静脉注射普罗帕酮、食道心房起搏和二者联用终止房室折返型心动过速的疗效比较

静脉注射普罗帕酮、食道心房调搏(TEAP)均为终止房室折返型心动过速(AVRT)常用的治疗方法[1]。本文比较单用静脉注射普罗帕酮,TEAP及二者联用终止AVRT的疗效。     

静脉注射维拉帕米或普罗帕酮治疗阵发性室上性心动过速的对比研究

目的观察静脉注射维拉帕米或普罗帕酮治疗阵发性室上性心动过速(PSVT)的疗效.方法静脉注射维拉帕米治疗35例78例次PSVT,并与普罗帕酮治疗31例59例次PSw对比观察.结果维拉帕米组总例次终止率为89.7%,普罗帕酮组总例次终止率为88.7%.两组疗效、终止PSVT发作的心电图形式等无显著性差异(P＞0.05).普罗帕酮组2例较长时间窦性停搏,1例致Ⅲ度房室传导阻滞(AVB),3例中2例死亡.结论房室结折返性心动过速(AVNRT)应用维拉帕米复律优于普罗帕酮(P＜0.05).普罗帕酮副作用较大.     

普罗帕酮与西地兰转复阵发性室上性心动过速48例疗效比较

目的:比较静脉注射普罗帕酮与西地兰转复阵发性室上性心动过速的疗效。方法:将48例阵发性室上性心动过速患者随机分成普罗帕酮组和西地兰组,分别静脉注射普罗帕酮70～175mg或西地兰0.4～1.0mg,观察室上性心动过速的转复情况。结果:普罗帕酮组23例,转复成功20例(86.9%);西地兰组25例,转复成功13例(52%),两组比较差异显著(P<0.01)。30min转复成功率,普罗帕酮组60.9%;西地兰组24%,两组比较差异显著(P<0.01)。转复成功时间,普罗帕酮组45.6±31.7min;西地兰组76.5±43.5min;两组比较差异显著(P<0.01)。结论:在转复阵发性室上性心动过速中普罗帕酮组的成功率高于西地兰组。     

静注普罗帕酮和西地兰转复阵发性心房颤动疗效观察

将 5 2例发生在 48h内的阵发性心房颤动 (房颤 )患者随机分为普罗帕酮组和西地兰组 ,分别静注普罗帕酮 70～ 2 10mg和西地兰 0 .4～ 0 .8mg。结果 :普罗帕酮组 2 8例 ,转复成功 2 2例 ( 78.9% ) ;西地兰组 2 4例 ,转复成功 10例 ( 41.7% ) ;转复成功时间 :普罗帕酮 62± 3 8.2min ,西地兰 96± 5 1.3min。两组比较有显著差异 (P <0 .0 1)。提示在阵发性房颤转复中普罗帕酮成功率明显高于西地兰 ,转复时间明显缩短     

普罗帕酮、毛花甙丙转复围术期室上性心动过速比较

对比分析围术期普罗帕酮和毛花甙丙转复阵发性室上性心动过速(PSVT)的疗效.方法:将PSVT患者随机分为普罗帕酮组(Ⅰ组)和毛花甙丙组(Ⅱ组),分别静脉注射普罗帕酮70～120 mg和毛花甙丙0.4～0.6 mg,连续观察心率、心律及血压的变化 .结果:60例患者,PSVT病程0～13.5年,Ⅰ组成功率为90.6%,Ⅱ组成功率为75.0%(P＞0.05).两组转复成功时间差异也无显著性(P＞0.05).结论:在围术期转复PSVT治疗中,普罗帕酮和毛花甙丙一样,有效、安全 .     

小剂量普罗帕酮静脉注射联合食道心房调搏终止阵发性室上性心动过速的疗效

阵发性室上性心动过速(PSVT)是临床常见的心律失常,发作时的心率为160～250次/min,大多数是由折返所至.PSVT起病突然,患者常出现发作性心悸、头昏、胸痛,严重者可发生血压下降等血液动力学障碍,甚至猝死.静脉注射普罗帕酮及食道心房调搏(TEAP)均为终止PSVT的常用方法.本研究旨在观察静脉注射小剂量普罗帕酮联合TEAP终止PSVT的疗效.     

索他洛尔对室上性心动过速疗效及其作用机制的初步研究

目的　研究索他洛尔注射液对阵发性室上性心动过速 (室上速 )的疗效及其作用机制。方法　室上速患者食管左房刺激诱发室上速后静脉注射索他洛尔或生理盐水。结果　 2 3例室上速患者静注索他洛尔总剂量 1.5 mg/ kg,15例 (65 .2 % )转复为窦性心率 ,平均转复时间 (10 .7± 11.6) m in;2 1例静注生理盐水 ,1例 (4 .8% )转复 ;2组疗效有显著差异 (P<0 .0 5 )。用药后房室折返性心动过速 (AVRT)和房室结内折返性心动过速 (AVNRT,收缩压 <10 .7k Pa)的终止部位主要 (3 / 4和4 / 6)在前传房室结和房室结逆传快通道。 2例患者在静注索他洛尔过程中出现无症状性低血压。结论　静脉注射索他洛尔终止室上速安全、有效     

食道心房调搏与心律平治疗阵发性室上性心动过速的疗效比较

目的 观察静脉注射心律平与食道心房调搏(TEAP)两种方法终止阵发性室上性心动过速(PSVT)的疗效.方法 68例PSVT患者随机分为静脉注射心律平组与TEAP组,比较两组终止PSVT的成功率,并观察其副作用.结果 转复成功率TEAP组29例(85.3%),心律平组20例(58.8%), P＜0.05,心律平组出现显著窦缓、房室阻滞、低血压等副作用.结论 TEAP终止PSVT效果较静脉注射心律平好,且安全易行,副作用轻微.     

三磷酸腺苷与普罗帕酮治疗阵发性室上性心动过速的临床观察

目的 比较静脉注射ATP和普罗帕酮在终止PSVT发作的疗效及安全性.方法 符合奈件的PSVT患者随机分为ATP组(46例)和普罗帕酮组(52例),分别经静脉ATP和普罗帕酮推注,记录给药前后和给药期间临床和心电图状况.以心电监测到PSVT转为窦性为转复成功.转复律时间以静脉注射药物开始计算,至PSVT终止结束.结果 ATP组转复成功率为89.13%,普罗帕酮组转复成功率为84.61%.ATP组从用药到PSVT终止的时间,显著短于普罗帕酮组.ATP组和普罗帕酮组的不良反应发生率分别为26.8%和23.3%.整个试验未发生严重不良事件.结论 三磷酸腺苷是治疗PSVT有效、安全的药物;与普罗帕酮转复成功率相似.但起效更快.     

逆向性房室折返性心动过速临床诊治24例

目的:探讨逆向性房室折返性心动过速患者临床诊治特点。方法:收集逆向性房室折返性心动过速患者24例,在一般治疗基础上,选用5%葡萄糖20ml加普罗帕酮70mg缓慢静脉推注,转复为窦性心律后即停止注射。若无效可于20min后再给与普罗帕酮35mg缓慢静脉推注,可反复应用,总量不超过210mg。应用普罗帕酮若无效,可换用5%葡萄糖20ml加胺碘酮150mg缓慢静脉推注,共推注约10min。5例出现持续性低血压或伴晕厥的患者以及经药物治疗无效的患者采用同步直流电复律。结果:2例经物理方法治疗后有效,13例使用普罗帕酮1次,2例使用普罗帕酮2次,1例使用普罗帕酮2次和胺碘酮1次,6例行同步直流电复律后恢复为窦性心律。结论:普罗帕酮对逆向性房室折返性心动过速是很有效的。治疗中,一旦出现血液动力学障碍或药物治疗无效时,应采取同步直流电复律。     

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.     

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.     

Notes for contributors to Journal of Nanjing Medical University

Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.