冠状动脉侧支循环的临床意义

有资料表明 :冠状动脉侧支循环存在与否直接影响冠状动脉病 (CAD)患者的预后。丰富的侧支循环能够限制急性心肌梗死面积 ,改善左心室功能 ,减少室壁瘤的发生 ,预防猝死 ,提高 CAD患者生活质量〔1〕。我们通过对在我院行冠状动脉造影 (SCA)的部分患者临床资料的总结、分析 ,试图揭示冠状动脉侧支循环的临床意义。1　临床资料1 .1　 1 998年 6月～ 1 999年 2月在我院行 SCA患者 34例。其中男 2 9例 ,女 5例。年龄 37～ 79岁 ,平均 (5 7.6 0± 7.1 3)岁 ;患者有吸烟史 1 7例。合并症 :高血压1 8例次 ,糖尿病 3例次 ,高脂血症 8例次 ;心功…     

贺普丁治疗慢性HBV感染的临床研究

我院自 1999年 9月至 2 0 0 1年 6月应用贺普丁 (3TC)治疗并随访慢性 HBV感染者 34例。现将结果报道如下。1　材料与方法1.1　病例选择1.1.1　我院治疗 34例慢性 HBV感染者均为住院及门诊患者 ,诊断符合 1995年 (北京 )第五次全国传染病与寄生虫病学术会议修订的病毒性肝炎防治方案 (试行 )标准 [1 ]。 34例接受3TC治疗中 ,慢性乙型肝炎 2 0例 ,男 12例 ,女 8例 ,年龄 13～ 5 0岁。对照组 2 0例患者为同期接受治疗的患者 ,两组的病情、性别及年龄分布相似 (P>0 .0 5 ) ;肝炎肝硬化活动型 9例 ,符合 Child- Pugh A级 4例 ,B级 5例 ,男 …     

108例肾病综合征患者血脂、载脂蛋白水平分析

为了解肾病综合征患者脂代谢紊乱情况 ,我们对近两年我院收治的 10 8例原发性肾病综合征患者进行血脂测定、并进行统计分析 ,现将结果报告如下 :1　材料和方法1 1　对象与分组 :①正常对照组 :健康检检者 48例。②肾病综合征组 :10 8例 ,2 0 0 0年 1月至 2 0 0 2年 1月在我院住院确诊的原发性肾病综合征患者。1 2　观测指标 :血清总胆固醇 (ＴＣ)、甘油三脂 (ＴＧ)、高密度脂蛋白胆固醇 (ＨＤＬ -Ｃ)、低密度脂蛋白胆固醇 (ＬＤＨ -Ｃ)、载脂蛋白ＡＩ(ＡＰＯＡＩ)、载脂蛋白Ｂ(ＡＰＯＢ)。1 3　测定方法 :总胆固醇、甘油三脂采用酶法测定 ,…     

先兆流产患者健康教育需求的调查分析

20 0 1年 2月～ 2 0 0 3年 5月 ,我院对 6 0例先兆流产患者健康教育需求进行调查分析 ,现报告如下。对象与方法　　 1.调查对象。随机调查 2 0 0 1年 2月～ 2 0 0 3年 5月住我院先兆流产患者 6 0例 ,年龄 2 0～ 36岁 ,文化程度 :高中以上4 8人 ,初中以下 12人。职业 :干部 30人 ,工人 12人 ,农民 8人 ,其他 10人。　　 2 调查内容。参照先兆流产患者健康教育计划[1 ] ,根据我院实际 ,采用自行设计的问卷进行调查 ,将内容分为 :(1)先兆流产患者入院健康教育需求程度调查 ;(2 )先兆流产患者治疗期健康教育需求程度调查 ;(3)先兆流产患者出院…     

纳洛酮联合血液透析抢救急性重症酒精中毒20例疗效观察

我院采用纳洛酮联合血液透析抢救 2 0例急性重症酒精中毒患者 ,并与常规治疗 30例急性重症酒精中毒作比较 ,取得良好的效果 ,现报道如下。1　资料与方法1.1　一般资料　 5 0例患者均系我院收住院的急性重症酒精中毒患者 ,全部为男性。治疗组 2 0例 :平均年龄 30 .5岁 ,对照组 30例 :平均年龄 31.5岁 ,两组间年龄、病情比较无显著性差异 (Ｐ >0 .0 5 )。1.2　临床表现　 5 0例患者入院前均有一次大量饮酒史 ,饮酒量折合 2 0 0～ 4 0 0 ｇ(5 0 %～ 6 0 %白酒 5 0 0～10 0 0ｍｌ)。酒后至就诊时间为 2～ 6小时 ,平均 4小时。 5 0例患者均有意识…     

真菌性角膜溃疡病原菌及其诱因分析

真菌性角膜溃疡是一种致盲率较高的感染性眼病 ,近年来患病率急剧增高[1 ] 。现将我院 74例真菌性角膜溃疡分析报告如下。一、材料与方法1 标本来源 :选择我院 1 978～ 2 0 0 0年门诊及住院经临床和真菌检查确诊的真菌性角膜溃疡患者 74例 (75只眼 )之角膜分泌物。 (1 )病例数 :1 978～ 1 989年共 2 2例。年平均1 8例。 1 990～ 2 0 0 0年 52例 ,年平均 5例。 (2 )发病月份 :全年均有病例发生 ,以秋冬季为多 ,1 0～ 1 2月份为 35例(47 3 % )。 6～ 9月份 1 7例 (2 3 % )。 (3)性别、眼别、年龄、职业 :74例中 (75只眼 ) ,男 ,51例 ,女 ,2 …     

患儿在高压氧治疗中的护理体会

近年来 ,随着高压氧 (hyperbaricoxygenHBO)治疗广泛应用于儿科疾病 ,从而大大减少了小儿因缺氧缺血性脑病、颅内感染、颅内出血及颅脑外伤等疾病所致的病残率 ,1 999～2 0 0 3年 ,我院对 1 1 2例患儿进行HBO治疗及护理 ,现将护理体会报告如下。临床资料1 999～ 2 0 0 3年 ,我院对 1 1 2例患儿进行HBO治疗 ,其中男 6 1例 ,女 5 1例 ;年龄 :～ 4岁 6 9例 ,～ 7岁 32例 ,～ 1 2岁1 1例。患儿的治疗次数多数为 2～ 6个疗程 (1 0次为 1个疗程 ) ,2 0～ 1 0 0余次 ,最少的仅治疗 1次 ,平均治疗 4 7次。护　　理一、治疗前的护理1 .心理辅导和…     

纤维支气管镜和呼吸机在有机磷农药中毒呼吸衰竭时的应用

急性呼吸衰竭是急性有机磷农药中毒 (AOPP)的主要致死原因 ,我院 2 0 0 0年 8月— 2 0 0 2年 8月共收治 AOPP致急性呼吸衰竭患者 2 6例 ,报告如下。1　病例与方法1.1　病例 :男 7例 ,女 19例 ;年龄 16～6 6岁 ,平均 2 8.9岁 ;均为口服中毒 ;农药种类 :甲胺磷 12例 ,氧化乐果 8例 ,敌敌畏 6例 ;服毒量 5 0～ 5 0 0 ml,平均74 .8m l;服毒到入院时间为 2 0分钟～6小时 ;按文献〔1〕标准均为急性重度有机磷农药中毒 ,患者均有急性胆碱能危象(ACC)、呼吸困难 (频率 >35次 / min)、肺水肿等表现 ,胆碱酯酶 (Ch E)活性均为 0 ,均在急诊科抢救…     

100例妇科腹腔内出血原因分析

在妇科急诊病例中 ,由于内出血导致急性腹痛、贫血 ,甚至休克的病例占相当比例。回顾分析我院收治的 1 0 0例妇科腹腔内出血患者的情况 ,报告如下。1　临床资料1 .1　病例 :1 0 0例患者为我院 1 992年1月— 2 0 0 0年 1 0月收治的住院者 ,年龄1 4～ 4 5岁 ,平均 32 .5岁 ,出血经临床及手术证实。异位妊娠 82例 ,占 82 .0 %(包括输卵管妊娠 76例 ) ,平均出血量为82 0 m l,其中发生休克 2 7例 (32 .9% )。黄体破裂 1 1例 (1 1 .0 % ) ,平均出血量为4 6 0 m l,发生休克 1例 (9.0 % )。卵泡破裂 2例 (2 .0 % ) ,平均出血量 370 ml,无休克发生者…     

宫颈妊娠9例保守治疗分析

宫颈妊娠临床上比较少见 ,我院于1998年 8月至 2 0 0 3年 2月共收治宫颈妊娠患者 9例 ,均行保守治疗 ,取得满意效果 ,为探讨宫颈妊娠的临床特点和治疗方法 ,现总结分析如下。1　临床资料1 1　一般资料　我院 1998年 8月至2 0 0 3年 2月共收治异位妊娠 3 98例 ,其中宫颈妊娠 9例。 9例患者年龄最大 44岁 ,最小 2 4岁。初产妇 6例 ,经产妇 3例。有 1次人工流产史 4例 ,2次以上人工流产史者 3例 ,3次以上人工流产史 2例。 9例患者均有停经史 ,均有不规则阴道出血 2～ 2 8d ,量不等。1 2　临床特点　 (1)停经后无痛性阴道流血为其主要特征。 9例…     

The Clinical Use of External Noninvasive Pacing in the Termination of Sustained Ventricular Tachycardia

In order to evaluate the potential use of external cardiac pacing (EXP) in the clinical termination of sustained ventricular tachycardia (VT), we attempted VT terminations in seven patients. All had recurrent sustained monomorphic ventricular tachycardia (mean rate 145 beats/min), which had previously required cardioversion. During subsequent VT episodes, all seven underwent overdrive pacing with EXP at a pulse amplitude of 120 mA, and rates of 200 pulses/min. A total of 18 of 18 episodes of VT were successfully terminated by EXP alone. In one patient, the first attempt at EXP termination of one episode of VT resulted in an acceleration of the tachycardia, which was then terminated by EXP. All patients tolerated EXP well with minimal sedation. We conclude that EXP may be an effective clinical modality for the termination of sustained monomorphic ventricular tachycardia.     

Preliminary Clinical Experience with the First Dual Chamber Pacemaker Defibrillator

The lack of specificity of VT detection is a significant shortcoming of current ICDs. In a French multicenter study, 18 patients underwent implantation of the Defender 9001 (ELA Medical), an ICD utilizing dual chamber pacing and arrhythmia detection. Over a mean follow-up period of 7.1 ± 4.5 months, 176 tachycardia episodes recorded in the device memory were analyzed, and physician diagnosis was compared with that by the device. All 122 VT/VF episodes were correctly diagnosed, as were 51 of 53 supraventricular tachyarrhythmias. Two episodes of AF with rapid regular ventricular rates were treated as VT, and a third episode, treated as VT, could not be diagnosed with certainty. A dual chamber pacemaker defibrillator offers improved diagnostic specificity without loss of sensitivity, in addition to the hemodynamic benefit of dual chamber pacing. (PACE 1997;20     

Long-Term Efficacy of an Antitachycardia Pacemaker and Implantable Defibrillator Combination

Antitachycardia pacemakers and implantable cardioverter defibrillators (ICD) were implanted in 14 patients to control recurrent hemodynamically stable ventricular tachycardia (VT), All patients underwent extensive preimplant testing in the elecrrophysiology laboratory documenting that in each patient at least 50 episodes of VT could be reliably terminated by an external model of the antitachycardia pacemaker. The burst scanning mode of anfitachycardia pacing was used in all patients. ICDs were implanted solely as a back up should acceleration of VT occur, and all had high nonprogrammable rate cutoffs (mean 191 ± 12 beats/min). During a mean follow-up of 25 ± 6 months, 6,029 episodes of VT were treated in the 14 patients. Only 103 ICD discharges were required (approximately one discharge per 60 episodes of VT). Ten of the 14 patients received discharges from their ICDs. No deaths have occurred. All devices remain active and in the automatic mode. Thus, an antitachycardia pacemaker and ICD combination can safely and effectively terminate VT in highly selected patients who are subjected to extensive preimplant testing. In such patients, the vast majority of episodes of VT can be terminated with antitachycardia pacing, and only rarely is a discharge required from the ICD.     

Termination of ventricular tachycardia by far-field stimulation in humans: a feasibility study

Background: Although a low‐energy cardioversion (LEC) shock from an implantable cardioverter‐defibrillator (ICD) can terminate ventricular tachycardia (VT), it frequently triggers ventricular fibrillation (VF) and is therefore not used in clinical practice. We tested whether a modified LEC shock with a very short duration (0.12–0.36 ms), termed “field stimulus,” can terminate VT without triggering VF. Methods: In 13 sedated patients with implanted ICDs, we attempted to induce VT and to terminate the arrhythmias by field stimuli during hospital predischarge tests. Results: In eight patients, 27 VT episodes were induced and treated with a total of 46 high‐voltage (25–200 V) field stimuli, which terminated 11 VT episodes (41% efficacy) and never accelerated VT into VF. VT episodes slower than 230 beats per minute (bpm) (median rate) were terminated more successfully than faster arrhythmia episodes (69% vs 15%, P < 0.01). The strength of the field stimulus had no major influence on the effectiveness. We therefore postulate that suboptimal timing of field stimuli (delivered simultaneously with a sensed event in the right ventricular apex) was the main reason for failed VT terminations. Conclusion: A short (0.12–0.36 ms), high‐voltage (50–100 V) field stimulus delivered from the shock coil of an implanted ICD system can safely terminate VT, especially for VT rates below 230 bpm. We believe that it would be reasonable to test the effectiveness of automatic field‐stimulus therapy from implanted ICDs in VT episodes up to 230 bpm that are not susceptible to termination by antitachycardia pacing. (PACE 2010; 33:1540–1547)     

The Impact of Antitachycardia Pacing with Defibrillation

Chronic recurrent ventricular tachycardia (VT) can be reproducibly terminated by programmed endocardiaJ right ventricular stimulation. However, antitachycardia pacing can be associated with possible acceleration of VT, while frequent episodes of VT and patient discomfort can limit treatment by an implantable cardioverter defibrillator (ICD). The combined use of antitachycardia pacing and the AICD (automatic implantable cardioverier defibrillator) was evaluated in 6 out of 51 patients (age 57 ± 11 years) in whom the AICD had been implanted because of recurrent VT. In each instance VT could be terminated by temporary overdrive pacing. The interactive mode of VT termination by a pacemaker (Tachylog) as well as by the AICD was assessed after implantation. In the automatic mode, the Tachylog functioned as a bipolar, ventricular inhibited (VVI) device with antitachycardia burst stimulation capability, allowing two to five stimuli at intervals of 260–300 ms and one or two interventions. During follow-up of 47 ± 24 months, the Tachylog terminated VT reliably 50–505 times per patient. When burst stimulation accelerated VT, termination was achieved by AICD discharge. Thus, drug resistant VT can be terminated by antitachycardia pacing to avoid patient discomfort. In the event of tachycardia acceleration, VT was terminated by the AICD. A universal pacemaker-defibrillafor should combine antibradycardia and antitachycardia pacing with back-up cardioversion defibrillation.     

Implantable Cardioverter Defibrillators in Patients with Chagas' Disease: Are They Different from Patients with Coronary Disease?

Chagas' disease is a parasitic affliction, endemic to certain regions of South America, which may lead to a chronic dilated nonischemic cardiomyopathy. Ten Chagasic patients were compared to 18 coronary patients undergoing transvenous ICD implantation for ventricular tachycardia (VT), ventricular fibrillation (VF), or aborted cardiac arrest. Indications for ICD implantation were either drug intolerance or refractoriness, or no inducible tachyarrhythmia at EPS. There were no statistically significant differences between the Chagas and coronary artery disease groups with respect to age (60.2 vs 62.6 yrs], NYHA Class II (50% vs 62%), ejection fraction (31.1% vs 29.7%), and incidence of cardiac arrest (20% vs 33%), respectively. The following ICD implant and long-term follow-up variables were compared between the two groups: pacing threshold (0.94 V vs 0.95V), defibrillation threshold (19.5 J vs 19.6 J), number of VT episodes (414 vs 435), number of spontaneous VT terminations (86 vs 187), percent efficacy of antitachycardia pacing (93.9% vs 92.1 %), and total number of shocks (112 vs 145). These differences were not statistically significant. We conclude that patients with Chagas' disease, compared with coronary artery disease patients, have similar clinical characteristics leading to ICD implantation. Furthermore, no differences were found with respect to ICD and long-term follow-up characteristics between the two groups.     

Antitachycardia pacing for spontaneous rapid ventricular tachycardia in patients with prophylactic cardioverter-defibrillator therapy

AIMS: Antitachycardia pacing (ATP) has not routinely been used in patients who received implantable cardioverter defibrillators (ICDs) for primary prevention of sudden death. This study investigated the efficacy of empirical ATP to terminate rapid ventricular tachycardia (VT) in heart failure patients with prophylactic ICD therapy. METHODS AND RESULTS: Ninety-three patients with a mean left ventricular ejection fraction of 22 +/- 7% (range: 9-35%) due to nonischemic or ischemic cardiomyopathy received prophylactic ICDs with empiric ATP. At least 2 ATP sequences with 6-pulse burst pacing trains at 81% of VT cycle length (CL) were programmed in one or two VT zones for CL below 335 +/- 23 ms and above 253 +/- 18 ms. Ventricular flutter and fibrillation (VF) with CL below 253 +/- 18 ms were treated in a separate VF zone with ICD shocks without preceding ATP attempts. During 38 +/- 27 months follow-up, 339 spontaneous ventricular tachyarrhythmias occurred in 36 of 93 study patients (39%). A total of 232 VT episodes, mean CL 293 +/- 22 ms, triggered ATP in 25 of 36 patients with ICD interventions (69%). ATP terminated 199 of 232 VT episodes (86%) with a mean CL of 294 +/- 23 ms in 23 of 25 patients (88%) who received ATP therapy. ATP failed to terminate or accelerated 33 of 232 VT episodes (14%) with a mean CL of 287 +/- 19 ms in 12 of 25 patients (48%) who received ATP therapy. CONCLUSIONS: Painfree termination of rapid VT with empirical ATP is common in heart failure patients with prophylactic ICD therapy. The occasional inability of empiric ATP to terminate rapid VT in almost 50% of patients who receive ATP for rapid VT warrants restrictive ICD programming with regard to the number of ATP attempts in order to avoid syncope before VT termination occurs.     

Results of Delivered Therapy for VT or VF in Patients with Third-Generation Implantable Cardioverter Defibrillators

Third-generation implantable cardioverter defibrillators (ICDs) offer tiered therapy and can provide significant advantage in the management of patients with life-threatening arrhythmias. Three different types of ICDs were implanted in 21 patients with ventricular tachycardia (VT) or ventricular fibrillation (VF). Arrhythmia presentation was VT(76%), VF(10%), or both (14%). The mean left ventricular ejection fraction for the group was 32.4 ± 7%. No surgical mortality occurred. Prior to discharge individual EPS determined the final programmed settings of the ICDs. During a mean follow-up of 13 ± 1.4 months (range 2–20) the overall patient survival was 85.7%. No sudden arrhythmic or cardiac death occurred. Twenty of 21 patients (95%) received therapy by their device. In 14 patients (67%) antitachycardia pacing (A TP) was programmed "on," 13 of which was self-adaptative autodecremental mode. There were 247 VT episodes, 231 of which were subjected to ATP with 97% success and 3% acceleration or failure. Low energy shocks reverted all other VT episodes. VF episodes were successfully reverted by a single shock (93%), two shocks (6%), or three shocks (1 %). We conclude that ATP therapy of VT is successful in the large majority of episodes with rare failures, and that VF episodes are generally terminated by a single ICD shock.     

Ventricular Arrhythmia Inducibility Predicts Subsequent ICD Activation in Nonischemic Cardiomyopathy Patients: A DEFINITE Substudy

Objectives: We evaluated whether electrophysiologic (EP) inducibility predicts the subsequent occurrence of spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) in the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial.
Background: Inducibility of ventricular arrhythmias has been widely used as a risk marker to select implantable cardioverter defibrillator (ICD) candidates, but is believed not to be predictive in nonischemic cardiomyopathy patients.
Methods: In DEFINITE, patients randomized to the ICD arm, but not the conventional arm, underwent noninvasive EP testing via the ICD shortly after ICD implantation using up to three extrastimuli at three cycle lengths plus burst pacing. Inducibility was defined as monomorphic or polymorphic VT or VF lasting 15 seconds. Patients were followed for a median of 29 ± 14 months (interquartile range = 2–41). An independent committee, blinded to inducibility status, characterized the rhythm triggering ICD shocks.
Results: Inducibility, found in 29 of 204 patients (VT in 13, VF in 16), was associated with diabetes (41.4% vs 20.6%, P = 0.014) and a slightly higher ejection fraction (23.2 ± 5.9 vs 20.5 ± 5.7, P = 0.021). In follow-up, 34.5% of the inducible group (10 of 29) experienced ICD therapy for VT or VF or arrhythmic death versus 12.0% (21 of 175) noninducible patients (hazard ratio = 2.60, P = 0.014).
Conclusions: In DEFINITE patients, inducibility of either VT or VF was associated with an increased likelihood of subsequent ICD therapy for VT or VF, and should be one factor considered in risk stratifying nonischemic cardiomyopathy patients.     

Worldwide Clinical Experience with aDown-Sized Active Can ImplantableCardioverier Defibrillator in 162 ConsecutivePatients

Treatment with an ICD is the first-line treatmentfor survivors of sudden cardiac death. More recently, evidence accumulates that prophylactic ICD therapy may be beneficial for selected subgroups of patients after myocardial infarction. Particularly for future studies on the value of prophylactic ICD therapy, downsized devices are needed to allow easy pectoral implantation with a single lead configuration and featuring extended memory capabilities.Accordingly, this study assesses the clinical performance of a downsized fourth-generation ICD in 162consecutive patients. All devices could be successfully implanted pectorally, in 96% with a single leadconfiguration with a low defibrillation threshold of 10.6 ± 5.2 J. During a 3-month follow-up, 26% of thepatients received ICD therapy. Twenty percent had appropriate therapy for ventricular fibrillation (n= 9) and VT (n = 23), which was effective in all cases. Of the 450 episodes of VT, 426 were terminated by an-titachycardia pacing. Fourteen patients (9%) had inappropriate ICD therapy mainly due to atrial fibrillation or sinus tachycardia, which could be reliably diagnosed by the ICD stored intracardiac electrograms.