自拟益气活血通络汤治疗椎-基底动脉供血不足引起眩晕急性发作的临床观察

椎-基底动脉供血不足是由于各种病因引起的椎-基底动脉狭窄或闭塞导致脑干、小脑或枕叶皮层的缺血,在老年人中十分常见。多因头位改变诱发,以急性眩晕发作为主要表现,属中医“眩晕”范畴。笔者2006年以来自拟益气活血通络汤治疗椎-基底动脉供血不足引起的急性眩晕发作,取得较满     

步长脑心通治疗糖尿病合并椎-基底动脉供血不足60例临床观察

椎-基底动脉供血不足是糖尿病患者最常见的伴发病之一,以发作性头痛、眩晕为主要表现,常常反复发作,严重影响患者的工作和生活.本文拟总结应用步长脑心通治疗糖尿病合并椎-基底动脉供血不足60例的疗效.     

天麻素联合长春西汀治疗老年椎基底动脉供血不足的疗效

椎基底动脉供血不足是神经内科常见的疾病之一,其发病机制是椎基底动脉血管血液循环不畅,导致大脑组织供血不足[1],从而出现眩晕、呕吐、乏力等临床表现,当严重供血不足时,还会有视力模糊、头痛、嗜睡、意识障碍症状,临床应当给予足够重视.目前采用中西医结合治疗老年椎基底动脉供血不足在临床深受青睐,现将我院神经内科采用天麻素联合长春西汀治疗老年椎基底动脉供血不足的研究经过整理总结.     

盐酸曲美他嗪辅助治疗椎-基底动脉供血不足性眩晕疗效观察

目的观察盐酸曲美他嗪辅助治疗椎-基底动脉供血不足性眩晕的效果。方法97例椎-基底动脉供血不足引发眩晕的患者随机分为2组,对照组给予盐酸倍他司汀治疗,治疗组给予盐酸倍他司汀联合盐酸曲美他嗪口服治疗,观察所有患者治疗14d后临床疗效及椎-基底动脉血流速度、阻力指数变化。结果治疗组总有效率优于对照组,治疗后两组患者椎-基底动脉血液流速、阻力指数较治疗前均明显改善,两组间比较无统计学差异。结论盐酸曲美他嗪辅助治疗椎-基底动脉供血不足引起的眩晕疗效显著,且不依赖于血流动力学的改变。     

纳洛酮与舒血宁治疗椎-基底动脉缺血性眩晕46例效果观察

椎-基底动脉缺血性眩晕是以椎-基底动脉硬化、颈椎退变以及血黏度增高等为病理基础,以发作性眩晕伴恶心、呕吐,视物昏花或视物旋转、跌倒发作等为主要临床特征的一种疾病,是中老年人的常见、多发病,严重影响中老年人的健康。在椎-基底动脉供血不足的常规治疗中,以抗血小板聚集、抗凝、钙离子拮抗剂、血管扩张药及对症治疗为主,但对急性发作的顽固性眩晕、呕吐等症状见效较慢、复发率高。我院于2007年6月—2009年5月对门诊及住院的92例椎-基底动脉缺血性眩晕患者,     

醒脑静治疗椎-基底动脉供血不足疗效观察

椎-基底动脉供血不足(vertebrobasilar ischemia,VBI)为临床常见病,是由椎-基底动脉系统短暂脑缺血发作(transient ischemic attack,TIA)导致.椎-基底动脉系统主要供应脑干、小脑、海马、枕叶、部分颞叶的血流,同时分出内听动脉供应内耳前庭系统.     

丹参酮ⅡA磺酸钠治疗椎基底动脉供血不足36例临床观察

椎-基底动脉供血不足（VBI）是缺血脑血管病中的常见多发病，中老年人易发，常以反复的头晕、眩晕、恶心、呕吐为主要临床表现，可发展为急性脑血管疾病。我们在临床上采用丹参酮联合尼莫地平治疗椎基底动脉供血不足取得了一定的疗效，现报道如下。     

椎基底动脉供血不足患者头部位置试验结果分析

以往临床诊断椎基底动脉供血不足多依据患者的临床表现 ,缺乏客观指标。椎基底动脉造影虽可确诊 ,但操作复杂 ,有一定创伤及危险性 ,尚难普及。我们采用经颅多普勒超声(TCD)测定了 2 31例动脉硬化患者头部不同方向运动时椎基底动脉的血流速度及供血情况 (头部位置试验 ) ,并探讨 TCD早期诊断椎基底动脉供血不足的价值。临床资料 :本文观察组为 2 31例动脉硬化患者 ,男 12 7例 ,女 10 4例 ,年龄 6 0～ 82岁 ;临床上有脑动脉硬化或脑梗死、眼底动脉硬化、冠状动脉硬化性心脏病等动脉硬化证据 ,并曾有一过性脑缺血发作的临床表现 (如眩晕、…     

脑脉泰治疗椎基底动脉供血不足临床分析

目的观察脑脉泰治疗椎基底动脉供血不足的临床疗效。方法将明确椎基底动脉供血不足103例病人随机分成两组,对照组41例,治疗组62例在对照组基础上加用脑脉泰治疗,观察临床疗效。结果治疗组疗效优于对照组。结论脑脉泰治疗椎基底动脉供血不足安全有效。     

葛根素联合纳络酮治疗椎基底动脉供血不足疗效观察

目的观察葛根素联合纳络酮治疗椎基底动脉供血不足的临床疗效。方法将138例椎基底动脉供血不足患者随机分为治疗组70例和对照组68例,治疗组静滴葛根素注射液与纳络酮,对照组静滴盐酸培他定注射液,治疗14d后观察疗效;并于治疗前后行血液流变学、经颅多普勒检查。结果与对照组比较,治疗组总有效率高,血液流变学参数及椎基底动脉血流速度明显改善（P均〈0．05）。结论葛根素注射液联合纳络酮能有效治疗椎基底动脉供血不足,改善血液黏稠度。     

先天性长QT综合征七例的临床研究

目的 对1例先天性长QT综合征（long QT syndrome,LQTS)患者（先证者）所在的家族进行普查，研究该家族的发病情况及临床和心电图特点，推测其相应的表现型和基因型。方法 按常规采集26例家庭成员的临床病史，进行体格检查，并采集同步12导联心电衅，测量QT间期和校正的QT间期，采用Schwartz提出的评分标准作为LQTS的诊断标准。结果 26例中有7例（28%）长QT综合征患者，6例可疑诊断。发生晕厥的诱因均为情绪激动或体力劳动，心电图表现为QT间期延长，在发病前后延长得更加明显，T波宽大有切迹，多可见U波，病情严重的患者心电图表现更加典型，该家族中患者的首次发病年龄较在，预后好，没有1例发生猝死或未成年夭折。结论 该家族中LQTS患者的临床和心电图表现符合LQTS1或者LQTS2。基因型有可能为KVLQT1或者HERG基因的突变。     

Glucagon secretion in acute and chronic pancreatitis.

Plasma pancreatic glucagon concentrations were determined in the basal state and after the infusion of alanine in 10 patients with acute pancreatitis (5 in an initial episode of pancreatitis), in 10 patients with chronic pancreatic insufficiency, and in 21 healthy controls. In acute pancreatitis, basal glucagon levels were nine times normal but were higher during the initial attack than with a history of previous attacks. The glucagon response to alanine was also increased threefold to fourfold in initial attacks. In contrast, after recovery from the initial attack of acute pancreatitis, during acute episodes of pancreatitis in patients with a history of previous attacks, and in patients with pancreatic insufficiency, alanine failed to elicit a consistent rise in plasma glucagon. The data suggest that hyperglucagonemia may contribute to the hyperglycemia of acute pancreatitis, particularly during the initial episode. Loss of alpha cell responsiveness to alanine provides a sensitive index of previous pancreatitis.     

Assessment of the accuracy of serial electrocardiograms in the diagnosis of myocardial infarction

The diagnostic accuracy of the 12-lead scalar electrocardiogram (ECG) for the presence or absence of acute transmural myocardial infarction (MI) was studied in 25 patients who died while in hospital for treatment of ischemic chest pain. Detailed autopsy studies revealed myocardial necrosis in 17 patients, with the ECG accurate in 11 (44%) of the 25 patients. None of the five pateints with autopsy-proven subendocardial infarction had abnormal Q waves. The admission ECG was diagnostic in only 4 of the 17 patients (24%) with infarction. The creatine kinase (CK) and CK-MB results agreed with the pathologic findings in 22 of the 25 patients (88%), were falsely negative in one patient, and falsely positive in two of the patients. In this selected population the most reliable diagnostic tests were CK or CK-MB isoenzymes. The ECG was frequently unhelpful (7 of 25 patients) because of left bundle branch block or paced rhythm, but when unaffected by these depolarization abnormalities it was useful in establishing the correct diagnosis.     

Osborn waves associated with ventricular fibrillation in a patient with vasospastic angina

A 52-year-old man with a history of vasospastic angina experienced a severe ischemic episode accompanied by a non-Q wave myocardial infarction. Two episodes of ventricular fibrillation (VF) occurred during the acute phase of the event. Osborn waves were observed on the ECG preceding each episode of VF. In the second episode, the gradual development of Osborn waves until VF occurred was confirmed on ECG. The Osborn waves appeared to be related to the occurrence of VF. This case may provide clinical evidence that a prominent I(to) participates in the development of VF during myocardial ischemia.     

Massive pulmonary embolism with ST elevation in leads V1-V3 and successful thrombolysis with tenecteplase

A 42 year old woman was referred to the emergency department from the radiology department after having a syncopal episode during a triplex examination of the lower extremities for acute painful right leg swelling five hours earlier that morning. She had no significant medical history, smoked 3-5 cigarettes a day, and had been taking contraceptive medication for menorrhagia for the preceding three months. On presentation she was cyanotic, dyspnoeic, and haemodynamically unstable. ECG showed sinus tachycardia of 120 beats/min with ST elevations from V1 through V3 mimicking anteroseptal acute myocardial infarction. Ten minutes after presentation she was thrombolysed with 80 mg tenecteplase leading to ST elevation resolution and remarkable haemodynamic recovery after 20 minutes. This case shows how pulmonary embolism can mimic anteroseptal acute myocardial infarction on ECG and the life saving results from rapid thrombolysis with tenecteplase.     

The patient with palpitations: from the clinical picture to the therapeutic decision]

Palpitations are a common complaint in a medical consultation. The initial approach to the patient his based on the history, physical examination and 12-lead electrocardiogram (ECG). The history is very important because most patients are initially seen by physicians after the episode of palpitations. The analysis of the characteristics of the episode, the presence of cardiac pathology and the effects of previous treatments are very important. Physical examination during the episode can provide some physical signs that may suggest a certain etiology. The physical examination after an episode can diagnose a certain cardiac disease. The ECG during the episode is very important and can provide the diagnosis. A normal ECG outside an episode does not exclude an arrhythmia. The initial diagnostic evaluation is complemented with other examinations, such as echocardiography or coronariography, to analyse a cardiac disease. Some other investigations are necessary, such as ECG Holter, Transtelephonic monitoring of cardiac rhythm or electrophysiological investigation to complement an initial diagnosis. This therapeutic decision is based on the type of arrhythmias, the associated symptomatology, the cardiac structural disease and the activity of the patient.     

Pancreatic pseudocysts during first attack of acute pancreatitis

One hundred and forty-eight patients admitted with their first episode of acute pancreatitis were examined by ultrasonography. During the acute attack 1 or more pseudocysts were found in 19 patients (13%), pancreatic abscess in 2, whereas 127 had a normal or swollen pancreas. Two small cysts resolved spontaneously, eight were cured after ultrasonically guided needle aspiration or catheter drainage, and cystogastrostomy was necessary in four cases. One patient refused treatment. Abscesses requiring surgical drainage developed in four of the patients with pseudocysts. The study showed that pseudocysts may appear as early as within 1 week of the first episode of acute pancreatitis. Some pseudocysts may resolve spontaneously, and ultrasonically guided aspiration or drainage may cure approximately half of the pseudocysts.     

Brugada syndrome occurring after autologous peripheral blood stem cell transplantation for acute myeloid leukemia

A 74-year-old male was found to be suffering from the Brugada syndrome after undergoing high dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ABSCT) for acute myeloid leukemia. A specific ECG pattern of right bundle-branch block and a coved-type ST-segment elevation in leads V1 through V3, which is compatible with the Brugada syndrome, was unmasked by febrile neutropenia on the 8th day after ABSCT. He experienced syncope on the 11th day due to ventricular tachycardia, which was immediately improved with the administration of intravenous lidocaine. The Brugada syndorome should be considered in febrile patients if they have a episode of syncope or ECG change.     

Late diagnosis of a severe attack of acute intermittent porphyria (AIP)--diagnostic dilemmas

The article presents diagnostic problems concerning the case of 54-year old woman with a delayed diagnosis of a severe attack of acute intermittent porphyria (AIP), which on admission manifested mainly as flaccid quadriplegia. The signs of neurological deficit were accompanied by changes in electrocardiographic recording that suggested acute myocardial ischaemia without apparent chest pain. Based upon a detailed history and identification of potential factors that might have triggered the attack the suspicion of acute hepatic porphyria was raised. The suspicion was confirmed by biochemical testing in the Institute of Hematology and Transfusiology in Warsaw. The treatment with glucose was administered, drugs contraindicated in porphyria were excluded, and early rehabilitation programme was instituted, which led to a marked improvement of general status and resolution of quadriplegia after 16 weeks. Parallel to the improvement of neurological status and a decrease in urinary excretion of heme precursors the normalisation of ECG changes was observed. The authors point out that differential diagnosis of abdominal pain with concomitant hyponatraemia should include an attack of acute porphyria since early administration of proper management prevents the development of life-threatening neurological signs accompanying the severe attack. The diagnosis of an attack of acute porphyria in the phase of predominant neurological signs, in the absence of abdominal pain, may be difficult and always warrants, apart from anamnestic data, the confirmation with appropriate biochemical testing.     

112例不稳定型心绞痛患者介入治疗的临床评价

目的 探讨不稳定型心绞痛患者介入治疗的安全性及临床效果。方法 不稳定型心绞痛112例．反复发作时即行冠状动脉造影,明确病变后对“罪犯”血管行经皮冠状动脉介入治疗,术后残余狭窄小于10％,前向血流按心肌梗死溶栓治疗临床实验（thrombolysisinmyocardialinfarction,TIMI）血流分级3级为手术成功;随访6月,分析即时及远期效果。结果 手术成功率100％,所有病例均随访6月,其中,17例（15％）患者在经皮冠状动脉介入术后3-6个月再发心绞痛,发作时心电图或平板负荷试验提示心肌缺血,此17例均再次冠状动脉造影提示“罪犯”血管支架内再狭窄,再次行经皮冠状动脉介入术。其余病例术后6个月内未再发心绞痛。随访期间无1例再发心肌梗死或死亡。结论 早期介入治疗不稳定型心绞痛患者是有效的治疗方法,手术成功率及安全性高,近期和远期临床效果满意。