高原心脏病心律失常临床分析

目的了解拉萨地区高原心脏病心律失常的发病情况及临床特点。方法对我院2002年1月-2007年6月诊治的343例高原心脏病患者作常规心电图及动态心电图检查，按发生心律失常类型以及有无心力衰竭进行统计。结果在343例患者中有214例心律失常，其中窦性心动过速25例，窦性心动过缓27例，窦性停搏11例，室上性早搏159例，房性心动过速67例，心房颤动14例，室性早搏133例，室性心动过速5例，一度房室传导阻滞7例，二度房室传导阻滞30例，束支传导阻滞8例；单一心律失常100例，发生心力衰竭14例；两种及两种以上心律失常113例，发生心力衰竭48例。结论成人高原心脏病心律失常的发生率较高，心电图表现多种多样，同一患者可出现多种心律失常，发生率也较高，说明缺氧既影响心肌细胞的兴奋性又影响心脏的传导系统。心电图检查尤其动态心电图对诊断心律失常型高原心脏病具有重要意义。     

高原地区无症状心肌缺血动态心电图分析

目的：探讨动态心电图（DCG）对高原地区冠心病患者无症状心肌缺血（SMI）的检出情况和发生规律。方法：对我院确诊的137例冠心病患者做为观察对象,进行12导联动态心电图监测,观察患者的心肌缺血检出率,进行ST段压低情况及昼夜节律分析。结果：无症状心肌缺血与有症状心肌缺血ST段压低差异无显著性（P〉0.05）。结论：动态心电图对无症状心肌缺血的检出率较高,这有助于冠心病的病情评估和早期防治。     

高血压病与心律失常关系分析

高血压病与心律失常关系分析唐学林史寅奎何耀忠军事医学科学院附属医院北京１０００３９高血压病尤其是高血压性左心室肥厚与心律失常、心肌缺血的关系密切，日益受到临床重视。根据动态心电图和超声心电图检查的结果，对１７１例高血压病病人进行分析，以探讨高血压病与...     

107例高原老年患者动态心电图分析

目的 :了解高原老年患者动态心电图 (DCG)检查时各种心律失常及最低心率情况 ;方法 :用美国惠普公司生产的HP43 42 0动态心电图系统做DCG检查 ;结果 :老年患者单发房性早搏检出率为 86.9% ,成对为 1 8.8% ,阵发性房性心动过速为 2 6.2 % ;单发室性早搏检出率为 71 .9% ,成对为 2 8.0 % ,阵发性室性心动过速的检出率为 7.5 % ;最低心率为 3 7次 /分～ 99次 /分 ,小于 40次 /分者 2例 ( 2 .4% ) ,最低心率并不随年龄增长而减慢 ;结论 :上述两种早搏检出率明显高于海平面老年前期健康人组 ,最低心率并不随年龄增长而减慢 ,心率波动范围亦非为窄 ,最低心率 <40次 /分并伴有最快心率 <1 0 0次 /分 ,应采取必要措施 ,以防发生意外     

1588例老年人动态心电图心律失常分析

动态心电图 (ＤＣＧ)是心血管领域中非创伤性检查的重要监测方法之一 ,尤其对心律失常的分析更显得重要。现将我科 1992～ 1997年住院的 15 88例老年病人ＤＣＧ发现有心律失常者 15 39例 (96 .9% )作综合分析如下。1　临床资料1.1　仪器使用美国ＣＩＲＣＡＤＩＡＮ公司产的ＷＣ - 2型 2 4ｈ心电图记录和分析系统 ,导联电极置于ＣＭ1和ＣＭ2位置。1.2　ＤＣＧ监测对象均为住院患者 ,进行 2 4ｈ连续监测的15 88例 ,有心律失常的 15 39例患者中 ,男 1347例 ,女 192例 ,年龄 6 0～ 92岁 ,平均 6 9.38± 6 .49岁。2　观测结果2 .1　心律失常种类…     

胺碘酮治疗高原地区心律失常56例

高原地区气候干燥、氧含量低,心律失常较为常见。胺碘酮为广谱、长效、安全性较大的抗心律失常药,治疗本病多收效良好。我院1998年2月～2002年2月采用胺碘酮治疗高原地区心律失常56例,疗效满意。     

心律失常和心肌缺血的动态心电图分析

目的：采用12导动态心电图对心律失常和心肌缺血患者检测分析,评价12导动态心电图对心律失常和心肌缺血的诊断价值。方法分析298例门诊心律失常患者,并进行12导动态心电图检测,诊断心律失常指标做定量分析。结果①12导动态心电图检出心律失常者238例,占81.2％,无心律失常者60例,占18.8％。②窦性心律失常者64例,占27％,室性心律失常者107例,占45％,房性心律失常者28例,占12％,房室传导阻滞者16人,占6.7％,束支传导阻滞者23人,占9.3％。③心律失常多发生于心血管病患者,其中高血压患者较多。结论12导动态心电图可发现并明确诊断心律失常和心肌缺血的类型及定位检测分析,在一定程度上提高了心律失常和心肌缺血的诊断率。     

动态心电图监测原发性高血压病心律失常79例

原发性高血压病特别是在合并左心室肥厚、冠心病等情况下更易发生各类心律失常．且有预后的严重性。动态心电图(DCG)对心律失常的检出率高，对疾病的早期诊断、防治和估计预后有重要价值。笔应用DCG监测79例原发性高血压病患的心律失常，分析如下：     

高原地区220例青年官兵心电图分析

对海拔4700m-5300m 220名一线边防官兵进行心电图检查,结果有126例有不同程度心电图改变,阳性率为57．27％,异常改变31例,阳性率1400％,认为高海拔对人体的主要影响是缺氧,缺氧是导致心肌损害,心电图异常的基本原因。     

高原肺心病伴心律失常116例

慢性肺源性心脏病 (肺心病 )伴心律失常较常见。1980年以来 ,我院 (驻地海拔 2 80 8ｍ )共收治肺心病伴心律失常 116例 ,分析报告如下。1　临床资料1 1　一般情况　本组男 87例 ,女 2 9例 ;年龄 3 178岁 ,平均 5 3岁。按 1977年第 2次全国肺心病会议修订的诊断标准 ,均为肺心病急性加重期合并心律失常。病程 63 0年。原发病 :慢性支气管炎肺气肿 10 8例 ,支气管哮喘 4例 ,肺结核 2例 ,支气管扩张症 2例。1 2　心电图检查　肺心病伴心律失常 116例中 ,合并2或 3种心律失常 2 8例 ( 2 4 1% ) ,共发生心律失常15 4例次 :房性早搏 3 8例次 ( 2 4…     

高原环境下高原病再发的流行病学研究

目的了解在高原环境下住院高原病患者的预后。方法以医院(海拔3658m)40年间收治、并符合筛选标准的19118例住院病历为样本,随访1～15年,样本中以高原病首次住院为病例组,以非高原病首次住院者为对照组。随访两组高原病的发病情况,并进行临床流行病学的分析。结果(1)对照组的急性高原病发病率、总体发病率随观察年限延长而增加且呈正相关(r急=08259,P<001,r总=06815,P<005);急性高原病组和慢性高原病组的慢性高原病发病率随观察年限延长而减低,且呈负相关(r急1～7=08993,P<001;r慢1～9=09068,P<0001)。(2)病例组总体高原病逐年发病率在急性高原病组和慢性高原病组均显著高于对照组(P<001),RR=1129。(3)各型高原病发病率在急性高原病组和慢性高原病组均显著高于对照组(P<001)。急性高原病组以急性轻型高原病和高原肺水肿发病率最高,达1712%和2766%,RR=759;慢性高原病组以急性轻型高原病和Monges病发病率最高,达1284%和1119%,RR=531。结论高原病患者再发生高原病的风险显著增加,不适宜长期滞留高原地区。     

高原先天性心脏病的围手术期处理

我院(3658m)2000-11-2001-07对22例先天性心脏病患者进行了手术治疗,取得满意效果。现对病例进行回顾性分析,探讨在高原地区开展先天性心脏病手术的围手术期处理方法。1临床资料1.1一般资料22例患者中,男性8例,女性14例;     

Energy at high altitude

For the military doctor, an understanding of the metabolic effects of high altitude (HA) exposure is highly relevant. This review examines the acute metabolic challenge and subsequent changes in nutritional homeostasis that occur when troops deploy rapidly to HA. Key factors that impact on metabolism include the hypoxic-hypobaric environment, physical exercise and diet. Expected metabolic changes include augmentation of basal metabolic rate (BMR), decreased availability of oxygen in peripheral metabolic tissues, reduction in VO2 max, increased glucose dependency and lactate accumulation during exercise. The metabolic demands of exercise at HA are crucial. Equivalent activity requires greater effort and more energy than it does at sea level. Soldiers working at HA show high energy expenditure and this may exceed energy intake significantly. Energy intake at HA is affected adversely by reduced availability, reduced appetite and changes in endocrine parameters. Energy imbalance and loss of body water result in weight loss, which is extremely common at HA. Loss of fat predominates over loss of fat-free mass. This state resembles starvation and the preferential primary fuel source shifts from carbohydrate towards fat, reducing performance efficiency. However, these adverse effects can be mitigated by increasing energy intake in association with a high carbohydrate ration. Commanders must ensure that individuals are motivated, educated, strongly encouraged and empowered to meet their energy needs in order to maximise mission-effectiveness.     

Delirium at high altitude

A 35-year-old man on a trek to the Mount Everest region of Nepal presented with a sudden, acute confusional state at an altitude of about 5000 m. Although described at higher altitudes, delirium presenting alone has not been documented at 5000 m or at lower high altitudes. The differential diagnosis which includes acute mountain sickness and high altitude cerebral edema is discussed. Finally, the importance of travelling with a reliable partner and using proper insurance is emphasized in treks to the Himalayas.     

Sleep at high altitude

New arrivals to altitude commonly experience poor-quality sleep. These complaints are associated with increased fragmentation of sleep by frequent brief arousals, which are in turn linked to periodic breathing. Changes in sleep architecture include a shift toward lighter sleep stages, with marked decrements in slow-wave sleep and with variable decreases in rapid eye movement (REM) sleep. Respiratory periodicity at altitude reflects alternating respiratory stimulation by hypoxia and subsequent inhibition by hyperventilation-induced hypocapnia. Increased hypoxic ventilatory responsiveness and loss of regularization of breathing during sleep contribute to the occurrence of periodicity. Interventions that improve sleep quality at high altitude include acetazolamide and benzodiazepines.     

Ketamine anesthesia at high altitude

There is a clinical need for a safe and effective anesthetic technique in high altitude and remote areas. This report presents a series of 11 consecutive cases documenting the use of ketamine anesthesia in a remote hospital at an altitude of 3,900 m, by primary-care physicians without specialist training in anesthesia. The method of administration is fully described. At a low dose of 2.0 mg/kg, ketamine produces a dissociative anesthesia that does not depress the hypoxic drive, or interfere with the pharyngeal or laryngeal reflexes. Although supplemental oxygen is useful in the recovery phase for less acclimatized individuals, it is usually not required as reductions in oxygen saturation can be raised by physical stimulation that encourages the patient to breathe faster and deeper. The common side effect of emergent nightmares was avoided using midazolam as premedication and a quiet recovery area. This study offers the first available evidence that ketamine with midazolam offers a safe and effective means of anaesthesia at very high altitude, without the need for specialist equipment or training, by careful clinicians experienced in basic airway management.     

The placenta at high altitude

The influence of oxygen pressure on placental and villous vascular development is reviewed and considered relative to the natural experiment afforded by residence at high altitude. Data obtained from normal high altitude pregnancies are compared with those from IUGR and preeclampsia, conditions believed to be caused by placental hypoxia. High altitude placentas are characterized by increased villous vascularization, thinning of the villous membranes, proliferation of the villous cytotrophoblast, and reduced perisyncytial fibrin deposition relative to low altitude placentas. The significance of reduced fibrin deposition is unknown; it could be explained by less apoptosis along the barrier membrane, less syncytiotrophoblast turnover, or altered ratios of local proversus anticoagulant production. Increased villous capillary density and thinning of the villous membranes increases oxygen diffusion capacity and is generally considered a beneficial adaptation. Nonetheless, there is evidence that hypoxia and/or reduced blood flow reduce placental nutrient transporter densities, and this may act in additive or synergistic fashion to reduce birth weight at high altitude. The available literature on high altitude placentas derives from less than 100 pregnancies from three different continents and six different ethnic groups, and were acquired in pregnancies ranging from 2500 to 4300 m in altitude. Thus differences between studies are likely to be due to variation in altitude and/or to ethnic variation, which in turn may be due to differences in population history of residence at high altitude (e.g., Andeans vs. Europeans). Nonetheless, systematic examination of human placental development under conditions of lowered maternal arterial oxygen pressure (high altitude > 2700 m) may provide useful insights into the etiology of pathological conditions believed to be associated with placental hypoxia.     

Cardiac arrhythmias at high altitude

Palpitations at high altitude have been experienced, but seldom recorded, for centuries. The hypoxia, sympathetic activation and alkalosis of altitude predispose to cardiac ischaemia and arrhythmia. Indeed, sudden cardiac death is responsible for 30% of all deaths during mountain sports at altitude. This article reviews the literature to date on the evidence for cardiac arrhythmias at altitude.     

Cardiovascular physiology at high altitude

The role of the cardiovascular system is to deliver oxygenated blood to the tissues and remove metabolic effluent. It is clear that this complex system will have to adapt to maintain oxygen deliver in the profound hypoxia of high altitude. The literature on the adaptation of both the systemic and pulmonary circulations to high altitude is reviewed.