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中国医学科学院学报 1999年第2期21卷 118-121页

作者：许海燕陈在嘉汤健朱大明张晨晖杨跃进陈纪林中国医学科学院中国协和医科大学阜外心血管病医院冠心病研究室北京医科大学心血管基础研究所

目的探讨同型半胱氨酸代谢过程的关键酶之一——甲烯四氢叶酸还原酶（ＭＴＨＦＲ）基因Ｃ６７７Ｔ多态性与早发冠心病发病的关系。方法采用限制性内切酶片段长度多态性方法检测患者的ＭＴＨＦＲ基因Ｃ６７７Ｔ位碱基突变。结果６７例患... 详细信息

目的探讨同型半胱氨酸代谢过程的关键酶之一——甲烯四氢叶酸还原酶（ＭＴＨＦＲ）基因Ｃ６７７Ｔ多态性与早发冠心病发病的关系。方法采用限制性内切酶片段长度多态性方法检测患者的ＭＴＨＦＲ基因Ｃ６７７Ｔ位碱基突变。结果６７例患者中Ｔ纯合基因型占３４．３％（２３／６７）、杂合基因型占４３．３％（２９／６７），Ｃ纯合基因型占２２．４％（１５／６７）；Ｔ等位基因频率为５５．９％（７５／１３４），Ｃ等位基因频率为４４．１％（５９／１３４）；与正常对照组比较，差异均有显著性意义（Ｐ＜０．０５）。结论ＭＴＨＦＲ基因Ｃ６７７Ｔ点突变可能是中国人早发冠心病发病的危险因素之一。

关键词：冠心病甲烯四氢叶酸还原酶

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血管内反推力牵引法拔除起搏电极导线治疗起搏器术后顽固性感染(摘要)

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中国循环杂志 1999年第S1期14卷 125-126页

作者：马坚王方正余培桢王锦志华伟张奎俊楚建民孙瑞龙陈新中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室!100037

Objective: To present an intravascular countertraction technique of lead extraction for treatment of refractory infection after pacemaker implantation- Methods : Eighteen patients (14 men and 4 women , mean age 56 ±13 years) with 28 leads were presented for lead extraction , because of refractory pacemaker pocket infection and erosion- Eleven atrial and seventeen ventricular leads had been implanted for 5-4 ±4-2 years- Alocking stylet was secured atthe distal electrode by counterclockwise rotation to reinforce the lead and facilitate traction ,and telescoping dilator sheaths were used to free the lead from adhesions in the venous system- Results :Twenty fourleads were completely removed and 2 partially removed ,the distal electrodes ofthe latter 2 were detached during extraction and retained in the hepatic vein and subclavian vein ,respectively- The other 2 leads in one patientfailed to be extracted , which were finally taken out by surgical thoracotomy- Afollow up of 11 ±7 months ,the infection was controlled in all patients- Conclusion : With appropriate precautions and patient selection , intravascular countertraction technique allows successful extraction of up to nearly 90 % of permanent pacemakerleads with a relatively low incidence of complications- The extraction ofinfected lead is an effective method for treating refractory infection of pacemaker implantation-

关键词：中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院电生理北京阜外医院牵引法起搏电极导线起搏器血管内反推力顽固性摘要

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急性血栓阻塞性冠状动脉缺血模型及其心律失常机制(摘要)

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中国循环杂志 1999年第S1期14卷 120-121页

作者：张澍中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室!100037

Objective : To further identify the occurrence and mechanism of spontaneous ventricular tachycardia caused by thrombotic coronary occlusion- Methods : Regionalischemia was induced by thrombotic occlusion using a wire electrode to deliver a 200 ～300 μA anodic currentto the intima of the proximalleft circumflex artery (LCX) in 10 open chest dogs- Results : Total occlusion occurred 47 ±18 minutes after delivery ofthe current as indicated by a Doppler flowmeter- Current required to totalk occlusion of LCXwas 200 ～300 ( mean 255)μA- In nine dogs ,nonsustained VT(NSVT) originated from numerous ,differentfocalsites wasinitiated and maintained- Sustained VT(susVT) occurred in six dogs and was alsoinitiated by focal mechanisms located nearthe ischemic borderin four dogs and within the ischemic region in the other two- In three dogs ,the susVT was maintained primarily through a focal mechanism , which arose in the ischemic border region- In the other three dogs ,susVT was maintained by macroreentry extended from the subendocardium of the ischemic regionanteriorly through the septum as the fast pathway , towards the epicardium of the posterior area of LV and then intramurally back to the subendocardium as the slow pathway- VTchanged into VF within 10 ～41 seconds in four of these six dogs- The transition from VTto VF was due exclusively to intramural reentry with multiple wavefronts involving the nonischemic region in three dogs ,the ischemic border region in one ,and the ischemic region in one- Conclusion : Thrombotic occlusion of coronary artery by delivering anodic current to intima of the vessel is a useful model to study the pathophysiological mechanism of acute ischemia-

关键词：心律失常机制冠状动脉急性血栓阻塞性缺血模型摘要

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深静脉血栓形成流行病学及遗传流行病学研究进展

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中国循环杂志 1999年第2期14卷 123-124页

作者：张啸飞中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院心脏肺循环研究室

肺栓塞（ＰＥ）是一种急性致死性疾病，而绝大多数ＰＥ病人都与下肢深静脉血栓形成（ＤＶＴ）并存。欧美国家进行了大量的流行病学和遗传流行病学研究，对ＤＶＴ、ＰＥ的发病率、死亡率、以及病因学进行了报道。本文将对近几年有关影响... 详细信息

肺栓塞（ＰＥ）是一种急性致死性疾病，而绝大多数ＰＥ病人都与下肢深静脉血栓形成（ＤＶＴ）并存。欧美国家进行了大量的流行病学和遗传流行病学研究，对ＤＶＴ、ＰＥ的发病率、死亡率、以及病因学进行了报道。本文将对近几年有关影响ＤＶＴ、ＰＥ发病的后天性因素，先天性的遗传因素，以及发病率、死亡率方面研究进行综述。

关键词：深静脉血栓形成肺栓塞流行病学

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含抑肽酶低温灌注液减轻体外循环肺损伤

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中华胸心血管外科杂志 1999年第3期15卷 177-179页

作者：王强刘迎龙朱晓东潘世伟阮英茆李永利中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院先心病研究室

目的：研究体外循环（ＣＰＢ）期间低温保护液肺动脉灌注对肺脏的保护作用。方法：１２只杂种犬随机均分为２组。主动脉阻断后，对照组右肺动脉灌注４℃乳酸林格液，实验组灌注４℃肺保护液。开放主动脉后和停ＣＰＢ后５、３０、６０、... 详细信息

目的：研究体外循环（ＣＰＢ）期间低温保护液肺动脉灌注对肺脏的保护作用。方法：１２只杂种犬随机均分为２组。主动脉阻断后，对照组右肺动脉灌注４℃乳酸林格液，实验组灌注４℃肺保护液。开放主动脉后和停ＣＰＢ后５、３０、６０、９０分钟；分别取各组肺静脉血标本行生化分析，测定肺功能，并行组织学检查。结果：ＣＰＢ结束后实验组气道压、肺血管阻力（ＰＶＲ）、右房血白细胞／右肺静脉血白细胞及丙二醛（ＭＤＡ）显著低于对照组（Ｐ＜０．０５）；两组右肺静脉血氧分压在ＣＰＢ结束后３０、６０分钟均较左肺高，实验组右肺静脉血氧分压在停ＣＰＢ６０分钟时显著高于对照组（Ｐ＜０．０５）；组织学观察两组左肺均有明显肺泡内出血和间质水肿，对照组右肺病理改变较左肺轻，实验组右肺组织结构基本正常。结论：ＣＰＢ期间肺动脉灌注低温肺保护液可以明显减轻ＣＰＢ对肺脏造成的损伤。

关键词：体外循环抑肽酶肺动脉灌注肺损伤治疗

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成人先天性冠状动脉-肺动脉瘘18例临床分析

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临床心血管病杂志 1999年第7期15卷 294-296页

作者：姚民陈珏吴元高润霖陈继林姚康宝杨跃进秦学文乔树宾中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院冠心病研究室北京100037

目的 :探讨成人先天性冠状动脉 -肺动脉瘘的特点。方法 :回顾性总结分析 18例冠状动脉 -肺动脉瘘患者的冠状动脉造影及临床资料。结果 :4173例冠状动脉造影中检出冠状动脉 -肺动脉瘘 18例 ,检出率为 0 .43% ,其中单一瘘道 15例 ,双瘘道 ... 详细信息

目的 :探讨成人先天性冠状动脉 -肺动脉瘘的特点。方法 :回顾性总结分析 18例冠状动脉 -肺动脉瘘患者的冠状动脉造影及临床资料。结果 :4173例冠状动脉造影中检出冠状动脉 -肺动脉瘘 18例 ,检出率为 0 .43% ,其中单一瘘道 15例 ,双瘘道 3例 ,其分流量均较小 ;11例 ( 61.1% )患者的单支或多支冠状动脉伴有 5 0 %以上狭窄病变 ;临床随访患者无肺动脉高压和心力衰竭等重要并发症发生。结论 :分流量较大的冠状动脉 -肺动脉瘘在成年人群中非常少见 ,而大多数分流量较小的冠状动脉 -肺动脉瘘通常是在选择性冠状动脉造影时被偶然发现。

关键词：先天性血管畸形肺动脉瘘冠状动脉造影 CPF

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射频导管消融右心房后位峡部和间隔峡部治疗典型心房扑动方法的对比研究(摘要)

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中国循环杂志 1999年第S1期14卷 114-115页

作者：马坚王方正余培桢王锦志张奎俊华伟楚建民张澍陈新孙瑞龙中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室!100037

Objective : To compare posterior isthmus (inferior vena cava tricuspid annulus isthmus) ablation technique and septal isthmus (tricuspid annulus Eustachian ridge isthmus) ablation technique for typical atrialflutter- Methods :Thirty five patients ( mean age 53 ±15 years) with typical atrial flutter were randomly assigned to undergo radiofrequency catheter ablation performed with posterior isthmus ablation technique (PIgroup ,15 patients) or septal isthmus ablation technique (SIgroup ,20 patients)- Radiofrequency energy was used to create linear lesion from tricuspid ring to inferior vena cava in the PIgroup and from tricuspid ring to Eustachian ridge in the SIgroup- The ablation technique was changed to the other,if one of the ablation techniques failed to block the isthmus after eight applications of radiofrequency energy- The endpoint of successful ablation included a complete bidirectional conduction block atisthmus and inability to induce atrial flutter- Results : Atrialflutter was present atthe onset of ablation in 10 patients of the PIgroup and in 15 patients of the SIgroup , however the cycle lengths of atrialflutter between the two groups were 240 ±30 ms and 220 ±23 ms ( p < 0-05) ,respectively- The endpoint of successful ablation was achieved in all of the patients without any complication- The ablation technique was changed for two patientsin both groups afterthe primary ablation technique was unsuccessful- The times ofradiofrequency application and proceduretime were notsignificantly differentin both groups- During a mean follow up of 15-4 ±3-8 months ,one patient (PIgroup) experienced atrialflutter recurrence- Conclusion : Radiofrequency ablation oftypical atrialflutteris safe and effective with eitherthe posterioristhmus ablation technique orthe septal isthmus ablation technique- The ablation success rate can be increased when these two techniques are used alternatively-

关键词：中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院电生理北京阜外医院典型心房扑动峡部射频导管消融右心房对比研究摘要

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中国心脏起搏与电生理发展现状概况

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中国循环杂志 1999年第S1期14卷 132-133页

作者：陈新王方正华伟中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院电生理研究室!100037

The Chinese society of cardiac pacing and electrophysiology organized nationalsurvey on cardiac pacinginthe period from January 1 ,1995 to December31 ,1997- There are 182 hospitals alloverthe country participated inthe survey- Followingisthe result ofthe survey- There were atotal number of5 000 new implanted pacemakersin Chinain 1997- It wasincreased rapidly ( > 15% ) annually compared with thatin 1994 (3 000)- There were about700 pacemakers replacement- Itis estimated there were about6 000 pacemakersimplanted in 1998- The single chamber ventricular(VVI) pacing accountedfor79-6 % oftotalpacemakerimplantation- However,the percentage of Dual chamberand rate responsive pacingisincreasing in 1997 (20-4 % ) ,compared with thatin 1996 (16-1% ) and in 1995 (14-5 % )- The indication for pacemaker implantation wassicksinussyndromein 50% ～53 % patientsand atrialventricular blockin41% ～44 % patients,othersin5 % ～7 % patientsfrom 1995 to 1997- coronary heart disease wasfoundin 50 % ～57 % patients- 66-8 % patients were over60 years old and male was 71-4 % in patientsreceived pacingtherapy- The new pacing technique,including automatic mode switch ,auto capture, mutisite pacing to treat atrialfibrillation and congestive heartfailure ,have been usedin China- SincetransvenousImplantable Cardioverter Defibrillators (ICD) were applied in China in 1996 ,there are a total of 71 ICDimplanted before 1998- Allthe devices werethethird generationICDincluded MedtronicJewel,CPIVantak seriesand Pacesetter Angstrom- The mean age ofpatients was48-7 years,61 males and 10 females- Most ofthem suffered from coronary heart disease and dilated cardiomyopathy- Allthe patients had syncope outof hospital and ventricular fibrillation was found in 27 patients and ventricular tachycardia was found in other 44 patients- Allthe implantation were performed inthe catheterlaboratory without complication- There are total about 20 000 cases were undertaken catheter ablation in China- The arrhythmias for ablation i

关键词：心脏起搏电生理恶性室性心律失常射频导管消融起搏器置入中国医学科学院中国协和医科大学心血管病研究所现状概况

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超声消融犬心肌的实验研究(摘要)

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中国循环杂志 1999年第S1期14卷 129-130页

作者：姚焰王方正张奎俊王崇慧田瑞国孙瑞龙陈新中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室!100037

Objective : Ultrasound is considered as an alternative enedrgy for post myocardial infarction ventricular tachycardia due to its good penetration through tissues- This study was designed to observe the effects of acoustic power, duration , repetitive ablations , tissue transducer interface temperature and different sites ofthe ultrasound ablation in vitro- The histological and electrical damages of ultrasound ablation and the feasibility of using ultrasound energy for chronic myocardial infarction scar ablation were also evaluated in vivo- Methods : At 1-8 MHz frequency , Ultrasound ablation were conducted with : ①Different acoustic powers (3-0 ～9-67 W/cm 2) , duration (20 ～90 sec) and repetitive times (1 ～4) ; ②Lesion volume and depth were compared between right and left ventricular muscles ; ③Two different types oftransducers with (model A) and without (model B) direct tissue contact were used in vitro and ①Ultrasound ablation was applied on the epicardium to compare the histological and electrophysiological damages in ten canines ; ②After chronic myocardial infarction , ultrasound ablation was applied on the scar regions in 5 canines in vivo- Results : In vivo : ①While the acoustic powerincreased from 3-0 W/cm 2to 9-67 W/cm 2 ,the lesion depth and volume increased from 1-96 ± 0-18 m m and 64 ±11-40 m m 3to 6-31 ±0-58 m m and 538-51 ±82-63 m m 3, respectively , and there were also significant differences between different powere levels ;Similarly , while the ablation time was prolonged from 30 s to 90 s at fixed acoustic powere levels , the lesion depth and volume significantly increased from 1-93 ±0-22 m m and 58-79 ±13-94 m m 3to 5-75 ±0-45 m m and 445-78 ±82-46 m m 3,respectively ; Repetitive ablations resulted in larger lesion size but such increase was not significant after the fourth time ablation ; Tissue transducerinterface temperature did not displayed a close relationship with thelesion size as acoustic power and ablation time did ; ②Both the lesion dept

关键词：中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院电生理北京阜外医院超声消融心肌实验研究摘要

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射频导管消融治疗伴发于Ebstein畸形的房室折返性心动过速

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中国循环杂志 1999年第2期14卷 94-95页

作者：姚焰王方正张奎俊马坚华伟田瑞国朱克平鲁志民孙瑞龙陈新中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室

目的：为治疗伴发于Ｅｂｓｔｅｉｎ畸形的阵发性室上性心动过速，我们对４例患者进行了射频导管消融。方法：４例伴发于Ｅｂｓｔｅｉｎ畸形的阵发性室上性心动过速患者，年龄２５～３４岁，药物治疗效果不佳或不能耐受，遂进行电生理检... 详细信息

目的：为治疗伴发于Ｅｂｓｔｅｉｎ畸形的阵发性室上性心动过速，我们对４例患者进行了射频导管消融。方法：４例伴发于Ｅｂｓｔｅｉｎ畸形的阵发性室上性心动过速患者，年龄２５～３４岁，药物治疗效果不佳或不能耐受，遂进行电生理检查和射频导管消融。结果：４例患者经心内电生理检查均证实为右侧旁路房室折返性心动过速。理想的消融靶点位于房室环、心内ＡＶ波大致相等处，其ＡＶ波间距较长。全部患者的射频导管消融均获成功。结论：射频导管消融通过阻断右侧旁路而治愈伴发于Ｅｂｓｔｅｉｎ畸形的室上性心动过速。正确认识其解剖和电生理特点，是消融成功的关键。附图射频导管消融治疗Ｅｂｓｔｅｉｎ畸形的旁路心内电生理图。图ａ：射频导管消融靶点图，消融导管远端（ＬＡＢｄ）所描记到的ＡＶ波振幅基本相等并有距离，在此进行消融。图ｂ：射频导管消融成功后ＡＶ间距明显增大。ＨＢＥ：希氏束电图ＲＶＡ１～２：右心室心尖部ＣＳ１～１０：冠状静脉窦ＣＳ９～１０：冠状静脉窦近端ＣＳ１～２：冠状静脉窦远端ＬＡＢｐ：消融电极近端３讨论Ｅｂｓｔｅｉｎ畸形是最常伴有预激综合征的先天性心脏病（可达１６．１％），且有１２．９％的患者有阵发性室上性心动过速［１］；与心动过速有关的晕厥及?

关键词： Ebstein畸形室上性心动过速射频导管消融

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