心房颤动导管消融中可调弯鞘使用的经验

目的报道心房颤动（简称房颤）导管消融过程中使用可调弯韒（Agilis NxT鞘）的经验。方法 15例房颤患者采用Agilis NxT鞘进行导管消融。阵发性房颤11例,持续性房颤4例。穿刺房间隔,双侧肺静脉造影后,在EnSite VelocityTMv.3.0指导下构建左房几何模型,先行双侧肺静脉电学隔离,持续性房颤或阵发性房颤合并典型心房扑动患者继行三尖瓣峡部线性消融,而后持续性房颤患者电复律,在窦性心律下行左房高密度标测,若有低电压区或碎裂电位,继续行基质改良。结果 15例均完成4根肺静脉电学隔离。持续性房颤中,4例完成三尖瓣峡部线性消融;复律后在窦性心律下行左房高密度标测2例后壁有低电压区,遂完成两侧消融圈后壁线消融;2例右下肺静脉前庭双电位与碎裂电位,行基质改良。阵发性房颤患者中,2例合并典型心房扑动行三尖瓣峡部线性消融,1例合并冠状窦口房性心动过速消融。右、左肺静脉隔离时间分别为（20.9±5.7）min、（19.2±7.1）min。没有1例出现严重并发症。随访（5.2±1.6）个月,1（6.7%）例3月后有房颤发作。结论在房颤导管消融过程中,使用Agilis NxT鞘,能便利消融且安全有效。     

垂体结核致尿崩症1例

中枢性尿崩症病因复杂，而垂体结核致本病者较罕见；现报道如下：ｌｌｗ床资料患儿，男，８岁，因盗汗！４个月，发热、多饮、多尿１２个月入院。患）Ｌ于１９９７年６月无明显诱因出现盗汗，晨起汗湿衣衫，无发热、咳嗽、纳差、倦乏等，予以中药治疗，无明显改善。２个月后，出现低热（体温３８Ｃ）、咽癌、轻咳，４ｄ后突然出现多饮、多尿、烦渴伴纳差，倦乏无力，每日饮水量与尿量大体相同，约８０００～１００００ｍｌ，于１９９７年９月５日拍胸片示右肺结核（其父胸片示：右上肺纤维性结核，右肺门淋巴结钙化），行禁水、加压素试验（…     

窦性心率震荡与环肺静脉左房线性消融术中去迷走效应

目的 观察环肺静脉左房线性消融术对窦性心率震荡(HRT)的影响,了解消融术对心脏迷走神经即刻活动的影响.方法 2006年3月至2006年12月间行射频消融术的阵发性心房颤动(AF)患者44名(男性26例,女性18例),年龄24～76(53±11)岁,左房内径27～50(36±5)mm,射血分数65%±4%(49%～71%).消融前及消融后即刻行右室心尖部RS2期前刺激,偶联间期60%,电压2倍于舒张期阈值,并以5次期前收缩的平均值为基础,测量术前、术后震荡初始TO(turbulence onset)及震荡斜率TS(turbulence slope).对照组为同期行室上性心动过速射频消融的患者37名(男性20例,女性17例),左房内径34±3 mm,射血分数65%±3%.结果 AF组和对照组HRT差异无统计学意义:TO为-0.0216%±0.0236%比-0.0236%±0.0185%(P=0.67),TS为7.3318±6.9835 ms/RR比9.6679±6.0652 ms/RR(P=0.12).AF组射频消融前HRT与射频消融后比较,其中TO为-0.0216%±0.0236%比0.0009%±0.0133%(P＜0.01),TS为7.3318±6.9835 ms/RR比2.0553±2.1724 ms/RR(P＜0.01),差异有统计学意义.结论 HRT的变化趋势表明环肺静脉左房线性消融术中发生去迷走效应是普遍的现象,而并非一定表现为生命体征的改变.这种变化本身也提示射频能量引起迷走反射主要为损伤或者刺激了迷走传入支而非传出支.     

Rh新生儿重度溶血病换血治疗一例

我院于2003年7月为1例产前诊断为母婴Rh血型不合、脐带血抗D抗体效价为1:256的早产儿进行换血治疗,效果显著,痊愈出院.现报告如下.     

沐舒坦对早产儿呼吸道疾病防治作用的探讨

目的　探讨早期应用沐舒坦预防早产儿肺透明膜病 (HMD)的效果 ,及其对呼吸系统特殊的保护作用。方法　观察治疗组 (n =78)与对照组 (n =4 0 )HMD的发生率、病死率、并发症 (肺部感染 )发生率 ,监测入院 6、2 4h的血气分析 ;比较两组抗生素使用时间及呼吸系统症状消失时间。结果　⑴治疗组HMD的发生率、病死率及并发症 (肺部感染 )发生率显著低于对照组 (P <0 .0 5 )。⑵两组入院 6h血气分析有显著差异 ,治疗组低氧血症、酸中毒发生率少。⑶治疗组抗生素使用时间及呼吸系统症状消失时间明显短于对照组。结论　早期应用沐舒坦对预防HMD、保护肺功能具有较好效果。     

单纯碎裂电位指导心房颤动消融的初步临床观察

Objective To evaluate the feasibility of mdiofrequency catheter ablation of atrial fibrilla-tion (AF) guided by complex fractionated atrial electrograms (CFAEs). Methods Twenty-two patients with drug refractory and symptomatic AF(16 paroxysmal, 6 persisten) were enrolled. Using Carto, the left atrial or biatrial replica was created during spontaneous or induced AF, and areas associated with CFAEs were identi-fied. Radiofrequency ablation at the site with CFAEs was performed and the end points were to eliminate CFAEs or convert to sinus rhythm. Results Thirteen patients(59%)were converted to sinus rhythm, (7 cases conver-ted directly to sinus rhythm, and 6 via the intermediate atrial tachycardia(AT) or atrial flutter (AFL). The re-maining nine patients required cardioversion with D. C. shock or drug. Repeat ablation was performed in 6 pa-tients (5 AT/AFL, 1 paroxysmal AF). During(10.9 ±4.8) months follow-up, 16 patients (73%) were free of arrhythmia and symptoms. CFAEs were most commonly found along the left interatrial septum, pulmonary veins, left atrial roof. CFAEs ablation prolonged AFCL[(157 ± 18) ms vs (211 ± 32) ms, P < 0.05]. Only one patient had pericardial tamponade that required pericardiocentesis. Conclusion Radiofrequeney catheter abla-tion of atrial fibrillation (AF) guided by CFAEs is safe and effective.     

新生儿窒息后胃液pH监测及综合防治

目的 探讨新生儿胃液pH与窒息、消化道出血发生频率的关系及降低并发症的综合方法。方法 采取动态监测窒息新生儿胃液pH、洗胃及胃内注入双八面体蒙脱石等综合性防治措施。结果 窒息新生儿(常规组)生后胃液pH值明显低于对照组，生后48h胃液pH值达最低值，但于生后24h予洗胃及胃内注入双八面体蒙脱石治疗后，其胃液pH值明显升高并接近对照组，消化道出血发生率降低。结论 对窒息新生儿胃液pH进行动态监测，可指导临床进行早期干预治疗，减少并发症的发生。     

磁导航技术结合CARTO指导下持续性心房颤动的导管消融一例

患者男性,4l岁,因心悸反复发作3年加重1月,心电图提示持续性心房颤动行射频消融术,采用磁导航技术结合CARTO三维标测系统,先构建左房几何三维模型,行双侧肺静脉消融至电学隔离,而后行三尖瓣峡部线性消融,随后电复律恢复成窦性节律,验证肺静脉电位未恢复,三尖瓣峡部线双向阻滞。术后随访2.5年无心房颤动、房性心动过速发生。     

QRS时限预测心律转复除颤器植入术后电风暴患者的远期预后

目的探讨影响植入型心律转复除颤器（IcD）术后发生电风暴（ES）患者远期预后的预测因子。方法回顾性分析2003年1月至2011年9月在南京医科大学第一附属医院心脏科植入ICD术后发生Es进行或未进行射频导管消融的47例患者的相关临床参数。结果47例患者平均年龄（51±14）岁，平均随访18个月，心脏性死亡10例。多因素Cox回归分析显示QRS时限为影响ICD术后发生Es患者生存情况的预测因子[危险比（HR）=1．042，P=0．012]，射频导管消融治疗不能改善患者的预后（HR=0．034，P=0．347）。对于QRS时限≥110ms的患者，射频导管消融治疗也不能影响患者的生存情况（HR=0．037，P=0．395）。结论QRS时限可作为ICD植人术后发生Es患者远期预后的预测因子，射频导管消融并不能改善此类患者的预后。     

单纯碎裂电位指导心房颤动消融的初步临床观察

Objective To evaluate the feasibility of mdiofrequency catheter ablation of atrial fibrilla-tion (AF) guided by complex fractionated atrial electrograms (CFAEs). Methods Twenty-two patients with drug refractory and symptomatic AF(16 paroxysmal, 6 persisten) were enrolled. Using Carto, the left atrial or biatrial replica was created during spontaneous or induced AF, and areas associated with CFAEs were identi-fied. Radiofrequency ablation at the site with CFAEs was performed and the end points were to eliminate CFAEs or convert to sinus rhythm. Results Thirteen patients(59%)were converted to sinus rhythm, (7 cases conver-ted directly to sinus rhythm, and 6 via the intermediate atrial tachycardia(AT) or atrial flutter (AFL). The re-maining nine patients required cardioversion with D. C. shock or drug. Repeat ablation was performed in 6 pa-tients (5 AT/AFL, 1 paroxysmal AF). During(10.9 ±4.8) months follow-up, 16 patients (73%) were free of arrhythmia and symptoms. CFAEs were most commonly found along the left interatrial septum, pulmonary veins, left atrial roof. CFAEs ablation prolonged AFCL[(157 ± 18) ms vs (211 ± 32) ms, P < 0.05]. Only one patient had pericardial tamponade that required pericardiocentesis. Conclusion Radiofrequeney catheter abla-tion of atrial fibrillation (AF) guided by CFAEs is safe and effective.