持续正压通气治疗阻塞性睡眠呼吸暂停综合征并发心房纤颤的临床研究

目的:研究持续正压通气治疗阻塞性睡眠呼吸暂停综合征(OSAHS)并发心房纤颤的临床疗效。方法:选取2013年1月到2014年1月我院收治的OSAHS并发心房纤颤患者60例,按照随机数字表法将患者分为实验组和对照组,每组30例。对照组给予常规治疗,实验组在对照组的基础上给予持续正压通气治疗,两组均治疗1年。分析治疗前、后两组心率(HR)、血氧饱和度(SPO2)、左心射血分数(LVEF)、脑钠肽(BNP),并比较两组心房纤颤转复率、复发率和不良反应。结果:治疗后实验组HR、SPO2、LVEF以及BNP显著优于对照组,两组比较差异具有统计学意义(P0.05);治疗后实验组心房纤颤转复率显著高于对照组,心房纤颤复发率显著低于对照组,两组比较差异具有统计学意义(P0.05);两组不良反应发生率比较无统计学意义(P0.05)。结论:持续正压通气治疗OSAHS并发心房纤颤具有较好的效果,有利于改善心功能,提高心房纤颤转复率降低房纤颤复发率。     

《自然-遗传学》：发现诱发心房纤颤新基因位点

德国慕尼黑大学7月13日发布公报说，德国研究人员参与的两个国际研究小组分别发现了可增加心房纤维性颤动患病风险的一个新基因位点。这一发现有助于人们进一步了解心房纤颤的患病机理。并据此找到治疗方法。     

蝮蛇抗栓酶加青龙肠溶胶囊治疗心房纤颤13例

蝮蛇抗栓酶加青龙肠溶胶囊治疗心房纤颤１３例石文马士英（廊坊市香河县五百户镇卫生院心脑血管专科０６５４００）我们应用蝮蛇抗栓酶加青龙肠溶胶囊治疗心房纤颤１３例,报告如下：本组患者男性９例,女性４例,年龄最小３９岁,最大８４岁;病程最长１０余年,最短３０...     

心房颤动与心房重构研究的最新进展

心房颤动(简称房颤)是临床最常见的持续性心律失常之一,严重威胁人类的健康,增加患者心衰、卒中、血栓栓塞等疾病的发生率与死亡率。房颤具有自身进展性,异位活动与折返是房颤发生和维持的主要条件,电重构、结构重构、代谢重构等心房重构是其发生的主要原因。而这些重构又促进房颤发生和维持,形成恶性循环,称为"房颤导致房颤"。随着年龄的增长,房颤的发生率也逐渐增加。目前,房颤已成为世界性的医疗问题,但其具体机制仍不清,本文就房颤与心房重构的关系作一综述,为相关研究提供理论依据。     

蛇毒制剂治疗心房纤颤13例疗效分析

蛇毒制剂治疗心房纤颤１３例疗效分析廊坊市香河县五百房镇卫生院心脑血管专科石文,马士英心房纤颤是临床常见的心律失常之一。治疗的方法有药物转复及心脏同步直流电转复。我们应用蛇毒制剂（蝮蛇抗栓酶和青龙肠溶胶囊）治疗心房纤颤１３例,报告如下：本组患者男性９例...     

蝮蛇抗栓酶治疗心房纤颤的体会

我院采用蝮蛇抗栓酶治疗心房纤颤6例,结果阵发性房颤3例痊愈,持续性房颤3例无效.应用蝮蛇抗栓酶治疗阵发性房颤获得良好效果,原因是蝮蛇抗栓酶有降低血浆纤维蛋白原和血液粘度,改善微循环及扩张冠脉等功能,从而改善心肌和心脏传导系统的血液、氧、能量的供应.恢复心脏的正常功能,消除折返激动而终止房颤.     

C57BL/6小鼠PD-1基因敲除后炎症与心房电重构的关系研究

目的:研究C57BL/6小鼠在PD-1基因敲除后体内炎症升高对房颤发病易感性的影响。方法:对两组动物进行了观察:C57BL/6小鼠和C57BL/6-PD-1基因敲除小鼠(各组均为15只,雄性,6-8周龄)。应用流式细胞仪微球芯片捕获技术对比了实验组与对照组的血清炎性细胞因子表达水平,应用多导电生理记录仪检测了实验组与对照组心房有效不应期和有效不应期离散度。结果:和对照组相比较,C57BL/6-PD-1-/-小鼠血清炎性细胞因子水平明显升高,C57BL/6-PD-1-/-小鼠心房肌有效不应期较对照组减低,而有效不应期离散度则明显升高。结论:PD-1基因敲除后出现的机体内炎性细胞因子水平的升高导致了C57BL/6小鼠的心房电重构,并由此使得C57BL/6-PD-1-/-小鼠心房纤颤发病易感性升高。     

氧化应激对原代培养乳鼠心房肌细胞中内质网应激及凋亡因子的影响

目的：研究氧化应激对原代培养乳鼠心房肌细胞凋亡、内质网应激及凋亡因子的影响。方法：实验分2组：对照组、氧化应激组。原代培养乳鼠心房肌细胞,氧化应激组在培养的原代心房肌细胞中加入终浓度为100μmol/L的H₂O₂培养2 h,检测氧化和抗氧化指标超氧化物歧化酶（SOD）活力、丙二醛（MDA）及还原型谷胱甘肽（GSH）含量;检测细胞凋亡、细胞GRP78、GRP94及chop、bax、bcl-2 mRNA表达。结果：与对照组相比较,氧化应激组心房肌细胞SOD活力和GSH含量下降、MDA含量增加（P < 0.01）,细胞凋亡增加（P < 0.01）,细胞GRP78、GRP94、chop、bax mRNA表达增加、bcl-2 mRNA表达减少（P < 0.01）。结论：氧化应激反应可能介导内质网应激反应并激活促凋亡因子表达,抑制抗凋亡因子表达,引起心房肌细胞凋亡增加。这可能与心房纤颤的发生有一定关联性。     

改良的乳鼠原代心房肌细胞的培养及鉴定方法

目的:主要探讨原代心房肌细胞的培养及鉴定方法,为进一步研究心房颤动的重构机制及治疗方法奠定基础。方法:选取1-3 d的SD乳鼠40只,雌雄不限,分离心房、心室肌,胰酶联合EDTA充分消化心房肌细胞,利用心房肌与成纤维细胞的差速贴壁及细胞传代方法纯化心房肌细胞,免疫细胞化学染色鉴定心房肌细胞。结果:心房肌细胞培养至第3天,可见心房肌细胞覆盖率高达90%,并出现波动性,免疫细胞化学染色可见90%的心房肌细胞肌经α-肌动蛋白抗体染色阳性。结论:经酶化学消化法可成功培养出原代心房肌细胞,是一种较好的培养及鉴定乳鼠心房肌细胞的方法。     

心房感受器,心房肽和肾脏的钠尿反应

早在1956年,Henry等就提出:心房参与肾功能调节,如扩张麻醉狗的左心房,可引起尿量增加。这种利尿反应在颈部迷走神经冷阻断后就不出现,因而证明这种利尿的反射性质。他们又进一步提出,当体内血容量增加时,心房压升高,使心房容量感受器兴奋,传入冲动经迷走神经传入到下丘脑,抑制抗利尿激素分泌,引起肾脏的利尿反应而使血容量减少。这就是所谓容量感受器假说。他们认为,左心房牵张感受器是这种心—肾之间反射性控制机制的重要部分。抗利尿激素的直接测定(最初是生物测定,后来是放射免疫测定)证实,在左心房压升高时,血浆中抗利尿激素的浓度确实降低。另外,Lydtin等报道,在清醒和麻醉的狗,左心房牵张除了引起利尿反应外,还引起尿钠排出增加。1975年Goetz等系统地总结了关于心房感受器和肾功能方面的文献,详细分析了支持左心房容量感受器     

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting an estimated 6 million people in the United States ¹. Since AF affects primarily elderly people, its prevalence increases parallel with age. As such, it is expected that 15.9 million Americans will be affected by the year 2050 ². Ischemic stroke occurs in 5% of non-anticoagulated AF patients each year. Current treatments for AF include rate control, rhythm control and prevention of stroke ³.The American College of Cardiology, American Heart Association, and European Society of Cardiology currently recommended rate control as the first course of therapy for AF ³. Rate control is achieved by administration of pharmacological agents, such as β-blockers, that lower the heart rate until it reaches a less symptomatic state ³. Rhythm control aims to return the heart to its normal sinus rhythm and is typically achieved through administration of antiarrhythmic drugs such as amiodarone, electrical cardioversion or ablation therapy. Rhythm control methods, however, have not been demonstrated to be superior to rate-control methods ^4-6. In fact, certain antiarrhythmic drugs have been shown to be associated with higher hospitalization rates, serious adverse effects ³, or even increases in mortality in patients with structural heart defects ⁷. Thus, treatment with antiarrhythmics is more often used when rate-control drugs are ineffective or contraindicated. Rate-control and antiarrhythmic agents relieve the symptoms of AF, including palpitations, shortness of breath, and fatigue ⁸, but don''t reliably prevent thromboembolic events ⁶.Treatment with the anticoagulant drug warfarin significantly reduces the rate of stroke or embolism ^9,10. However, because of problems associated with its use, fewer than 50% of patients are treated with it. The therapeutic dose is affected by drug, dietary, and metabolic interactions, and thus requires detailed monitoring. In addition, warfarin has the potential to cause severe, sometimes lethal, bleeding ². As an alternative, aspirin is commonly prescribed. While aspirin is typically well tolerated, it is far less effective at preventing stroke ¹⁰. Other alternatives to warfarin, such as dabigatran ¹¹ or rivaroxaban ¹² demonstrate non-inferiority to warfarin with respect to thromboembolic events (in fact, dabigatran given as a high dose of 150 mg twice a day has shown superiority). While these drugs have the advantage of eliminating dietary concerns and eliminating the need for regular blood monitoring, major bleeding and associated complications, while somewhat less so than with warfarin, remain an issue ^13-15.Since 90% of AF-associated strokes result from emboli that arise from the left atrial appendage (LAA) ², one alternative approach to warfarin therapy has been to exclude the LAA using an implanted device to trap blood clots before they exit. Here, we demonstrate a procedure for implanting the WATCHMAN Left Atrial Appendage Closure Device. A transseptal cannula is inserted through the femoral vein, and under fluoroscopic guidance, inter-atrial septum is crossed. Once access to the left atrium has been achieved, a guidewire is placed in the upper pulmonary vein and the WATCHMAN Access Sheath and dilator are advanced over the wire into the left atrium. The guidewire is removed, and the access sheath is carefully advanced into the distal portion of the LAA over a pigtail catheter. The WATCHMAN Delivery System is prepped, inserted into the access sheath, and slowly advanced. The WATCHMAN device is then deployed into the LAA. The device release criteria are confirmed via fluoroscopy and transesophageal echocardiography (TEE) and the device is released.     

Atrial natriuretic factor

Mammalian atria contain different peptides with potent diuretic, natriuretic, smooth muscle relaxing and blood pressure lowering properties. A preprohormone of these peptides is synthetized and stored in specific granules in atrial myocytes. Different peptides have been isolated, analyzed and in vitro synthetized. Their biological activity indicates a potential role in the regulation of volume and sodium homeostasis as well as in blood pressure regulation.     

Navx-guided Cryoablation of Atrial Tachycardia Inside the Left Atrial Appendage

Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavX-guided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed.     

国产房缺封堵器治疗多孔型房缺

目的：评估国产封堵器治疗多孔型房缺的可行性及安全性。方法：在X线及超声引导下对19例多孔型房缺植入国产房缺封堵器,术后常规进行心电图及经胸心脏超声随访半年。结果：所有患者均成功进行了房缺封堵,其中5例放置1枚国产普通型房缺封堵器,7例放置2枚国产普通型房缺封堵器,另7例则分别放置1枚细腰大边型房缺封堵器,术后即刻超声检查1例仍有少许分流,术后1月时随访分流消失,所有患者随访半年未出现明显并发症。结论：国产房缺封堵器可安全应用于多孔型房缺患者的封堵治疗,在经验丰富的先心病介入治疗专科中心,封堵治疗可做为部分多孔型房缺患者的首选治疗。