心电向量图T环改变对冠心病诊断价值的探讨

目的:探讨心电向量图T环改变对冠心病的临床诊断价值。方法:对56例冠心病患者及60例健康人进行心电向量T环改变统计分析。结果:冠心病组在QRS/T值、QRS-T夹角、T环的L/W比值、T环角度方面与对照组有显著性差异(P<0.01),而在T环转位方面无显著性差异(P>0.05)。结论:T向量环改变对冠心病诊断有重要价值。     

病毒性脑炎患者的脑电图分析

目的：探讨脑电图（EEG）检查在病毒性脑炎的诊断和治疗中的作用。方法：对250例病毒性脑炎的病人进行EEG检查及跟踪观察。结果：250例患者中EEG诊断界限28例,轻度异常58例,中度异常128例,重度异常40例。EEG大多为弥慢性异常。其中有44例在弥漫性异常的基础上出现局灶性改变,临床伴有抽风发作者EEG出现尖波,棘波,尖棘慢综合波等改变（异常率占90．40％）与其他文献报道相符合。结论：EEG检查对病毒性脑炎的诊断治疗及病情转归,是不可缺少的重要检查手段之一。     

心电图在陈旧性心肌梗死诊断中的应用

目的 研究陈旧性心肌梗死诊断中心电图的应用效果。方法 选取我院2017年12月~2018年12月接收治疗的88例心肌梗死患者,根据患病类型的不同分为实验组和参照组,各44例,其中实验组为陈旧性心肌梗死患者,参照组为非陈旧性心肌梗死患者,全部患者均开展心电图检查,对比准确率、敏感度、特异性,缺血性T波、损伤性ST段抬升和坏死性Q波发生率。结果实验组的准确率、敏感度、特异性分别为70.45%、58.33%、85.00%,均高于参照组的47.73%、40.74%、58.82%,差异有统计学意义（P＜0.05）;实验组的缺血性T波、损伤性ST段抬升的发生率分别为9.09%、15.91%,均低于参照组的36.36%、29.55%,实验组的坏死性Q波的发生率为75.00%,高于参照组的34.09%,差异具有统计学意义（P＜0.05）。结论 利用心电图来对患者进行陈旧性心肌梗死的临床检查与诊断,能够表现出较高的特异性,但准确率及敏感度偏低,易出现误诊情况,在从整体来看仍具有较好的临床价值。     

肌萎缩侧索硬化症患者的临床与神经电生理特点分析

目的：探讨肌萎缩侧索硬化症（ALs）患者的临床特点以及肌电图（EMG）和神经传导检测对ALS的诊断价值。方法：对56例ALS患者回顾性分析其临床特点、神经传导检测及其胸锁乳突肌、下胸段脊旁肌及肢体肌的EMG资料。结果：56例患者均呈广泛神经原性损害,胸锁乳突肌EMG异常率为89％,胸段脊旁肌EMG异常率为77％。两者异常率均低于上、下肢肌EMG的异常率（分别为100％,91％）。结论：早期EMG及神经传导检测有助于ALS的早期确诊,行胸锁乳突肌及下胸段脊旁肌EMG检测对ALs的诊断及鉴别诊断有重要价值。     

老年癫癎的临床和脑电图分析

目的：探讨老年人癫癎的临床特点和脑电图表现。方法：对56例老年癫痫患者作脑电图检查。结果：脑电图正常者2例（3．57％）,轻度异常8例（14．8％）,中度异常34例（36％）,高度异常12例（22：2％）,脑电图总异常率96．43％。结论：脑电图对老年人癫癎的诊断及指导治疗有一定的帮助。     

心磁图：临床优势明显，技术仍需完善

心磁图检查是无创伤心功能检查领域的最新技术，对心肌缺血、冠心病的诊断较心电图更敏感、更准确。 1 填补空白，优势突出 与现行的检查方法相比，心磁图技术填补了现行冠心病诊断技术中低灵敏度无创伤检查与高灵敏度有创伤检查之间的空白。心磁图既避免了有创检查（如冠状动脉造影）操作难度大且有一定危险性的弊端，又使无创伤检查的灵敏度从现在的50％（如运动心电图）提高到近80％。对怀疑有冠状动脉病变（胸痛、胸闷等）但心电图并无异常改变的患者，可以通过心磁图对心肌缺血程度进行检查来明确诊断。     

糖尿病患者周围神经传导速度及其临床意义

目的探讨糖尿病患者周围神经传导速度的变化及其临床意义。方法应用日本光电MEB-2200型肌电／诱发电位仪，对56例临床上确诊为糖尿病的患者和30例健康人，进行了周围运动神经传导速度（MCV）及感觉神经传导速度（SCV）检查及研究。并进行对照分析。结果56例患者中MCV或SCV至少有一项异常者37例，占66％（37／56例）。其中正中神经异常率为35．7％（40／112侧），尺神经异常率为26．8％（30／112侧），腓总神经异常率为61．6％（69／112侧）。而临床上确诊有周围神经病变者仅为17．9％（10／56）。病程大于10年的糖尿病患者组MCV、SCV与健康人比较有统计学意义（P〈0．01）。异常率下肢高于上肢，且传导速度的改变呈双侧对称性并与病程有关。结论神经传导速度的测定对早期诊断糖尿病性周围神经病变（DPN）是有价值的。     

产前二维超声在胎儿泌尿系统异常诊断中的应用

目的：探讨产前二维超声在胎儿泌尿系统异常诊断中的临床应用价值。方法：对1258例在我院行产前二维超声检查的胎儿的检查结果进行回顾性分析,总结胎儿泌尿系统异常的声像图特征及诊断要点。结果：检出泌尿系统异常的胎儿269例（21．4％）,其中尿路扩张255例,’肾脏囊性疾病7例,单侧单发肾囊肿3例,肾缺如2例,马蹄肾1例,胎儿巨膀胱1例。其中,尿路扩张中172例在随后的产前检查中、73例于胎儿出生后随诊发现肾盂积水消失,其余24例经产后解剖或随访证实。结论：产前超声对胎儿泌尿系异常的诊断具有重要临床价值。     

肌萎缩侧索硬化症患者临床与肌电图特点分析

目的：探讨肌萎缩侧索硬化症（ALS）患者的临床特点、肌电图（EMG）和神经传导速度（NCV）对ALS的诊断价值。方法：对42例ALS患者回顾性分析其临床特点、NCV及其胸锁乳突肌、胸段脊旁肌及肢体肌EMG资料。结果：42例患者均呈广泛神经原性损害,胸锁乳突肌EMG异常率为90％,胸椎旁肌EMG异常率为88％,两者异常率均低于上、下肢肌EMG的异常率（100％,98％）,而胸椎旁肌自发电位异常率又高于胸锁乳突肌。结论：早期EMG及NCV检查有助于ALS的早期确诊,行胸锁乳突肌及胸椎脊旁肌EMG检测对ALS的诊断及鉴别诊断有重要价值。     

神经根型颈椎病和腕管综合征的神经肌电图诊断与鉴别诊断

目的：探讨神经肌电图检查在神经根型颈椎病和腕管综合征中诊断及鉴别诊断的意义。方法：对临床上诊为神经根型颈椎病和腕管综合征的病例142例进行神经肌电图检查。结果：56例临床诊为神经根型颈椎病病例的肌电图中24例（43％）符合神经根型颈椎病,10例（18％）符合腕管综合征。86例临床诊为腕管综合征的患者,其中,42例（49％）符合腕管综合征,10例（12％）符合神经根型颈椎病。两组共有15例（11％）符合神经根性颈椎病合并腕管综合征。神经根型颈椎病神经原性损害主要在C6,C7水平。腕管综合征主要表现正中神经受损,其神经原性损害主要在C8水平（拇短展肌）。结论：神经肌电图检测对神经根型颈椎病和腕管综合征的诊断及鉴别诊断有重要价值。     

Vectorcardiogram more sensitive than 12-lead ECG in the detection of inferior myocardial infarction

The vectorcardiogram (VCG) is commonly stated to be more sensitive than the 12-lead electrocardiogram (ECG) for the diagnosis of inferior myocardial infarction. However, a recent study indicated that VCG is not superior to ECG for this diagnosis. The purpose of this study was to compare the performance of VCG and ECG criteria and to indicate possible explanations for the disagreement between earlier studies. Accordingly, we studied 65 patients with inferior myocardial infarction verified by left ventriculography or 201-TI myocardial scintigraphy and 351 normal subjects. Sensitivity was 69% (45/65) and 43% (28/65) for the VCG and ECG criteria, respectively. This difference was highly significant (P less than 0.001). Among the normal subjects there were only three with false positive ECG. We conclude that both VCG and ECG criteria for the diagnosis of inferior myocardial infarction are highly specific and that VCG criteria have greater sensitivity than ECG criteria.     

老年、青年急性心肌梗塞临床心电图特点对比研究

目的：探讨82例老年、青年心肌梗塞心电图的临床特点。方法：应用心电图检查对两组临床证实的心肌梗塞病人进行对比观察分析。结果：老年人发生心肌梗塞时有典型心前区疼痛仅占51．9％，远低于青年组83．3％。老年组多部位心肌梗塞占28．8％，明显高于青年组13．3％。老年组无Q波型心肌梗塞占44．2％，明显高于青年组13．3％，两组相比差异有显性意义。结论：老年和青年组心肌梗塞比较，老年组病人，临床症状、心电图不典型，易误诊、漏诊，临床上必须针对病情，结合病史，动态观察，做好综合判断，达到早期诊断，早期治疗。     

心肌梗死超急性期50例诊断分析

目的探讨心电图和超声心动图两种方法诊断心肌梗死超急性期的灵敏性、准确性。方法将50例心肌梗死超急性期患者随机分为心电图组和超声心动图组,比较确诊、漏诊、误诊率及对心肌梗死定位、并发症的检测和评估。结果超声心动图组确诊率（84%）明显高于心电图组（56%）,差异具有统计学意义（P〈0.05）。结论超声心动图不仅能对心肌梗死超急性期迅速作出准确诊断,还能评估心肌梗死面积、心肌受损程度、心肌存活性、左心功能、机械并发症,超声心动图组诊断方法优于心电图组。     

冠心病高频心电图与冠状动脉造影的对比研究

本文报道１２６例选择性冠状动脉造影的冠心病患者高频心电图（ＨＦＥＣＧ）变化。结果提示：高频切迹数随冠状动脉狭窄程度的加重而增多,冠脉造影显示冠脉狭窄＜５０％者,１２导联高频切迹（ＨＦＮ）平均数１４１６±２５６。冠脉狭窄５０—７４％者ＨＦＮ平均数１８６４±３６３。冠脉狭窄≥７５％者ＨＦＮ平均数为２３２１±３２５。本文ＨＦＥＣＧ诊断冠心病的敏感性、特异性和总符合率分别为８８４％、７８６％和８１０％。     

急性心肌梗塞病人高频心电图分析及动态观察的临床意义

本文对２８例急性心肌梗塞病人及２０例正常人做了高频心电图检查。并对１２人做了３－４周的动态观察。结果表明：急性心肌梗塞患者高频成分明显增多，有并发症者高频成分增加更明显，动态观察显示，急性心肌梗塞患者第２周高频成分减少，第３－４周高频成分又稍增加，反映了急性心肌梗塞的病情变化。     

Acute myocardial infarction: an easy diagnosis in general practice?

In the imminent myocardial infarction Rotterdam (IMIR) study, contacts by patients with their general practitioners for symptoms of potential coronary artery disease were registered. Those who had acute myocardial infarction were diagnosed on the basis of the modified World Health Organization criteria, and those with this definite diagnosis were then compared with the initial diagnosis made by the general practitioner at the moment of contact without laboratory assistance.

Of the 1,343 patients included in the study, 93 (seven per cent) had `definite' acute myocardial infarction and another 37 (three per cent) had `possible' acute myocardial infarction according to the diagnostic criteria used.

At the time of contact with the general practitioner 41 (44 per cent) of the 93 patients with definite myocardial infarction were recognized as such by the general practitioner, while in another 31 (33 per cent) the general practitioner diagnosed `imminent' myocardial infarction.

Of the 1,213 patients free of acute myocardial infarction at the time, 40 (three per cent) were incorrectly diagnosed by the general practitioner as having `acute' myocardial infarction.

In the 22 patients who in fact had acute myocardial infarction but in whom the general practitioner did not make this diagnosis at the time, it was found that there was an absence of physical signs and, similarly, in patients who subsequently did not have infarction the presence of physical signs was related to a falsepositive general practitioner diagnosis of myocardial infarction.

In view of the inaccuracy of the general practitioner's provisional diagnosis of acute myocardial infarction, we believe that electrocardiogram and enzyme tests should be carried out systematically in all patients who present to general practitioners with symptoms of potential coronary artery disease. Laboratory support should be readily available and we support the idea of having a special diagnostic service.

     

血液流变学监测在预防急性心肌梗塞中的临床意义

观察无心肌梗塞的冠心病患者46例,治疗前后血液流变学10项指标的改变.结果:治疗后患者的血液流变学10项指标明显低于治疗前,经t检验差异性非常显著(P<0.01).血液流变学指标的改变出现于心电图改变之前,出现于心肌梗塞发病之前.是冠心病发生心肌梗塞之前最早的发现.对冠心病患者进行血液流变学监测,发现异常及时处理,对预防急性心肌梗塞发主具有特殊意义.     

诱导多能干细胞移植后对急性心肌梗死小鼠心律的影响

背景：诱导多能干细胞被认为是治疗缺血性心肌病最具前景的一种方法,但其移植的安全性、有效性仍需进一步研究。 目的：探讨诱导多能干细胞移植后对急性心肌梗死小鼠心脏节律产生的影响。 方法：建立ICR小鼠心肌梗死模型并将其随机分为急性心肌梗死组,急性心肌梗死+生理盐水组,急性心肌梗死+诱导多能干细胞组,急性心肌梗死+成纤维细胞组,同时设立正常对照组。各组分别于移植诱导多能干细胞5 min、1周、2周、3周后,应用BL-420生物机能系统检测各组小鼠体表心电图肢体Ⅱ导联心律的变化。免疫组化染色法检测各组小鼠心肌缝隙连接蛋白43的表达,并应用Image Proplus软件进行半定量分析。 结果与结论：与急性心肌梗死组和急性心肌梗死+成纤维细胞组比较,移植2,3周时急性心肌梗死+诱导多能干细胞组小鼠体表心电图Ⅱ导联室性早搏发生率明显减少,梗死心肌缝隙连接蛋白43表达明显增加(P < 0.05),前两组相比差异无显著性意义。结果说明诱导多能干细胞移植2周后可明显减少梗死后小鼠室性早搏发生率,进而改善心肌组织的电活动并增强其电位稳定性,可使小鼠梗死心肌缝隙连接蛋白43的表达增加,而成纤维细胞移植的小鼠中则未出现此现象。     

Clinical first myocardial infarction: coronary artery disease and old infarcts in 53 consecutive fatal cases from a coronary care unit

The frequency and size of previous unrecognized myocardial infarction in patients with first clinical diagnosed acute myocardial infarction are unknown. In this study, 53 consecutive patients with clinical first acute myocardial infarction which proved fatal were studied postmortem. All showed acute infarction (inclusion criterium). Acute coronary thrombosis was found in 51 (96%). One-, two-, and three-vessel disease diagnosed by postmortem coronary angiography (diameter stenosis greater than or equal to 75%) was present in 17 (32%), 22 (42%), and 14 (26%), respectively. One or more old infarcts were found in 24 of the cases (45%) despite no history of previous myocardial infarction. Old infarcts were found in 86% of the hearts with three-vessel disease and in 55% of the hearts with two-vessel disease, but none were found in the hearts with one-vessel disease. The median weight of the old infarcts was 4 grams (range: 0.5 to 25 grams) corresponding to 5% (0.5 to 14%) of the ventricular myocardium. Thus, two- or three-vessel coronary artery disease and old infarcts are often present in patients dying from their clinical first acute myocardial infarction.