目的 分析平板运动试验阳性患者行冠脉造影检查后结果阳性者与冠心病的高危因素的关联性,从而预警冠心病。方法 选取浙江大学医学院附属第二医院2016年3月—2019年3月行平板运动试验的阳性患者经冠脉造影结果为阳性,且资料完整者280例患者为研究对象,筛选出影响冠心病的独立危险因素。结果 性别、体质量指数(BMI)、高甘油三酯、平板恢复1、2 min心率是影响冠心病的独立危险因素。结论 对于男性、BMI>24、高甘油三酯、平板恢复1、2 min心率异常的患者,当其平板运动试验为阳性时,应建议其进一步行冠脉造影检查。

Objective To analyze the correlation between coronary angiography and the risk factors of coronary heart disease in patients with positive treadmill exercise test, so as to give early warning of coronary heart disease. Methods A total of 280 patients who underwent treadmill exercise tests from March 2016 to March 2019 in the Second Affiliated Hospital of Medical College of Zhejiang University were selected as the study subjects with positive coronary angiography results and complete data to screen out independent risk factors for coronary heart disease. Results Gender, body mass index, high triglycerides, high cholesterol, heart rate after 1 or 2 minutes of tablet recovery were the risk factors for positive coronary angiography. Conclusion For men, patients with BMI>24, high triglycerides, and abnormal heart rate after 1 or 2 minutes of tablet recovery, when the treadmill exercise test is positive, further coronary angiography should be recommended.

目的 探讨多指标联合监测在冠心病(CHD)早期诊断中的应用。方法 选择2018年6月—2018年12月在我院就诊的患者180例,其中动脉硬化中低危人群60例(低危组),动脉硬化中高危人群60例(高危组),确诊的冠心病患者(CHD组),另选取健康体检者60例为对照组。分析血浆游离脂肪酸、高敏C反应蛋白、尿β-2微球蛋白、血清25羟维生素D及血脂水平与冠心病之间的关系。结果 低危组、高危组和CHD组患者FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平均高于对照组,血清25羟维生素D₃、HDL-C水平均低于对照组,差异均有统计学意义(P＜0.05);低危组、高危组和CHD组患者的血清FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平逐渐升高,血清25羟维生素D₃、HDL-C逐渐降低,以CHD组最为显著。冠心病患者血清HDL-C的敏感度高于其他各指标(P＜0.05);血清FFA、hs-CRP的特异度高于其他各指标(P＜0.05)。结论 多指标联合检测对于早期诊断冠心病患者有一定意义。

Objective To explore the application of multi-index combined monitoring in early diagnosis of coronary heart disease (CHD). Methods 180 patients were selected from June 2018 to December 2018 in our hospital. Among them, 60 patients with middle and low risk of atherosclerosis (low risk group), 60 patients with middle and high risk of atherosclerosis (high risk group), 60 patients with confirmed coronary heart disease (CHD group), and 60 healthy people were selected as control group. The relationship between plasma free fatty acid, high sensitivity C-reactive protein, urinary β-2 microglobulin, serum 25-hydroxyvitamin D and blood lipid levels and coronary heart disease was analyzed. Results The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group were higher than those in control group, and serum levels of 25-hydroxyvitamin D3 and HDL-C were lower than those in control group (P<0.05). The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group increased gradually, while serum levels of 25-hydroxyvitamin D3, H-MG, TC, TG and LDL-C increased gradually. DL-C decreased gradually, especially in CHD group. The sensitivity of serum HDL-C in patients with coronary heart disease was higher than that of other indicators (P<0.05), and the specificity of serum FFA and hs-CR P was higher than that of other indicators (P<0.05). Conclusion The combined detection of multiple indicators has certain significance for the early diagnosis of coronary heart disease.

目的 探讨应用三维斑点追踪技术(3D-STI)评价冠心病患者左前降支冠状动脉支架置入(PCI)术前、术后左室局部收缩功能。方法 对30例接受左前降支PCl术的患者分别于术前、术后3～5天,术后3个月进行常规及三维超声心动图检查,获得患者左前降支冠状动脉供血的7个心肌节段(即前壁基底段、前间隔基底段、前壁中间段、前间隔中间段、前壁心尖段、前间隔心尖段及心尖帽)的收缩期纵向应变、径向应变、圆周应变及面积应变,分析冠状动脉支架植入术前、后各参数的变化规律。结果 PCI术后3～5天5/7节段纵向应变(前壁基底段、前壁中间段、前间隔基底段、前间隔中间段、前壁心尖段)、3/7节段面积应变(前壁基底段、前壁中间段、前间隔中间段)、3/7节段圆周应变(前壁基底段、前间隔基底段、前壁中间段)及2/7节段径向应变(前间隔基底段、前壁中间段)较术前相应心肌节段升高,差异有统计学意义(P＜0.05),PCI术后3个月左前降支供血各心肌节段纵向、圆周、径向及面积应变较术前、术后3～5天均升高,差异有统计学意义(P＜0.05)。结论 3D-STI能够早期评价冠心病患者左前降支冠状动脉PCI治疗前后左室局部收缩功能的改善,为临床早期评价PCI疗效及后续治疗提供诊断依据。

Objective To evaluate the left ventricular regional systolic function before and after left anterior descending coronary artery stent implantation (PCI) using three-dimensional speckle tracking imaging (3D-STI) in patients with coronary artery disease. Methods 30 patients who received left anterior descending PCl were underwent routine and three-dimensional echocardiography before and after 3~5 days, 3 months to obtain longitudinal strain(LS), radial strain(RS), circumferential strain(CS)and area strain(AS) of the seven myocardial segments(BA,BAS,MA,MAS,AA,AS,A ),which accepted blood from the left anterior descending coronary artery. We analyzed the changes of the parameters before and after the coronary stent implantation. Results The 5/7 segment of the longitudinal strain(BA,MA,BAS,MAS,AA), 3/7 segment of area strain(BA,MA,MAS), 3/7 segment of circumferential strain (BA,BAS,MA)and 2/7 segment of radial strain (BAS,MAS)at 3~5 days after PCI were higher than that before the operation. The difference was statistically significant (P＜ 0.05). The longitudinal, circumferential, radial and area strain of the left anterior descending branch at 3 months after the operation were higher than that before and 3~5 days after the operation. The difference was statistically significant (P＜ 0.05). Conclusion 3D-STI may early evaluate the improvement of left ventricular regional systolic function before and after coronary artery PCI treatment in patients with coronary heart disease, and provide a basis for early clinical evaluation of PCI effect and follow-up treatment.

目的 探讨在急诊冠心病快速心律失常患者中应用胺碘酮治疗的临床效果。方法 选取在我院接受治疗的164例冠心病快速心律失常患者进行研究,采用随机数字表法将其随机分为对照组和研究组,每组82例。对照组给予利多卡因治疗,研究组给予胺碘酮治疗,比较两组患者的临床治疗效果及不良反应发生情况,同时比较研究组中不同类型心律失常患者的治疗效果。结果 研究组患者治疗总有效率为89.0%,对照组为64.6%,两组比较均有差异(P＜0.05);采用胺碘酮治疗的研究组患者中,室性早搏患者的治疗总有效率最高,其次为阵发性房颤、持续性房颤、阵发性室性心动过速、室性心动过速,其中室性早搏和阵发性房颤治疗总有效率高于心动过速(P＜0.05)。结论 胺碘酮治疗急诊冠心病快速心律失常在适应症和禁忌症的严格掌握和心率、血压的密切监测的前提下效果更为确切,可作为首选药物应用。