不同类型束支阻滞患者心功能的相关分析

目的探讨不同类型及同种类型不同QRS时限束支传导阻滞患者的心功能差异。方法将285例束支传导阻滞患者按阻滞类型分为左束支传导阻滞组(A组,n=105)和右束支传导阻滞组(B组,n=180);依据QRS时限将A、B两组分为A1组(n=49)、B1组(n=126)(两者QRS时限均150 ms)或者A2组(n=56)、B2组(n=54)(两者QRS时限≥150 ms)。对比分析不同类型及同种类型不同QRS时限传导阻滞患者的常规心脏超声及心电图等心功能相关指标间的差异。结果 A、B两组在同一QRS时限时两者的LVEF(左室射血分数),FS(左室短轴缩短率)及BNP差异有统计学意义(P0.05);B组收缩功能指标在不同QRS时限时差异有统计学意义(P0.05),心率与QRS时限正相关(r=0.176,P0.05)。结论右束支传导阻滞组的心功能在QRS时限各水平均优于左束支阻滞组,随着QRS时限延长左束支阻滞组患者心功能下降更明显,整体而言无论束支阻滞形态如何,心率均随着QRS时限延长而增快。     

QRS时限在扩张型心肌病中的临床意义探讨

目的 探讨QRS时限在扩张型心肌病(DCM)的意义.方法 分析91例DCM患者和85例健康体检者心电图,分析其QRS时限的差异.91例DCM患者按QRS时限分为QRS时限＜120ms组和QRS时限≥120ms组,比较左心室舒张末内径(LVEDD)和左心室射血分数(LVEF)的差异.结果 与健康对照组比较,DCM患者QRS时限均值明显增宽(118.64±2.70 vs91.75±1.23,P＜0.05).QRS时限≥120ms组DCM患者相较于QRS时限＜120ms组,LVEDD明显增大(66.97±1.37 vs61.63±1.03,P＜0.05),LVEF明显降低(32.55±0.92 vs 36.24±0.70,P＜0.05).结论 DCM患者QRS时限有显著改变,QRS时限与左心室舒张末内径以及心功能有一定关系,可能对临床诊断和治疗选择有一定参考价值.     

多层面心电图与心电向量图对右胸导联终末r′的研究

目的:探讨右胸导联终末r′,在非典型性右束支传导阻滞(AIRBBB)与假性右束支传导阻滞(假性RBBB)的鉴别诊断指标.方法:用多层面的心电图(ECG)与心电向量图(VCG)观察162例右胸导联(V1、V2)终末r′波的形态特征与差别.结果:AIRBBB与假性RBBB在ECG特征上,以S1、V5时限增宽及下一肋间V1仍呈rSr′最具有明显差异性(P＜0.01),但QRS总时限、r′时限均无显著性差异(P＞0.05).在VCG的特征上,AIRBBB与假性RBBB两组横面终末r′向量所在的方位有显著差异性(P＜0.01),AIRBBB主要分布在右后上下或右前上下,而假性RBBB主要分布在左侧,两组QRS环终末向量延缓时限AIRBBB(38.6±7.3)ms大于假性RBBB(24.5±4.7)ms,P＜0.01.结论:ECG中S1、V5时限≥50 ms及(或)下一肋间V1仍呈rSr′型和VCG出现附加环,横面终末向量在右侧,可作为对AIRBBB与假性RBBB鉴别诊断有用指标.而终末向量延缓时限超过30 ms是否可视为AIRBBB与假性RBBB的分界点.     

非ST段抬高心肌梗死病人伴或不伴ST段下降的临床特点和意义

目的:研究在非ST段抬高心肌梗死(NSTEMI)病人中伴或不伴ST段下降的临床特点和意义并行早期危险分层.方法:128 名 NSTEMI病人根据入院时心电图(FCG)相邻2个导联伴或不伴ST段下降分为2组:ST段下降＜1mm组(Ⅰ组)和ST段下降≥1mm组(Ⅱ组),分析比较2组间各种临床指标的差异及冠状动脉造影(CAG)的结果.结果:在两组间病人基本临床特点中,Ⅱ组病人的糖尿病发病率及血浆中心肌肌钙蛋白Ⅰ(cTNI)的峰值显著高于Ⅰ组[26/68 vs 13/60;(19.6±15.4)vs(11.6±6.9),P＜0.05];在CAG检查中,Ⅱ组病人中冠状动脉三支及左主干病变的比率显著高于Ⅰ组(26/44 vs 10/38,P＜0.005);心动超声检查左室功能(LVEF)Ⅱ组显著低于Ⅰ组[(51.9±10.5)vs(64.2±8.6),P＜0.05].结论:在NSTEMI病人中,ECG上伴有ST段下降≥1mm,表明多合并有糖尿病和冠状动脉多支血管病变,存在有心肌广泛及严重缺血,致心功能下降,预后不良.     

室内传导阻滞与心力衰竭B阶段患者血清脑钠素水平的关系

目的通过测定心力衰竭分级B阶段合并有室内传导阻滞(IVCD)患者的血清脑钠素(BNP)浓度,探讨IVCD对于心力衰竭分级B阶段患者预后的影响。方法选取2009年2月至2010年7月在该院心内科住院的心力衰竭B阶段的患者133例。根据入院时心电图QRS波群时限将患者分为对照组(QRS时限小于100ms)及IVCD组(QRS时限大于100ms)。IVCD组分为右束支传导阻滞组和左束支传导阻滞组。用酶联免疫法测定各组BNP值,并进行比较。结果左束支传导阻滞组BNP水平明显高于对照组(P<0.01),且完全左束支传导阻滞组BNP水平最高,完全右束支传导阻滞组BNP水平与对照组差异无统计学意义(P=0.12)。结论在相似的左室射血分数(LVEF)下,心力衰竭B阶段合并左束支传导阻滞患者的BNP水平的显著升高预示其相对无IVCD的患者而言有更高的心血管事件的发生风险。     

急性非ST段抬高心肌梗死冠状动脉病变与临床特点

目的分析急性非ST段抬高心肌梗死(NSTEMI)患者的临床及冠状动脉病变的特点。方法对自2006年1月至2011年12月在北京顺义区医院心内科住院并确诊的154例NSTEMI和166例急性ST段抬高心肌梗死(STEMI)患者的临床及冠状动脉造影结果进行分析。结果与STEMI患者相比,NSTEMI患者的危险因素较多,NSTEMI组既往心绞痛与陈旧性心肌梗死史多见(32.5%vs13.3%,11.7%vs 2.4%,P<0.01),NSTEMI组合并高血压的比例及女性所占比例较STEMI组高(70.8%vs 53.0%,P<0.01;27.9%vs 16.9%,P<0.05);NSTEMI组梗死后心绞痛比STEMI组增多(19.5%vs 1.8%,P<0.01)。NSTEMI组肌酸激酶、肌酸激酶同工酶水平低[(650.7±625.4)vs(1825.8±1318.1);(77.2±71.4)vs(208.5±147.5),均P<0.01]。NSTEMI组三支病变及左主干病变的比例较STEMI组高(56.5%vs 42.2%,13.6%vs 6.0%,P<0.05);NSTEMI组中度狭窄(76%⁸9%)、重度狭窄(≥90%)病变较STEMI组多(14.3%vs 7.2%,P<0.05;55.2%vs 27.1%,P<0.01);NSTEMI组完全闭塞病变较STEMI组少(24.0%vs 61.4%,P<0.01);NSTEMI组侧支循环比STEMI组多(23.4%vs 10.8%,P<0.01)。结论 NSTEMI组患者危险因素较多,冠状动脉病变严重,三支病变、左主干病变及严重狭窄病变发生率高,梗死后心绞痛常见,应重视对其治疗。     

老年人左束支传导阻滞时QRS波时限变化对心功能不全的影响

目的探讨老年人左束支传导阻滞时QRS波时限变化对心脏功能不全的影响。方法对2003年至2006年住院确诊的左束支传导阻滞合并心脏功能不全的老年患者160例,根据心电图QRS波时限分为A、B、C组,分别测定各组入院时及治疗后心电图QRS波时限,心脏彩色超声心动图,对比分析各组治疗前、后QRS波时限变化对左心室功能参数的影响。结果B、C组缺血性心脏病?陈旧性前壁心肌梗死?扩张型心肌病患者均明显高于A组(P<0.05);重度心衰在B、C组明显高于A组,C组二尖瓣反流明显多于B、A组,P<0.05,差异具有统计学意义。结论老年人左束支传导阻滞时QRS波时限越长,心肌电活动紊乱越重,预后越差。     

完全性左束支阻滞合并左室肥厚的心电图分析

目的:探讨左束支传导阻滞合并左心室肥大心电图诊断价值。方法:分析54例左束支传导阻滞心电图,经超声心动图和X线心脏检查,证实合并左室肥厚者24例(观察组);无左室肥厚者24例(对照组);6例双侧心室肥厚未予以分组。结果:两组RV5(V6)+SV1(V2)、QRS空间向量无明显差异(P>0.05),而QRS时间却有明显差别(P<0.01)。结论:在完全性左束支传导阻滞时,诊断左心室肥大以QRS时间≥150ms为标准,较QRS电轴及电压指标敏感可靠。     

宽QRS波群心动过速的鉴别诊断

宽QRS波群心动过速是指体表心电图QRS波群时限≥120 ms,频率＞100 次/分的心动过速.它分为室性心动过速和室上性心动过速伴束支传导阻滞或室内差异传导两大类,由于两者对患者的危害性和治疗方法差异较大,因此及时和正确地做出鉴别诊断极为重要.     

心电图对急性肺动脉栓塞患者预后价值的探讨

目的探讨心电图在急性肺动脉栓塞患者预后分析中的作用。方法回顾性分析本院1990~2004年确诊的80例急性肺动脉栓塞住院病人。结果①ECG正常25/80(31%),异常55/80(69%);在螺旋CT诊断的亚组(SCT组)35例中,心电图正常病例[15/35(43%)]比非SCT诊断组[10/45(22%)]增多(P<0.05);②80例中,右室内径增大在ECG正常组(21.1±2.6 mm)较异常组(26.5±5.8 mm)轻(P<0.05);且在SCT组中,右室内径增大程度在ECG正常组较异常组轻(21.8±2.2 mm vs 28.1±6.3 mm)(P<0.05);③80例病例中,动脉血氧分压减低(62.5±13.6mmHg)。SCT组中,动脉血氧分压减低程度在ECG正常组较异常组轻(67.1±13.7 vs 62.0±13.4mmHg)(P<0.05);④80例病例中,ECG正常组死亡率较异常组低(1/80 vs 12/80)(P<0.05)。结论心电图正常的肺动脉栓塞病人病情较轻且预后较好。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.