关附庚素与关附甲素及壬素抗心律失常的比较

关白附成分关附庚素,甲素及壬素对氯仿诱发的小鼠室颤,乌头碱诱发的大鼠窒性心律失常皆有明显的对抗作用。其作用强度是庚素>甲素>壬素。庚素还对抗电刺激诱发离体豚鼠心脏室颤的作用。庚素,甲素及壬素皆有明显减慢大鼠心率,延长P-R间期的作用。庚素及甲素还能明显延长Q—T间期和T波宽度,以上作用也以庚素最强。庚素尚有延长QRS波宽作用。庚素,甲素对离体豚鼠心脏皆具有减慢心率和减少冠脉流量的作用,共作用强度相似,但对心肌收缩性的抑制作用以庚素较强。     

关附甲素对麻醉兔心脏传导和收缩的影响

关附甲素25mg/kg静脉推注延长麻醉兔窦房结恢复时间、窦房传导时间和心房有效不应期,延长P-R间期和希氏束电图的A-H、H-V间期,并降低左室收缩压、dp/dt max和Vpm。以普鲁卡因胺25mg/kg作对照,它们的作用相似,但在用药后15分钟内以关附甲素作用较明显。表明关附甲素对心脏自律性和传导性的抑制有利于防治快速性和折返引起的心律失常。     

抗心律失常药物的研究：Ⅲ.关附甲素酯类化合物的合成及抗…

以关附甲素和关附醇胺为原料，设计合成了６个关附甲素酯类化合物药效实验结果表明，化合物ⅠⅡⅢ和Ⅳ对乌头碱诱发大鼠心律失常具有明显的保留作用，其中化合物Ⅰ、Ⅱ的生物活性优于关附甲素。构效关系研究结果表明，抗心律失常活性与分子疏水面积和亲水表面积的比值呈非线性关系。     

抗心律失常药物的研究Ⅲ．关附甲素酯类化合物的合成及抗心律失常活性研究

以关附甲素和关附醇胺为原料，设计合成了６个关附甲素酯类化合物。药效实验结果表明，化合物Ⅰ、Ⅱ、Ⅲ和Ⅵ对乌头碱诱发大鼠心律失常具有明显的保护作用，其中化合物Ⅰ、Ⅱ和Ⅵ的生物活性优于关附甲素。构效关系研究结果表明，抗心律失常活性与分子疏水表面积和亲水表面积的比值呈非线性关系     

侧脑室注射阿托品东莨菪碱对兔呼吸心率的影响

给兔侧脑室注射阿托品有兴奋呼吸作用,且可增强毛果芸香碱、氨甲酰甲胆碱、槟榔碱兴奋呼吸效应;东莨菪碱对呼吸影响不明显,但却可拮抗毛果芸香碱、氨甲酰甲胆碱、槟榔碱兴奋呼吸效应。阿托品与东莨菪碱对呼吸影响不同的原因可能与选择性阻滞中枢不同亚型M受体有关。侧脑室注射阿托品似有减慢心率倾向,东莨菪碱对心率影响不明显,但均可拮抗以上拟胆碱药的心率减慢作用。     

蝎毒对家兔心电图的影响

观察了山东泗水产东亚钳蝎对清醒家兔心电图的作用。结果表明静脉注射蝎毒溶液(0.75mg/kg)引起R—R间期显著延长(p<0.01),心率减慢,而对P—R间期和QRS波时程无明显影响。大剂量静注蝎毒出现窦房结活动抑制,房室传导阻滞,室性心律和心室内传导阻滞等心律失常。     

柳胺苄心定抗电刺激兔脑杏仁内侧核引起的心律失常

电刺激麻醉兔脑杏仁内侧核(AME)可引起室性及室上性心律失常,伴血压升高,心率减慢。柳胺苄心定(LBT)0.5～2.0mg/kg静咏滴注(iv)能明显抑制上述室性心律失常。LBT 0.05mg/kg和心得安0.2mg/kg侧脑室内给药(icv)对上述室性心律失常也有明显抑制作用,酚妥拉明则无效。提示阻断中枢神经内β受体可以抑制此种心律失常。     

窦性心率震荡研究现状及其进展

窦性心率震荡是指单个室性期前收缩后窦性心率短暂的初期加速和紧随其后的减慢现象,是室性期前收缩所致的心排血量的变化引起压力反射的结果,它反映了迷走神经的反射功能。作为反映自主神经功能的心电学指标,窦性心率震荡对心血管死亡危险的预测价值已被多项临床研究证实。     

电刺激兔大脑皮层运动区引起缩瞳反应

电刺激麻醉兔的大脑皮层运动区的某些点,可引起双侧瞳孔缩小和心率减慢。切断双侧颈交感神经干对缩瞳反应无影响,阻断副交感神经对瞳孔括约肌作用后,缩瞳反应明显减弱。切断双侧迷走神经,心率减慢反应减弱,静脉注射心得安后,心率减慢反应则完全消失。结果表明兔大脑皮层运动区内存在缩瞳区及心率减慢区。     

小剂量索他洛尔治疗老年室性心律失常的疗效及安全性观察

目的　探讨小剂量索他洛尔 (80～ 16 0mg/d)对老年室性心律失常的疗效及安全性。方法　选择 4 5例年龄 6 0岁以上患者接受治疗 1～ 4周。结果　小剂量索他洛尔治疗老年室性心律失常总有效率为 6 4 .4 4 % ,服药前后QTC无明显延长 ,血压下降不明显 ,但心率减慢 ,P <0 .0 1。结论　小剂量索他洛尔对于老年室性心律失常疗效确切 ,副作用少 ,无明显致心律失常的作用     

心脉龙注射液对家兔实验性心律失常的防治作用

目的：观察纯中药制剂心脉龙注射液防治家兔实验性心律失常的效应。方法：用氯化钡(BaCI2)溶液恒速滴注和缓慢、恒速、静脉一次推注，造成家兔实验性心律失常模型，用心脉龙进行预防和治疗。结果：心脉尤能显著提高家兔致死的BaCI2剂量及延长家兔的存活时间；能防止或减少BaCI2引起的室性过早搏动(VPB)、室性心动过速(VI)及心室纤颤(VF)，与对照组相比(P＜0．01)；能明显提高窦性心律转复率(P＜0．05)。结论：心脉龙对BaCI2所致的室性心律失常有良好的预防和/或治疗作用。     

安定抗麻醉大鼠缺血性心律失常的作用

目的：观察安定对麻醉大鼠缺血性心律失常的作用。方法：给麻醉大鼠注射安定，然后结扎冠状动脉左前降支，造成心肌缺血，观察心律失常发生情况。结果：安定可明显降低麻醉大鼠的室性期外收缩的数目，与对照组相比，室性期外发生率大剂量、中级量和小剂量给药组分别降低96％、90％和83％。室颤发生率对照组89％，各给药组分别降低至0。对室速时程也有明显缩短作用，与对照组比，大剂量、中级量和小剂量和小剂量给药组室速时程分别降低91％、71％和63％。结论：安定对大鼠缺血性心律失常有明显抑制作用。     

Potential proarrhythmic effect of cardiac resynchronization therapy during perioperative period: data from a single cardiac center

Background Cardiac resynchronization therapy （CRT） could improve heart function, symptom status, quality of life and reduce hospitalization and mortality in patients with severe heart failure （HF） with optimal medical management. However,the possible adverse effects of CRT are often ignored by clinicians.Method A retrospective analysis of CRT over a 6-year period was made in a single cardiac center.Results Fifty-four patients were treated with CRT（D） device, aged （57±11） years, with left ventricular ejection fraction of （32.1±9.8）%, of which 4 （7%） developed ventricular tachycardia/ventricular fibrillation （VT/VF） or junctional tachycardia after operation. Except for one with frequent ventricular premature beat before operation, the others had no previous history of ventricular arrhythmia. Of the 4 patients, 3 had dilated cardiomyopathy and 1 had ischemic cardiomyopathy,and tachycardia occurred within 3 days after operation. Sustained, refractory VT and subsequent VF occurred in one patient, frequent nonsustained VT in two patients and nonparoxysmal atrioventricular junctional tachycardia in one patient. VT was managed by amiodarone in two patients, amiodarone together with beta-blocker in one patient, and junctional tachycardia was terminated by overdrive pacing. During over 12-month follow-up, except for one patient＇s death due to refractory heart and respiratory failure in hospital, the others remain alive and arrhythmia-free.Conclusions New-onset VT/VF or junctional tachycardia may occur in a minority of patients with or without prior history of tachycardia after biventricular pacing. Arrhythmia can be managed by conventional therapy, but may require temporary discontinuation of pacing. More observational studies should be performed to determine the potential proarrhythmic effect of CRT.     

莲心碱醚类衍生物抗心律失常作用

目的:研究两种莲心碱醚类衍生物莲心碱二甲醚、莲心碱二乙醚抗心律失常作用。方法:采用哇巴因、乌头碱、CaCl2和冠状动脉再灌注等多种抗心律失常模型。结果:两种莲心碱衍生物（5mg/kg,iv）均能显著提高哇巴因致豚鼠、乌头碱致大鼠发生室性早搏（VE）、室性心动过速（VT）、心室纤颤（VF）及心脏骤停（CA）的用量;延长CaCl2诱发大鼠心律失常的出现时间,缩短存活大鼠的窦律恢复时间,减少死亡率。还能对抗心肌缺血复灌所致的大鼠心律失常。结论:两种莲心碱衍生物均有广泛的抗心律失常作用。     

AICD treatment in 2004--state of the art

Primary and secondary prevention of sudden cardiac death is not sufficiently assured by medication. The (automatic) implantable cardioverter/defibrillator ((A)ICD) is able to terminate life-threatening arrhythmias (ventricular fibrillation/flutter, ventricular tachycardia) reliably. The identification and care of risk patients is of crucial importance. Initially, only survived resuscitation for ventricular fibrillation or ventricular tachycardia was regarded as a confirmed indication. Several studies (CABG patch, MADIT, MADIT II, MUSTT, DINAMIT, CAT AMIOVIRT, DEFINITE, COMPANION, SCD-HeFT) have examined the prophylactic indication for ICD therapy in risk groups. Patients with chronic state after myocardial infarction with markedly impaired left ventricular function and/or spontaneous, non-sustained ventricular tachycardia have been documented to benefit. Patients with moderately severe or severe heart failure also profit from ICD implantation, where appropriate in combination with cardiac resynchronization therapy in conduction disorders. There is divergent data on dilated cardiomyopathy. ICD is not indicated in patients with acute infarctions or undergoing elective bypass surgery.     

高血压对急性心肌梗死影响的临床分析

目的:分析高血压对急性心肌梗死(AMI)患者的影响。方法:按有无高血压病史将350例AMI患者分为两组:A组154例既往有高血压病史或入院时血压升高;B组196例既往无高血压病史和(或)入院时血压正常。回顾性分析两组在糖尿病、冠心病家族史等AMI的易患因素及冠心病病史,实验室检查,急性心力衰竭(包括心源性休克)、室速室颤、房室传导阻滞等严重心律失常的发生及4周内死亡率的差别。结果:高血压病史组糖尿病、冠心病家族史、陈旧性心肌梗死、心绞痛相关病史的比例均较无高血压病史组高(P<0.05);即时血糖,甘油三酯,胆固醇,低密度脂蛋白的数值高血压病史组较无高血压病史升高(P<0.05);出现心力衰竭包括心源性休克、室速室颤、房室传导阻滞等严重并发症及住院病死率(<4周)均高于无高血压病史组(P<0.05)。结论:合并高血压的AMI患者具有更多的冠心病易患因素,心脏严重并发症较多,预后较差。     

Ventricular arrhythmias.

Sudden cardiac death claims thousands of Canadians annually. Ventricular tachycardia and fibrillation account for up to 85% of these deaths. Identifying the patients at risk remains a major challenge. Those who have recurrent ventricular tachycardia or have been resuscitated from ventricular fibrillation are generally considered to be at highest risk. Although ventricular premature beats in the absence of previous ventricular tachycardia or fibrillation are not helpful in identifying such patients in most cases, they can indicate increased risk for sudden cardiac death in the presence of a structural cardiac abnormality, particularly recent myocardial infarction; however, the need for treatment in such cases is speculative and is being investigated. Treatment is mandatory for survivors of an episode of ventricular fibrillation and those with recurrent sustained ventricular tachycardia or torsade de pointes ventricular tachycardia. The approach to management is either invasive or noninvasive. Selection of an antiarrhythmic agent is facilitated by knowledge of some basic electrophysiologic features of the heart and of the classification of antiarrhythmic drugs. However, drug therapy has to be individualized on the basis of efficacy, left ventricular function and adverse effects or potential adverse effects of the drug. Amiodarone therapy or nonpharmacologic therapy should be considered if a suitable antiarrhythmic agent cannot be found.     

倒卵叶五加总皂甙抗心律失常作用的实验研究

探讨倒卵叶五加总皂甙对实验性心律失常的影响。方法：采用经动物颈静脉恒 注射的模型,监测哇巴因诱发豚鼠和乌头碱诱发大鼠首次出现室早搏、室速、室颤、心律停搏所用时间并换算成哇巴因和乌头碱的剂量。统计上采用组间ｔ检验。结论ＳＡＯＨ有一定的抗心律失常的作用。     

胺碘酮治疗心律失常75例临床分析

目的：探讨胺碘酮抗心律失常作用的合理应用。方法：回顾分析应用胺碘酮治疗心律失常75例住院患者,男性51例,女性24例,平均年龄58．8岁,阿斯综合征发作3例,频发室早、室性心动过速45例、阵发性房颤房朴22例,频发房早、房速5例,观察心律失常控制情况、并发症及预后。结果：阿斯综合征3例中2例抢救成功,室性心律失常45例中43例发作均减少75％以上,房颤、房朴22例均恢复窦性心律,肝功能损害1例,突发室性逸搏心律2例,1例猝死,静脉炎17例,低血压反应6例。结论：胺碘酮对室早、室速、房早、房速及房颤均有明显控制作用,静脉胺碘酮主要用于急性心肌梗死、急性心力衰竭伴发的心律失常的治疗。对完全性左束支阻滞患者应用胺碘酮应检查窦房结及房室传导功能,加强病因的治疗。深静脉置管可以减少静脉炎的发生。     

Tp-e间期，Tp-e/QT与ICD一级预防患者发生恶性室性心律失常的关系

目的：探讨心电图T波峰末间期（Tp-e）及T波峰末间期与QT间期的比值（Tp-e/QT）与ICD一级预防患者发生恶性室性心律失常的关系。方法分析我院2011年3月~2014年2月因严重慢性心功能不全（左室射血分数≤35%,纽约心功能分级为Ⅱ/Ⅲ级,且既往从未发生过室速或室颤等恶性心律失常）接受ICD（植入式心脏复律除颤器）一级预防的患者68例,对所有的患者随访18~38个月（平均26个月）。在随访过程中,患者根据是否发生终点事件分为高危组及低危组;本研究以SCD或室颤、室速作为终点事件。术前对所有的患者进行12导联心电图、心脏彩超、24 h动态心电图等检查,并分析Tpeak-Tend间期及（Tpeak-Tend）/QT。结果随访过程中,因ICD识别持续性室速或室颤而引发恰当放电的患者共11例,由ICD发现非持续性室速而不需治疗的患者共7例,故高危组患者共18例。从未发生室速或室颤者共50例为低危组。高危组患者的（Tp-e）105±15 ms明显高于低危组90±17 ms（P=0.003）;（Tpeak-Tend）/QT比值在高危组与低危早组相比有明显的统计学差异（0.27±0.04 vs 0.22±0.05,P=0.002）. TpTe/QT≥0.255预测ICD一级预防患者发生恶性室性心律失常风险的敏感性和特异性分别为72.2%和65.9%;TpTe≥103 ms预测ICD一级预防患者发生恶性室性心律失常风险的敏感性和特异性分别为66.7%和67.9%。结论 Tp-e间期、Tp-e/QT比值与ICD一级预防患者发生恶性室性心律失常的关系密切,Tpeak-Tend间期及Tp-e/QT比值越大,ICD一级预防患者发生恶性室性心律失常如室速、室颤的可能性越大。