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Hemodynamic effects and safety of pulmonary angiography in Chinese patients with pulmonary hypertension

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Chinese Medical Journal 2011年第20期124卷 3232-3237页

作者： ZHANG Hong-liang WANG Yong LIU Zhi-hong XIONG Chang-ming ni xin-hai HE Jian-guo LUO Qin ZHAO Zhi-hui ZHAO Qing SUN xing-guo Center for Pulmonary Vascular Diseases Fuwai Hospital and Cardiovascular Institute Peking Union Medical College and Chinese Academy of Medical Sciences Beijing 100037 China Respiratory and Critical Care Physiology and Medicine Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center St. John＇s Cardiovascular Research Center 1124 West Carson Street RB2 Box405 Torrance California 90502 USA

Background Pulmonary angiography is widely performed in pulmonary hypertension patients, but its immediate effects on right heart hemodynamics and safety are not well known. The objective of this study was to investigate the right heart hemodynamic effects and safety of pulmonary angiography in Chinese patients with pulmonary hypertension. Methods Between January 2008 and June 2009, pulmonary hypertension patients undergoing pulmonary angiography were consecutively enrolled. Pulmonary angiography was performed during breath-holding after deep breathing. The baseline clinical data, hemodynamic measurements before and after pulmonary angiography and complications occurring within 48 hours after angiography were recorded. Results ninety-five patients were included. All received non-ionic contrast medium with a volume of （75.7±29.8） ml. Angiography reduced heart rate in patients with baseline mean pulmonary arterial pressure 〉 60 mmHg （change of heart rate：（-3.1±7.0） beats/min, P=0.005）, increased mean right atrial pressure, diastolic and end-diastolic right ventricular pressure in patients with baseline mean pulmonary arterial pressure 〈60 mmHg （all P 〈0.05）. Patients with decreased mean pulmonary arterial pressure （change of mean pulmonary arterial pressure 〈 -10 mmHg） had the highest total pulmonary resistance （P=0.009 vs. no change in mean pulmonary arterial pressure （change of mean pulmonary arterial pressure, -10 mmHg to 10 mmHg）; P=0.03 vs. increased mean pulmonary arterial pressure （change of mean pulmonary arterial pressure 〉 10 mmHg）） and the lowest cardiac output （P=-0.018 vs. no change in mean pulmonary arterial pressure; P=0.013 vs. increased mean pulmonary arterial pressure）. There were 7 complications （7%）, with 6 related to catheter and only 1 directly related to angiography. All complications were mild and no death occurred. Conclusion Pulmonary angiography has minimal effect on right heart hemodynamics and is safe in pulmonary hypertension patients.

关键词： pulmonary hypertension pulmonary angiography contrast medium hemodynamics complication

Acute responses to inhalation of Iloprost in patients with pulmonary hypertension

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Chinese Medical Journal 2012年第16期125卷 2826-2831页

作者： ZHANG Hong-liang LIU Zhi-hong WANG Yong XIONG Chang-ming ni xin-hai HE Jian-guo LUO Qin ZHAO Zhi-hui ZHAO Qing SUN xing-guo Center for Pulmonary Vascular Diseases StateKey Laboratory of Cardlovascalar Disease Fuwai Hospital National Center for Cardiovascalar Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Laboratory of Cardiopulmonary Exercise Testing StateKey Laboratory of Cardlovascalar Disease Fuwai Hospital National Center for Cardiovascalar Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background Iloprost has been used to test acute pulmonary vasoreactivity in idiopathic pulmonary arterial hypertension （PAH）. We aimed to investigate the acute hemodynamic and oxygenation responses and tolerability to 20 pg aerosolized Iloprost in Chinese patients with pulmonary hypertension. Methods Between March 2005 and May 2010, 212 pulmonary hypertension patients inhaled a single dose of 20 pg Iloprost over 10-15 minutes for vasoreactivity testing. The acute hemodynamic and oxygenation responses and adverse events were recorded. Results Iloprost decreased total pulmonary resistance （（1747±918） dyn.s-cm-5 vs. （1581±937） ***-5, P 〈0.001）, increased stroke volume （（45.0±22.1） ml vs. （47.0±24.2） ml, P=0.002）, and cardiac output （（3.7±1.7） L/ml vs. （3.9±1.9） L/min, P=0.009）. Heart rate and systemic vascular resistance remained stable during inhalation. However, systemic arterial blood oxygen saturation fell slightly （（91.0±6.8）% vs. （90.3±6.7）%, P=0.002）. Pulmonary and systemic arterial blood pressures declined within 1-3 minutes after inhalation initiation and reached their lowest levels within 10-15 minutes. Idiopathic PAH responded more favorably than pulmonary hypertension due to other causes （P 〈0.001） and patients with less severe pulmonary hypertension have better responses to Iloprost. No adverse events requiring medical care or leading to termination of inhalation occurred. Conclusions Inhalation of 20 pg Iloprost showed potent and selective pulmonary hemodynamic effects and was well tolerated in the Chinese pulmonary hypertension patients. Patients with idiopathic PAH and less severe pulmonary hypertension responded more favorably to inhalation of Iloprost.

关键词： pulmonary hypertension, pulmonary arterial hypertension, Iloprost hemodynamics

Changes of the proportion and mortality of pulmonary thromboembolism in hospitalized patients from 1974 to 2005

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Chinese Medical Journal 2006年第12期119卷 998-1002页

作者： TAN Xiao-yan HE Jian-guo ZOU Zhi-peng ZHAO Yan-fen CHEN Bai-ping GAO Ying XIONG Chang-ming ni xin-hai CHENG Xian-sheng Centre of Diagnosis and Management of Pulmonary VascularDiseases Fuwai Hospital Chinese Academy of Medical Sciences＆ Peking Union Medical College Beijing 100037 China

Background Pulmonary thromboembolism （PTE） has become a common disease that severely endangers people＇s health. This study analysed the changes in proportion and mortality of PTE in hospitalized patients to provide data for prevention and management of the disease. Methods The data of 763 hospitalized patients with PTE from 1974 to 2005 in Fuwai Hospital were analysed. Results During the 1970s, 0.27% of patients in a cardiovascular hospital had PTE （〈 5 cases per year）; while so far this century the proportion is 0.94% （48 to 113 per year）. The mortality of hospitalized PTE patients fell from 20.00% in the 1970s to 4.10% this century. Prior to 1990, the mortality of hospitalized PTE patients was 12.50%, and in the years after 1990 only 3.40%. The difference was statistically significant （P〈0.005）. People with this disease were mostly between the ages of 30 and 69 years. Men were most susceptible between the ages of 30 and 69 years, while women between the ages of 40 and 69 years. Men contracted PTE 10 years earlier than women. The mortality of male PTE patients was 4.70%, not significantly different from female patients, 5.06% （0.50〈P〈0.75）. There were not any significant differences between the mortality of patients in the different age groups overall （≤39, 40-49, 50-59, and ≥60 years, P〉0.1）. More people contracted the disease in winter than in other seasons （P〈0.05）. There was no obvious difference between the mortality in different seasons overall （0.75〈P〈0.90）. Conclusion PTE is an increasingly significant disease and deserves adequate attention.

关键词： pulmonary thromboembolism mortality proportion of hospitalization

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清华大学艺术博物馆暖通空调设计

建筑热能通风空调 2013年第5期32卷 97-100,49页

作者：倪歆海杨佳中国建筑科学研究院

本文介绍了清华大学艺术博物馆空调系统的设计情况,系统冷源采用冰蓄冷空调系统,空调设备机房集中布置,以适应博物馆建筑的功能特点。根据建筑功能及对室内温湿度要求,藏品库和展厅采用恒温恒湿空调,其他区域采用舒适性空调。

关键词：博物馆冰蓄冷空调恒温恒湿

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心脏白塞氏病

心血管病学进展 2000年第5期21卷 296-298页

作者：牟德华倪新海中国医学科学院

白塞氏病(Behcet's disease;BD)是一种以广泛的血管炎及多系统受累为基本表现的疾病,与自身免疫异常有关.当心脏受累时称为心脏白塞氏病(CardioBehcet's Disease;CBD).随着对BD研究的深入,有关CBD的报道也逐渐增多.现就其目前的研究进... 详细信息

白塞氏病(Behcet's disease;BD)是一种以广泛的血管炎及多系统受累为基本表现的疾病,与自身免疫异常有关.当心脏受累时称为心脏白塞氏病(CardioBehcet's Disease;CBD).随着对BD研究的深入,有关CBD的报道也逐渐增多.现就其目前的研究进展综述如下.

关键词：心脏白塞氏病流行病学诊断治疗

核素肺显像在慢性血栓栓塞性肺动脉高压诊断和定量评价的应用

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中华心血管病杂志 2008年第1期36卷 7-10页

作者：方纬倪新海何建国柳志红熊长明何作祥中国医学科学院北京协和医学院阜外心血管病医院核医学科 100037 中国医学科学院北京协和医学院心肺循环研究室 100037

目的评价放射性核素肺灌注／通气（Q／V）显像在慢性血栓栓塞性肺动脉高压（CTEPH）诊断和定量评价中的价值。方法78例肺动脉高压住院患者，经超声心动图排除了瓣膜性心脏病和先天性心脏病引起的肺动脉高压，且既往无急性肺栓塞病史。... 详细信息

目的评价放射性核素肺灌注／通气（Q／V）显像在慢性血栓栓塞性肺动脉高压（CTEPH）诊断和定量评价中的价值。方法78例肺动脉高压住院患者，经超声心动图排除了瓣膜性心脏病和先天性心脏病引起的肺动脉高压，且既往无急性肺栓塞病史。所有患者均接受Q／V显像，并以肺动脉造影确诊，分别计算Q／V显像对CTEPH的诊断敏感性、特异性和准确性。对肺动脉造影确诊为CTEPH患者的肺灌注显像进行定量分析，计算全肺灌注缺损百分数（PPDs％），并对PPDs％分别与平均肺动脉压（mPAP）、肺动脉收缩压（SPAP）进行相关性分析，并进行统计学检验。结果以高度可能分级作为CTEPH的诊断标准，Q／V显像的诊断敏感性、特异性和准确率分别为96．0％，81．1％和86．9％；而如果将高度和中度可能分级均作为CTEPH的判断依据，则分别为100％，69．8％和79．5％。PPDs％与mPAP和SPAP均具有直线相关性，PPDs％与mPAP，r=0．538，P〈0．01；PPDs％与SPAP，r=0．456，P〈0．05。结论Q／V显像是CTEPH诊断和定量评价的有价值的无创性影像学方法。

关键词：高血压,肺性肺栓塞放射性核素显像

睡眠呼吸暂停对充血性心力衰竭患者预后的影响

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中国循环杂志 2010年第3期25卷 192-195页

作者：罗勤陶新曹柳志红赵智慧熊长明倪新海中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院肺血管病诊治中心北京市100037 北京友谊医院急诊科

目的:评价睡眠呼吸暂停对充血性心力衰竭(CHF)患者预后的影响。方法:前瞻性病例对照研究。对年龄大于18岁、左心室射血分数≤0.45和纽约心功能分级(NYHA)Ⅱ～Ⅳ级的患者进行睡眠呼吸监测,根据结果分为CHF不合并睡眠呼吸暂停组、CHF合并... 详细信息

目的:评价睡眠呼吸暂停对充血性心力衰竭(CHF)患者预后的影响。方法:前瞻性病例对照研究。对年龄大于18岁、左心室射血分数≤0.45和纽约心功能分级(NYHA)Ⅱ～Ⅳ级的患者进行睡眠呼吸监测,根据结果分为CHF不合并睡眠呼吸暂停组、CHF合并阻塞型睡眠呼吸暂停组和CHF合并中枢型睡眠呼吸暂停组。并对其进行随访。随访结束时比较各组间死亡率。结果:共入选128例患者,其中男性105例,女性23例。128例入选患者中,CHF不合并睡眠呼吸暂停组23例、CHF合并阻塞型睡眠呼吸暂停组55例和CHF合并中枢型睡眠呼吸暂停组50例。平均随访35个月。不合并睡眠呼吸暂停组死亡率明显低于中枢型睡眠呼吸暂停组(分别为6.72/100人年和18.22/100人年,P=0.017),非存活患者中CHF合并睡眠呼吸暂停的比例明显高于存活者(分别为90%和79%,P=0.017)。多元分析显示校正年龄、性别、体重指数等混杂因素后,不管睡眠呼吸暂停的发生(包括OSA或CSA),还是睡眠呼吸暂停的严重程度(如呼吸暂停低通气指数和最低血氧饱和度)与CHF患者全因死亡均无明显独立相关。结论:CHF合并中枢型睡眠呼吸暂停患者死亡率高于不合并睡眠呼吸暂停的CHF患者,多因素分析显示睡眠呼吸暂停对CHF患者的预后未达独立相关作用。

关键词：死亡率预后心力衰竭,充血性阻塞型睡眠呼吸暂停中枢型睡眠呼吸暂停

症状性大脑中动脉缺血患者脑血管储备能力的变化及其相关因素

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神经损伤与功能重建 2017年第1期12卷 25-27页

作者：黄忠卫陈刚倪海鑫江苏省海门市人民医院神经内科江苏海门226100

目的:观察症状性大脑中动脉(MCA)缺血患者脑血管储备能力(CVR)的变化,探讨其相关影响因素。方法:收集症状性MCA缺血患者50例为观察组,同时选取健康成年人50例为对照组。比较2组CVR的差异,分析不同临床病理特征的MCA患者CVR能力的差异,... 详细信息

目的:观察症状性大脑中动脉(MCA)缺血患者脑血管储备能力(CVR)的变化,探讨其相关影响因素。方法:收集症状性MCA缺血患者50例为观察组,同时选取健康成年人50例为对照组。比较2组CVR的差异,分析不同临床病理特征的MCA患者CVR能力的差异,分析影响MCA患者CVR能力的因素。结果:观察组的CVR明显低于对照组,有显著性差异(t=6.276,P<0.001);年龄≥65岁、合并高血压、合并高脂血症、有吸烟史的症状性MCA患者其CVR较低;多因素分析显示,合并高脂血症、合并高血压和吸烟史是影响患者CVR能力的因素。结论:症状性MCA缺血患者CVR较低,且与患者是否合并高脂血症、高血压、吸烟史密切相关。

关键词：症状性大脑中动脉缺血脑血管储备能力多重逐步回归影响因素

B型尿钠肽水平对急性心肌梗死患者心源性死亡的预测价值

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中华内科杂志 2007年第6期46卷 450-453页

作者：杨跃进毛懿倪新海陈纪林高润霖陈在嘉中国医学科学院中国协和医科大学阜外心血管病医院冠心病诊治中心北京100037

目的探讨急性心肌梗死(AMI)患者血 B 型尿钠肽(BNP)水平预测死亡的价值。方法对264例 AMI 患者随访(14.7±5.3)个月,随访率为87.1%。检测肌酸激酶同工酶(CK-MB)、肌钙蛋白(TnT)、左室舒张末径、左室射血分数和 BNP,并绘制受试者工作特... 详细信息

目的探讨急性心肌梗死(AMI)患者血 B 型尿钠肽(BNP)水平预测死亡的价值。方法对264例 AMI 患者随访(14.7±5.3)个月,随访率为87.1%。检测肌酸激酶同工酶(CK-MB)、肌钙蛋白(TnT)、左室舒张末径、左室射血分数和 BNP,并绘制受试者工作特性曲线(ROC)对比评价BNP 等指标对 AMI 后心源性死亡的预测价值。结果 ROC 曲线显示仅 BNP 能预测心源性死亡。据ROC 曲线定864ng/L 为最佳分界值时,预测 AMI 后1、6个月和1年时心源性死亡的敏感性、特异性、准确度、阳性和阴性预测值分别为76.2%～92.9%、84.3%～85.6%、82.2%～86.1%、21.3%～36.2%和97.3%～98.9%。多元回归分析显示 BNP 是预测 AMI 后近、远期心源性死亡的独立危险因素(P864ng/L 组(97.3%比72.3%,P<0.001),死亡者中位生存时间在前者亦显著长于后者(16.0比10.7个月,P<0.01),且与急诊 PCI 和 ST 段抬高与否无关。结论与传统指标相比 BNP 水平能预测 AMI 患者心源性死亡,且预测作用最佳。

关键词：心肌梗塞利钠肽,脑死亡率