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Jingdong book

国家心血管病中心专家答疑丛书:心律失常专家解读290问

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《国家心血管病中心专家答疑丛书:心律失常专家解读290问》是目前一本较全面介绍心律失常的通俗科普读物。内容编排上采用问答式,以门诊和日常生活中人们*常见、*疑惑的有关心律失常的问题,诸如病名所指、常规诊断名词所指、治疗手段名称所指、手术并发症名词所指、用药药名药理等多方面进行了深入浅出的解释。
《国家心血管病中心专家答疑丛书:心律失常专家解读290问》不仅可帮助广大心律失常患者,对其他注重保健意识的社会阶层,甚至非心律失常专业的心内科医生及其他专业的医生,帮助其利用碎片化的业余时问从一个个日常具体问题人手,逐步理解晦涩艰深的心律失常都具有极强的实用性。
Author Description

贾玉和,男,医学博士,主任医师,中国医学科学院阜外医院第22病区副主任。中国医学科学院北京协和医学院硕士研究生导师。中华医学会心电生理和起搏分会第五届青年委员。中国民族医药学会心血管组常委,九三学社北京市委科技委员会委员。
从1998年起从事临床心律失常的电生理检查和射频消融治疗工作。目前主要致力于经导管射频消融治疗各类心房颤动,同时对心肌梗死后恶性室性心动过速、外科手术后瘢痕性室速、心房扑动、室上性心动过速等均有多年的消融经验和较深的消融体会。2009年、2010年曾分别于美国Mayo Clinic心律失常中心、德国Asklepios Klinic St.Georg电生理中心进行学术交流、访问。2015年1月在国内首次引进和开展心腔内三维超声导管辅助房颤射频消融的工作,为对造影剂过敏、甲状腺功能异常及肾功能不全的房颤患者开辟了新的治疗选择。

张澍,男,1959年5月生,江苏人,国家心血管病中心、中国医学科学院阜外医院心内科主任,心律失常中心主任,博士生导师。牵头完成多项包括国家“十五”“十一五”等重大课题,发表文章200余篇,获国家科技进步奖等多个奖项。目前兼任中国医学科学院学术委员会委员、中华医学会心电生理和起搏分会前任主任委员、中国医师协会心律学专业委员会主任委员、中国老年保健医学研究会理事兼老年康复分会副会长、北京市医学会心电生理和起搏分会主任委员、中华医学会心电生理和起搏专科医师培训中心主任、卫生计生委心血管介入诊疗管理专家工作组组长、国家卫生计生委心律失常介入治疗质控中心主任、国家医学考试心血管病医师考试委员会主任、《中华心律失常学杂志》总编辑。International of Heart Rhythm主编,美国心律学会Fellow、欧洲心脏学会Fellow、亚太心律学会(Asia-Pacific Heart Rhythm Society)副主席,世界心律失常学会(World society of Arrhythmias)候任主席,欧洲心脏起搏杂志(Europace)、亚太心律学会杂志(J of Arrhyth-mia)、美国《Joumal of Innovations in Cardiac Rhythm Management》国际编委。第十、第十一届北京市政协委员,第十一、第十二届全国政协委员。
Catalogue

第一部分 正常心脏的结构和功能
1.什么是心脏的正常解剖结构?它是一个怎样的器官?
2.心脏为什么能够自主跳动?为什么能够泵血?
3.什么是心脏的力学系统?它由哪些结构构成?
4.什么是心脏的电学系统?
5.心脏电学系统由哪些结构构成?
6什么是窦房结?
7.什么是房室结?
8.什么是希氏束?
9.什么是束支?
10.什么是浦氏纤维?

第二部分 心律失常概述
11.什么是心律失常?
12.心律失常有哪些大概类型?
13.什么叫“心动过速”?它会有哪些症状?
14.心动过速包括哪些类型?
15.什么是心动过缓?它有哪些症状?
16.什么叫早搏?
17.早搏有哪些类型?
18.早搏可有哪些症状?有哪些危害?
19.什么是窦性心律?窦性心律是异常心律吗?
20.什么是窦性心律失常?它包括哪些类型?
21.什么叫窦性心动过速?它是心律失常病吗?
22.什么叫窦性心动过缓?它是心律失常病吗?
23.什么叫窦性心律不齐?它是心律失常病吗?
24.什么是“窦房传导阻滞”?
25.什么叫慢一快综合征?
26.什么叫“快一陧综合征”?
27.什么叫“病态窦房结综合征”?
28.什么是房性心动过速?
29.什么是心动过速的“耐受”现象?耐受现象有益处吗?
30.什么叫心动过速性心肌病?
31.什么是房性早搏?为什么有的房性早搏易诱发房颤?
32.什么是加速性交界性心动过速?
33.什么叫室上性心动过速?它包括哪些类型?
34.什么是交界性早搏?什么叫逸搏?
35.什么是室性心动过速?包括哪些类型?
36.什么是室性早搏?
37.什么叫流出道室早?
38.什么叫流人道室早?
39.为什么流出道和流人道这些区域易产生早搏?
40.为什么说导管射频消融是治疗流出道室早和流人道室早的最佳方法?
41.什么是乳头肌室早?
42.什么是“假腱索”?它与心律失常有何关系?
43.什么是房室阻滞?
44.房室阻滞包括哪些类型?
45.儿童先天性三度房室阻滞需装心脏起搏器吗?
46.什么是束支阻滞?束支阻滞包括哪些?
47.束支阻滞有危险吗?
48.单侧束支阻滞患者可以怀孕吗?可以剖腹产吗?可以做其他手术吗?
49.什么是良性心律失常和恶性心律失常?
50.如何评价心律失常的危险性?即如何对心律失常进行危险分级?
51.什么是器质性心律失常?
……

第三部分 心律失常专科门诊就诊要点
第四部分 导管消融部分
第五部分 心房颤动
第六部分 起搏器
第七部分 晕厥和猝死
第八部分 心律失常的药物治疗
第九部分 门诊、住院实用指南和流程
Book Abstract

《国家心血管病中心专家答疑丛书:心律失常专家解读290问》:
早搏非常常见,任何人一生中没有不发生过早搏的,只不过有的人症状明显而来医院就医检查才发现,有的人症状不明显根本未就医而已。医生判断早搏的好坏或严重程度,主要取决于两个方面:①该早搏是发生在已有病变的心脏还是正常的心脏上。若是前者则需慎重对待,若是后者则只需缓解症状即可。②该早搏引起的直接相关症状的严重程度如何。所谓直接的相关症状,指的是早搏引起的,诸如突然胸憋、胸痛、头晕、脸红发热、一脚踩空感等,这些是早搏可以引起的症状。而许多中年女性的症状多数与更年期失眠有关(如手心、脚心潮热,头晕,耳鸣,后背持续发紧等),只是其他原因就医时顺带发现了早搏。早搏与这些症状是并行的关系,切不可将此并行关系主观上判定为因果关系,最后发展为对早搏的心理畏惧,进而失眠、疑病,如此就不值当了。
一般讲,房早引起的症状要小于室早,因为在室早后多有一个较长的代偿间期,即室早后有一短暂的无心跳时期,此时可产生短暂的胸憋闷、一脚落空感等。而在这个短暂的无心跳代偿期过后,心脏再次正常跳动时,由于其前有一个短暂代偿期,一方面使返回到心室的血液大大增加,另一方面使每个心肌细胞内的钙离子浓度也大大增加,这两方面的原因使早搏过后这次的心脏搏动格外有力,会引起左乳区撞击感、心脏扭动感伴有一过性头晕、颜面潮热感等多种症状。
对早搏的治疗主要也从以上两方面考虑,并不是将早搏治疗的一个没有才算成功。
……
Introduction

本人从事心血管内科工作近20年,从事心律失常诊治工作也10余年了。有个鲜明的感受:向朋友或患者解释冠心病发病机制和心脏支架植入术时明显生动有力,看得出别人也很容易理解。但每每向朋友介绍自己的工作内容时,朋友总觉得不太理解。什么是心律失常?什么是电生理?这些拗口的名词具体指的是什么?无论如何解释不清。最后只能笼统地讲,心律失常科就诊治两种病:一种是心跳太快的,可用导管射频消融治疗;一种是心跳太慢的,有时需装心脏起搏器。关于心脏起搏器大家好像有所了解,而关于射频消融又不了解啦,得接着解释……
在门诊同样如此,当患者向你抱怨,他的室性早搏药吃了好久还未见好,你向他介绍用导管射频消融治疗既快又好时,患者会很惊愕地看着你,然后提出一系列问题,不说别的,只向患者介绍这些概念和如何操作、有哪些危险等就需耗费至少10分钟,还不知是否解释清楚了。
经过门诊介绍,患者及家属再上网查询,许多概念大致了解了,患者住院准备接受射频消融治疗或起搏器植入,但面对手术签字单上那么多并发症项目肯定胆寒了,于是一遍遍找手术医生咨询,托熟人下保证,而专家却很少能给准话……
还有的患者已住院接受了射频消融治疗或起搏器治疗,但出院后看不懂出院医嘱,不知术后如何护理,在生活中需注意哪些问题,如何到医院复查等。尤其稍有不适时紧张得不得了,怀疑自己手术没做好,或病情恶化了,甚至有人怀疑自己的病“转移了”,导致精神压力加大,失眠、焦虑,甚至轻生的都有。
有感于每天重复着同样的话但面对的却是不同的人群时,就会产生办个讲座或写个小册子的念头。但真正实施起来才发现并不简单。这是因为,心律失常太专业了,许多名词是从外文翻译过来的,而且还很庞杂,要将这些专业名词用大白话讲出来是有相当难度的。有的甚至不可能。就像想用白话文翻译佛经的某些概念一样,是相当困难和忐忑的。因此,本手册只对日常诊疗中常用的诊断、治疗名词和目前一些新的治疗进展做一通俗的解释和介绍,对不影响患者理解的已经通俗化的专业名词不做过多解释。

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