心脏永久起搏器并发症分析

过去40年,永久起搏器由最初治疗心动过缓逐渐向改善患者生存率和生活质量的方向发展。随着起搏器病例的增加,其并发症正受到越来越多的关注。本文选择我科1978—2002年12月以来安置的366例起搏器病例,对其中的起搏器并发症进行分析,以期探讨防治措施。     

以甲真菌病样病变为首发症状的毛发红糠疹1例

患者女,42岁,上海市人.双侧掌、跖部红斑角化、皲裂伴趾甲增厚14年,四肢鱼鳞病样皮损5年.颈后、腰、臀部干燥性红斑半年、伴有瘙痒,1996年底以来多次来我科就诊,曾诊断为真菌病、鱼鳞病,给予维生素A和E丸、伊曲康唑及外用药治疗,皮损均无明显改善.1999年3月因肢体皮损扩大伴剧烈瘙痒,再次到我科就诊.体检:全身情况良好.     

肝细胞生长因子治疗缺血性疾病研究进展

近年来,随着社会的老龄化以及生活水平的提高和生活方式的改变,动脉粥样硬化性疾病的发生率呈逐年上升趋势。动脉粥样硬化最终可以导致机体各重要器官与脏器的缺血性疾病,如死亡率与致残率极高的心脑血管疾病,严重危害人类健康和生命安全,带来了沉重的社会及经济负担,所以日益受到政府和医学界的重视。尽管取得了很多进展,但是缺血性疾病的治疗效果还不理想,迫切需要研究新的治疗方法。肝细胞生长因子(hepatocytegrowth factor,HGF)由于其具有抗缺血、抗凋亡等多种生物学功能备受关注。近年来,HGF在基础及临床研究方面皆已取得了很大进展…     

乳房外湿疹样癌1例

乳房外湿疹样癌是一种好发于大汗腺分布部位的恶性肿瘤。本病例发生于腋部,临床上极为少见,现报道如下。临床资料患者女,63岁。于1993年开始于左腋部出现豌豆大小红斑,表面少许渗出,偶痒。曾被当地医院诊断为湿疹,给予多种糖皮质激素软膏外用,疗效不佳。自1998年开始,斑片逐渐扩大,有鸡蛋大小,有微痛感。于2000年5月来我院就诊。家族中无类似病史。查体:一般情况尚可,无发热,各系统检查未见明显异常,浅表淋巴结未见肿大。皮肤科检查:左腋下可见形态不规则,边界清楚暗红色浸润斑片,约3.0 cm×5.0 cm,表现湿润,上覆少量鳞屑(图1)。左腋下未触…     

中国经导管消融治疗心房颤动注册研究-2007

Objective To report the outcome of registered cathered catheter ablation of atrial fibrillation (AF) in China 2007. Methods Data on AF ablation from registered hospitals in 2007 was analyzed retrospec-tively. Results A total of 2620 cases from 40 hospitals wererecruied,male 1719,female 901 ,mean age 58.5± 11.2years. Proportions of patients with paroxysmal, long-standing permanent AF were 77.4% ,15.7% and 6.9%, respectively. Patients accompanied with underlying disease were 54.1%. Left atrial diameter was (38.3 ± 6.3) mm,left ventricular end-diastolic dimension was(47.8 ±5.2)ram,and left ventricular ejection fraction waa 0.63 ±0.08. The most common prcedures were circumferential pulmonary veins (PV) ablation and circumferential PV ablation plus additional hnes. The most often used ablation energy was radiofrequency (99.8%). Total success rate was 80.3% ,and recurrence rate was 19.7%. Factors impacting success and rencurrence rates included left atrial diameter,type of AF,and procedures. After catheter ablation,antiarrhythmic drug application increased mod-erately,and the anticoagulation therapy stengthened. Complications occurred in 26 patients (1.7%), no severe coplications such as esophagus atrail fistula and pulmonary vein stenosis were observed. Conclusions The catheter ablation could be recommended as a first-line therapy for patients with symptomatic paroxsmal AF in qualified hospitals.     

中国经导管消融治疗心房颤动注册研究-2007

Objective To report the outcome of registered cathered catheter ablation of atrial fibrillation (AF) in China 2007. Methods Data on AF ablation from registered hospitals in 2007 was analyzed retrospec-tively. Results A total of 2620 cases from 40 hospitals wererecruied,male 1719,female 901 ,mean age 58.5± 11.2years. Proportions of patients with paroxysmal, long-standing permanent AF were 77.4% ,15.7% and 6.9%, respectively. Patients accompanied with underlying disease were 54.1%. Left atrial diameter was (38.3 ± 6.3) mm,left ventricular end-diastolic dimension was(47.8 ±5.2)ram,and left ventricular ejection fraction waa 0.63 ±0.08. The most common prcedures were circumferential pulmonary veins (PV) ablation and circumferential PV ablation plus additional hnes. The most often used ablation energy was radiofrequency (99.8%). Total success rate was 80.3% ,and recurrence rate was 19.7%. Factors impacting success and rencurrence rates included left atrial diameter,type of AF,and procedures. After catheter ablation,antiarrhythmic drug application increased mod-erately,and the anticoagulation therapy stengthened. Complications occurred in 26 patients (1.7%), no severe coplications such as esophagus atrail fistula and pulmonary vein stenosis were observed. Conclusions The catheter ablation could be recommended as a first-line therapy for patients with symptomatic paroxsmal AF in qualified hospitals.     

头胸导联心电图在显性旁道定位诊断中的作用

同时记录预激综合征患者常规心电图及头胸导联心电图各1份,比较两种体表心电图对旁道定位的准确率。结果:头胸导联心电图的准确率较常规心电图略低(78.3%vs84.8%);但尚无统计学差异(P>0.05)。结论:在对预激综合征患者显性旁道定位诊断方面,头胸导联心电图也有较高的准确率。     

节段性肺静脉电隔离治疗阵发性心房颤动的方法学

目的 对阵发性心房颤动(房颤)经药物治疗无效并接受射频导管消融治疗的患者，采用经改良的节段性电隔离方法隔离肺静脉进行治疗，并研究该方法的有效性及安全性。方法 61例阵发房颤患者采用一次房间隔穿刺技术，分别送入标测及消融电极导管。应用猪尾造影导管用高压注射器非选择性左心房造影显示肺静脉开口及左心耳位置，指导导管行进方向以减少心脏压塞风险。标测中常规探查、标测右下肺静脉，避免遗漏可能触发房颤的肺静脉电位。在肺静脉与左心房之间肺静脉电位优势传导部位用温控导管或冷盐水灌注导管做多点消融形成节段性隔离。结果 单个节段或多个节段消融可使肺静脉与左心房之间形成完全性电隔离，使肺静脉电位消失。节段性隔离靶肺静脉173根，即刻成功168根，成功率97．1％。术中2例发生心脏压塞，1例左上肺静脉狭窄60％。结论 节段性电隔离肺静脉法可有效隔离肺静脉，可替代点状隔离和环状隔离方法。与其他传统方法比较，手术时间短、成功率高，可明显减少肺静脉的损伤和避免肺静脉狭窄的发生。     

加强关键教学环节管理提升内科临床教学质量

临床教学是医学教育的重要组成部分,临床教学质量直接关系到高级医学人才的培养和医学的发展。影响临床教学质量的环节繁多,从临床教学的关键环节入手,狠抓课堂教学、临床见习及临床实习环节管理,使教师的教学意识和能力显著增强,临床教学质量明显提高。     

血脂检测测什么

血脂是血浆中的中性脂肪（甘油三酯、胆固醇）和类脂（磷脂、糖脂、固醇、类固醇）的总称,最主要的成分是甘油三酯和胆固醇。目前已知胆固醇,尤其是低密度脂蛋白胆固醇的升高,是动脉粥样硬化最重要的危险因素。因而心脏病患者要常规检测血脂。