【摘要】　目的　總結經橈動脈穿刺行冠狀動脈介入治療的圍手術期護理要點及并發癥預防。　方法　對2011年1-6月間226例經橈動脈穿刺行冠狀動脈介入治療患者，術前做好心理護理及橈動脈準備，術后做好生命體征監測，密切觀察術側肢體循環，預防各種并發癥的發生。　結果　226例患者經橈動脈穿刺行冠狀動脈介入治療術后未發生嚴重并發癥，治療和護理效果滿意。　結論　圍手術期實施有效的護理措施是保證治療成功的重要因素之一。

易誤診的皮下脂膜炎樣T細胞淋巴瘤一例

Association between Snoring and Risk Factors of Cardiovascular Disease in Urban Middle-aged and Elderly People in Chengdu

目的　阻塞性睡眠呼吸暫停低通氣綜合征（OSAHS）可引起心血管疾病發生增高，是高血壓病及冠心病等的獨立危險因素。打鼾是OSAHs的主要臨床癥狀。本研究的主要目的是了解成都地區自然人群打鼾發生情況及其與心血管疾病危險因素的關系。 方法　2007年在成都市成華區采用隨機抽樣方法對男、女性共711人進行了心血管疾病危險因素調查[年齡45～80歲，平均（3.28 ± 6.25）歲，男性患者占所有患者的57.8%]，主要包括問卷調查、體格檢查及血液學檢查等，其中打鼾調查主要包括打鼾時間、次數及憋醒情況。將與打鼾相關的3個指標綜合考慮后，計算出打鼾的嚴重程度，并分析了其與心血管疾病危險因素的關系。 結果　男性人群中打鼾率較女性高（62.0%、51.0%，P=0.003），且重度及極重度打鼾率也較女性高。隨著打鼾的嚴重程度增加，體質量指數、血肌酐及尿酸等心血管疾病危險因素逐漸升高（趨勢P均＜0.05），而高密度脂蛋白膽固醇逐漸降低（P=0.001）。另外，隨著打鼾的嚴重程度增加，高血壓患病率及收縮壓也逐漸升高，但無統計學意義（趨勢P=0.063，0.08）。 結論　成都地區中老年城鎮人群的打鼾率較高，且男性高于女性。另外，隨著打鼾的嚴重程度增加，心血管疾病危險因素也逐漸升高。這提示我們在臨床工作中，對于打鼾的患者需要加強心血管疾病危險因素的篩查及干預，以期減少它的發生發展。

Application of Cardiac Enhanced MRI in Acute Myocardial Infarction with Normal Result of Coronary Angiography

ObjectiveTo explore the application of cardiac enhanced MRI in acute myocardial infarction with normal result of coronary angiography. MethodsOn October 18, 2013, a male patient underwent coronary angiography under the local anesthesia. Mild coronary stenosis both in left and right side were found in the surgery, but the results of dynamic cardiogram and myocardial markers were abnormal, which accorded with the clinical procedure of myocardial infarction. The patient underwent cardiac enhanced MRI at the 6th day and was finally diagnosed as acute myocardial infarction. We reviewed the database to find out the significance of cardiac enhanced MRI in diagnosis of acute myocardial infarction. ResultsAlthough coronary angiography was the gold standard for the diagnosis of coronary diseases, it had limitations in the diagnosis of coronary eccentric stenosis, branch vascular stenosis and coronary spasm. Cardiac enhanced MRI had the advantages of accurate measurement of the attenuation of myocardium and exhibition of functional changes of ischemic myocardium. ConclusionCardiac enhanced MRI is important for the diagnosis of myocardial infarction with normal result of coronary angiography.

Analysis of the characteristics of thromboembolic events in patients with hypertrophic cardiomyopathy

ObjectiveTo analyze the clinical characteristics of thrombo embolism (TE) in Chinese hypertrophic cardiomyopathy (HCM) patients. MethodsThis study retrospectively analyzed HCM patients admitted to West China Hospital of Sichuan University. The endpoints were defined as a composite of TE events, including ischemic stroke, transient ischemic attack, and peripheral arterial embolization. ResultsA total of 537 HCM patients were included with a median follow-up of 4.2 years. Forty-two patients reached the TE endpoint and the incidence was 1.9%. The annual incidence of TE was approximately 1.1% and 6.6% for HCM patients without/with atrial fibrillation, respectively. The recurrence rate of TE was high (approximately 26.2%). The mean age was 66.4±13.7 years for the first TE, and the incidence of TE was significantly increased at age ≥70 years. ConclusionThe incidence of TE is high in HCM patients, especially in those with atrial fibrillation, and the recurrence rate of TE is also high.

心率變異性研究進展

大量流行病學資料顯示，心率變異性的降低在一般人群及心血管疾病人群中都預示著不良預后，包括高血壓、充血性心力衰竭、心肌梗死后致死性心律失常、糖尿病神經癥等，并且低心率變異性已被證實為心律失常事件和心肌梗死后死亡的獨立危險因子。近年來，心率變異性的分析方法不斷改進，并出現一些新的方式，這對于相關疾病預后的評估具有重要意義。

心房顫動發病機制的研究進展

心房顫動（房顫）是臨床上常見的心律失常，具有很高的致殘率及致死率。房顫及其并發癥對人類健康造成了巨大的危害，且發病率及患病率逐年升高。了解房顫的發病機制，有助于房顫的預防及治療。近年來，對房顫的發病機制主要集中在電重構、結構重構、炎癥及基因遺傳等方面，現將其研究進展作一闡述。

Changes of Thyroid Hormone Receptor Activity in Patients with Hypertensive Non-valvular Atrial Fibrillation

目的　研究高血壓非瓣膜心房顫動患者甲狀腺激素受體（TR）的活性差異，以探討此類患者心房顫動發生發展的可能機制。 方法　2008年1月－2010年1月序貫收集103例高血壓非瓣膜心房顫動患者的相關資料（48例陣發性心房顫動、55例持續性心房顫動），并收集50例單純高血壓患者。收集各組患者的相關人口學數據及檢查結果，并采用放射性分析技術測定各組患者外周血淋巴細胞及淋巴細胞核TR的活性，主要包括平衡解離常數（Kd）及最大結合容量（MBC）。 結果　心房顫動患者淋巴細胞TR的Kd較單純高血壓患者小（越小表示與甲狀腺激素的親和力越高），且持續性心房顫動患者的Kd較陣發性心房顫動患者更小（0.77 ± 0.43、1.02 ± 0.41，P＜0.001）；心房顫動患者淋巴細胞TR的MBC較單純高血壓患者小(越小表示受體總量越少)，且持續性心房顫動患者TR的MBC較陣發性心房顫動患者更小（36.10 ± 12.40、65.22 ± 30.90，P＜0.001）。淋巴細胞核TR的Kd及MBC也存在類似情況。簡單相關分析提示左房直徑與淋巴細胞TR的Kd及MBC呈負相關，另外，調整相關指標后偏相關分析也提示左房直徑與Kd及MBC呈負相關（Kd：r=?0.296，MBC：r=?0.448；P均＜0.01）；淋巴細胞核TR的Kd及MBC也存在類似情況。 結論　高血壓非瓣膜心房顫動患者中，TR的總量減少，并且持續心房顫動組低于陣發心房顫動組；甲狀腺激素與受體的親和力在心房顫動患者中升高，且持續心房顫動組高于陣發心房顫動組。另外，還發現TR的Kd和MBC與左房直徑均呈負相關。這些改變可能是高血壓非瓣膜心房顫動患者心房顫動發生及維持的一種重要機制。

Research on the relationship between a body shape index and abnormal inflammation

Objective To investigate the relationship between a body shape index (ABSI) and abnormal inflammation. Methods In May 2007, a cross-sectional study was conducted among 651 individuals by random sampling method in an urban community located in Chenghua district of Chengdu. We mainly assessed the relationship between ABSI and abnormal inflammation, which was defined as high sensitive C-reactive protein equal to 3 mg/L or higher. Results Logistic regression analysis showed that body mass index (BMI), waist circumference (WC) and ABSI were independently associated with abnormal inflammation. For identifying abnormal inflammation, WC had the best discriminatory power with the area under the receiver operating characteristic curve (AROC) was 0.627 [95% CI (0.564, 0.689)], followed by BMI (AROC: 0.609) and ABSI (AROC: 0.608). In addition, combination with ABSI could improve the discriminatory power of BMI for abnormal inflammation, and AROC increased from 0.609 to 0.646. Combination with ABSI could also improve the discriminatory power of WC for abnormal inflammation, and AROC only increased from 0.627 to 0.631. Conclusions In the general Chinese population, ABSI is independently associated with abnormal inflammation, but the discriminatory power is poor, no better than BMI and WC. Furthermore, combination with ABSI can improve the discriminatory power of BMI and WC for abnormal inflammation, especially for BMI. Further studies about ethnic specificities of ABSI are needed.