目的 总结GuideLiner^®延长导管在复杂经皮冠状动脉介入治疗(PCI)中的初步经验,探讨其有效性及安全性。方法 选择2015年3月—2017年3月因冠心病于广州市第一人民医院行PCI的患者13例,因复杂病变需要更强支撑力而使用GuideLiner^®延长导管完成手术,总结手术成功率、并发症以及6个月随访主要不良心脏事件的发生情况。结果 13例患者在GuideLiner^®延长导管应用下均成功完成手术。使用延长导管的目的2例手术为辅助球囊通过,7例为辅助支架通过,4例为辅助支架及球囊通过。全部患者均未发生术中及住院期间死亡、急性心肌梗死,未发生急性支架内血栓形成、目标冠脉夹层或穿孔、心包填塞等并发症,6 个月随访均无不良心脏事件发生。结论 应用延长导管可提高支撑力,有效辅助球囊和/或支架到达冠状动脉病变部位,提高手术成功率,安全性较高。

Objective To evaluate the clinical efficacy and safety of GuideLiner^® guide extension catheter during complex coronary percutaneous coronary intervention(PCI) procedures. Methods Thirteen patients with coronary heart diseases performed PCI procedures were included in this study from March 2015 to March 2017. GuideLiner^® guide extension catheters were used in these complex cases. The PCI success rate,incidence of complications and 6-month follow up data were observed. Results Benefited from the stronger support produced by GuideLiner^®, PCI success rate was 100%. The guide extension catheters were used for the delivery of balloons in 2 cases, while 7 cases for stents, and 4 cases for both balloons and stents. No death were observed during the procedure or in hospital, and there were no dissection or acute myocardial infarction. During 6 months of follow-up,there was no major adverse cardiac events (MACE). Conclusion GuideLiner^® guide extension catheter may improve procedure success rate by ensuring the delivery of balloons and stents in complex PCI.

目的 总结GuideLiner^®延长导管在复杂经皮冠状动脉介入治疗(PCI)中的初步经验,探讨其有效性及安全性。方法 选择2015年3月—2017年3月因冠心病于广州市第一人民医院行PCI的患者13例,因复杂病变需要更强支撑力而使用GuideLiner^®延长导管完成手术,总结手术成功率、并发症以及6个月随访主要不良心脏事件的发生情况。结果 13例患者在GuideLiner^®延长导管应用下均成功完成手术。使用延长导管的目的2例手术为辅助球囊通过,7例为辅助支架通过,4例为辅助支架及球囊通过。全部患者均未发生术中及住院期间死亡、急性心肌梗死,未发生急性支架内血栓形成、目标冠脉夹层或穿孔、心包填塞等并发症,6 个月随访均无不良心脏事件发生。结论 应用延长导管可提高支撑力,有效辅助球囊和/或支架到达冠状动脉病变部位,提高手术成功率,安全性较高。

Objective To evaluate the clinical efficacy and safety of GuideLiner^® guide extension catheter during complex coronary percutaneous coronary intervention(PCI) procedures. Methods Thirteen patients with coronary heart diseases performed PCI procedures were included in this study from March 2015 to March 2017. GuideLiner^® guide extension catheters were used in these complex cases. The PCI success rate,incidence of complications and 6-month follow up data were observed. Results Benefited from the stronger support produced by GuideLiner^®, PCI success rate was 100%. The guide extension catheters were used for the delivery of balloons in 2 cases, while 7 cases for stents, and 4 cases for both balloons and stents. No death were observed during the procedure or in hospital, and there were no dissection or acute myocardial infarction. During 6 months of follow-up,there was no major adverse cardiac events (MACE). Conclusion GuideLiner^® guide extension catheter may improve procedure success rate by ensuring the delivery of balloons and stents in complex PCI.

目的 观察社区综合防治健康管理模式对社区高血压患者血压控制疗效及药物经济学的影响。方法 收集2012年7月—2013年7月广州参与研究的三级医院及社区卫生服务中心收治的原发性高血压病患者2 383例,病例入组后随机分为综合管理组和常规治疗组。记录及随访两组高血压患者基线血压值、降压药物使用方案、是否更换药物、血压控制疗效及药物经济学相关费用情况。结果 与常规治疗组相比,综合管理组患者血压治疗效果较好,显效率及总有效率提高[(60.71% vs 46.01%); (90.20% vs 71.06%), P＜0.001];高血压治疗及管理的药物费用虽有升高(t=16.186,P＜0.001),但相关的门诊费用、住院费用、护理费用及总费用降低(t=25.647, t=35.785, t=22.274,t=73.710,P＜0.001);在降压方案方面,从减少抗高血压药物使用,减少费用考虑,单独用药方式适合单纯性轻度高血压患者,从费用效果分析上,成本效果比以单药组最低,联用药组逐渐增大;增量成本-效果比:二药联用降压方案优于其他降压联合方案,因而两药联用降压为兼顾疗效和成本的降压较佳组合。结论 应用社区综合防治模式对高血压患者进行干预,效果满意,能够有效降低成本-效果比,值得临床推广应用。

Objective To investigate the effects of comprehensive prevention and control measures on the therapeutic efficient and pharmacoeconomics in community hypertension patients. Methods 2383 cases of hypertension were collected from July 2012 to July 2013 in the tertiary and community hospitals in Guangzhou, which were randomly divided into general therapy group, in which the patients were treated by general administration of drugs, and comprehensive management group that the patients were visited regularly. The sources of drugs, drugs use and changes in drugs were investigated. Results Compared with the general therapy group, better treatment effects were achieved in the comprehensive group. The apparent efficiency and total efficiency were both increased in the comprehensive group[(60.71% vs 46.01%); (90.20% vs 71.06%), P＜0.001]. Although the therapy and pharmacy fees were slightly increased in the comprehensive group as compared to the control group (t=16.186, P＜0.001), the outpatient expenses,hospitalization expenses, nursing expenses and the total expenses were decreased(t=25.647; t=35.785; t=22.274;t=73.710;P＜0.001). Considering reducing the use of drugs and decreasing the cost, the method of using single drug is beneficial to the patients of low-risk mild hypertension. The method of using calcium antagonist is the most economical and reasonable way. Conclusion Standardizing management of hypertension in community is effective in improving hypertension treatment and decreasing the cost, which is thus worth popularizing.

目的 探讨心肌细胞RyR2和L型钙通道的基因变异与室性心律失常和心源性猝死的相关性。方法 回顾分析2010年1月—2012年12月在我院就诊的慢性心力衰竭患者622例的临床资料,并选取同一时期体检中心体检的健康人群516例作为对照组,门诊或者电话随访记录慢性心力衰竭患者的死亡为终点,通过候选基因分析可能具有相关功能的4个基因变异,rs41315858(G1885E)、rs3766871(G1886S)、rs790896(G>A)和rs723672(T>C),采用Logestic、Cox回归分析对4个候选基因变异进行相关性研究。结果 入选622例慢性心力衰竭患者和516例对照组,基因分析结果显示RyR2上的基因变异rs376687lA等位基因携带可以增加慢性心力衰竭患者发生室性心律失常的风险性;校正可能与该疾病相关的危险因素后,rs376687lA等位基因携带会增加心源性死亡和心源性猝死的风险,RyR2上的基因变异rs790896A等位基因携带可以降低心源性猝死风险。结论 RyR2上的基因变异rs376687lA是室性心律失常和心源性猝死的遗传学预测因子,而rs790896A等位基因是慢性心力衰竭患者的保护因子,可降低室性心律失常和心源性猝死的风险。

Objective To investigate the myocardial cells RyR2 and L-type calcium channel gene variants with ventricular arrhythmias and sudden cardiac death correlation. Methods Retrospective analysis of patients with chronic heart failure from January 2010 to December 2012 in our hospital including 622 cases of clinical data, and to select 516 cases of healthy people in medical examination center during the same period as a control group.Clinic or telephone follow-up recorded chronic patients with heart failure and sudden death acting as end. We analyzed possible candidate genes, according to four gene variants related functions, rs41315858 (G1885E), rs3766871 (G1886S), rs790896 (G> A) and rs723672 (T> C), by using Logestic, Cox regression analysis of four candidate gene variants for related research. Results 622 cases of chronic heart failure patients were enrolled and 516 patients in the control group. Genetic analysis showed that the gene variant alleles carried rs376687lA RyR2 may increase in patients with chronic heart failure ventricular arrhythmia risk; correction may be associated with the disease after risk factors, rs376687lA allele carries an increased risk of cardiogenic death and sudden cardiac death, and gene mutation alleles carried on rs790896A RyR2 can reduce the risk of sudden cardiac death. Conclusion Gene mutation rs376687lA RyR2 on genetics is predictor of ventricular arrhythmias and sudden cardiac death, and rs790896A allele is protective factor in patients with chronic heart failure which can be reduced ventricular arrhythmias and sudden cardiac death in risk.

目的 观察阵发性房颤(PAF)环肺静脉电隔离术(CPVI术)治疗对左心房结构和功能的影响。方法 对63例PAF患者行CPVI术,超声心动图测定术前及术后3天、6个月时左心房内径(LAD)、左心房面积(LAA) 、左心房最大容积(LAVmax)、收缩期前容积(LAVp)、最小容积(LAVmin),测量二尖瓣血流频谱A峰流速(VA)、左心房被动射血分数(LAPEF)、主动射血分数(LAAEF)、扩张指数 (LaexpI)。结果 63例患者中54例于术后6个月时仍维持窦性心律,维持窦性心律者 LAD、LAA、LAVmax、LAVp、LAVmin对比术前减小 (P<0.05); VA、LAAEF术后3天降低(P<0.05),6个月对比术前无变化(P>0.05); LaexpI、LAPEF术后3天及6个月时均无改变(P>0.05)。结论 阵发性房颤环肺静脉电隔离术后左心房结构逆重构,早期辅泵功能下降,6个月时左心房功能未受影响。