窦性激动经房室结双径路前传双重激动心室致心动过速的电生理特点

目的:研究窦性冲动沿房室结双径路同时前传导致心动过速的电生理机制,探讨房室结快、慢径同时传导的影响因素。方法:56岁男性患者,室上性心动过速无休止发作,抗心律失常药物无效,心电生理检查明确心律失常性质,射频消融改良房室结。结果:心动过速时,记录食道电图P波后两个QRS波群呈P-QRS1-QRS2型;希氏束电图示A-H1-V1-H2-V2,心房激动沿双径同时前传时快径文氏或高度阻滞、慢径不典型文氏阻滞;心房内电生理刺激诱发出1∶2房室激动现象,呈S-A-H1-V1-H2-V2;快径不应期430 m s,慢径不应期260 m s;房室结区无室房逆传功能。P-P间期≤0.72 s,1∶2房室传导多见。射频消融改良慢径后,心动过速终止,房室传导为1∶1。随访3月未再发作心动过速,心脏结构与功能正常。结论:房室结双径路同时前传窦性冲动引起心动过速为非折返性心动过速。快/慢径前传不应期、传导时间差异及房室结区无室房逆传特性、窦性频率变化可能是窦性冲动能否同时沿双径路前传双重激动心室的影响因素。射频消融可根治此类心律失常。     

静脉注射地尔硫卓对左侧隐匿性房室旁道患者心内电生理的影响

目的 观察单剂静脉注射地尔硫卓对左侧隐匿性房室旁道患者心内电生理的影响。方法 对反复发作阵发性心动过速患者行心内电生理检查，对明确诊断为左侧隐匿性房室旁道且诱发出房室折返型室上性心动过速(AVRT)者，单剂静脉注射地尔硫卓(剂量按0．25mg/kg体重计算)转律，观察其转律效果、用药前后心内电生理的变化。结果 对心内电生理的影响中除H—V间期在用药前后无明显变化外，P—P间期、A—H间期明显延长，对房室结的传导功能有明显阻滞作用，而对室房旁道阻滞点无影响，对心房有效不应期(AVNERP)和房室结有效不应期(AVNERP)的增加也非常明显，单剂静注地尔硫卓转律的成功率为73．3％，且AVRT中止于房室结顺传。结论 除H—V间期外，地尔硫卓对心内电生理的影响显著，且能有效转律阵发性室上性心动过速(PSVT)，其折返中止于房室结，对房室旁道无影响。     

射频消融房室结改良术对房室结电生理功能的影响

比较２３例房室结折返心动过速经导管射频消融房室结改良术治疗前后房室结电生理变化，结果发现，快径前传下不应期明显缩短（Ｐ〈０．０１），且在慢径阻断组与改良组间无明显差异；在慢径改良组，术后前传不应期明显延长（Ｐ〈０．０１），而房室结前传文氏点，房室结逆传不应期，逆传文氏点均无明显的变化，提示射频消融房室结改良术仅影响房室结快径和慢径的前传不应期，对房室结逆传功能无明显影响。     

房室结双径路伴房室结折返性心动过速的室房传导探讨

根据电生理检查结果，将接受射频消融术患者６２例分为房室旁道伴房室折返性心动过速３２例，房室结双径路伴房室结折返性心动过速３０例。以房室旁道伴ＡＶＲＴ室房传导特征为对象，探讨ＤＡＶＮＰ伴ＡＶＮＲＴ ＶＡ传导特征。结果表明ＤＡＶＮＰ伴ＡＶＮＲＴ其ＶＡ传导发生率为１００％；室房逆传多经房室结快径；快径逆传具有房室旁道逆传特征。     

普鲁卡因静脉复合麻醉对犬心脏传导系统的电生理作用

本文采用希氏束电图法研究了普鲁卡因、芬太尼、琥珀胆碱静脉复合麻醉对犬心脏传导系统的电生理作用。实验发现,此麻醉方法可使A-H间期、H-V间期延长,AVNERP、VERP延长,HR减慢。说明其对窦房结、房室结、希浦系统和心室均有抑制作用。结果提示普鲁卡因静脉复合麻醉具有抗房室结折返型心律失常和异位自律性增强所致心律失常的作用。     

罗通定在预激综合征病人中的临床电生理作用

中华心血管病杂志1993；21（5）：286作者在静脉注射罗通定治疗室上性心动过速（SVT）获得较好的临床疗效基础上，又观察了14例预激综合征伴快速室上性心律失常患者用该药（2mg／kg）后的急性电生理效应。结果该药明显延长A-H间期、房室结有效不应期和房室结文氏周长，对窦房结功能无明显影响，延长旁路前传时间及旁路前传有效不应期，明显延长心房有效不应期，防止程序电刺激诱发SVT有效率达77.8％。作者认为其结果主要由于：①房室结有效不应期延长较旁路正传有效不应期延长明显，两者有效不应期离散度减小，②明显抑制房室结传导，激…     

室房间期差值对间隔部旁道与快径逆传心动过速的鉴别诊断价值

[目的]研究间隔部旁道参与的和房室结功能连续曲线性快径逆传的室上性心动过速的电生理特征,为射频治疗提供准确的定位依据.[方法]选择10例间隔旁道介导的房室折返性心动过速(AVRT,旁道组)与10例房室结功能连续曲线的房室结折返性心动过速(AVNRT,房室结组)病人,分别在与心动过速相同的频率起搏右心室及心动过速发作时,测量希氏束(HBE)、冠状窦近端(CS9-10)导联记录的室房传导间期(VAVP和VASVT)及两者差值△VA(VAVP-VASVT).[结果]①房室结组心室起搏与心动过速时VA间期差异显著(P＜0.001),而旁道组差异无显著性(P＞0.05);②心室起搏时旁道组与房室结组的VAVP相比差异无显著性(P＞0.05);③心动过速时VA间期旁道组明显长于房室结组,两者相比VASVT差异显著(P＜0.001);④旁道组△VA与房室结组比较差异显著(P≤0.001).[结论]CS9-10导联△VA是鉴别隐性间隔部旁道介导的AVRT与AVNRT的重要参考指标,特别对房室结功能连续曲线性房室结折返性心动过速的鉴别有较高价值.     

美托洛尔注射液对房室结双径路功能的影响

目的评价美托洛尔注射液对房室结双径路功能的影响.方法11例房室结折返性心动过速的病人在行射频消融术治疗前接受电生理试验,比较静推美托洛尔注射液(0.1 mg/kg)前后房室结双径路前传有效不应期和传导速度的变化.结果静推美托洛尔注射液后,快径有效不应期由338.2±56.4 ms延长至376.4±53.3 ms(P＜0.01),快径路传导速度由191.8±48.1 ms延长至218.2±42.9 ms(P＜0.05);慢径路的有效不应期和传导速度在静推美托洛尔注射液后无显著改变.结论(1)美托洛尔注射液主要影响快径路的有效不应期和传导速度,对慢径路无明显影响.(2)推测房室结的快慢径路是由具有不同电生理特性的细胞参与组成.     

多旁道及旁道伴房室结双径的射频消融

目的:总结多旁道及旁道伴双径的电生理特点及射频消融方法.方法:多旁道11例,其中体表心电图呈显性预激3例,正常8例;治疗采用先消融显性旁道,后消融阻断所有旁道顺序.旁道伴双径21例,电生理检查中观察PSVT发作时前传及逆传途经,然后对AP或SP进行消融治疗.结果:多旁道11例,共22条AP,成功率100%.旁道伴双径21例,其中慢径前传-旁道逆传10例,快径前传-旁道逆传4例,慢径-旁道折返伴快径-旁道折返2例,慢-快径交替前传折返2例,慢径前传-快径逆传(旁道旁观)3例.21例患者均作AP消融,诱发AVNRT者作SP消融.术后随访半年均无复发及并发癌.结论:多旁道及旁道合并双径多需经腔内电生理检查才能被确诊,体表心电图可提供某些诊断线索.逐条消融是可避免多旁道的漏诊漏治;AP合并双径者,无论旁道是否作为旁观者,治疗关键是阻断旁道,旁道消融后应常规再次做房室结电生理检查,如仅有AH跳跃,不必接受房室结改良.     

右室流出道和右室心尖部起搏对心肌复极离散度的影响

目的:探讨右室流出道(RVOT)和右室心尖部(RVA)起搏时心电图心肌复极标志的变化及不同起搏方式对心肌复极离散度的影响。方法:选取我院因三度房室传导阻滞安装DDD起搏器的患者68例,将心室电极分别置于RVOT或RVA,术前及术后1周观测体表心电图的QRS时限、QTc间期、Tp-ec间期和Tp-e/QT。结果:术后两组QRS时限、QTc、Tp-ec间期及Tp-e/QT比值较术前均延长,且RVA组较RVOT组延长显著(P<0.05)。结论:与RVA起搏比较,RVOT起搏对心电同步性及心肌复极离散度、跨壁复极离散度(TDR)影响较小。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.