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临床麻醉学杂志 2000年第9期16卷 435-436页

作者：胡鹏于荣国徐经大刘进北京市中国医学科学院中国协和医科大学心血管研究所阜外心血管病医院麻醉体外研究室 100037 湖南衡阳医学院附属二院麻醉教研室

目的 :测定并比较紫绀型与非紫绀型先天性心脏病患儿吸入麻醉药血 /气分配系数 (B/G) ,判断红细胞压积 (Hct)对B/G的影响。方法 :紫绀型与非紫绀型先天性心脏病患儿各 10例 ,平均年龄 5岁 ,采桡动脉血 10ml,用两次平衡法测定地氟醚、异... 详细信息

目的 :测定并比较紫绀型与非紫绀型先天性心脏病患儿吸入麻醉药血 /气分配系数 (B/G) ,判断红细胞压积 (Hct)对B/G的影响。方法 :紫绀型与非紫绀型先天性心脏病患儿各 10例 ,平均年龄 5岁 ,采桡动脉血 10ml,用两次平衡法测定地氟醚、异氟醚和氟烷的B/G ,并测定血浆总胆固醇、甘油三脂、白蛋白、球蛋白浓度和Hct,t检验比较两组间血液成分和吸入麻醉药B/G有无差别。结果 :紫绀型与非紫绀型先天性心脏病患儿Hct有显著差异 (紫绀型为 6 8 7%± 11 1% ,非紫绀型 37 7%± 2 9% ,P <0 0 5 ) ;但两组间其他血浆成分和三种吸入麻醉药的B/G无差异 (P>0 0 5 )。结论 :Hct对B/G无影响。

关键词：先天性心脏病吸入麻醉药血/气分配系数儿童

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α-内收蛋白Gly460 Trp多态性与脑梗死的关系

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中华老年心脑血管病杂志 2000年第3期2卷 215-215页

作者：赵勇马丽媛于丽天王兴宇刘力生 KlausLindpaintner 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高血压研究室北京100037

欧洲学者研究发现,α-内收蛋白基因与原发性高血压发生有关.由于高血压是缺血性脑卒中的危险因素,因此,我们对α-内收蛋白基因Gly460Trp多态性与脑梗死的关系进行了病例-对照研究.

关键词：脑梗塞基因

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冠心病患者同型半胱氨酸代谢相关酶基因多态性的研究

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中华医学杂志 1999年第6期79卷 414-416页

作者：许海燕陈在嘉汤健姜玉新张晨晖朱大明张春玲叶珏赵如冰杨跃进陈纪林惠汝太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医科大学心血管研究所中国妇婴保健中心

目的研究冠心病患者同型半胱氨酸代谢相关酶甲烯四氢叶酸还原酶（ＭＴＨＦＲ）基因Ｃ６７７Ｔ和胱硫醚缩合酶（ＣＢＳ）基因Ｔ８３３Ｃ位碱基突变。方法对２０９例冠心病患者和１０１例健康对照者，采用多聚酶链反应限制性内切酶片段... 详细信息

目的研究冠心病患者同型半胱氨酸代谢相关酶甲烯四氢叶酸还原酶（ＭＴＨＦＲ）基因Ｃ６７７Ｔ和胱硫醚缩合酶（ＣＢＳ）基因Ｔ８３３Ｃ位碱基突变。方法对２０９例冠心病患者和１０１例健康对照者，采用多聚酶链反应限制性内切酶片段长度多态性技术检测ＭＴＨＦＲＣ６７７Ｔ基因型，用扩增阻滞突变体系法检测ＣＢＳ基因Ｔ８３３Ｃ多态性，采用高压液相色谱法测定同型半胱氨酸血浆水平。结果患者组ＭＴＨＦＲ基因Ｔ纯合基因型和杂合基因型频率（分别为２７．８％和４５．４％）显著高于正常对照组（分别为２２．８％和３４．６％），两组基因型和等位基因频率分布差异有显著意义（Ｐ＜０．０５）。ＣＢＳ基因在患者组发现２１例突变纯合子，正常组中发现２例突变纯合子，两组基因型和等位基因频率分布差异有非常显著意义（Ｐ＜０．００１），同时，患者组和正常对照组ＭＴＨＦＲ和ＣＢＳ基因突变者血浆同型半胱氨酸水平均高于无基因突变者。结论显示高同型半胱氨酸血症可能是中国人较早发冠心病的一个独立危险因素，而ＭＴＨＦＲ基因Ｃ６７７Ｔ点突变和ＣＢＳ基因Ｔ８３３Ｃ点突变可能是其发病的重要遗传因素。

关键词：冠心病同型半胱氨酸 MTHFR CBS 基因多态性

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65例慢性肺原性心脏病合并其它类型心脏病的尸检病理分析

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中国循环杂志 1999年第2期14卷 96-98页

作者：赵红阮英茆司文学张连庄李秀云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病理研究室

目的：分析慢性肺原性心脏病（肺心病）及合并其它类型心脏病的尸检率及形态学变化。方法：采用本院６５例肺心病尸检材料，对单纯肺心病５０例与肺心病合并其它类型心脏病１５例做组织学检查、形态学分析及统计学处理。结果：肺心病的... 详细信息

目的：分析慢性肺原性心脏病（肺心病）及合并其它类型心脏病的尸检率及形态学变化。方法：采用本院６５例肺心病尸检材料，对单纯肺心病５０例与肺心病合并其它类型心脏病１５例做组织学检查、形态学分析及统计学处理。结果：肺心病的病因构成为多因素。肺心病可与一种或两种其它类型心脏病同时并存（２３．１％），以冠心病并存率最高（２０．０％）。冠状动脉粥样硬化Ⅲ～Ⅳ级病变检出率２０．０％。低体重是晚期肺心病的特点之一。女性心脏增重显著大于男性，心脏重量与体重比值较单纯心脏称重更有评估意义。肺心病与其它类型心脏病并存时心室结构重塑程度重于单纯肺心病，尤以左心室为著。结论：肺心病并存其它类型心脏病时，心脏病变程度重，临床表现复杂，应防止肺心病或合并症漏诊。

关键词：肺心病并发症心脏病慢性尸体解剖病理分析

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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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无支架房室瓣膜替换三尖瓣的实验研究

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中华实验外科杂志 1999年第2期16卷 118-120页

作者：高光强朱晓东胡盛寿任兵李永利张玉萍谢宁中国医学科学院北京100037 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瓣膜研究室

探索无支架房室瓣膜替换三尖瓣外科技术。方法选用深低温保存犬二尖瓣制成的无支架房室瓣膜１０枚，体外循环下将其前叶缝合于犬三尖瓣隔瓣环，后叶缝合于三尖瓣前后瓣环，两乳头肌缝合于右室前壁。血流动力学监测，测定计算移植瓣膜跨... 详细信息

探索无支架房室瓣膜替换三尖瓣外科技术。方法选用深低温保存犬二尖瓣制成的无支架房室瓣膜１０枚，体外循环下将其前叶缝合于犬三尖瓣隔瓣环，后叶缝合于三尖瓣前后瓣环，两乳头肌缝合于右室前壁。血流动力学监测，测定计算移植瓣膜跨瓣压差、瓣口面积，超声心动图测定其功能。结果１０条犬均顺利脱落ＣＰＢ。无房室传导阻滞。术后血流动力学稳定，术后无支架瓣膜平均跨瓣压差１５２ｍｍＨｇ±０．４２ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ）。１０条犬中，仅２条犬因手术失误造成少～中量返流。结论同种二尖瓣制成的无支架房室瓣膜设计合理，植入技术可行，在三尖瓣位置上近期血流动力学性能优良。

关键词：无支架人工心脏瓣膜同种移植物

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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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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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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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