急性心肌梗死患者直接经皮冠状动脉介入治疗前后窦性心律振荡的临床观察

探讨急性心肌梗死（AMI）患者直接经皮冠状动脉介入（PCI）前后窦性心律振荡（HRT）的变化及意义.选择伴室性早搏的AMI患者（观察组）和无器质性心脏病的室性早搏患者（对照组）各42例,PCI前伴室早的观察组患者,用节律Ⅱ导联记录室早的心电图,PCI后2周时观察组及对照组均记录24h动态心电图（AECG）,计算其震荡初始（TO）和震荡斜率（TS）,并行心脏彩色多普勒超声检查,测定左室射血分数（LVEF）.结果观察组PCI后2周时和对照组LVEF分别为：（59.1＆#177;7.5）%和（61.3＆#177;8.4）%.观察组PCI前TO显著升高,TS显著降低,差异有统计学意义（P＜0.05）;观察组PCI后2周TO较前降低,TS较前升高,但和对照组相比差异仍有统计学意义（P＜0.05）;观察组PCI后2周时和对照组左室射血分数（LVEF）相比无差异.提示AMI患者HRT减弱,PCI后2周HRT改善但和观察组相比仍有统计学意义,提示AMI患者PCI后早期仍存在心脏自主神经功能下降,HRT可作为评价AMI患者预后的一个指标.     

绝经妇女激素替代治疗的回顾与思考

随着人们平均寿命的延长,对生活质量要求的不断提高,绝经后的问题也日益受到全社会的广泛关注,绝经后骨质疏松和冠心病、阿尔茨海默病等的增加引起人们对激素替代治疗(HRT)的兴趣,其旨在改善妇女生活质量。但随着研究的深入,其所引发的问题也不断涌现。HRT对绝经后妇女的生活质量究竟是否有总体益处已成为目前关注的焦点。自从1963年Wilson倡导HRT以来,HRT的发展走过了一段曲折之路,对HRT的认识,经历了几十年反复的过程,体现了辩证唯物主义认识论和矛盾论的观点。     

心脏冠状动脉多层CT检查——临床上我们是否应用得当?

心脏冠状动脉多层CT扫描目前在对心脏进行整体扫描进而发现冠状动脉狭窄或冠状动脉钙化方面应用较多,但从经济费用-临床效益比值考虑,是否所有患者均需进行此项检查值得商榷。为降低患者就诊成本,我们认为,对于年轻非糖尿病患者可先根据Framingham冠心病危险量表进行测算患者未来10年出现冠心病的危险度,如果根据此量表计算的患者未来10年出现冠心病的危险度10%的中度以上危险度的患者,才应该给予心脏冠状动脉多层CT扫描检查以了解其是否需要进一步深入治疗。     

绝经妇女激素替代治疗的回顾与思考

随着人们平均寿命的延长,对生活质量要求的不断提高,绝经后的问题也日益受到全社会的广泛关注,绝经后骨质疏松和冠心病、阿尔茨海默病等的增加引起人们对激素替代治疗(HRT)的兴趣,其旨在改善妇女生活质量.但随着研究的深入,其所引发的问题也不断涌现.HRT对绝经后妇女的生活质量究竟是否有总体益处已成为目前关注的焦点.自从1963年Wilson倡导HRT以来,HRT的发展走过了一段曲折之路,对HRT的认识,经历了几十年反复的过程,体现了辩证唯物主义认识论和矛盾论的观点.     

心脏冠状动脉多层CT检查——临床上我们是否应用得当?

心脏冠状动脉多层CT扫描目前在对心脏进行整体扫描进而发现冠状动脉狭窄或冠状动脉钙化方面应用较多,但从经济费用-临床效益比值考虑,是否所有患者均需进行此项检查值得商榷.为降低患者就诊成本,我们认为,对于年轻非糖尿病患者可先根据Framingham冠心痛危险量表进行测算患者未来10年出现冠心痛的危险度,如果根据此量表计算的患者未来10年出现冠心病的危险度>10%的中度以上危险度的患者,才应该给予心脏冠状动脉多层CT扫描检查以了解其是否需要进一步深入治疗.     

对无保护左主干冠状动脉狭窄血运重建的临床决策

对于无保护左主干（LMS）狭窄的冠状动脉疾病,冠状动脉旁路移植术（CABG）一直被认为是“标准治疗”,原因就是有充分的证据证明其具有远期生存率方面的益处。但是,目前却出现了越来越多的使用药物支架而不是CABG治疗左主干狭窄的趋势,尽管目前这方面的证据还不充分。在此,本文在汇总了经皮血运重建技术（PCI）干预无保护左主干、对比支架和外科手术治疗无保护左主干的随机对照研究资料的基础上,总结认为,对于适合外科手术的无保护左主干狭窄患者,CABG仍旧是血运重建的首选。     

抑郁和焦虑对经皮冠状动脉介入治疗患者的影响及对策

越来越多的冠心病患者接受经皮冠状动脉介入治疗,但是这些患者表现出的焦虑抑郁情绪对经皮冠状动脉介入治疗（PCI）围术期的影响却少有报道。研究发现,焦虑和抑郁对心脏事件发生后的恢复有不利的影响,而接受 PCI 治疗的患者情感障碍的发生率是比较高的。主要心血管事件与这些负面影响是相关联的,研究表明密切监测这些患者的情感状态可以明显改善临床预后。     

重新认识激素替代治疗的利与弊

随着老龄化社会的到来和女性对生活质量改善需求的增加 ,越来越多的妇女在进入更年期或因病行卵巢切除后开始接受激素替代治疗 (HormoneReplacementTreatment,HRT)以改善因体内性激素水平下降所引起的种种不适。经过临床观察 ,HRT自使用以来 ,确实大大提高了妇女的生存质量。但随着使用人数的增多 ,加之国外的一些大样本、系统的深入研究的开展 ,其弊端逐渐显现出来 ,可以说HRT是一把双刃剑 ,所以临床医生在对病人使用HRT时 ,需要重新权衡其利与弊 ,这是势在必行的。1　是否能延缓老年性痴呆老年性痴呆 (Alzheirmer’sdisease,AD)是…     

心肌保护技术研究中的历史及启示

心肌保护技术研究中的历史及启示第四军医大学９７级研究生（西安７１００３２）李宏导师易定华心肌保护是心脏手术的基础：只有心肌组织在手术期间得到了良好的保护,手术矫治心脏疾病才有意义,术后良好的心功能才有保障,病人才能得以顺利康复。而回顾心肌保护技术的发...     

阿司匹林可提高女性稳定型心脏病的生存率

一项来自于女性健康计划（WHI）的观察研究提供的额外证据证实阿司匹林可以减少患有心脏病或脑中风的绝经后妇女的死亡危险性。这项研究发表在了循环杂志：心血管的质量和结果。对于女性患者的阿司匹林给药剂量也提出了新的观点,建议低剂量给药（81mg）同高剂量给药（325mg）效果相当。但是,患有心血管病的女性患者必须要确定最佳的阿司匹林给药剂量。国际心肺血液病协会雅克博士分析了来自8928位绝经后妇女数据,她们以前都经历过心脏病发作．心率加快或是短暂的心跳停止,或是经历过冠状动脉搭桥手术以保证血流通畅。     

The effect of hormone replacement therapy on mood and everyday memory in younger mid-life women

Research on the effect of hormone replacement therapy (HRT) on both mood and memory indicates that oestrogen may enhance verbal memory in younger mid-aged women. This study examined the effect of HRT on everyday memory, while accounting for mood changes, in women between ages 40 and 60. A within-subjects comparison of 17 women, showed that mood, everyday memory, working memory, and delayed verbal memory improved after 3 months of HRT use. The improvement in memory was not mediated by mood, but changes in mood were moderated by exercise habits. The results suggest that verbal memory in particular may be enhanced by HRT in this age group, and everyday memory is an important construct to consider in future research.     

纳米细菌与冠心病

最近新发现的纳米细菌是目前已知的最小的细菌,其直径为几十至几百纳米.与其它细菌不同,它们是一种生长繁殖缓慢,能通过普通滤菌器(0.2um),吴有生物矿化作用和一定抗辐射能力,革兰氏染色阴性的球形细菌.它们最特殊的生物学特性是可以在生理状态的钙、磷浓度下分泌主要由羟磷石灰碳酸盐构成的保护性外壳.因此,它们被认为与机体内病理性钙化密切相关.近年来研究发现,它们可能是冠心病的一种感染性致病源.抗纳米细菌治疗的临床实验显示在冠心病患者中具有一定疗效.     

性激素替代治疗在冠心病防治中的作用

冠心病的发病率有着明显的性别差异,大量研究表明内源性雌激素和雄激素与冠心病的发生发展有着密切关系,它对于女性和男性分别有抗动脉粥样硬化作用,这提示人们可以通过恢复机体激素水平达到防治冠心病的作用。因此性激素替代治疗成为了对冠心病的防治研究的热点,本文主要综述性激素替代治疗在冠心病防治中的研究进展。     

放松训练对心率、T波幅度、心算成绩的影响研究

本实验目的在于探讨放松训练对正常状态和心算应激时心率、T波幅度的影响。实验组接受放松训练,控制组不接受放松训练。结果发现：放松训练使身体常态时的心率显著降低,对心算应激时的心率和T波无显著影响;放松训练降低了心算时心率和心算错误率的方差;实验组的心算速度快,与控制组比较有显著差异。     

Heart rate during group flooding therapy for PTSD

The objective of this study was to assess, via heart rate, the arousal levels of participants in group trauma reexposure therapy for posttraumatic stress disorder, and so to better understand this common mode of treatment, particularly in regards to its presumed curative factor, extinction. Six Vietnam combat-related PTSD inpatients participated twice weekly in group trauma reexposure therapy during which their electrocardiograms were recorded. Heart rate was quantified continuously off-line. Heart rates of participantsnot directly engaged in imaginal reexposure to their personal combat traumas consistently exhibited mild linear declines from the beginnings to the ends of the approximately 2.5 hour sessions. Participants actively engaged in personal combat trauma reexposure exhibited higher whole-session heart rates. Most also exhibited more specific elevation extending over the later portions of therapy sessions during which intensive reexposure usually occurred. Surprisingly, no patients exhibitedfocal increases in heart rate concurrent with periods of most intensive traumatic incident review as judged from videotape. Administering imaginal reexposure in a group context does not preclude substantial physiological (sympathetic) arousal, as is preconditional for extinction. Under conditions in which the actively engaged reexposure patient is reliably identified, group trauma reexposure therapy may not provide an opportunity for “vicarious” flooding in nonengaged participants.     

从炎症在心力衰竭进展中的作用谈心力衰竭治疗策略的制订

心力衰竭是一个以免疫激活和低程度的慢性炎症为特点的疾病。一些炎症因子能通过促进心肌细胞肥厚、恶化心肌收缩功能以及诱导凋亡,在心衰的发展过程中具有重要作用。炎症因子能成为心衰治疗的重要目标。但炎症因子还有心脏代偿和保护作用。制订新的心衰治疗策略时需要进一步了解心衰中炎症反应激活的机制。     

Behavior Therapy for Tics via Videoconference Delivery: An Initial Pilot Test in Children

Habit reversal training (HRT) has been proven effective for reducing tics in children with Tourette's syndrome (TS). However, the availability of the intervention is limited. Videoconference technology represents a promising mode through which HRT may be disseminated to underserved areas. Using a multiple-baseline across participants design, the current study tested the effectiveness of videoconference-delivered HRT for 3 children with TS. Similar to results from randomized controlled trials studying face-to-face delivered HRT, videoconference-delivered HRT was effective for reducing tics. All three children demonstrated significant tic reduction following videoconference HRT delivery. All participants and their families rated the delivery modality as acceptable and the therapeutic relationship as strong. These results suggest that videoconference delivery may be a promising method for disseminating behavior therapy for tics.     

Reward Influence on the Heart: Cardiovascular Response as a Function of Incentive Value at Five Levels of Task Demand

This study examined cardiovascular effects of incentive value in men and women confronted with cognitive challenges that were more and less difficult to meet. Participants performed computer memory tasks varying in difficulty from low to high, with instructions that they could earn chances toward a $100 prize or $10 prize by attaining a 90% success rate. Analysis of cardiovascular responses assessed during work revealed an interaction between difficulty and incentive value for heart rate. Participants' heart rate responses were proportional to task difficulty and unaffected by incentive value in all conditions except for the most difficult one. Where difficulty was greatest, $100 participants showed relatively high heart rate responsiveness, whereas $10 participants showed low heart rate responsiveness. This heart rate finding corroborates and extends cardiovascular results from previous experiments, and lends further support to the view that cardiovascular responses will be proportional to incentive value only under some task conditions.