急性心肌梗塞后QT离散度的演变及其与室性心律失常的关系

目的　研究急性心肌梗塞 (AMI)后QT离散度 (QTd)的演变及其对快速室性心律失常的预测价值。方法　测量 34例AMI后患者不同时期和伴室性心律失常时的QTd ,并与健康对照组 (90名 )相比。结果　AMI后患者的QTd在急性期 (72± 18ms)明显大于亚急性期 (5 8± 17ms,P <0 .0 1) ,亚急性期大于陈旧期 (49± 2 1ms,P <0 .0 1) ,均明显大于对照组 (36± 10ms,P <0 .0 1)。陈旧期内心功能Ⅰ级、Ⅱ级者的QTd(36± 14ms,41± 15ms)与对照组无明显差异 (P >0 .0 5 ) ,Ⅲ～Ⅳ级者的QTd(6 6± 2 0ms)明显延长 (P <0 .0 1)。 9例AMI伴室速 /室颤 (VT/VF)者的QTd(91± 18ms)显著长于急性期不伴VT/VF者 (70± 14ms,P <0 .0 1)。结论　AMI后 0～ 3天QTd显著延长 ,随梗塞愈合渐趋正常 ,QTd显著延长是预示危重室性心律失常的不良之兆     

溶栓治疗对急性心肌梗死QTcd的影响

目的　为探讨急性心肌梗死 (AMI)静脉溶栓治疗对心率校正QT离散度 (QTcd)的影响及其意义。方法　回顾分析 10例AMI静脉溶栓成功者溶栓前与溶栓 2 4h后心电图以及同期 10例未行溶栓治疗的AMI患者入院时与入院 2 4h后心电图 ,测定QTcd。结果　溶栓组治疗前后QTcd分别为 71.8± 16.3ms和 45 .6± 17.4ms ,差异有显著性(P <0 .0 1) ,未溶栓组为 72 .5± 17.0ms和 71.7± 15 .9ms ,差异无显著性 (P >0 .0 5 )。两组治疗 2 4h后QTcd差异有显著性 (P <0 .0 1)。结论　成功的溶栓能使紊乱的心肌复律恢复稳定 ,显著缩短AMI的QTcd ,改善预后。QTcd缩短可作为AMI溶栓成功指标之一。     

直接PTCA对急性心肌梗死的QT离散度的影响

目的　观察直接PTCA对急性心肌梗死 (AMI)患者QT离散度 (QTd)及QTc离散度 (QTcd)的影响。方法　对 30例AMI患者行直接PTCA ,使病变血管血流达到TIMI血流 3级 ,于PTCA术前、术后 2h、4 8h作同步 12导心电图并测量QTd及QTcd ,然后与 30例正常人对照。结果　AMI组与正常对照组间QTd及QTcd有极显著差异 (P <0 .0 1)。有室性心律失常的AMI患者其QTd和QTcd高于无室性心律失常患者 ,但差异无显著性(P >0 .0 5 ) ,PTCA术后其QTd和QTcd下降 (P <0 .0 1) ,室性心律失常好转。结论　成功的直接PTCA可降低AMI患者的QTd和QTcd ,减少室性心律失常的发生 ,改善预后     

高血压并阵发性心房颤动患者P波离散度改变

目的　探讨高血压病患者P波离散度改变规律。方法　观察 3 4例高血压并阵发性心房颤动患者 (房颤组 )的最宽P波 (Pmax)和P波离散度 (Pdisp) ,并与 3 9例无阵发性心房颤动的高血压病患者 (对照组 )对比分析。结果　房颤组的Pdisp为 5 1± 11ms ,其中Pdisp≥ 40ms为 2 9例 (85 .2 9% ) ;对照组的Pdisp为 3 6± 9ms ,其中Pdisp≥ 40ms为 5例 (12 .82 % )。两组比较差异均有高度显著性 (P <0 .0 1)。结论　Pdisp是预测高血压病患者心房颤动发生的可靠指标 ,当Pdisp≥ 40ms时预测有较高的敏感性和特异性。     

冠心病冠状动脉介入性治疗前后QT离散度的变化

目的 :探讨冠状动脉介入手术 (PTCA和冠状动脉内支架置入术 )对冠心病患者QT离散度 (QTd)的影响。方法 :记录 6 1例冠心病患者介入手术前后静态 12导联心电图 ,计算QTd ,并进行对比分析。结果 :6 1例冠心病患者介入性治疗前QTd为 (10 5 7± 41 3)ms ,介入性治疗后QTd为 (5 9 4± 2 8 6 )ms,前后相比QTd差异有显著性 (P <0 0 1)。PTCA术后与冠脉内支架置入术后QTd分别为 (6 2 9± 2 9 2 )ms和 (5 6 2± 2 8 1)ms,二者相比差异无显著性(P >0 0 5 )。结论 :冠心病经介入性治疗后QTd明显减小 ,QTd可作为介入手术后心肌再灌注成功的参考指标。是否可作为冠脉再狭窄的早期指标 ,有待于进一步观察     

AMI患者急诊PTCA+支架植入术对QT离散度的影响

目的观察26例急性心肌梗死(AMI)患者梗死相关血管(IRA)早期再灌注对QT离散度(QTd)的影响.方法对26例AMI患者予急诊冠状动脉造影,对IRA予急诊PTCA+支架术,在术前及术后24小时内分别记录体表12导联同步心电图,测量QTd,并监测严重心律失常发生情况.结果AMI患者行急诊PTCA+支架术后,IRA开通率100%,所有病人IRA血流达TIMIⅢ级.QTd从术前的(78.6±17.4)ms降至术后的(48.6±14.8)ms(P＜0.01).7例术前有恶性心律失常,其QTd明显高于无心律失常的患者(82.3±15.6)术后QTd降至(49.8±13.7),室性心律失常消失.结论急性PTCA+支架术可显著降低QTd,IRA早期再灌注可减少危险性心律失常的发生.     

三种心电信息对急性心肌梗塞患者恶性室性心律失常事件发生的预测价值

目的 :探讨心室晚电位 (VLP)、QT离散度 (QTd)、校正QT离散度 (QTcd)对急性心肌梗塞 (AMI)患者恶性室性心律失常事件发生的预测价值。方法 :测定 6 4例AMI患者和 30例健康人的VLP、QTd、QTcd ,并对AMI患者随访 1年。结果 :AMI组VLP阳性率 (4 2 2 % )较对照组 (6 7% )明显增高 (P <0 0 1) ,QTd、QTcd分别为 74 2± 18 4ms和 81 3± 2 2 6ms较对照组 (2 8 4± 10 6ms和 34 8± 15 3ms)明显延长 (P <0 0 1)。 6 4例AMI患者随访 1年发生恶性室性心律失常事件 18例 ,其中VLP阳性率、QTd、QTcd分别为 88 9%、86 5± 2 7 4ms、93 6± 34 8ms和非事件组(2 3 9%、6 2 7± 2 4 3ms、6 9 4± 2 5 2ms)比较 ,差异有显著性 (P <0 0 1)。在预测AMI患者恶性室性心律失常事件发生的敏感性 ,特异性和有效性QTd分别为 6 6 5 %、85 4%、78% ,QTcd分别为 72 4%、71 3 %、71% ,VLP分别为42 6 %、92 8%、6 8%。结论 :VLP(+ )和QTd、QTcd明显延长与AMI患者发生恶性室性心律失常事件密切相关 ,并可作为AMI患者预后和恶性室性心律失常事件发生可靠的 ,非侵入性预测指标。其中以QTcd敏感性最高 ,VLP(+ )最具特异性。     

P波离散度与阵发性心房颤动关系的探讨

目的 :探讨 P波离散度 (Pdisp)与阵发性心房颤动 (房颤 )之间的相互关系。方法 :应用体表心电图测定 46例阵发性房颤患者在转复成窦性心律时的 P波离散度 ,并与 46例健康体检者 (对照组 )对比分析。结果 :46例阵发性房颤组的 Pdisp为 (5 2± 10 ) ms,其中 Pdisp≥ 40 ms者为 42例 (91.3%) ;46例对照组的 Pdisp为 (2 8± 7) m s,其中 Pdisp≥ 40 ms为 5例 (10 .8%)。两组比较有非常显著性差异 (P <0 .0 1)。结论 :P波离散度是预测阵发性心房颤动发生的一个可靠的指标 ,当 P波离散度≥ 40 ms时预测有较高的敏感性和特异性。     

门冬氨酸钾镁治疗急性心肌梗死对QT离散度的影响

目的 :评估门冬氨酸钾镁治疗急性心肌梗死对QT离散度的影响。方法 :采用随机、单盲、对照的方法将44例急性心肌梗死患者在常规治疗的基础上分为两组。治疗组 (n =2 1 )给予静脉门冬氨酸钾镁治疗 ,对照组(n=2 3 )不用门冬氨酸钾镁治疗。取入院时、入院后 2 4h及 1周的心电图 ,测量QT离散度 ,观察急性心肌梗死后心律失常的发生率。结果 :治疗组与对照组QT离散度在入院后 2 4h分别为 61 .62±7.3 5ms和 71 .0 6±1 4.0 1ms(P <0 .0 5 ) ,1周时分别为 5 3 .0 7± 5 .64ms和 66.0 0± 1 0 .5 1ms(P <0 .0 5 )。治疗组与对照组住院期间室性心律失常的发生率分别为 2 3 .8%和 5 6.5 % (P <0 .0 5 )。结论 :门冬氨酸钾镁治疗急性心肌梗死可以减少QT离散度和室性心律失常的发生率。     

QT离散度在急性心肌梗塞预后中的临床意义

目的 :探讨 QTd对预测 AMI患者预后的价值。方法 :对 2 64例 AMI患者及1 0 0例正常人 QTd、JTd及 QTcd结果进行分析。结果 :QTd、JTd及 QTcd在 AMI组显著延长 ,分别为 63 .8± 1 7.4ms、5 9.4± 1 8.1 ms及 68.1± 2 0 .3 m s,明显高于对照组 2 4.7± 8.6ms、2 0 .3± 1 0 .1 ms及 2 8.1± 1 1 .3 ms;在有室性心律失常组分别为 71 .6± 2 1 .9ms、67.5±2 2 .1 m s及 75 .3± 2 3 .7m s,明显高于无室性心律失常组 5 3 .3± 1 9.2 ms、49.1± 1 7.6ms及5 4.2± 2 4.0 m s;在死亡组分别为 82 .6± 1 8.4ms、76.3± 1 7.6ms及 86.9± 1 9.6m s,亦明显高于生存组 5 6.5± 1 6.0 ms、5 3 .7± 1 6.5 ms及 61 .1± 2 0 .2 ms。结论 :QTd可作为识别 AMI后高危患者临床心电学的敏感指标之一 ,对判断 AMI预后有一定意义     

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…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

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.