目的 本研究旨在探讨血浆chemerin水平与原发性高血压合并心房颤动的相关性。方法 选择2016年2月—2017年12月期间在广州市第一人民医院心内科及老年心内科住院的高血压患者160例,根据是否合并心房纤颤分为心房纤颤组(AF组,n=72)及非心房纤颤组(NAF组,n=88),另选取140例我院体检中心体检结果正常的正常健康人作为对照组(CON组,n=140)。采用全自动生化检测仪测定甘油三脂、总胆固醇、低密度脂蛋白、C反应蛋白等生化学指标;使用ELISA法检测血浆chemerin水平。结果 AF组患者的血浆chemerin水平较NAF组患者升高[(180.45±15.23)ng/mL vs(162.36±13.44)ng/mL,P<0.05],且均较CON组升高[(142.36±11.83)ng/mL,P<0.05)],多元Logistic回归分析显示血浆chemerin水平与高血压病合并心房纤颤呈独立相关性(OR 1.112, 95% CI 1.023～1.302;P<0.001)。结论 高血浆chemerin水平可能是预测高血压合并心房纤颤的独立危险因素,血清chemerin可能成为一种预测高血压发生心房纤颤的重要生物学标记物。

Objective To explore the relationship between chemerin levels and permanent atrial fibrillation in patients with hypertension. Methods A total of 160 patients with hypertension were enrolled in this study. All the patients were classified as AF(n=72) or NAF(n=88) based on the permanent atrial fibrillation or not. And 140 healthy people were collected as a control group(CON). Triglycerides, total cholesterol, low density lipoprotein cholesterol and C-reactive protein were measured by automatic biochemical detector. Serum chemerin levels were determined by enzyme-linked immunosorbent assay(ELISA). Results Serum chemerin levels were higher in AF patients than those in NAF patients(180.45±15.23 ng/mL vs 162.36±13.44 ng/mL,P<0.05). They were both higher than that of the CON patients(142.36±11.83 ng/mL,P<0.05). Multivariate logistic regression demonstrated that chemerin level was independently associated with the permanent atrial fibrillation in patients with hypertension(OR 1.112, 95% CI 1.023～1.302;P<0.001). Conclusion Serum chemerin is an independent risk factor for permanent atrial fibrillation with hypertension. The results suggest that chemerin might be a useful biomarker for predicting the permanent atrial fibrillation with hypertension.

目的 研讨阿司匹林广泛用于高危血栓、栓塞抗凝的预防治疗应用。方法 查阅参考文献,结合临床实践,新口服抗凝药疗效终点卒中和体循环栓塞方面为基准。结果 界於CHADS2和CHA2DS2-VASc 评分所涵盖的风险和差异因素,后期华法林与新口服抗凝药可能取舍或并存。结论 在危险分层,卒中抗拴防凝治疗中,我国房颤患者不建议继续服用阿司匹林。

Objective To Study and discuss the applications for prevention and treatment of high risky thrombosis and embolism anticoagulation of Aspirin. Methods Combining literature consultation and clinical practice,making stroke and general circulation embolism of oral anticoagulant curative effect terminal point as the base. Results According to the risky and different factors covered by CHADS2 and CHA2DS2-VASc in the later stage, warfarin and the new oral anticoagulant can be taken together or abandon one of them. Conclusion In the risky factors classification and stroke anticoagulant therapy, we suggest that the atrial fibrillation patients should not take Aspirin.

       目的 探讨术中未恢复窦性心律需要行电复律的心房颤动（房颤）患者在清醒和镇静两种状态下的安全性及有效性。方法 选择2022年1月—2023年12月100例接受射频消融术中行同步直流电复律的持续性房颤患者进行研究，采用随机数字表法将患者分为观察组（清醒状态）和对照组（镇静状态），其中观察组和对照组各为50例。观察两组患者接受电复律的成功率、复发率和不良事件发生率（呼吸抑制、低血压、谵妄、肺水肿、心律失常）等指标。结果 观察组和对照组首次电复律成功分别有48、49例，成功率分别为96%、98%，组间比较差异无统计学意义（P=0.558）。观察组术后30 min内有2例复发，对照组术后30 min内无复发，组间比较差异无统计学意义（P=0.153）。在不良反应方面，观察组共发生1例心律失常事件，1例低血压事件，不良反应的总发生率为4%。对照组共发生3例呼吸抑制事件、2例谵妄事件、1例心律失常事件、2例低血压事件，不良反应的总发生率为16%，组间比较差异有统计学意义（P=0.046）。结论 对持续性房颤患者在射频消融术中，处于清醒状态下行电复律也具有良好的临床疗效，可以减少不良事件的发生，安全性更高。

  Objective  To compare the safety and efficacy of awake state and sedation state in patients with atrial fibrillation（AF）who did not recover sinus rhythm and needed electrical cardioversion during operation．Methods  A total of 100 patients with persistent atrial fibrillation who underwent synchronous direct current cardioversion during radiofrequency ablation from January 2022 to December 2023 were selected and divided into the observation group（awake state）and the control group（sedation state）according to the random number table method，with 50 cases in each group．The success rate of electrical cardioversion，recurrence rate and incidence of adverse events（respiratory depression，hypotension，delirium，pulmonary edema，arrhythmia）were observed．Results  The first electrical cardioversion was successful in 48 and 49 patients in the observation group and the control group，and the success rates were 96% and 98%，respectively．There was no significant difference between the two groups（P=0.558）．There were 2 cases of  recurrence in the observation group and no  recurrence in the control group within 30 minutes after operation，and there was no significant difference between the two groups（P=0.153）．In terms of adverse reactions，there were 1 case of arrhythmia event and 1 case of hypotension event in the observation group，and the total incidence of adverse reactions was 4%．There were 3 cases of respiratory depression events，2 cases of delirium events，1 case of arrhythmia events，and 2 cases of hypotension events in the control group．The total incidence of adverse reactions was 16%，and the difference between the two groups was statistically significant（P=0.046）．Conclusions  Electrical cardioversion in awake state during  radiofrequency ablation of persistent atrial fibrillation has a good clinical efficacy and safety，which can reduce the occurrence of adverse events．