经皮冠状动脉腔内成形术对冠心病患者QT离散度的影响

目的通过分析经皮冠状动脉腔内成形术(percutaneoustransluminalcoronaryangioplasty,PTCA)中缺血和再灌注时QT离散度的变化。评价成功的PTCA术对改善QT离散度的临床意义。方法22例冠心病患者行成功的PTCA术治疗,其中男17例,女5例,年龄43～79岁,平均年龄(59.8±9.0)岁,记录PTCA术中及当日同步十二导联动态心电图。分别于术前、首次球囊扩张期间、首次球囊扩张后即刻、术后2h及12h测定QT间期和RR间期,QTd=QTmax-QTmin。结果QTd在首次球囊扩张期间与扩张前比较明显增大(P<0.05),在术后2h及12h均较术前减小(P<0.05),且术后12h与术后2h比较差异有统计学意义(P<0.05);首次球囊扩张后即刻与扩张前比较差异无统计学意义(P>0.05)。结论PTCA球囊扩张期间,由于产生一过性短暂的心肌缺血使QTd增加,而成功的PTCA术可降低冠心病患者的QT离散度,从而可能预防恶性室性心律失常的发生。     

镁对老年人急性心肌梗死QT离散度的影响

目的　探讨镁对老年急性心肌梗死 (AMI)患者QT离散度 (QTd)的影响。方法　随机分组、单盲处理、前瞻性研究 ,观察 60例AMI患者 (用镁治疗 3 0例 ,常规治疗 3 0例 )治疗前后QTd及RR间期、改良校正QT离散度 (QTLcd)、最大QT间期 (QTmax)、最小QT间期 (QTmin)的变化。结果　试验组及对照组治疗前后 1天的RR间期、QTd、QTLcd、QTmax及QTmin均无差异 (P >0 0 5 ) ;治疗后第 3天试验组RR间期、QTmin较对照组延长(P <0 0 5 ) ,QTd、QTLcd较对照组缩小 (P <0 0 5 ) ,两组QTmax无差异 (P >0 0 5 ) ;治疗 1周时试验组RR间期及QTmin较对照组延长 ( P <0 0 5 ) ,QTd和QTLcd较对照组缩小 ( P <0 0 5 ) ,两组QTmax无差异 ( P >0 0 5 ) ;治疗 2周时RR间期、QTd和QTLcd、QTmax两组无差异 (P >0 0 5 ) ,QTmin试验组较对照组延长 (P <0 0 5 ) ,血镁试验组较对照组升高 (P <0 0 5 )。结论　镁通过缩小AMI患者QTd ,使心肌复极化趋向同步 ,有利于防止恶性心律失常的发生 ,减少心肌梗死的病死率     

PTCA术对QT间期离散度的影响

目的　对临床疑似冠心病行冠脉造影 ,并分析冠状动脉造影冠脉异常及冠脉正常患者QT间期离散度的差异 ,PTCA及冠脉内支架植入术前后QT间期离散度的变化 ,以探讨PTCA及冠脉内支架植入术对QT间期离散度的影响。方法　分别测量冠造正常组及冠造异常组QTmax ,QTmin ,QTd ,QTcd ;测量冠造异常并行PTCA术的术前及术后 1、3、7dQTmax ,QTmin ,QTd ,QTcd。结果　 (1)冠脉异常组QTd ,QTcd >冠脉正常组 (P <0 0 0 1)且QTmax增大 (P <0 0 0 1)。 (2 )PTCA组术后 1、3、7dQTd ,QTcd分别 >PTCA术前 (P <0 0 0 1)。结论　成功的PTCA及冠脉内支架植入术可以预防心血管事件的发生。     

射频消融治疗对特发性室性心动过速患者QT离散度的影响

目的　为探讨射频消融治疗 (RFCA)对特发性室性心动过速 (IVT)患者QT间期、QT离散度(QTd)的影响及其临床意义。方法　对 16例IVT患者成功地进行了RFCA治疗 ,并测量了消融前心速发作间歇期和成功消融后心电图的最大QT间期 (QTmax)、最小QT间期 (QTmin)、QTd及心率校正QT离散度(QTcd)。并测定 16例年龄、性别相近的健康者的上述同样指标作为对照。结果　IVT组行RFCA前与对照组比较 ,QTmax、QTmin、QTd、QTcd均无显著性差异 (P >0 .0 5) ;IVT组成功消融前、后QTmin、QTcd差异均无显著性 (P均 >0 .0 5) ,而成功消融后QTmax及QTd比消融前减少 ,差异有显著性。结论　IVT发作间歇期QT间期、QT离散度于正常人无差别 ,QTd、QTcd不能作为IVT患者发生室速的预测指标 ;RFCA治疗IVT安全有效 ,不会导致心室肌复极离散程度的增加 ,消融后QTmax、QTd减少可能与副交感神经张力下降、交感神经张力增高有关     

PTCA及支架安装术后患者近期Q-T离散度的变化

目的　观察冠脉内成形 +支架术 (PTCA +Stent)对急性心肌梗塞 (AMI)患者QT离散度的影响。方法　选择我院心内科 2 0 0 0～ 2 0 0 1年经PTCA +Stent术的急性心肌梗塞患者 3 7名 ,取术前 1～ 5d(2 .3 1± 1.86)d、术后 1～6d(2 .5 6± 1.3 7)d和术后 3mo三份心电图。从导联间最大QT间期 (QTmax)减去最小QT间期 (QTmin)得到QTd ,并与3 0例正常人进行对比分析。结果　QTd术前为 (78.69± 18.43 )ms、术后 1～ 6d(4 2 .2 7± 12 .18)ms、术后 3mo(3 7.91±17.3 6)ms,急性心肌梗塞患者QTd术前和术后均明显延长 ,且术前较术后 1～ 6d和术后 3mo明显延长 ,术后 1～ 6d和术后 3moQTd延长无明显差异。结论　PTCA +Stent术后患者QTd明显缩短 ,术后 3mo内QTd变化不明显     

冠脉内成形及支架术对QT离散度的影响及其意义

目的 :观察成功的经皮冠状动脉腔内成形术 (PTCA)及支架植入术前后QT离散度 (QTdispersion ,QTd)的变化 ,并探讨其临床意义。方法 :96例经冠状动脉造影证实单或双支冠脉管径狭窄≥ 70 %而成功进行PTCA及支架植入术的患者纳入研究。术前 1周内及术后 2 4h内分别记录体表 12导联同步心电图 ,测量QTd及心率校正QT离散度 (QTcd)。结果 :术后QTd及QTcd明显减小 ,与术前比较差异有显著性 (P <0 .0 1) ;术前双支病变组QTd较单支病变组明显增大 (P <0 .0 5 )。结论 :成功的PTCA及支架植入术可降低冠心病患者的QT离散度 ,QT离散度可能是提示PTCA术后冠脉供血改善的一个指标     

直接经皮腔内冠状动脉成形术对急性心肌梗死患者QT离散度的影响

目的观察直接经皮腔内冠状动脉成形术 (percutaneoustransluminalcoronaryangioplasty ,PTCA)对急性心肌梗死患者QT离散度 (QTdispersion ,QTd)和JT离散度 (JTdispersion ,JTd)的影响。方法以 4 8例急性心肌梗死患者为患者组 ,测定其成功行直接PTCA术前、后QTd和JTd ,同时以 4 8例冠状动脉造影正常者为对照组。结果①患者组直接PTCA术后QTd和JTd显著减小 (P <0 .0 1) ,对照组冠状动脉造影术后QTd和JTd与术前比较无显著性差异 (P >0 .0 5 )。②与对照组比较 ,患者组直接PTCA术前QTd及JTd显著增大 (P <0 .0 1) ;术后患者组QTd及JTd虽高于对照组 ,但无显著性差异。结论直接PTCA能改善急性心肌梗死患者心肌血流再灌注 ,逆转心肌缺血 ,缩小QTd及JTd。     

200例健康成人QT间期离散度分析

目的　探讨健康成人QT间期离散度 (QTd)及影响因素。方法　用 12导联同步与非同步方法描记2 0 0例健康成人心电图 ;测RR间期 ,QTmax、QTmin、QTd及QTmax、QTmin和QRS出现最早导联 ;对照分析记录方法、年龄、性别对QTd的影响。结果　 (1) 2 0 0例健康成人 12导联同步描记QTd为 (33 0 7± 10 87)ms (10～ 5 7ms) ;(2 ) 12导联同步与非同步描记检测对照QTd ,非同步描记QTmax增大 (P =0 0 2 5 ) ,QTd减小 (P =0 0 0 1) ;(3)年龄增加QTd有增大趋势 ,但无显著性差异 (P >0 0 5 ) ;(4 )女性QTmax大于男性P =0 0 4) ,但QTd小于男性 (P =0 0 0 5 )。结论　本组测得 2 0 0例健康成人QTd范围 10～ 5 7ms,提示QTd >6 0ms应视为延长 ;在QTd检测中应强调 12导联同步描记 ,在分析时应注意性别影响     

经皮腔内冠状动脉成形术对心绞痛患者QT间期离散度的影响

目的探讨经皮腔内冠状动脉成形术(PTCA)对心绞痛患者QT间期离散度(QTd)的影响,评价成功的PTCA术对改善QT间期离散度的临床意义。方法对40例心绞痛患者行PTCA术前和术后24h内12导联心电图QT间期、QTc、QTd及QTcd4项指标进行分析。结果PTCA术后QT和QTc与术前无显著性差异,而QTd和QTcd则较术前明显减少,有极显著性差异(P<0.001)。结论PTCA能显著减少心绞痛患者的QTd,能改善心肌复极电生理,有助于减少恶性心律失常的发生。     

QT离散度对长期口服卡托普利的高血压病人临床评价

QT离散度(以下简称QTd)是指标准12导联心电图上最长的QT间期(QTmax)与最短的QT间期(QTmin)之差,QTd的改变与心肌肥厚、心律失常乃至心源性猝死密切相关.近年来观察到高血压病LVH具有QTd增加的特点,我们观察发现长期口服卡托普利治疗的高血压病左室肥厚(LVH)病人QTd下降,现报道如下.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.