Efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure and its effect on N-terminal pro-brain natriuretic peptide level / 中国基层医药

Objective:To investigate the clinical efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure and its effect on N-terminal pro-brain natriuretic peptide (NT-pro BNP) level.Methods:The clinical data of 89 patients with chronic heart failure who received treatment in Jinan 2 nd People's Hospital from January 2020 to April 2022 were retrospectively analyzed. These patients were divided into Group A ( n = 48) and Group B ( n = 41) according to different treatment methods. Group A was treated with sacubitril and valsartan combined with bisoprolol. Group B was treated with sacubitril and valsartan combined with metoprolol. All patients were treated for 3 months. Clinical efficacy as well as heart function and NT-pro BNP level pre- and post-treatment were compared between the two groups. The incidence of adverse reactions was calculated in each group. Results:Total response rate in group A was significantly higher than that in group B [95.83% (46/48) vs. 82.93% (34/41), χ2 = 4.05, P < 0.05]. After treatment, the left ventricular ejection fraction in both groups increased significantly and the left ventricular ejection fraction in group A was significantly higher than that in group B ( t = 2.19, P < 0.05). After treatment, NT-pro BNP level in group A was (416.51 ± 30.56) ng/L, which was significantly lower than (450.20 ± 35.79) ng/L in group B ( t = 4.79, P < 0.001). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:The efficacy of sacubitril and valsartan combined with bisoprolol in the treatment of chronic heart failure is superior to that of sacubitril and valsartan combined with metoprolol. The former can greatly decrease NT-pro BNP level. Corresponding drugs can be selected for the treatment of chronic heart failure according to the actual needs of patients.

Application of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals / 中国基层医药

Objective:To investigate the application value of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals.Methods:The clinical data of 51 patients with acute coronary syndrome who received treatment in Feng Tai People's Hospital from January 2020 to January 2022 were retrospectively analyzed. They were divided into a control group ( n = 25) and an observation group ( n = 26). The control group was given standard dual antiplatelet and statin drugs. The observation group underwent percutaneous coronary intervention and stent implantation based on conventional drug treatment. All patients were followed up for 1 year. Cardiac function indexes left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were compared between the two groups. The number of readmissions, length of hospital stay, quality of life score, medication, the incidence of complications, and the incidence of adverse cardiovascular events were compared between the two groups. Results:Before treatment, there were no significant differences in LVEF and LVEDD between the two groups (both P > 0.05). After treatment, LVEF was increased, and LVEDD was decreased in each group compared with before treatment. After treatment, LVEF and LVEDD in the observation group were (50.34 ± 5.97)% and (49.01 ± 5.02) mm, respectively, which were significantly superior to (45.61 ± 5.42)% and (52.12 ± 5.24) mm in the control group ( t = -2.96, 2.17, both P < 0.05). After treatment, the number of readmissions in the observation group was significantly less than that in the control group [(0.8 ± 0.1) times vs. (2.1 ± 0.3) times, t = 20.14, P < 0.001]. The length of hospital stay in the observation group was significantly shorter than that in the control group [(12.4 ± 3.1) days vs. (25.3 ± 3.9) days, t = 13.10, P < 0.001]. Quality of life score in the observation group was significantly higher than that in the control group [(85.3 ± 5.9) points vs. (72.5 ± 5.2) points, t = -8.19, P < 0.001]. After treatment, the incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group [3.9% (1/26) vs. 28.0% (7/25), χ2 = 3.94, P = 0.041). Conclusion:Use of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals is feasible. It can improve patients' cardiac function and has a remarkable clinical effect with a low incidence of adverse cardiovascular events.

Effects of phentolamine on cardiac function, myocardial injury index, and hemodynamics in septic patients with myocardial injury / 中国基层医药

Objective:To investigate the efficacy of phenolamine in the treatment of sepsis-induced myocardial dysfunction and its effect on cardiac function, myocardial injury index, and hemodynamics in patients.Methods:The clinical data of 79 patients with sepsis-induced myocardial dysfunction who received treatment in Huangshi Central Hospital, Edong Healthcare Group from February 2017 to February 2020 were retrospectively analyzed. These patients were divided into a control group (without phenolamine treatment, n = 41) and an observation group (with phenolamine treatment, n = 38) according to whether they received phenolamine treatment or not. Clinical efficacy, cardiac function, myocardial injury index, and hemodynamic index pre- and post-treatment were compared between the two groups. Results:There was no significant difference in 28-day mortality rate between the two groups ( P > 0.05). Intensive care unit length of stay and mechanical ventilation duration in the observation group were (9.33 ± 3.52) days and 83.00 (28.50, 138.00) hours, which were significantly shorter than (12.17 ± 4.15) days and 111.00 (47.50, 169.00) hours in the control group ( t = 3.26, Z = -2.27, both P < 0.05). The response rate in the observation group was significantly higher than that in the control group [81.58% (31/38) vs. 60.98% (25/41), χ2 = 4.05, P < 0.05]. After 7 days of treatment, the left ventricular ejection fraction in each group was significantly increased, and the left ventricular end-diastolic diameter and left ventricular end-systolic diameter in each group were significantly decreased compared with before treatment (all P < 0.05). After 7 days of treatment, the left ventricular ejection fraction in the observation group was significantly higher than that in the control group ( t = 3.29, P < 0.05), and left ventricular end-diastolic diameter and left ventricular end-systolic diameter were significantly lower than those in the control group ( t = 5.94, 11.21, both P < 0.05). N-terminal pro-brain natriuretic peptide and cardiac troponin I levels in each group were significantly decreased with time (both P < 0.05). At 24 and 72 hours and 7 days after treatment, N-terminal pro-brain natriuretic peptide and cardiac troponin I levels in the observation group were significantly lower than those in the control group (both P < 0.05). After 7 days of treatment, heart rate in each group decreased significantly compared with that before treatment (both P < 0.05), mean arterial pressure, cardiac index, and stroke output index in each group increased significantly compared with those before treatment (all P < 0.05). After 7 days of treatment, heart rate in the observation group was significantly lower than that in the control group ( t = 4.90, P < 0.05), and mean arterial pressure, cardiac index, and stroke output index in the observation group were significantly higher than those in the control group ( t = 4.37, 3.23, 6.01, all P < 0.05). Conclusion:Phentolamine can improve hemodynamics, reduce myocardial injury and improve cardiac function in patients with sepsis-induced myocardial dysfunction.

Índice de rendimiento biventricular del corazón fetal

Objetivo. Proponer un índice de rendimiento biventricular basado en los valores promedio de la duración del ciclo cardíaco de cada uno de los ventrículos, determinar la variable incluida en el estudio con la correlación estadística más significativa, establecer valores de referencia que permitan identificar el trabajo de cada ventrículo en función de dicha variable y obtener un índice de gasto biventricular equilibrado. Metodología. Estudio prospectivo y transversal en fetos de 168 gestantes, en embarazos entre las 16 y 38 semanas sin patologías materno-fetales. Se obtuvieron ondas de velocidad de flujo de ambas válvulas atrioventriculares y el tiempo total del ciclo sístole-diástole se calculó en milisegundos para cada válvula. Se calcularon promedios, desviación estándar y puntuación Z del tiempo sistólico-diastólico para cada ventrículo y el índice de rendimiento ventricular individual dividiendo el valor obtenido entre la frecuencia cardiaca fetal. Se obtuvo el valor promedio de ambos y este, al ser dividido por la frecuencia cardíaca, permitió obtener el índice de rendimiento biventricular para establecer la correlación entre este, la frecuencia cardiaca fetal y la edad de gestación. Resultados. Se halló valores de tiempo sistólico-diastólico en milisegundos para el ventrículo derecho de 420,8 (DE ±28,3) y para el ventrículo izquierdo de 418,8 (DE ±26,3), sin diferencias estadísticamente significativas (p=0,371). La correlación con la frecuencia cardíaca fetal resultó negativa para ambos ventrículos (-0,491 y -0,553; p<0,05). El tiempo promedio biventricular fue de 418,37 ms (± 20,59) y la correlación con la edad gestacional de 0,48 (p<0,05); la correlación con la frecuencia cardiaca fetal fue negativa, -0,50 (p<0,05). El índice de rendimiento biventricular mostró valores de 2,8 (extremos 2,4 (P5) y 3,4 (P95)). La correlación entre el índice de rendimiento biventricular y la frecuencia cardiaca fetal fue 0,78 (p<0,05), de menor grado (0,27) con la edad gestacional. Conclusiones. Se demostró que los tiempos sistólico-diastólicos de cada ventrículo no difirieron entre sí y se correlacionaron de manera negativa con la frecuencia cardiaca fetal. Se comprobó que es posible evaluar el ciclo cardíaco fetal de cada ventrículo mediante el índice de rendimiento ventricular, así como calificar con el índice de rendimiento biventricular el gasto cardíaco combinado como equilibrado.

Objectives: To propose a biventricular performance index based on the average values of the duration of the cardiac cycle of each of the ventricles, to determine the variable included in the study with the most significant statistical correlation, to establish reference values that allow the work of each ventricle to be identified according to this variable, and to obtain a balanced biventricular output index. Methodology: Prospective and cross-sectional study in fetuses of 168 pregnant women, in pregnancies between 16 and 38 weeks without maternal-fetal pathologies. Flow velocity waves were obtained from both atrioventricular valves and the total systole-diastole cycle time was calculated in milliseconds for each valve. Averages, standard deviation, and Z-score were calculated of the systolic-diastolic time for each ventricle and the individual ventricular performance index (VPI) were calculated by dividing the value obtained by the fetal heart rate (FHR). The average value of both was obtained and this, when divided by the heart rate, made it possible to obtain the biventricular performance index (BPI) to establish the correlation between this, the fetal heart rate and gestational age. Results: Systolic-diastolic time values in milliseconds for the right ventricle were 420.8 (SD ±28.3) and for the left ventricle 418.8 (SD ±26.3), with no statistically significant differences (p<0.371). The correlation with the FHR was negative for both ventricles: (-0.491 and -0.553; p<0.05). The mean biventricular time was 418.37 ms (±20.59) and the correlation with gestational age was 0.48 (p<0.05); the correlation with FHR was negative, -0.50 (p<0.05).The BPI showed values of 2.8 (extremes 2.4 (P5) and 3.4 (P95)). The correlation between BPI and FHR was 0.78 (p<0.05) and of lesser degree with gestational age (0.27; p<0.05). Conclusions: It was demonstrated that the systolic-diastolic times of each ventricle did not differ from each other and were negatively correlated with fetal heart rate. It was shown that it is possible to evaluate the fetal cardiac cycle of each ventricle by means of the ventricular performance index as well as to qualify with the biventricular performance index the combined cardiac output as balanced.

Effects of open-lung strategy on cardiopulmonary function in frail elderly patients undergoing laparoscopic surgery / 中华麻醉学杂志

Objective:To evaluate the effect of open-lung strategy (OLS) on cardiopulmonary function in frail elderly patients undergoing laparoscopic surgery.Methods:Eighty-four frail elderly patients aged 65-80 yr, with body mass index of 18.5-30.0 kg/m 2, of American Society of Anesthesiologists physical status Ⅱor Ⅲ, with preoperative Fried frailty phenotype scale score ≥3, undergoing elective laparoscopic radical rectal cancer or radical prostate cancer surgery under general anesthesia, were divided into 2 groups ( n=42 each) by the random number table method: OLS group and non-OLS group (NOLS group). The patients underwent recruitment maneuvers and individualized positive end-expiratory pressure (PEEP) in OLS group, while patients received fixed PEEP (5 cmH 2O) in NOLS group.At 10 min after endotracheal intubation (T 0, baseline value), immediately after the peak of recruitment maneuvers (T 1), 30 min (T 2) and 1 h (T 3) after individualized PEEP setting and 10 min before the end of surgery (T 4), cardiac function indexes were measured by transoesophageal echocardiography, optic nerve sheath diameter was measured, and the arterial blood gas analysis indexes and pulmonary function indexes were recorded.The levels of serum cardiac troponin T, creatine kinase-MB and precursor of type B natriuretic peptide were determined by chemiluminescence before surgery and at 1 and 2 days after surgery.The postoperative pulmonary complications within 7 days after surgery and postoperative outcomes were also recorded. Results:Eighty-one patients were finally enrolled, with 41 in NOLS group and 40 in OLS group.Compared with NOLS group, the left ventricular end diastolic area, left ventricular ejection fraction, stroke volume, ratio of early mitral flow velocity to early mitral annulus velocity, mitral annular plane systolic excursion, left ventricular global longitudinal strain, right ventricular end diastolic area, right ventricular fractional area change, tricuspid annular plane systolic excusion and right ventricular global longitudinal strain were significantly decreased at T 1, 2 ( P<0.05), and no significant change was found in the indices mentioned above at the remaining time points ( P>0.05), PaO 2, oxygenation index, and lung compliance were increased at T 1-4, PaCO 2 and alveolar arterial partial pressure difference of oxygen were decreased, the total incidence of pulmonary complications was reduced within 7 days after operation, and the duration of postanesthesia care unit stay, time to first out-of-bed activity and postoperative length of hospital stay were shortened ( P<0.05), and no significant change was found in optic nerve sheath diameter and concentrations of serum cardiac troponin T, creatine kinase-MB, and precursor of type B natriuretic peptide at each time point in OLS group ( P>0.05). Conclusions:OLS can improve lung function in frail elderly patients, which is helpful for patient prognosis without causing negative cardiac effects, and can be safely used for intraoperative airway management in frail elderly patients without obvious cardiac dysfunction.

Effects of driving pressure-guided individualized PEEP ventilation on intraoperative cardiac function in elderly patients undergoing laparoscopic surgery / 中华麻醉学杂志

Objective:To evaluate the effect of driving pressure-guided individualized PEEP ventilation on intraoperative cardiac function in elderly patients undergoing laparoscopic surgery.Methods:Seventy American Society of Anesthesiologists physical statusⅠor Ⅱ patients, aged 60-75 yr, with body mass index of 18-25 kg/m 2, with left ventricular ejection fraction (LVEF)>50%, undergoing elective laparoscopic radical gastrectomy under general anesthesia, were divided into 2 groups ( n=35 each) by the random number table method: conventional PEEP ventilation group (group P) and driving pressure-guided individualized PEEP ventilation group (group D). The patients were mechanically ventilated in the volume-controlled ventilation mode, with a V T of 7 ml/kg, an inspired oxygen concentration of 60%, an inspiratory/expiratory ratio of 1∶2, and an end-inspiratory pause time of 10%.In group P, 5 cmH 2O PEEP was given for ventilation from 5 min after the establishment of pneumoperitoneum until the end of operation.In group D, driving pressure-guided individualized PEEP titration was performed at 5 min after the establishment of pneumoperitoneum, and ventilation was maintained with the titrated individualized PEEP until the pneumoperitoneum was closed.After the pneumoperitoneum was closed, group D underwent driving pressure-directed individualized PEEP again, and ventilation was maintained with re-titrated PEEP until the end of surgery.Before pneumoperitoneum (T 0), at 5 min after establishment of pneumoperitoneum (T 1), 5 min of PEEP ventilation (T 2), 30 min of PEEP ventilation (T 3) and 5 min after the end of pneumoperitoneum (T 4), MAP was recorded, LVEF, global longitudinal strain of left ventricle, tricuspid annular systolic displacement, early diastolic peak velocity (E peak) of mitral valve and tricuspid valve orifice, early diastolic peak velocity (e′) and systole peak velocity (S′) of mitral valve and tricuspid valve annulus were measured using transesophageal ultrasonography, and myocardial performance index (MPI) and E/e′ were calculated. Results:Compared with group P, MAP, LVEF, mitral valve annulus S′, global longitudinal strain of left ventricle, tricuspid valve annulus S′, and tricuspid annular systolic displacement were significantly decreased at T 2 and T 3, and left ventricular MPI, mitral valve E/e′, right ventricular MPI and tricuspid E/e′ were increased in group D ( P<0.05). Conclusions:Driving pressure-guided individualized PEEP ventilation can decrease the cardiac function during pneumoperitoneum in elderly patients undergoing laparoscopic surgery.

High-flux versus low-flux hemodialysis for end-stage renal disease in the older adults / 中国基层医药

Objective:To investigate the effects of high-flux versus low-flux hemodialysis on end-stage renal disease in older adults and evaluate its effects on myocardial injury indexes and micro-inflammatory response indexes. Methods:Seventy-two patients with ESRD who received treatment in Affiliated Hospital of Shaoxing University from January 2019 to January 2020 were included in this study. They were randomly assigned to receive either low-flux hemodialysis (control group, n = 36) or high-flux hemodialysis (observation group, n = 36). All patients received 6 months of treatment. Micro-inflammatory response indexes and renal function indexes pre- and post-treatment, and reverse reactions were observed in each group. Results:Serum interleukin-6, tumor necrosis factor α, and high-sensitivity C-reactive protein levels post-treatment in the observation group were (7.16 ± 1.32) ng/L, (2.10 ± 0.36) pg/L, (2.20 ± 1.06) mg/L respectively, which were significantly lower than those in the control group [(10.45 ± 1.42) ng/L, (5.22 ± 0.65) pg/L, (3.84 ± 1.57) mg/L, t = 10.19, 25.19, 5.19, all P < 0.001]. Serum parathyroid hormone, B-type natriuretic peptide, and cardiac troponin T levels post-treatment in the observation group were (520.36 ± 95.65) pmol/L, (0.45 ± 0.10) μg/L, (15.05 ± 6.37) ng/L, respectively, which were significantly lower than those in the control group [(830.25 ± 102.35) pmol/L, (0.85 ± 0.13) μg/L, (30.25 ± 6.59) ng/L, t = 13.27, 14.63, 9.95, all P < 0.001]. The total response rate was significantly higher in the observation group than in the control group [75.00% (27/36) vs. 47.22% (19/36), χ2 = 3.85, P < 0.05]. The overall incidence of adverse reactions was significantly lower in the observation group than in the control group [19.44% (7/36) vs. 41.67% (15/36), χ2 = 4.18, P < 0.05). Conclusion:High-flux hemodialysis can highly improve the control effect of micro-inflammatory responses and alleviate myocardial injury in older adult patients with end-stage renal disease. High-flux hemodialysis is more effective and safer than low-flux hemodialysis.

Study on cardiovascular monitoring and diagnosis of athletes / Estudo de monitoramento cardiovascular e diagnóstico de atletas / Estudio de monitoreo cardiovascular y diagnóstico de atletas

ABSTRACT Introduction: The study and collection of athletes' heart function index parameters and the correct and reasonable evaluation of body functions can effectively adjust training plans and avoid athletes' bodily exhaustion. Objective: To study the diagnosis of myocardial injury by cardiovascular monitoring in athletes from two aspects: extraction of characteristic parameters of heart function and research of signal processing. Methods: The heart function intelligent evaluation algorithm was studied by using multi-source information fusion, and embedded technology; miniature sensors were used as well. Results: The incidence of severe ventricular arrhythmia was lower in both groups. The incidence of sinus arrhythmia and intermittent second degree I atrioventricular block in the high-intensity group was significantly higher than that in the control group. The number of atrial and ventricular premature beats was lower in the control group, but increased significantly in the high-intensity group. Conclusions: This study applied the theory of multi-source information fusion to carry out representative research on the intelligent monitoring and evaluation of the heart function of elite athletes, centering on the application requirements of the heart function monitoring of elite athletes. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: O estudo e a coleta de parâmetros indiciais da função cardíaca em atletas e a avaliação correta e razoável das funções corporais podem, efetivamente, levar ao ajuste de planos de treinamento e evitar a sobrecarga física de atletas. Objetivo: Estudar o diagnóstico da lesão miocárdica pelo monitoramento cardiovascular em atletas a partir de dois aspectos: a extração de parâmetros característicos da função cardíaca e a pesquisa do processamento de sinais. Métodos: O algoritmo de avaliação inteligente da função cardíaca foi estudado usando a fusão de informações de múltiplas fontes, além da tecnologia embarcada. Sensores em miniatura também foram usados. Resultados: A incidência de arritmia ventricular severa era menor nos dois grupos. A incidência de arritmia sinusal e o bloqueio atrioventricular de segundo grau do tipo I intermitente no grupo de alta intensidade foi significativamente mais alta do que no grupo de controle. O número de batidas prematuras atriais e ventriculares era menor no grupo de controle, mas aumentava consideravelmente no grupo de alta intensidade. Conclusões: Este estudo aplicou a teoria da fusão de informações de múltiplas fontes para conduzir uma pesquisa importante sobre o monitoramento e avaliação inteligentes da função cardíaca de atletas de elite, enfocando as exigências de aplicação do monitoramento da função cardíaca de atletas de elite. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: El estudio y la recogida de parámetros indíciales de la función cardíaca en atletas y la evaluación correcta y razonable de las funciones corporales pueden efectivamente llevar al ajuste de planes de entrenamiento y evitar la sobrecarga física de atletas. Objetivo: Estudiar el diagnóstico de la lesión miocárdica a través del monitoreo cardiovascular en atletas a partir de dos aspectos: la extracción de parámetros característicos de la función cardíaca y la investigación del procesamiento de señales. Métodos: El algoritmo de evaluación inteligente de la función cerebral se estudió utilizando la fusión de informaciones de múltiples fuentes, además de la tecnología embebida. Sensores en miniatura también se utilizaron. Resultados: La incidencia de taquicardia ventricular severa era menor en los dos grupos. La incidencia de arritmia sinusal y bloqueo auriculoventricular de segundo grado del tipo I intermitente en el grupo de alta intensidad fue significativamente más alta que en el grupo de control. El número de contracciones prematuras auriculares y ventriculares era menor en el grupo de control, pero aumentaba considerablemente en el grupo de alta intensidad. Conclusiones: Este estudio aplicó la teoría de la fusión de informaciones de múltiples fuentes para conducir una investigación importante sobre el monitoreo y evaluación inteligentes de la función cardiaca de atletas de élite, centrando las exigencias de aplicación del monitoreo de la función cardíaca de atletas de élite. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

A detection system of exercise electrocardiogram / Um sistema de detecção de eletrocardiograma de exercício / Un sistema de detección de electrocardiograma de ejercicio

ABSTRACT Introduction: A new exercise electrocardiogram (ECG) detection system was investigated in this study to diagnose and analyze cardiopulmonary function and related diseases in a comprehensive and timely manner and improve the accuracy of diagnosis. Besides, its reliability and clinical applicability were judged. Objective: A new type of exercise ECG detection system was constructed by adding parameters such as respiratory mechanics, carbon dioxide, and oxygen concentration monitoring based on the traditional ECG detection system. Methods: The new system constructed in this study carried out the ECG signal detection, ECG acquisition module, blood pressure and respiratory mechanics detection and conducted a standard conformance test. Results: The heart rate accuracy detected by the exercise ECG system was greatly higher than that of the doctor's manual detection (P < 0.05). The accuracy of the new exercise ECG detection system increased obviously in contrast to that of the manual detection result (P < 0.05). The key technical index input noise and input impedance test results (24.5 μV and 12.4 MΩ) of the exercise ECG detection system conformed to the standard (< 30 μV and > 2.5 MΩ). The common-mode rejection and sampling rate test results (103.5 dB and 515 Hz) of key technical indicators in the exercise ECG detection system were all in line with the standards (≥89 dB and ≥500 Hz). Conclusion: The complete exercise ECG detection system was constructed through the ECG acquisition module, blood pressure detection, and respiratory mechanics detection module. In addition, this system could be applied to detect ECG monitoring indicators with high accuracy and reliability, which could also be extensively adopted in clinical diagnosis. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Um novo sistema de detecção de eletrocardiograma de exercício (ECG) foi investigado neste estudo para diagnosticar e analisar a função cardiopulmonar e doenças relacionadas de maneira abrangente e oportuna e melhorar a precisão do diagnóstico. Além disso, sua confiabilidade e aplicabilidade clínica foram julgadas. Objetivo: Um novo tipo de sistema de detecção de ECG de esforço foi construído adicionando parâmetros como mecânica respiratória, dióxido de carbono e monitoramento da concentração de oxigênio com base no sistema de detecção de ECG tradicional. Métodos: O novo sistema construído neste estudo realizou a detecção do sinal de ECG, módulo de aquisição de ECG e detecção de pressão arterial e mecânica respiratória, e conduziu um teste de conformidade padrão. Resultados: A precisão da frequência cardíaca detectada pelo sistema de ECG de esforço foi muito maior do que a detecção manual do médico (P <0,05). A precisão do novo sistema de detecção de ECG de esforço aumentou obviamente em contraste com o resultado da detecção manual (P <0,05). O ruído de entrada do índice técnico principal e os resultados do teste de impedância de entrada (24,5 μV e 12,4 MΩ) do sistema de detecção de ECG de esforço estão em conformidade com o padrão (<30 μV e> 2,5 MΩ). A rejeição do modo comum e os resultados do teste de taxa de amostragem (103,5 dB e 515 Hz) dos indicadores técnicos principais no sistema de detecção de ECG de esforço estavam todos alinhados com os padrões (≥89 dB e ≥500 Hz). Conclusão: O sistema completo de detecção de ECG de esforço foi construído através da combinação de módulo de aquisição de ECG, detecção de pressão arterial e módulo de detecção de mecânica respiratória. Além disso, esse sistema poderia ser aplicado à detecção de indicadores de monitoramento de ECG com alta precisão e confiabilidade, o que poderia ser amplamente adotado no diagnóstico clínico. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.

RESUMEN Introducción: En este estudio se investigó un nuevo sistema de detección de electrocardiograma de esfuerzo (ECG) para diagnosticar y analizar la función cardiopulmonar y enfermedades relacionadas de manera integral y oportuna, y mejorar la precisión del diagnóstico. Además, se evaluó su confiabilidad y aplicabilidad clínica. Objetivo: Se construyó un nuevo tipo de sistema de detección de ECG de ejercicio agregando parámetros como la mecánica respiratoria, el dióxido de carbono y el monitoreo de la concentración de oxígeno sobre la base del sistema de detección de ECG tradicional. Métodos: El nuevo sistema construido en este estudio llevó a cabo la detección de la señal de ECG, el módulo de adquisición de ECG y la detección de la presión arterial y la mecánica respiratoria, y realizó una prueba de conformidad estándar. Resultados: la precisión de la frecuencia cardíaca detectada por el sistema de ECG de ejercicio fue mucho mayor que la de la detección manual del médico (P <0,05). La precisión del nuevo sistema de detección de ECG de esfuerzo aumentó obviamente en contraste con el resultado de la detección manual (P <0.05). Los resultados de la prueba de impedancia de entrada y ruido de entrada de índice técnico clave (24,5 μV y 12,4 MΩ) del sistema de detección de ECG de esfuerzo cumplieron con el estándar (<30 μV y> 2,5 MΩ). Los resultados de la prueba de frecuencia de muestreo y rechazo en modo común (103,5 dB y 515 Hz) de los indicadores técnicos clave en el sistema de detección de ECG de esfuerzo estaban en línea con los estándares (≥89 dB y ≥500 Hz). Conclusión: El sistema completo de detección de ECG de ejercicio se construyó mediante la combinación del módulo de adquisición de ECG, la detección de la presión arterial y el módulo de detección de la mecánica respiratoria. Además, este sistema podría aplicarse a la detección de indicadores de monitoreo de ECG con alta precisión y confiabilidad, que también podría adoptarse ampliamente en el diagnóstico clínico. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.

Clinical study on long-snake moxibustion plus Western medicine in treating chronic heart failure due to heart-kidney yang deficiency / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of long-snake moxibustion plus Western medicine for chronic heart failure due to heart-kidney yang deficiency.Methods: A total of 80 patients were randomized into a control group and an observation group, with 40 cases in each group. The control group was treated with routine Western medicine, and the observation group was treated with long-snake moxibustion therapy on the basis of routine Western medicine. Left ventricular ejection fraction (LVEF), stroke volume (SV) and left ventricular end-diastolic diameter (LVEDd) were measured before and after treatment, and the heart function was assessed. The serum brain natriuretic peptide (BNP) level was measured, the 6 min walking distance was recorded, and the Minnesota living with heart failure questionnaire (MLHFQ) was assessed and scored. The serum galectin-3 (Gal-3) and soluble growth stimulation expressed gene 2 (sST2) protein levels were measured. Clinical efficacy was evaluated after treatment. Results: The total effective rate of the observation group was higher than that of the control group, and the difference between the two groups was statistically significant (P<0.05). After treatment, LVEF and LVEDd in both groups were significantly improved (all P<0.05), and LVEF, SV and LVEDd in the observation group were superior to those in the control group (all P<0.05). The heart function classification in both groups were improved after treatment (both P<0.05), and the heart function classification in the observation group was superior to that in the control group (P<0.05). The serum BNP level in both groups decreased (both P<0.05), and the serum BNP level in the observation group was lower than that in the control group (P<0.05). The 6 min walking distance and MLHFQ scores in both groups were improved (all P<0.05), and the 6 min walking distance and MLHFQ score in the observation group were superior to those in the control group (both P<0.05). The serum Gal-3 and sST2 levels in the observation group decreased significantly (both P<0.05), and all lower than those in the control group (both P<0.05). Conclusion: Long-snake moxibustion plus Western medicine has significant efficacy in treating chronic heart failure due to heart-kidney yang deficiency; it can improve heart function, reduce the serum BNP level, and improve the exercise endurance and quality of life in the patients. This may be related to the down-regulation of serum Gal-3 and sST2 levels.

Efficacy of atenolol combined with perindopril in the treatment of chronic heart failure in older adult patients and its effect on serum connective tissue growth factor and nexin levels / 中国基层医药

Objective:To investigate the efficacy of atenolol combined with perindopril in the treatment of chronic heart failure in older adult patients and its effects on ventricular function, serum connective tissue growth factor (CTGF), and nexin.Methods:120 older adult patients with chronic heart failure who received treatment in the Department of Cardiology, the First People's Hospital of Fuyang District from January 2016 to January 2018 were included in this study. They were randomly assigned to receive either basic treatment + atenolol treatment (control group, n = 60) or atenolol combined with perindopril treatment (observation group, n = 60). Clinical efficacy and clinical symptom, serum CTGF, nexin level and ventricular function pre- and post-treatment, as well as adverse reactions were compared between the control and observation groups. Results:After treatment, effective rate in the observation group was significantly higher than that in the control group (91.6% vs. 78.3%, χ2 = 4.183, P = 0.041). After treatment, CTGF and nexin levels in the control and observation groups were decreased compared with before treatment (both P < 0.05). After treatment, CTGF and nexin levels in the observation group were (4.42 ± 0.46) μg/L and (0.82 ± 0.03) μg/L, respectively, which were significantly lower than those in the control group [(4.82 ± 0.51) μg/L, (0.98 ± 0.04) μg/L, t = 18.153, 4.511, 19.335, 24.787, all P < 0.05]. After treatment, left ventricular end diastolic diameter and left ventricular end systolic diameter in the control and observation groups were deceased compared with before treatment (both P < 0.05). After treatment, left ventricular end diastolic diameter and left ventricular end systolic diameter in the observation group were (48.73 ± 4.41) mm and (41.13 ± 4.15) mm, respectively, which were significantly lower than those in the control group [(56.01 ± 4.67) mm, (47.45 ± 4.17) mm, t = 5.700, 8.799, 8.317, 8.351, all P < 0.05]. After treatment, left ventricular ejection fraction in the control and observation groups was significantly increased compared with before treatment. After treatment, left ventricular ejection fraction in the observation group was significantly higher than that in the control group [(44.86 ± 4.59) % vs. (39.05 ± 4.69) %, P < 0.05]. Conclusion:Atenolol combined with perindopril in the treatment of older adult patients with chronic heart failure can reduce clinical symptoms, improve ventricular function, decrease serum CTGF and nexin levels and is highly safe. Therefore, this method is worthy of clinical application.

Effects of cardiac exercise rehabilitation on heart failure with preserved ejection fraction / 中国基层医药

Objective:To investigate the effects of cardiac exercise rehabilitation on heart failure with preserved ejection fraction.Methods:200 patients with clinically diagnosed heart failure with preserved ejection fraction who received treatment from May to December 2019 were included in this study. They were randomly assigned to receive either routine treatment (control group, n = 100) or routine treatment combined with cardiac exercise rehabilitation (observation group, n = 100). Before and after treatment, the distance walked during the 6-minute walk test was compared between the control and observation groups. Before and after treatment, plasma level of brain natriuretic peptide, left ventricular ejection fraction, left ventricular short-axis fractional shortening, left atrial diameter, left ventricular end diastolic diameter were compared between the two groups. Adverse events such as falls during treatment were recorded in each group. Before and after treatment, quality of life was evaluated using The Minnesota Living With Heart Failure Questionnaire in each group. All patients were followed up for 3 months. Three-month rehospitalization rate was calculated in each group. Results:After treatment, the distance walked during the 6-minute walk test in the observation group was significantly longer than that in the control group [(421.63 ± 86.75) m vs. (328.44 ± 74.93) m, t = 8.130, P < 0.001). After treatment, the distance walked during the 6-minute walk test in each group was significantly increased compared with before treatment ( tcontrol group = 6.584, P < 0.001; tobservation group = 15.337, P < 0.001). After treatment, plasma level of brain natriuretic peptide in the observation group was significantly lower than that in the control group [(227.68 ± 31.22) mg/L vs. (269.74 ± 36.81) mg/L, t = 8.714, P < 0.001]. After treatment, plasma level of brain natriuretic peptide in each group was significantly decreased compared with before treatment ( tcontrol group = 24.669, P < 0.001; tobservation group = 38.776, P < 0.001). After treatment, left ventricular end diastolic diameter and left atrial diameter in each group were significantly decreased compared with before treatment ( t = 4.031, 10.166, 3.715 and 12.569, all P < 0.05), while left ventricular ejection fraction and left ventricular short-axis fractional shortening in each group were significantly increased compared with before treatment ( t = 7.610, 11.906, 3.915 and 6.105, all P < 0.05). The amplitude of improvement in abovementioned indices in the observation group was significantly greater than that in the control group ( t = 7.255, 12.739, 4.703 and 2.442, all P < 0.05). During the treatment, no falls, adverse cardiovascular events, or death occurred in each group. After treatment, the Minnesota Living With Heart Failure Questionnaire scores in physical domain, emotional domain and other domains in the observation group were (23.96 ± 4.75) points, (9.47 ± 2.02) points, (26.31 ± 1.84) points, respectively, which were significantly lower than those in the control group [(28.63 ± 5.12) points, (12.35 ± 1.89) points and (32.76 ± 2.49) points, t = 6.867, 10.411 and 20.833, all P < 0.001]. After treatment, the Minnesota Living With Heart Failure Questionnaire scores in various domains in each group were significantly decreased compared with before treatment ( t = 6.648, 14.746, 28.782, 35.262, 9.665 and 27.962, all P < 0.05). Three-month rehospitalization rate in the observation group was significantly lower than that in the control group [10.0% (10/100) vs. 22.0% (22/100), χ2 = 5.357, P = 0.021]. Conclusion:Cardiac exercise rehabilitation for the treatment of heart failure with preserved ejection fraction can help improve the heart function, increase exercise endurance, improve prognosis, reduce rehospitalization rate, and improve quality of life.

Effect of recombinant human brain natriuretic peptide on the cardiac function and serum N terminal pro-B-type natriuretic peptide level in elderly patients with heart failure / 中国基层医药

Objective To analyze the effect of recombinant human brain natriuretic peptide (rhBNP) on the cardiac function and serum N terminal pro-B-type natriuretic peptide (NT-proBNP) level in elderly patients with heart failure.Methods From January 2015 to December 2017,150 elderly patients (aged 80 years) with heart failure in the 117th Hospital of the Chinese People's Liberation Army were selected in the research.According to the digital random list method,the patients were divided into two groups,with 75 cases in each group.The control group was given nitroglycerin treatment,and the observation group was given rhBNP treatment.The levels of serum NT-proBNP,left ventricular ejection fraction (LVEF),clinical efficacy and complications were compared between the two groups.Results After treatment,the levels of serum NT-proBNP in the two groups were significantly lower than before treatment,and the level of NT-proBNP in the observation group [(2 964.42 ± 607.25) pg/mL] was significantly lower than that in the control group [(4 213.57 ± 524.07) pg/mL] (t =13.49,P ＜ 0.01).After treatment,the levels of LVEF in the two groups were significantly higher than those before treatment,and the level of LVEF in the observation group [(51.26 ±4.77)％] was significantly higher than that in the control group [(46.03 ±5.22)％] (t =6.41,P ＜ 0.01).The total effective rate of the observation group was 94.67 ％ (71/75),which was significantly higher than 70.67％ (53/75) of the control group (x2 =13.45,P ＜ 0.01).There was no statistically significant difference in the incidence rate of complications such as headache,blood pressure drop,renal function deterioration and tachycardia etc.in the two groups (P ＞ 0.05).Conclusion rhBNP in the treatment of elderly patients with heart failure can effectively improve the symptoms of dyspnea and systemic symptoms,reduce serum NT-proBNP levels,improve heart function,and will not cause serious complications,with good safety,so it is worthy of clinical promotion and application.

Effect of Wenxin granule combined with routine therapy on cardiac function, ventricular remodeling and local inflammatory response in patients with paroxysmal atrial fibrillation / 中国基层医药

Objective To explore the effects of Wenxin granule combined with conventional therapy on cardiac function,ventricular remodeling and local inflammatory response in patients with paroxysmal atrial fibrillation (PAF).Methods From February 2016 to February 2017,116 patients with PAF in the Integrated Traditional Chinese and Western Medicine Hospital of Taizhou were randomly divided into control group(55 cases) and combined group(61 cases) according to the digital table.The control group was treated with routine amiodarone hydrochloride tablets and enalapril maleate tablets,and the combined group was treated with Wenxin granule on the basis of the control group.The clinical efficacy of the two groups was compared,and the cardiac function,the level of inflammatory reaction and the index of ventricular remodeling before and after treatment were compared and analyzed in the two groups.The adverse reactions were observed and analyzed in the two groups.Results The total effective rate in the combined group was 93.44％,which was significantly higher than 76.36％ in the control group (x2 =6.745,P ＜ 0.05).After treatment,the left atrial diameter,the FS and CI levels in the combined group were significantly higher than those in the control group and before treatment (all P ＜ 0.05).The level of Pd in the combined group after treatment was (47.16 ± 0.80) ms,,which was significantly lower than that in the control group [(50.25 ± 0.75) ms] and that before treatment (t =21.395,48.318,all P ＜ 0.05).The levels of hs-CRP and BNP in the combined group were (7.12 ± 2.71) mg/L,(118.43 ± 11.16) ng/L,respectively,which were significantly lower than those in the control group [(11.21 ± 2.89) mg/L,(123.6 ± 11.27) ng/L] and before treatment (t =7.865,2.504,8.585,8.752,all P ＜0.05).After treatment,the LVEF level in the combined group was higher than that in the control group and before treatment (t =4.785,10.573,all P ＜ 0.05).The LVEDD and LVSV levels in the combined group were significantly lower than those in the control group and before treatment (t =9.089,2.313,10.890,4.299,all P ＜ 0.05).The total incidence rate of adverse reactions in the combined group was 6.56％,which was slightly lower than 7.28％ in the control group,but there was no statistically significant difference between the two groups(x2 =0.023,P＞0.05).Conclusion Wenxin granule combined with routine treatment in the treatment of PAF can significantly improve the clinical efficacy,improve the cardiac function obviously,delaye the ventricular remodeling,decrease the level of local inflammatory reaction significantly and the safety is high.

Research progress of pulse wave velocity applied in cardiovascular diseases / 中国基层医药

Cardiovascular diseases have become the most common and most prevalent chronic diseases in the elderly.Smoking,hyperlipidemia,diabetes and other high －risk factors participate in the occurrence and development of atherosclerosis by impairing the structure and function of the vascular wall ,resulting in the occurrence of arterial stiffness.Pulse wave conduction velocity (PWV) is the rate at which a pulse wave travels from one specific location of the artery to another specific location along the wall of the artery.It is a simple,effective and repeatable noninvasive index for evaluating arterial elasticity and vascular function.PWV is closely related to cardiovascular disease.In recent years,the relationship between PWV and cardiovascular disease has been deeply studied.The relationship between PWV and coronary heart disease , hypertension, cardiac function, atrial fibrillation and pulmonary hypertension is described in this paper.

Comparison of the effect of percutaneous coronary intervention via radial and femoral arteries in elderly patients with coronary heart disease / 中国基层医药

Objective To compare the effect of percutaneous coronary intervention ( PCI) via radial and femoral arteries in elderly patients with coronary heart disease (CHD).Methods From March 2015 to March 2017, the clinical data of 167 elderly patients with CHD who underwent PCI in the People ˊs Hospital of Quzhou were retrospectively analyzed.According to the different ways of artery puncture ,the patients were divided into radial artery group(102 cases) and femoral artery group(65 cases).The related conditions in terms of preoperation and postoperation, changes of cardiac function before and after operation ,and occurrence of complications were compared between the two groups.Results The catheter insertion time and X －ray exposure time of the radial artery group were significantly longer than those of the femoral artery group [(3.47 ±1.04) min vs.(2.25 ±0.83) min,(25.17 ±8.49) min vs. (19.31 ±6.31)min,t＝7.974,4.784,all P＜0.05].The time of bed rest in the radial artery group was shorter than that in the femoral artery group [(5.48 ±1.64) h vs.(20.58 ±3.45) h,t ＝38.017,P ＜0.05].There were no statistically significant differences in the number of stents ,stent diameter,stent length,arterial puncture time,contrast agent dosage, postoperative bedridden time , postoperative hospital stay and surgical success rate between the two groups(t＝0.429,0.313,0.157,1.341,0.762,0.637, all P ＞0.05 ).The LVEF of the two groups increased significantly after PCI compared with before PCI [(49.38 ±7.36)%vs.(40.95 ±6.48)%,(49.01 ±6.93)% vs. (41.21 ±7.21)%,t＝8.682,6.288,all P＜0.05],but the LVESD and LVEDD decreased significantly [(52.17 ± 8.40)mm vs.(48.96 ±7.22)mm,(51.48 ±6.95) mm vs.(49.02 ±6.10) mm,(59.87 ±6.49) mm vs.(53.13 ± 5.84)mm,(59.12 ±5.88)mm vs.(52.98 ±5.32)mm,t＝2.927,2.145,7.797,6.243,all P＜0.05].There was no statistically significant difference in cardiac function between the two groups before and after PCI (all P＞0.05). The incidence rates of vascular complications ,local bleeding and local hematoma in the radial artery group were signif－icantly lower than those in the femoral artery group (7.84%vs.21.54%,1.96%vs.15.38%,0.98%vs.16.92%, χ2 ＝6.510,8.808,12.834,all P＜0.05).There were no statistically significant differences in the incidence rates of cardiovascular events between the two groups during PCI and follow －up(4.90% vs.4.62%,8.82% vs.10.77%, χ2 ＝0.082,0.174,all P＞0.05).Conclusion For elderly patients with CHD,transradial and transfemoral PCI have similar short －term and long －term effects, while transradial puncture of patients with local vascular puncture complications significantly can be reduced ,but the puncture time and X －ray exposure time significantly increased.

Research progress of pulse wave velocity applied in cardiovascular diseases / 中国基层医药

Cardiovascular diseases have become the most common and most prevalent chronic diseases in the elderly.Smoking, hyperlipidemia, diabetes and other high-risk factors participate in the occurrence and development of atherosclerosis by impairing the structure and function of the vascular wall, resulting in the occurrence of arterial stiffness.Pulse wave conduction velocity(PWV) is the rate at which a pulse wave travels from one specific location of the artery to another specific location along the wall of the artery.It is a simple, effective and repeatable noninvasive index for evaluating arterial elasticity and vascular function.PWV is closely related to cardiovascular disease.In recent years, the relationship between PWV and cardiovascular disease has been deeply studied.The relationship between PWV and coronary heart disease, hypertension, cardiac function, atrial fibrillation and pulmonary hypertension is described in this paper.

Comparison of the effect of percutaneous coronary intervention via radial and femoral arteries in elderly patients with coronary heart disease / 中国基层医药

Objective@#To compare the effect of percutaneous coronary intervention(PCI) via radial and femoral arteries in elderly patients with coronary heart disease(CHD).@*Methods@#From March 2015 to March 2017, the clinical data of 167 elderly patients with CHD who underwent PCI in the People's Hospital of Quzhou were retrospectively analyzed.According to the different ways of artery puncture, the patients were divided into radial artery group(102 cases) and femoral artery group(65 cases). The related conditions in terms of preoperation and postoperation, changes of cardiac function before and after operation, and occurrence of complications were compared between the two groups.@*Results@#The catheter insertion time and X-ray exposure time of the radial artery group were significantly longer than those of the femoral artery group[(3.47±1.04)min vs.(2.25±0.83)min, (25.17±8.49)min vs.(19.31±6.31)min, t=7.974, 4.784, all P<0.05]. The time of bed rest in the radial artery group was shorter than that in the femoral artery group[(5.48±1.64)h vs.(20.58±3.45)h, t=38.017, P<0.05]. There were no statistically significant differences in the number of stents, stent diameter, stent length, arterial puncture time, contrast agent dosage, postoperative bedridden time, postoperative hospital stay and surgical success rate between the two groups(t=0.429, 0.313, 0.157, 1.341, 0.762, 0.637, all P>0.05). The LVEF of the two groups increased significantly after PCI compared with before PCI[(49.38±7.36)% vs.(40.95±6.48)%, (49.01±6.93)% vs.(41.21±7.21)%, t=8.682, 6.288, all P<0.05], but the LVESD and LVEDD decreased significantly[(52.17±8.40)mm vs.(48.96±7.22)mm, (51.48±6.95)mm vs.(49.02±6.10)mm, (59.87±6.49)mm vs.(53.13±5.84)mm, (59.12±5.88)mm vs.(52.98±5.32)mm, t=2.927, 2.145, 7.797, 6.243, all P<0.05]. There was no statistically significant difference in cardiac function between the two groups before and after PCI (all P>0.05). The incidence rates of vascular complications, local bleeding and local hematoma in the radial artery group were significantly lower than those in the femoral artery group(7.84% vs.21.54%, 1.96% vs.15.38%, 0.98% vs.16.92%, χ2=6.510, 8.808, 12.834, all P<0.05). There were no statistically significant differences in the incidence rates of cardiovascular events between the two groups during PCI and follow-up(4.90% vs.4.62%, 8.82% vs.10.77%, χ2=0.082, 0.174, all P>0.05).@*Conclusion@#For elderly patients with CHD, transradial and transfemoral PCI have similar short-term and long-term effects, while transradial puncture of patients with local vascular puncture complications significantly can be reduced, but the puncture time and X-ray exposure time significantly increased.