电生理特征不典型房室结折返性心动过速的射频消融治疗

目的:分析电生理特征不典型的房室结折返性心动过速的射频消融结果.方法:将32例房室结折返性心动过速分为两组:甲组16例,心房刺激均呈连续性房室结功能曲线;乙组16例,心房刺激均呈跳跃性房室结功能曲线.比较两组患者慢径消融有效靶点分布及射频消融前后组内及组间的电生理参数.结果:两组慢径消融有效靶点分布相似(P＞0.05 );消融后两组患者心房递增起搏时最大AH间期(A1H1max)均比消融前显著缩短(P＜0.05或P＜0.01);与消融前比,乙组消融后心房程序刺激时最大AH间期(A2H2/A3H3max) 及房室结有效不应期(ERPAVN)与消融前比有显著变化(P＜0.05或P＜0.01),而甲组变化不大(P＞0.05 ).结论:电生理特征不典型房室结折返性心动过速慢径消融成功靶点与典型的房室结折返性心动过速分布相似.消融后 A1H1max的显著缩短可作为其消融成功的指标之一.     

预激综合征旁路前传可能缩短PJ间期

目的 探讨预激综合征旁路前传能否缩短PJ间期及预激综合征PJ间期延长的临床意义.方法 选择导管射频消融根治的显性单旁路预激综合征143例,按房室结前传经路(正路)有无房室和束支阻滞分为A,B两组.A组为正常组132例(按旁路部位进一步分10个亚组),B组为并I度房室阻滞或束支阻滞组11例.各组分别对照分析有无旁路传导心电图.结果 (1)A组右后和右后间隔亚组PJ间期较消融旁路后缩短,差异有统计学意义[分别为(226±18)ms vs(236±19)ms和(221±18)ms vs(238±31)ms 均P＜0.05].(2)B组11例旁路前传均不同程度缩短正路阻滞引起延长的PJ间期:I度房室阻滞(4例),PJ间期虽缩短但仍大于正常范围;束支阻滞(7例),有4例PJ间期缩短到正常范围.结论 预激综合征在正路传导正常时,旁路前传不延长PJ间期,且可能缩短PJ间期;在正路传导异常时旁路前传能缩短延长的PJ间期;预激综合征PJ间期延长提示并房室或束支阻滞,但PJ间期正常不能排除并束支阻滞.     

射频消融慢径路对不典型房室结双径路前传功能的影响

目的:观察不典型房室结折返性心动过速(AVNRT)患者慢径路被消融后对快径路前传功能的影响。方法:38例成功行慢径射频消融的AVNRT患者,其中19例心房刺激均呈连续性AVNFC(甲组);对照组(乙组)19例心房刺激均呈跳跃性AVNFC。比较两组患者慢径射频消融前后的电生理参数变化。结果:消融后两组患者心房递增起搏时最大AH间期(A1H1max)均比消融前显著缩短,乙组A2H2max及ERPAVN-前传有明显变化,而甲组变化不大。结论:房室结双径路是彼此有相互关联的两条径路,与典型AVNRT一样,不典型AVNRT射频消融慢径路后前传功能得到改善。     

不同生理性起搏方式的临床应用研究（摘要）

目的对因病态窦房结综合征伴有正常房室传导功能而植入DDD起搏器的患者进行观察,以比较不同生理起搏模式AAI(R)与DDDS(R) (即较短房室间期以确保心室100%起搏)对患者心功能及生活质量的影响.     

房室结慢径消融术对AVNRT患者冠状静脉窦电生理的影响

目的：：探讨房室结折返性心动过速(AVNRT)患者房室结慢径消融术前、后冠状静脉窦(CS)电生理的改变。方法：48例均经心内电生理检查确诊为 AVNRT患者,分别测量房室结慢径消融术前、后 CS近端(CSp)CS9~10,CS中端(CSm)CS5~6,CS远端(CSd)CS1~2的有效不应期(ERP),应用程序刺激 S1 S1500,400,350,300,280 ms 分别起搏 CSp 及 CSd,分别测量 CSp~CSd及CSd~CSp的A波传导时间。结果：(1)房室结慢径消融术前、后CS不同部位的ERP分别为CSp(213.75±24.98)ms,(223.54±16.44)ms(P <0.00001);CSm(222.71±22.67)ms,(230.00±14.14)ms(P <0.001);CSd(229.17±36.83)ms,(235.83±22.86)ms(P <0.05)。CS 的 ERP 离散度分别为(26.88±25.94)ms,(20.83±13.81)ms(P <0.05)。(2)应用程序刺激 S1 S1500,400,350,300,280 ms分别起搏 CSp 及 CSd,分别测量房室结慢径消融术前、后 CSp~CSd及CSd~CSp的 A波传导时间,差异均无统计学意义(均P>0.05)。结论：AVNRT患者房室结慢径消融术前、后 CSp,CSm, CSd的 ERP均延长,CS的 ERP离散度减小,而CS的 A波传导时间无明显改变,可能与房室结慢径消融术导致的迷走神经功能改变有关。     

缺血再灌注对家兔房室传导功能影响的实验研究

目的：探讨缺血－再灌注对家兔心脏房室传导功能的影响。为临床防治提供实验依据。方法：以家兔为实验对象，开胞暴露心脏，通过结扎及再通右冠状动脉，建立房室结缺血－再灌注模型，监测血流动力学、希氏束电图及体表心电图，观察不同时间缺血及缺血－再灌注时的AH及HV间期的变化。结果：结扎右冠状动脉后，94．8％的动物出现AH间期明显延长（P＜0．01），再灌注后延长的AH间期明显缩短（P＜0．01）；缺血120min再灌注组，AH间期恢复结扎前水平后，随着再灌注的继续，AH间期则再次出现延长。结论：缺血可引起家兔在体心脏房室传导功能障碍，及时的再灌注可使房室传导功能完全恢复，延迟的血供恢复则可残留部分的房室传导障碍。     

一项关于阻塞性睡眠呼吸暂停患者中生理性起搏的前瞻性随机交叉试验

目的:本试验拟评估利用生理性起搏预防心动过缓对阻塞性睡眠呼吸暂停严重性的影响。背景:睡眠时呼吸暂停发作伴随呼吸暂停期心率变慢及觉醒后心动过速。当永久性起搏器植入患者的起搏器频率设定为快于自发性夜间心率时,睡眠呼吸暂停发作可减少。方法:在阻塞性睡眠呼吸暂停患者中进行了一项前瞻性、随机、单盲、交叉试验,通过临时心房起搏来减低呼吸暂停低通气指数(AH I)。15例具有中至重度阻塞性睡眠呼吸暂停(AH I34±14)的患者(年龄60±13岁,12例为男性)经左锁骨下静脉放置心房永久起搏器。在医院里,患者分别在心房起搏频率设定为75次/m…     

双腔起搏器自身房室传导搜索功能临床应用

目的评价具有自身房室传导搜索功能(Autointrinsic Conduction Search,AICS)双腔起搏器减少右心室起搏比例的效果。方法选择18例病窦综合征患者(排除Ⅲ度房室传导阻滞患者),观察应用AICS功能前后患者自身房室传导的比例变化。结果除2例失访外,16例在自身房室传导功能打开后,总心室起搏比例明显下降(5.43&#177;1.7%vs29.5&#177;10.05%,P&lt;0.05),心室起搏百分比&gt;10%的患者比例亦明显减少(5/16例vs10/16例)。结论自身房室传导自动搜索功能可以有效降低右心室起搏的比例,因而可以减少起搏器的能量消耗,改善患者血流动力学效应。     

雷米普利对兔心交感神经传导及去甲肾上腺素释放的影响

转化酶抑制剂雷米普利(Ramipril下简称Ram)在离体灌流家兔心脏减弱外源性去甲肾上腺素(NE)和心交感神经刺激所致心率(HR)、心肌收缩力(FC)及冠脉流量(CF)的变化;显著减少心交感神经刺激期间内源性NE的释放。结果表明Ram能抑制心交感神经的传导及交感递质的释放,推测其作用原理可能是Ram在心脏局部抑制血管紧张素Ⅱ(ANGⅡ)的生成,从而干扰肾上腺素能神经传导时这一促进性肽所介导的接通。     

伊布利特对人心脏正常传导系统及房室旁道的电生理作用?

目的:观察新型Ⅲ类抗心律失常药物伊布利特对人心脏正常传导系统及房室旁道的电生理作用,评价其应用于电生理检查及射频消融的安全性.方法:21例经电生理检查证实为房室折返性心动过速患者,静脉注射伊布利特1 mg,比较用药前、用药后即刻、15 min、30 min时P-A间期、A-H间期、H-V间期、QRS时限、QT间期、右室起搏下QT间期、右心房不应期、右心室不应期、房室结不应期、房室结文氏点、旁道前传及逆传不应期.结果:与用药前相比,用药后P-A间期、A-H间期、H-V间期、QRS时限均无明显变化(P》0.05), QTc间期、右室起搏下QT间期、右房不应期、右室不应期、房室结文氏点均明显延长(P《0.05);与用药前相比,用药后旁道前传及逆传不应期明显延长(P《0.05),无1例出现前传或逆传功能丧失;无尖端扭转性室速及其他不良反应发生.结论:伊布利特对心脏正常传导系统的传导性无明显影响;常规剂量伊布利特能够延长旁道不应期但不阻断旁道传导功能,不影响对房室旁道的标测和消融;将其用于房室折返性心动过速患者未发生不良反应.     

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…