具有心室自动阈值夺获功能起搏器的临床应用

目的:观察具有自动阈值夺获功能起搏器植入术后参数变化及起搏器安全性。方法:植入具有心室自动阈值夺获功能起搏器患者40例,观察起搏器植入术中、术后1周、1个月、6个月起搏阈值、阻抗、心腔内R波幅度、ER波振幅及心室极化电位、起搏阈值曲线、输出电压参数,并行动态心电图观察有无心室起搏失夺获。结果:心室起搏阈值于术后1周达最大值,由术中的(0.43±0.08)V到术后1周的(0.73±0.22)V,1周后阈值逐渐下降并稳定。术后起搏器的平均输出电压一般在0.73～1.06V,明显低于常规起搏器输出电压程控水平(约2.5～4.5V)。在患者程控随访及动态心电图检查过程中,所有未夺获心室的脉冲后均有后备起搏脉冲出现,无失夺获现象。术中ER波幅值与R波幅度未有相关性。结论:具有心室自动阈值夺获功能的起搏器可根据阈值自动调整输出电压,可减少起搏器电池能量消耗,况且低输出电压状态下工作是安全可靠的。术中ER波振幅测试对具有自动阈值夺获功能的起搏器是必须的,因为术中ER波振幅与R波幅度不存在相关性。     

心室具有自动阈值夺获功能起搏器的远期随访

目的：观察双腔心室自动闽值夺获起搏器的长期各参数变化，节能功能及起搏安全性。方法：对65例患者植入具有AC功能双腔起搏器，观察术中、术后6个月心室起搏阈值，输出电压，ER振幅，阻抗和极化电位及自动工作方式转换功能。结果：术后心室起搏阈值早期升高1．10V±0．18V以后逐渐稳定，长期心室起搏电压仅在0．45V±0．13V。63例在术后测定各参数即刻启动AC功能并于术后1周及6个月随访心室各参数变化。1例术中R波振幅15．2mV，ER值为10．4mV，极化电位0．4mV，术后发生心房颤动给普罗帕酮600mg转律，测试时发现AC功能自动关闭，当时ER值9．4mV，极化电位0．8mV，再测ER值10．2mV，极化电位0．4mV，AC功能可以打开并工作正常。比较术中、术后1周起搏阈值升高，P〈0．05，术后一周与6个月相比起搏阈值下降，P〈0．05。其余无统计学意义。结论：具有自动阈值夺获功能的双腔起搏器，高效能保护起搏电压，耗能低而且安全性好，能满足患者的生理需要。     

自动夺获起搏器的临床应用

目的观察8例具有自动夺获功能的单心腔起搏器的各种参数特点及程控功能。方法8例患者,植入RegencySC+型VVI起搏器6例,RegencySR+型VVIR起搏器2例,随访1～18个月,检查动态心电图并通过程控观察起搏阈值、ER值及极化电位的变化。结果8例患者起搏功能良好,6例ER值及极化电位良好而打开自动夺获功能,起搏阈值稳定在0．9～1．5mV间,可见后备脉冲多为融合波触发。1例因ER值较低(1．8mV),另1例ER值偏低(3．3mV)且极化电位大于ER的60％,未能打开自动夺获功能。结论具有自动夺获功能的起搏器安全可靠,但有赖于良好的ER值、极化电位和感知安全度。ER值可能与心肌病变有关。调整ER感知灵敏度可能获得较好的ER信号及感知安全度。     

自动夺获起搏器的临床应用

目的观察8例具有自动夺获功能的单心腔起搏器的各种参数特点及程控功能.方法8例患者,植入RegencySC+型VVI起搏器6例,RegencySR+型VVIR起搏器2例,随访1～18个月,检查动态心电图并通过程控观察起搏阈值、ER值及极化电位的变化.结果8例患者起搏功能良好,6例ER值及极化电位良好而打开自动夺获功能,起搏阈值稳定在0.9～1.5mV间,可见后备脉冲多为融合波触发.1例因ER值较低(1.8mV),另1例ER值偏低(3.3mV)且极化电位大于ER的60%,未能打开自动夺获功能.结论具有自动夺获功能的起搏器安全可靠,但有赖于良好的ER值、极化电位和感知安全度.ER值可能与心肌病变有关.调整ER感知灵敏度可能获得较好的ER信号及感知安全度.     

心室自动阈值夺获自动模式转换双腔起搏器临床观察(附50例报告)

目的　介绍自动阈值夺获 (Autocapture)自动模式转换 (AutomaticModeSwitch)双腔起搏器测试及随访。方法　 5 0例患者 ,肥厚梗阻型心肌病 1例 ,Ⅲ°房室传导阻滞 (AVB) 2 9例 ,病窦 2 0例 ,其中阵发性房颤 (AF) 8例。植入AffinittyDC 5 2 3 0起搏器 ,植入手术同普通DDD ,术中及随访测试起搏阈值 ,阻抗 ,输出电压 ,刺激除极波 (ER) ,极化电位。结果　除 1例肥厚梗阻型心肌病外 ,余 49例患者自动阈值夺获 (其中 8例阵发性AF患者开启自动模式转换 )术中或术后 3天均开启 ,随访 6个月工作良好。结论　具有自动阈值夺获及自动模式转换功能双腔起搏器安全节能使用寿命长 ,模式自动转换功能尤适用于伴阵发性AF的慢 -快综合征患者。     

自动夺获功能起搏器的植入与测试

目的探讨具有自动夺获功能心室起搏器的植入方法及各项参数的测试。方法：6例患者植入具有自动夺获功能的心室起搏器,术中打开起搏器的自动夺获功能,测试参数。术后1周和1个月分别行24h动态心电图检查,同时测试各项参数。结果：植入时起搏阈值（0．37±0．08）V,R波斜率（0．97±0．32）V／s,阻抗（605±59．58）Ω。自动夺获阈值（0．40±0．15）V,R波振幅（1．26±3．89）mV,ER振幅（9．93±3．56）mV,极化电位振幅（1．32±0．34）mV,VARIO测试自动夺获阈值（0．40±0．15）V。术后1周及1个月测试的自动夺获阈值明显升高（P＜0．05）,R波振幅、ER振幅和极化电位振幅均无显著变化（P＞0．05）,起搏器各项功能运行良好。结论：植入具有自动夺获功能的心室起搏器时,除满足心室起搏的常规参数外,术中还应满足起搏器自动夺获功能的要求。     

自动阈值夺获和自动模式转换双腔起搏器的临床应用

目的　评价具有自动阈值夺获和自动模式转换功能的双腔起搏器的有效性及随访情况。方法　 2 1例患者因病态窦房结综合征或Ⅲ度房室传导阻滞植入具有自动阈值夺获和自动模式转换功能的PacesetterENTITYTMModelDC 5 2 2 6型双腔起搏器 ,其中 15例有阵发性快速房性心律失常 ,随访 3月～ 2年 ,测试植入术中及术后的起搏阈值 ,阻抗 ,心室除极波 (evokedresponse ,ER) ,极化电位 ,术后 3d心电监护 ,结合EKG和HOLTER检查 ,回顾自动模式转换功能 (AMS)的启动情况。结果　除 1例外其余 2 0例自动阈值夺获 (autocapture,AC)功能运行良好。应用EKG ,HOLTER评价AMS工作情况 ,15例患者术后 3d 5 13次启动了自动模式转换 (automaticmodeswitch ,AMS)功能 ,总检测失败率为 4 .87% (2 6 / 5 34) ,误检率 0 .97% (5 / 5 13)。发现AMS功能误检率低 ,成功率高 ,安全可靠。结论　具有自动阈值夺获和自动模式转换功能的双腔起搏器安全 ,可靠 ,使用寿命长 ,尤适用于伴阵发性快速房性心律失常的慢—快综合征患者     

自动夺获和阈值管理功能对起搏器输出电压的影响

目的 探讨自动周值管理及自动夺获功能对起搏器输出电压的影响,及不同夺获功能原理下起搏器输出电压的差异,以评估自动夺获功能对起搏器寿命的影响.方法 分别选取植入自动夺获功能起搏器患者13例和植入无自动夺获功能起搏器患者20例进行临床随访.比较自动夺获功能组起搏器和无自动夺获功能组起搏器输出电压、脉宽等,并比较具有不同阈值夺获原理的起搏器之间输出电压的差异性.结果 经统计分析表明具有阈值夺获功能起搏器组平均输出电压为(2.023±1.294)V,无阈值夺获功能起搏器组平均输出电压为(3.622±0.353)V,差异有统计学意义(P<0.01).两组脉宽并比较差异无统计学意义(P>0.05).虽然Medtronic公司的Kappa 700系列型起搏器平均起搏电压(2.485V)较ST.JUDE公司的Pacesetter ENTI-TYTM Model DC 5226或5130型起搏器平均输出电压(1.778V)高,但两组比较差异无统计学意义(P>0.05).结论 自动阈值管理或自动夺获功能可有效的减少起搏器输出电压不必要的损耗,节省起搏器电池能量,达到延长起搏器寿命的目的 .     

自动夺获型起搏器的临床应用

普通心脏起搏器植入后的输出电压是固定的 ,而自动夺获功能起搏器 (Ａｕｔｏｃａｐｔｕｒｅｐａｃｅ ｍａｋｅｒ)能自动测定起搏阈值 ,输出最低最有效的电压 ,可节约电能。我院自２０００年２月始应用有自动夺获功能的心脏起搏器１１例 ,现将临床应用总结如下。１．一般资料１１例患者中男性５例 ,女性６例 ;年龄３８～８３岁 ,平均 (６４±１４)岁。植入起搏器的指征为病态窦房结综合征７例 ,心房颤动伴ＲＲ长间歇１例 ,Ⅲ度房室传导阻滞２例 ,因扩张型心肌病而行双腔起搏１例。为检测自动测定阈值结果的可靠性 ,作了非创伤性自动起搏阈值…     

起搏器自动阈值夺获及临床意义

1 临床资料 患者男性，74岁，常规体检查心电图。既往因病窦综合征，房颤于10a前行DDD起搏器植入术至今，无不良反映。查体：心率72次／min，听诊双肺及心各瓣膜区无异常。查心电图提示：双腔起搏心电图起搏器自动阈值夺获（见图1）。图中第2、4搏S1为起搏脉冲信号的发放，因某种原因起搏阈值增高，起搏电压相应降低，未能夺获心室。     

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.     

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.     

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…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.