胎儿期心律失常的诊断及其临床意义探讨

目的：探讨胎儿期心律失常的诊断方法、临床意义及对新生儿预后的影响。方法收集产前检查中发现胎儿心律失常的57例孕妇资料,分析孕妇病史、胎儿心电图、胎儿超声心动图、妊娠结局等。结果胎儿心律失常中胎儿心动过速、胎儿心动过缓和不规则胎儿心律的发生率分别为7.0%、3.5%和89.5%。经期待疗法,孕期胎儿心律恢复正常的有21例（36.8%）,出生后新生儿心律迅速恢复正常的有15例（26.3%）,产后7d新生儿心律恢复正常的有14例（24.6%）。4例胎儿（7.0%）发现心脏结构异常。结论大部分胎儿心律失常与胎儿的心脏调节功能尚未完善有关,约91.2%在分娩前或出生后心律恢复正常;胎儿期心律失常预后不良相关的因素为胎儿水肿、持续性心律失常。     

胎儿期心律失常52例预后分析

目的 总结胎儿心律失常原因,探讨其临床意义及对胎儿预后的影响.方法 选取2005-03～2008-04在我市妇幼保健院产前检查中发现胎儿心律失常孕妇52例做为观察组,分析孕妇病史,连续胎儿监护,胎儿超声心动图检查,妊娠结局,并随机选同期分娩而无胎儿心律失常病史的孕妇60例作为对照组,比较观察组和对照组之间新生窒息发生的情况.结果 首次发现胎儿心律失常的孕周平均为33+5周,与新生儿预后没有显著相关;持续发作心律失常的胎儿,其预后差于偶发心律失常胎儿;孕妇有合并症如上感发热、贫血、心脏病经治疗胎儿心律失常恢复正常,以及经期待疗法胎儿心律恢复正常共32例(61.5%);出生后新生儿心律迅速恢复正常15例(28.8%),经治疗新生儿心律恢复正常3例(5.8%).有2例(3.2%)胎儿心脏结构异常.观察组和对照组新生儿窒息率无显著性差异.结论 孕妇合并症对胎儿心律有影响,应积极改善孕妇自身状况,大部分心律失常胎儿预后良好,临床上可以随诊观察.     

窦性心律失常

正常情况下,心脏的起搏点位于窦房结,由窦性冲动引起的心律称为窦性心律。正常心脏总是窦性心律。但很多心脏病患者也多为窦性心律,因此,窦性心律的存在并不能说明心脏是否正常。 窦性频率受多种因素影响,其中包括迷走和交感神经的作用、化学介质、呼吸动作、体位、情绪激动、体力活动、体温、心脏疾病、代谢情况、药物等因素。 由窦性冲动的形成和传导障碍形成的心律失常,称为窦性心律失常。包括窦性过早搏动,窦性心动过速、窦性心动过缓、窦性心律不齐、窦性静止和窦房传导阻滞。 窦性心动过速(心率>100次/min)、寞性心动过缓(心率<60次/min)、窦性心律不齐多受生理因素所影响,但亦见于某些病理情况。受生理因素影响的,一般无需治疗,发生于病理状态下,可给予相应的治疗。     

胎儿心律失常的原因及对胎儿预后的影响

目的:总结胎儿心律失常原因,进一步探讨胎儿心律失常对胎儿预后的影响.方法:采用回顾性分析方法,对21例胎儿心律失常孕妇的情况,胎儿心律失常的临床表现、诊断方法,结合长期随诊结果进行总结.结果:胎儿心律失常的发生率为0.3%.21例胎儿心律失常中,4例为胎儿心动过:速(19.0%),3例为胎儿心动过缓(14.3%),14例为不规则胎儿心律(67.7%);胎儿心律失常平均诊断孕周岁36 2周(28周～41 1周).21例中18例为产前胎心听诊时发现胎儿心律失常;3例胎心监测发现胎儿心律失常.6例产前进行了胎儿超声心动检查,其中2例胎儿超声心动检查提示胎儿室性早搏,心脏结构未见异常,占33.3%,余未见异常.产后新生儿均存活,随诊20例(95.2%),10例新生儿进行了超声心动检查,其中1例诊断为先天性心脏病,为法洛四联症.先天性心脏病新生儿在心律失常胎儿中发生率为4.8%.结论:大多数心律失常的胎儿预后是好的,心脏畸形的发生率很低.对于持续性心率慢的胎儿,需注意心脏结构异常的存在;对于心律失常胎儿的处理采用期待疗法,根据产科指征决定终止妊娠的方式.     

阿霉素对冠心病患者心脏毒性作用——附9例报告

我院收治的12例癌症患者合并有冠心病,用阿霉素治疗时,9例出现心脏毒性表现。现报告如下。临床资料一、阿霉素引起心脏毒性作用 (一)心律失常:①窦性心动过速6例,心率由治疗前80次/分,增至101～170次/分。②心房纤颤1例,心室率达160次/分,持续3天死于循环衰竭。③室性早搏2例,其中1例呈室性二联律,后出现混乱性心律     

彩色多普勒超声心动图在胎儿心律失常中临床应用探讨

目的探讨超声检测在胎儿心律失常方面的诊断价值及临床意义。方法对临床疑有胎儿心律失常或伴其他异常妊娠史的200例胎儿进行超声心动图检查。结果经超声检测显示25例（12．5％）胎儿出现心律失常现象,其中心动过速10例（包括5例窦性心动过速及5例室上性心动过速）,心动过缓5例,房性早搏5例。室性早搏2例,房扑1例,合并先天性心脏病2例（其中心内膜垫1例,室缺1例）。结论彩色多普勒超声心动图能够早期诊断胎儿心律失常的类型及胎儿心脏结构功能状况,能为是否需要终止妊娠提供参考临床依据：胎儿心律失常多为功能性及暂时性的,超声检测在胎儿心律失常的正确诊断及在临床合理的干预中具有重要的指导意义。     

232例老年窦性心律不齐心电图分析

窦性心律不齐是临床最常见的心律失常之一.凡由于窦房结不规则发放冲动而产生节律不匀齐的心律,就称为窦性心律不齐,是一种良性心律失常.一般没有重要的临床意义.按其表现形式不同,可以有5种类型:呼吸性窦性心律不齐;非呼吸性窦性心律不齐;窦房结内游走节律;心房内游走节律;心室相性心律不齐.其中非呼吸性窦性心律不齐常见于老年人,具有窦性心律不齐的特点,其心率变化与呼吸周期无关,此型心律不齐多为病理性表现.本文收集观察了2010年本科检查的763例老年患者的常规心电图,旨在探讨老年人窦性心律不齐的特点、规律及临床意义.     

新生儿心率失常51例临床分析

目的：研究新生儿心律失常的临床特点。方法：采用回顾分析的方法，对51例新生儿心律失常的类型、发病原因和临床表现等进行研究。结果：51例新生儿心率市场中没有诱因的有21例，其余都有原发病，有22例无明显的临床表现，经过心电图检查后，有窦性心动过缓21例，期前收缩13例，传导阻滞9例，阵发性室上性心动过速6例，室性心动过速1例，复合心率失常1例；经过心脏彩色多普勒超声检查后，发现先天心脏病5例，室间隔缺损2例，动脉导管未闭1例，房间隔缺损2例。结论：新生儿心率失常在临床上比较多见，可以没有任何诱因，在治疗的过程中，以治疗原发病为主。     

不同类型胎儿心律失常的围产期处理及结局

目的探讨不同类型胎儿心律失常的围产期处理及结局。方法回顾性分析2003年10月~2010年12月在深圳市妇幼保健院经超声心动图筛查诊断为胎儿心律失常的病例。结果共筛查胎儿心律失常130例,其中期前收缩59例、窦性心动过缓23例、窦性心动过速16例、房室传导阻滞12例、房颤3例、其他心律失常17例。其中12例(9.2%)合并先天性心血管畸形,胎儿心动过缓多见。心律失常不同分类之间的预后有显著性差异(P=0.000)。心律失常分类(P=0.024)、合并先天性心脏病(P=0.000)及胎儿水肿(P=0.008)是胎儿预后不良的危险因素。结论大部分阵发性心律失常胎儿在严密监护保守治疗下,胎儿预后良好,胎儿心动过缓预后较差。胎儿心律失常围生期预后与胎儿心律失常分类、是否伴有心血管或其他畸形、有无胎儿水肿密切相关。     

超声定量研究室性早搏后心功能恢复与心脏储备力的关系

对５８例不同病因引发的室性早搏患者，通过超声定量检测室性早搏及室性早搏后第一个窦性心律射血分数（ＥＦ）、面积变化分数（ＦＡＣ），并与自身正常心律相比较，研究室性早搏发生瞬时心功能降低情况下，心脏能否迅速恢复到正常状态，与其心脏储备功能的关系。结果表明，单纯性室性早搏的室性早搏后ＥＦ、ＦＡＣ增加，可迅速恢复正常状态，Ｐ＞０．０５；心脏存在器质性心脏病时，心功能指标仅恢复到正常低限值或低于正常，Ｐ＜０．０５；合并心衰时，室性早搏后第一个窦性心律不能恢复到原有心功能水平，Ｐ＜０．０５。结果证实：室性早搏后心脏迅速恢复主要取决心脏储备功能，储备力越好，心肌纤维生理性伸长越大，心肌收缩力越强，ＥＦ、ＦＡＣ越接近正常心律心功能指标；反之心脏恢复越差，心功能越低。合并心衰时，心脏储备力严重降低，室性早搏及室性早搏后心功能均处于低水平状态，是致命的危险因素，所以了解室性早搏后心脏恢复与心脏储备力的关系，有重要临床价值及意义。     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…