心电图ST_(V_3/Ⅲ)比值对判断急性下壁心肌梗死相关动脉及闭塞位置的作用

目的 :探讨心电图 STV3/ 比值 (STV3/ )对判断急性下壁心肌梗死 (AIMI)相关动脉及闭塞位置的作用。方法 :对 36例 AIMI患者的心电图和冠状动脉造影资料进行对比分析。结果 :1右冠状动脉 (RCA)近段、RCA远段、左旋支 (L CX)组 导联 ST段抬高程度依次减小 ,V3导联 ST段降低程度依次增加 ,但多无显著性差异 ;而STV3/ 在 3组间差异显著 (P <0 .0 5或 0 .0 0 1) ;2 STV3/ 的分布 :STV3/ <0 .5者在 RCA近段组占 13/ 17例 ,0 .5≤ STV3/ ≤ 1.2者在 RCA远段组占 9/ 13例 ,STV3/ >1.2者在 L CX组占 4/ 6例。 3以 STV3/ <0 .5预测 RCA近段的敏感性 76 .5 %、特异性 78.9% ,以 0 .5≤ STV3 / ≤ 1.2预测 RCA远段的敏感性 6 9.2 %、特异性 78.3% ,以STV3/ >1.2预测 L CX的敏感性 6 6 .7%、特异性 96 .7%。结论 :心电图 STV3 / 是判断 AIMI患者梗死相关动脉及闭塞位置较准确的新指标。     

下壁急性心肌梗死患者心电图对梗死相关动脉定位的再评价

目的探讨ST段抬高型下壁急性心肌梗死(AMI)患者心电图对梗死相关动脉(IRA)定位的价值。方法分析76例ST段抬高型急性下壁心肌梗死患者心电图改变并与冠状动脉造影结果进行回顾性对比分析。结果①梗死相关动脉多为右冠状动脉(RCA),其次为左回旋支(LCX),分别为56例(73.7%)、20例(26.3%)。②患者心电图STⅢ↑/STⅡ↑>1、STaVL↓/STI↓>1对判断梗死相关动脉在RCA敏感性分别为87.5%、96.4%,特异性分别为85.0%、85.0%。STV3↓/STⅢ↑>1.2对判断梗死相关动脉为LCX的特异性为94.6%。③心电图STaVF↑+STV2↓>0对于判断梗死相关动脉为RCA的特异性、阳性预测值分别为90.0%、95.8%。④心电图V1～V3导联ST段压低之和与下壁导联ST段抬高之和的比值ST(V1～V3)↓/ST(inf)↑≤0.5对于判断相关动脉为RCA的敏感性、阳性预测值分别为78.6%、91.7%。⑤心电图STV3↓/STⅢ↑≤0与心电图STV1↑预测梗死动脉在RCA近端的敏感性分别为54.5%、86.4%,特异性分别为29.4%、88.2%。结论心电图STⅢ↑/STⅡ↑>1、STaVL↓/STI↓>1,STV3↓/STⅢ↑>1.2,STaVR↓≥0.05 mV预测IRA为RCA或LCX特异性较高;STV1↑预测IRA为RCA近段的敏感性、特异性较高;而STV3↓/STⅢ↑≤0预测RCA近段闭塞结果不理想。     

急性下壁ST段抬高心肌梗死直接冠脉内支架置入术靶血管判定及预后评估

目的 总结急诊介入治疗（PCI）的急性下壁心肌梗死患者心电图及临床资料,分析其对急性下壁心肌梗死患者罪犯血管判定及预后评估的作用.方法 选择2007年1月到2010年7月进行急诊PCI的急性下壁心肌梗死患者280例,根据冠脉造影结果分为右冠状动脉（RCA）梗死组及左冠回旋支（LCX）梗死组;根据临床结果分为高危急性下壁心梗组（高危组）及低危组.分析各组的心电图表现、危险因素及预后.结果 RCA组与LCX组比较,STⅢ＞STⅡ、STavL或STⅠ＞1 mm下移更多见于RCA梗死.高危组年龄比低危组偏大,糖尿病患者更多,更多出现心肌梗死溶栓治疗（TIMI）分级中的0级（无灌注）及1级（渗透而无灌注）,RCA近端闭塞及双支、三支病变患者,心电图出现STV3R-5R↑、STV7-V9↑、STV4-6↓、STV1↑、STAVR↓的比例更高.结论 心电图在急性下壁心肌梗死进行急诊PCI的患者诊断及预后判断中有重要作用,对进行急诊PCI靶血管判定有一定的协助作用.冠脉造影TIMI 0、1级,RCA近端闭塞,双支、三支病变患者,年龄偏大患者和糖尿病患者整体预后均较差.     

心电图STV5V6压低在急性下壁心肌梗死中是合并前降支病变的证据

目的　观察急性下壁心肌梗死心前导联ST段压低与冠状动脉病变的关系。方法　对 38例急性下壁心肌梗死患者均常规行冠状动脉造影检查 ,根据常规心电图心前导联ST段压低≥ 1 0mm分为STV1～ 4 压低组 (17例 )与STV1～ 6压低组 (2 1例 ) ,比较心电图与冠状动脉造影之间的关系。结果　STV1～ 4 段压低是下壁ST段抬高的对应性改变(P <0 0 1) ,STV1～ 6段压低证实合并明显的前降支病变(P <0 0 1) ,其灵敏度、特异度、阳性预测值、阴性预测值分别为 86 %、88%、90 %、83%。结论　急性下壁心肌梗死心电图STV5V6压低是合并前降支病变证据。     

急性下壁心肌梗死的相关动脉与体表心电图改变的关系

目的　对 5 0例急性下壁心肌梗死患者的心电图进行分析并与冠状动脉造影的结果进行比较 ,以揭示体表心电图对梗死相关动脉的预测价值。　方法　根据冠状动脉造影的结果将 5 0例急性下壁心肌梗死患者分为 3组 :右冠状动脉 (right coronary artery,RCA)闭塞组 2 4例 ,左回旋支 (left cir-cum flex artery,L CX)闭塞组 17例 ,右冠状动脉及左回旋支 (RCA L CX)同时闭塞组 9例。结果　 (1)RCA组 ST 抬高 >ST 抬高的发生率明显高于 L CX组及 RCA L CX组 (P<0 .0 0 5 ) ,灵敏度、特异度、诊断符合率、阳性预测值及阴性预测值分别为 87.5 %、84.6 %、86 %、84%、86 % ;L CX组与 RCA L CX组后壁导联梗死图形的发生率明显高于 RCA组 (P<0 .0 0 5 ) ,阴性预测值分别为 84.6 %、10 0 % ;RCA组及 RCA L CX组右心室梗死的发生率明显高于 L CX组 (P<0 .0 1) ;(2 ) RCA组及 RCA L CX组侧壁导联 ST段下移的发生率及 STa VL下移 >STI 下移的发生率明显高于 L CX组 (P<0 .0 0 5～ 0 .0 5 ) ,其中a VL 导联 ST段下移及 STa VL 下移 >STI 下移对各自梗死相关动脉的阴性预测值分别为 76 .2 %、90 .5 %、73.3%、83.3% ;L CX组前壁导联 ST段下移的发生率明显高于 RCA组及 RCA L CX组 (P<0 .0 0 5～ 0 .0 5 ) ,其灵敏度、特     

体表心电图对老年急性下壁心肌梗死患者梗死相关血管的预测价值

目的探讨体表心电图对老年急性下壁心肌梗死患者梗死相关血管(IRA)的预测价值。方法对70例老年急性下壁心肌梗死患者的入院心电图和冠状动脉造影资料进行回顾性分析,寻找可以预测IRA的心电图改变。结果70例老年急性下壁心肌梗死患者中,IRA为左前降支(LAD)者3例(4%),右冠状动脉(RCA)者53例(76%),左回旋支动脉(LCx)者14例(20%)。经χ2检验,STV1抬高、STⅢ抬高>STⅡ抬高、STⅠ和(或)STaVL压低、STV3压低/STⅢ抬高≤1.2等4项指标提示RCA为IRA。其中,STV1抬高的特异度和阳性预测值最高,均为100%;灵敏度则以STI和(或)STaVL压低为最高,达94%。反之,STV1压低、STⅢ抬高≤STⅡ抬高、STⅠ和(或)STaVL抬高、STV3压低/STⅢ抬高>1.2提示LCx闭塞可能性大。其中灵敏度和阴性预测值以STV1压低为最高,分别为71%和89%,特异度和阳性预测值则以STⅠ和(或)STaVL抬高为最高,均为100%。结论急性下壁心肌梗死时,体表心电图对预测IRA有重要价值。     

心电图在右冠病变所致急性下壁心肌梗死时的预测价值

目的通过体表心电图探讨右冠状动脉(RCA)病变及判断RCA是否为优势血管对ST段抬高型急性下壁心肌梗死时的预测价值。方法对84例经冠状动脉造影证实RCA为梗死相关动脉患者的18导联心电图进行回顾性分析。结果 RCA近段病变的62例,RCA远段病变的22例。RCA近段病变患者中,STV4R抬高≥1 mm为56例,阳性率为90.3%,STV1-V2抬高≥2 mm的为52例,阳性率为83.9%。RCA远段病变的22例患者中,出现STV4R抬高≥1 mm的为0例,出现STV1-V2抬高≥2 mm的为1例,阳性率为4.5%。RCA优势型为56例,非RCA优势型为28例,RCA优势型的56例患者中,STV5-V6抬高≥1 mm为50例,阳性率为89.3%。非RCA优势型的28例患者中,STV5-V6抬高≥1 mm为0例。结论对于RCA病变所致ST段抬高型急性下壁心肌梗死患者,心电图STV4R抬高≥1 mm、STV1-V2抬高≥2 mm对RCA近段闭塞的识别有较大的价值,如同时合并有STV5-V6抬高≥1 mm,常提示患者为RCA优势型,其诊断的特异性、敏感性均较高。     

心电图判断高危急性下壁心肌梗死的相关冠脉

目的探讨心电图判断高危急性下壁心肌梗死患者梗死相关冠脉(IRA)的价值。方法选择2001年10月～2008年7月住院的急性下壁心肌梗死患者44例,对患者的临床资料、体表心电图及冠状动脉造影资料进行回顾性分析,将出现低血压、缓慢性心律失常、休克三个并发症之一的患者作为高危组,不出现任何并发症者为低危组。结果①STV3↓/STⅢ↑0.5者高危组(76.47%)多于低危组(44.44%),0.5≤STV3↓/STⅢ↑1.2和STV3↓/STⅢ↑≥1.2,高危组(17.64%和5.88%)分别低于低危组(40.74%,14.81%)(p0.01);STV3R～V5R↑在高危组高于低危组(23.52%vs.7.40%),STV7～V9↑在高危组低于低危组(5.88%vs.22.22%)(p0.01);②IRA为RCA近端病变者,高危组(70.58%)明显高于低危组(11.11%)(p0.01);高危组中2支(47.05%vs.33.33%)、3支(47.05%vs.37.03%)病变明显多于低危组,而单支病变的例数少于低危组(5.88%vs.26.62%)(p0.05)。结论常规体表心电图指标是判断急性下壁心肌梗死的罪犯血管及梗死部位的良好方法。     

急性下壁心肌梗塞患者冠状动脉造影结果分析

目的探讨下壁急性心肌梗死（AMI）心电图（ECG）相关冠脉病变的判断及合并右室AMI的判断。方法选择急性期内进行了冠脉造影（CAG）的下壁AMI者58例，比较ECG与CAG结果。结果58例中单支病变37例，其中右冠脉（RCA）病变29例，左旋支（LCX）病变8例。多支病变21例中伴V4～V6导联ST段压低者13例，单支病变7例（P〈0．05）；伴I、aVL导联ST抬高LCX病变3例，RCA病变无（P〈0．05）。以V2、Ⅲ、aVF导联ST位移代数和来判断：STaVF＋V2〉0RCA病变25例，LCX病变3例（P〈0．05）。合并右心室梗死5例中，以STⅢ／STⅡ〉1判断，4例并右室（P〈0．05），以STV2↓／STaVF↑≤50％判断则有3例（P〉0．05）。结论下壁AMI相关血管以RCA病变为主，少部分为LCX病变。伴左胸前V4～V6导联ST压低多支病变多见；STaVF＋V2〉0多见于RCA病变；伴I、aVL导联ST抬高则多见于LCX病变。以STⅢ／ST〉1判定下壁AMI并右室AMI，差别有统计学意义。     

急性前壁心肌梗死心电图ST段改变与前降支阻塞部位关系的研究

目的探讨急性前壁心肌梗死心电图的ST段改变与冠状动脉阻塞部位的关系。方法对34例急性前壁心肌梗死病人进行回顾性分析。结果34例患者中19例为前降支病变,15例为前降支合并多支血管病变,心电图STⅠ、aVL抬高,STⅡ、Ⅲ、aVF压低,STaVL>STⅠ,STV2>STaVR,STV3/Ⅱ<-2.3,均为前降支近端狭窄,STⅡ、Ⅲ、aVF、V5、V6抬高,STV5>STⅡ,STV6>STaVF,均为前降支远端狭窄。结论急性前壁心肌梗死病人进行心电图常规检查,可以预测梗死与冠状动脉阻塞部位的关系。STⅠ、aVL抬高,Ⅱ、Ⅲ、aVF压低>1mm,为前降支近端病变。Ⅱ、Ⅲ、aVF、V5、V6抬高>1mm为前降支远端病变。     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

Weighing the QT Intervals with the Slope or the Amplitude of the T Wave

Objective: The reproducibility of QT interval measurements is low, even for the mean QT interval based on the standard ECG. In this study we analyzed whether the reproducibility of the mean weighed QT interval was better than the simple mean QT interval. The weighing was based on the amplitude of the T wave or the slope of the steepest tangent on the terminal part of the T wave. Material and methods: 12‐lead ECGs of 130 postmyocardial infarction patients were obtained. The QT intervals were measured by the tangent‐method on two occasions by the same observer Mismatch QT intervals were defined as QT intervals that were measured at only one occasion. Sixteen ECGs were rejected. The data were split into 34 and 80 ECGs for optimization and validation of the weighing, respectively. The weighed QT dispersion was calculated as the weighed mean of the three longest minus the weighed mean of the three shortest QT intervals. Results: Weighing with the slope increased the reproducibility by 41% (P = 3 10^‐6), but weighing with the amplitude reduced it by 20% (P = 0.02). However, if measurements with errors above 75 ms were rejected, weighing with the slope or the amplitude increased the reproducibility with 26% and 20% (P = 0.02), respectively. Weighing did not change the reproducibility of the weighed QT dispersion. Conclusion: Weighing with the slope improved the reproducibility of the mean weighed QT interval. However, if measurements with errors above 75 ms were rejected, weighing with the amplitude also increased the reproducibility. Weighing did not change the reproducibility of the weighed QT dispersion. Weighing is particularly efficient at reducing the negative impact of mismatch QT intervals on the reproducibility. A.N.E. 2002;7(1):4–9     

大骨节病病区水,粮实验对动物的骨和软骨中化学元素组成的影响

用质子激发 X 线荧光分析方法(PIXE)测定了大骨节病病区和非病区的水、粮以及用该水粮喂养的大白鼠的肋软骨和硬骨中22种化学元素的含量。结果发现水粮中存在差异的元素反应在用该水粮喂养的大白鼠的骨、软骨中也存在差异,含量都低的元素有 P、Mn、Cu、As、Zn。都高的有铅。其中锌低在水、粮、硬骨和软骨中都完全一致呈非常显著性差异(p<0.01)。提示病区水、粮中化学元素对骨质的影响不是单一元素缺乏或过多所致,而是多种元素的复合因素。     

Assessment of the Soft-Tissue Seal at the Interface between the Base of the Fixed Denture Pontic and the Oral Mucosa

Fixed dentures (bridges) are often selected as a treatment option for a defective prosthesis. In this study, we assess the contact condition between the base of the pontic and oral mucosa, and examine the effect of prosthetic preparation and material biocompatibility. The molars were removed and replaced with experimental implants with a free-end type bridge superstructure after one week. In Experiment 1, we assessed different types of prosthetic pre-treatment: (1) the untreated control group (Con: mucosa recovering from the tooth extraction); (2) the laser irradiation group (Las: mucosa recovering after the damage caused by a CO₂ laser); and (3) the tooth extraction group (Ext: mucosa recovering immediately after the teeth extraction). In Experiment 2, five materials (titanium, zirconia, porcelain, gold-platinum alloy, and self-curing resin) were placed at the base of the bridge pontic. Four weeks after the placement of the bridge, the mucosa adjacent to the pontic base was histologically analyzed. In Experiment 1, the Con and Las groups exhibited no formation of an epithelial sealing structure on the pontic base. In the Ext group, adherent epithelium was observed. In Experiment 2, the sealing properties at the pontic interface were superior for titanium and the zirconia compared with those made of porcelain or gold-platinum alloy. In the resin group, a clear delay in epithelial healing was observed.     

高胆红素血症对肿瘤标志物测定的影响探讨

目的探讨高胆红素血症对Ca19-9、Ca24-2和CEA检测的影响.方法对320例胆管、胆囊良恶性疾病病人,15例胆囊炎病人的胆汁和血清以及10例肝硬化、10例黄疸肝炎病人进行Ca19-9、Ca24-2和CEA检测.结果在良性胆管、胆囊疾病中,Ca19-9的假阳性最高;在胆红素增高的良性疾病中,Ca19-9假阳性率达46.7%;15例胆汁和血清以及10例肝硬化和10例黄疸肝炎病人中,Ca19-9的假阳性率分别为93%、20%、80%和80%.结论高胆红素血症对Ca19-9检测影响最明显,胆囊、胆管良恶性疾病鉴别时,以Ca24-2和CEA检测为佳.     

Hepato-pancreato-biliary fat: the good, the bad and the ugly

Obesity has become epidemic in the United States, in Europe, and in many urban areas in the developing world. The globalization of certain 'fast foods' and 'soft drinks' may, in part, be contributing to this epidemic. Diets high in saturated fatty acids and trans fats as well as drinks that have high fructose corn syrup levels may be particularly harmful. Recent research suggests that fat is a dynamic endocrine organ and that visceral fat is associated with the metabolic syndrome. Central obesity leads to organ steatosis and altered serum adipokines including reduced adiponectin and markedly elevated leptin. This abnormal adipokine milieu results in increased tissue infiltration of monocytes and macrophages which produce proinflammatory cytokines that alter organ function. Over many years, the combination of steatosis and local inflammation leads to fibrosis and eventually to cancer. Nonalcoholic fatty liver disease (NAFLD) is a precursor for nonalcoholic steatohepatitis (NASH). NAFLD and NASH (1) lead to cirrhosis and hepatocellular carcinoma, (2) increase the risk of liver resection, and (3) compromise the outcome of liver transplantation. Similarly, in the pancreas nonalcoholic fatty pancreas disease (NAFPD) may lead to nonalcoholic steatopancreatitis (NASP). NAFPD and NASP may (1) promote the development of chronic pancreatitis and pancreatic cancer, (2) exacerbate the severity of acute pancreatitis, and (3) increase the risk of pancreatic surgery. In the gallbladder nonalcoholic fatty gallbladder disease (NAFGBD, cholecystosteatosis) may lead to steatocholecystitis. Cholecystosteatosis may be an explanation for (1) the increased incidence of chronic acalculous cholecystitis and (2) the increased number of cholecystectomies.