体内起搏器间断接触法在起搏器置换中的应用

目的探讨起搏器高度依赖性患者起搏器置换时,体内起搏器间断接触法的方法与疗效.方法对22例起搏器高度依赖性患者,在起搏器与电极的接口松解前,应用体内起搏器间断接触法,使自身逸搏心律得以恢复,然后再松解接口并进行必要的起搏参数测试.结果起搏器体外次数3～8(5.3±2.2)次,最长逸搏间期为3.10～6.80(4.70±1.22)s,自身逸搏心率为30～45(38.4±5.3)次/min,均顺利完成起搏器置换.结论体内起搏器间断接触法切实可行,能明显提高起搏器高度依赖性患者起搏器置换的安全性.     

起搏器电极线部分损伤心电图变化1例

1 临床资料 患者,男,83岁,体质量指数19.4,于2004年10月因病态窦房结综合征行永久人工心脏起搏器(DDD)置入术.术后未定期复检.2009年6月10日,患者因活动时出现晕厥于当地医院就诊,发现心率慢(40次/分左右)而再次到本科就诊.入院时心电图如图1所示,起搏器工作正常.但活动时再次感头昏,无黑朦和晕厥,心电图如图2,起搏器仅有电信号,不能正常带动心房和心室,患者为室性逸搏心律,频率28次/分,伴有心房反复搏动,心室率为56次/分左右.     

永久起搏器治疗指南

按 :Ⅰ级为安装永久起搏器适应证 ;Ⅱ级为是否需要安装永久起搏器意见分歧 ;Ⅲ级为认为不需要安装永久起搏器。Ⅰ　成人获得性房室传导阻滞 (ＡＶＢ)Ⅰ级 　 1　任何解剖部位、持续或间歇性的、Ⅲ度房室传导阻滞伴下列任一并发症 ;ａ　有症状的心动过缓。症状与ＡＶＢ有关 ,而非另外原因引起。ｂ　充血性心力衰竭。ｃ　Ⅲ度ＡＶＢ伴异位节律和一些需要用药物抑制逸搏点的自律性从而导致有症状的心动过缓。ｄ　在无症状病人中记录到停搏时间≥ 3.0ｓ或逸搏心率 <40次 /ｍｉｎ。ｅ　意识模糊状态下 ,安装永久起搏器后意识转清。ｆ　房室交接区…     

县级医院安置永久性心脏起搏器5例报告

人工心脏起搏器为治疗缓慢性心律失常的有效方法 ,但技术条件及设备条件要求较高 ,我省县级医院能独立开展此项工作者甚少。 1998年 12月至 1999年 9月 ,我院共安置永久性心脏起搏器 5例 ,现报告如下。1　临床资料见表 1。表 1　 5例安置永久起搏器患者的情况例号性别年龄 临床诊断心电图发现 安置时间起搏器型号例 1男 6 7冠心病、病窦综合征、昏厥、阿斯综合征严重窦缓、快速房颤、多型室速 PSV T( 16 6～ 172次 /分 )、交界区逸搏、窦性停博 ( 9～ 14秒 )4天 Prem ier730 1例 2女 2 7扩张型心肌病、病窦综合征、昏厥交界区逸搏心律 ( 3…     

起搏器更换原因分析及健康教育

目的:回顾性分析埋藏式起搏器更换原因,并对不同的更换原因提出健康教育措施.方法:共82例96例次更换起搏器,其中、男38例,女44例;年龄15～95(58.26±16.85)岁.其中,69例更换1次,12例更换2次,1例更换3次.我院植入76例,外院植入6例.结果:起搏器电池耗竭80例次,其中,自然耗竭64例次,提前耗竭16例次.电极导线断裂或绝缘层破裂3例.电极脱位和微脱位7例.由于起搏器的技术进步提前更换2例,起搏器囊袋感染并外露3例,起搏器位置移动1例.结论:起搏器更换原因多为电池耗竭或使用时间已到质保期.少见的原因是起搏器植入并发症.针对性的健康教育能让病人最大获益.     

63例次永久起搏器更换术临床分析

目的 分析永久起搏器更换原因及更换术并发症的防治对策,并探讨旧电极的处理方法.方法 更换术病人57例,男38例,女19例,年龄74岁±8岁(56～94)岁,病态窦房结综合征31例,Ⅱ度和Ⅲ度房室传导阻滞26例.单腔起搏器49例,双腔起搏器8例,起搏器平均使用时间9.25(2～15)年.共更换63例次,其中更换电极13例次.结果 起搏器更换术原因为起搏器电池自然耗竭57例次,电池提前耗竭2例,电极导线不全断裂2例,囊袋感染2例.更换术并发症9例,分别为囊袋血肿4例,电极脱位3例,废弃电极脱入右室2例.更换起搏器时起搏阈值[(0.77±0.40)V]比初次植入时的阚值[(0.60±0.21)V]明显高(P<0.01).更换时的电极阻抗[(854±136)Ω]、R波振幅[(12±4)mV]与植入时[(828±176)Ωn、(12±4)mV]比较,差异无统计学意义(均P>0.05).结论 起搏器更换主要原因为电池自然耗竭.经测试大部分心室电极可以继续使用.起搏器更换术严重的并发症是废弃电极脱入右室,正确的电极处理方法可以避免此类并发症的发生.     

起搏器更换原因分析及健康教育

目的:回顾性分析埋藏式起搏器更换原因,并对不同的更换原因提出健康教育措施。方法:共82例96例次更换起搏器,其中,男38例,女44例;年龄15~95(58.26±16.85)岁。其中,69例更换1次,12例更换2次,1例更换3次。我院植入76例,外院植入6例。结果:起搏器电池耗竭80例次,其中,自然耗竭64例次,提前耗竭16例次。电极导线断裂或绝缘层破裂3例。电极脱位和微脱位7例。由于起搏器的技术进步提前更换2例,起搏器囊袋感染并外露3例,起搏器位置移动1例。结论:起搏器更换原因多为电池耗竭或使用时间已到质保期。少见的原因是起搏器植入并发症。针对性的健康教育能让病人最大获益。     

植入自动阈值夺获起搏器二例报告

我院于1998年11月为两例心房颤动伴长停搏间歇患者分别植入了自动阈值夺获起搏器,现报告如下。1　临床资料例1,男性,74岁。患者因反复胸闷、头晕20年、晕厥二次于1998年11月4日入院。入院当日夜晚又出现晕厥一次,心电图示心房颤动伴长停搏间歇,完全性右束支传导阻滞,于当晚即行临时起搏器安装术,经心肌酶学、肌钙蛋白Ⅰ检测,除外急性心肌梗死,于次日行自动阈值夺获起搏器植入术。例2,男性,77岁。患者因反复胸闷、气逼、双下肢浮肿12年,加重4ｄ于1998年11月5日入院。入院心电图示:心房颤动伴长停搏间歇(最长ＲＲ间期为2800ｍｓ),完全性右束支…     

尿毒症高钾伴阿斯综合征的救治体会

我院有两名作规律性、维持性透析的尿毒症患者在透析期间几次出现阿斯综合征,究其原因主要是高钾引起的高度危险性心律失常。二例相继或先后出现过结性逸搏心律(20～30次/min)、室性选搏心律、短阵性室速、室颤、多源性室性早搏等心律失常。一例室性逸搏心律,心率20～30次/min时多次发生阿斯综合征,经常规治疗后,并用异丙肾上腺素维持心率在>40次/min,收缩压>12kPa后作了紧急透析,透析5h血钾才由5.8mmol/L降低到4.8mmol/L,心律才由室性逸搏心律转变成窦性心律伴多源性定性早搏。另一例在1小时内3次出现室颤,后经电除颤转为结性逸搏心律,经血透半小时血钾由8.2mmol/L降低到5.8mmol/L,结性逸搏心律(用异丙肾上腺素维持心率在40～80次/min)转变成窦性心律,20分钟后再转成房颤(患者原有房颤律).两患者现仍在作规律性透析已一年有余。     

多参数程控起搏器临床19例应用

我院自1977年4月始作心脏起搏器埋藏术80余例次,其中临床应用多参数程控起搏器19例,取得了满意的疗效,现总结如下。(一)使用仪器使用瑞士Intermedics公司生产的SuprimaⅡ型多参数程控起搏器。该机可通过体外程控仪调节起搏器5个参数:(1)起搏频率:30～120次/分,共15档;(2)脉冲宽度:0.15～2.29ms,共15档;(3)脉冲幅度:2.7V、5.4V、8.1V,共3档;(4)感知灵敏度:4.2～0.6mV,共6档;(5)起搏模式:VVI、VVT、VOO。本起搏器重量40g,导管     

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.     

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…     

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.     

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     

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.