心先安治疗病态窦房结综合征疗效观察

目的评价心先安（MCA）对病态窦房结综合征（SSS）的疗效。方法采用随机单盲对照法,将164倒SSS分为治疗组（A组）和对照组（B组）．两组分别静脉滴注心先安和黄芪注射液15d后比较两者临床、心电图及食道电生理变化。结果①A组和B组总有效率分别是90．7％和50．0％,两组有显著差异（P〈0．01）;②体表心电图（ECG）和24h动态心电图（DCG）：A组和B组总有效率分别是88．4％和39．7％,其24h心率总数分别是87460±5887次／分和61240±4080次／分,统计学比较有明显差异（P〈0．01）;③食道电生理检查窦房结功能：窦房结恢复时间（SNRT）、校正后窦房结恢复时间（cSNRT）和窦房结传导时间（SACT）在A组与B组治疗前后相比较．A组于治疗后有明显提高心率的作用（P〈0．01）。结论心先安治疗SSS有明显疗效,近期疗效好、副作用少．远期疗效尚有待观察。     

心先安联合生麦注射液治疗病态窦房结综合征的临床观察

目的观察心先安联合生脉注射液治疗病态窦房结综合征的临床疗效。方法将62例病窦患者分为两组,治疗组38例给予心先安联合生脉注射液,对照组24例仅给予心先安,连续使用14d后比较前后症状改善和心电图变化。结果治疗组总有效率84.2%,对照组总有效率54.2%,两组综合疗效比较有显著差异;心电图及不良反应比较无明显差异。结论心先安联合生脉注射液治疗病态窦房结综合征临床疗效确切,值得推广应用。     

心先安联合复方丹参治疗病态窦房结综合征30例

目的观察心先安、复方丹参对病态窦房结综合征（简称病窦综合征）的疗效。方法治疗组30例应用心先安120mg和复方丹参注射液20mL静脉输注，每日1次，疗程2周；对照组应用复方丹参注射液20mL加入5％葡萄糖静脉输注治疗14d后，评定两组临床疗效。结果治疗组24h平均心率提高17／min，矫正窭房结恢复时间（CSNRT）平均缩短290、22ms。两组总有效率治疗组为90.00％，对照组为53、33％。结论心先安联合复方丹参注射液治疗病窦综合征疗效显著，     

心先安治疗病态窦房结综合征28例疗效观察

目的观察心先安治疗病态窦房结综合征的疗效及安全性.方法采用随机单盲对照法,将51例病人分为治疗组和对照组,两组分别静脉输注心先安和黄芪注射液,14 d后比较两组临床、心电图、24 h动态心电图的变化.结果治疗组和对照组总有效率分别是85.7%和47.8%,体表12导联心电图治疗组和对照组总有效率分别是85.7%和39.1%,治疗组和对照组治疗后24 h动态心电图检查,24 h心率总数分别是(89 421±5 869)次和(64 293±4 231)次,两组比较有统计学意义(P＜0.01).结论心先安是治挝疗病态窦房结综合征的安全有效药物,未发现明显的不良反应.     

心先安治疗病态窦房结综合征26例临床观察

目的 :观察心先安治疗病态窦房结综合征的疗效及安全性。方法 :2 6例病人除常规基础治疗外 ,均接受静脉输注心先安12 0mg～ 180mg ,每日 1次 ,10d为一疗程 ,均不应用抗胆碱能神经药、拟肾上腺素能神经药及其他抗心律失常药 ,比较治疗前后临床症状的改变、心电图 (ECG)、2 4h动态心电图 ( 2 4hDCG)的变化。结果 :治疗 10d后 ,总有效率 84.6% ,治疗前后 2 4h总心率分别为 ( 5 3 42 8± 413 6)次和 ( 843 97± 5 170 )次 ,两者比较有统计学意义 (P <0 .0 1) ;平均心率 ( 4 1.6± 3 .5 ) /min和( 5 6.3± 7.2 ) /min ,两者间亦有统计学意义 (P <0 .0 1)。结论 :心先安是治疗病窦的安全有效药物 ,未发现明显的不良反应。     

环磷腺苷葡甲胺治疗病态窦房结综合征疗效观察

我院为观察环磷腺苷葡甲胺 (心先安 )对病态窦房结综合征 (病窦 )的疗效 ,7年来以心先安治疗病窦患者 43例 ,比较治疗前后临床表现及窦房结功能 ,报告如下。资料与方法一般资料　病窦患者 86例随机分为 2组 ,治疗组 43例(男 2 6,女 17) ,年龄 3 1～ 72岁 ,其中冠心病 2 4例 ,高血压 12例 ,糖尿病 5例 ,心肌病 2例。对照组 43例 (男 3 0 ,女 13 ) ,年龄 2 9～ 68岁 ,其中冠心病 2 0例 ,高血压 11例 ,糖尿病 7例 ,心肌病 5例。所有患者以心电图、食道电生理检查及阿托品试验证实为病窦 ,符合病窦的诊断标准。临床资料　所有患者均有心悸、胸闷…     

心宝联合心先安治疗病态窦房结综合征临床观察

目的探讨心宝联合心先安治疗病态窦房结综合征临床疗效.方法将60例病态窦房结综合征病人随机分为观察组和对照组各30例,观察组应用心宝口服联合心先安静脉输注,对照组应用阿托品口服,对比两组间症状、心电图改变.结果治疗前后两组临床症状改善有统计学意义(P＜0.05).结论心宝联合心先安治疗病态窦房结综合征效果显著,应用方便,值得临床推广.     

生脉注射液联合氨茶碱治疗病态窦房结综合征疗效观察

目的 观察生脉注射液联合联合氨茶碱治疗病态窦房结综合征（简称病窦）的疗效.方法 对43例病窦患者给予生脉注射液（30ml/日静滴）联合氨茶碱（0.25-0.5/日静滴）14天为一疗程,观察治疗前后患者临床疗效、心电图、食道电生理的变化.结果 治疗前后临床疗效总效率83.7%,心电图总有效率86%,窦房结恢复时间、窦房导时间均显著改善（P＜0.01）.结论 生脉注射液联合氨荼碱治疗病窦有明显疗效.     

七叶皂苷钠并心先安治疗老年心力衰竭疗效分析

目的探讨七叶皂苷钠、心先安合用治疗老年冠心病心力衰竭疗效。方法对40例老年冠心病心力衰竭患者给予七叶皂苷钠20mg,心先安150mg加入5%葡萄糖注射液250ml中静点,1次/日,10天为1疗程。结果心功能(心脏指数、射血分数)与对照组相同,肺部湿罗音、下肢浮肿消退,降低心肌耗氧量优于对照组（P<0.05）。结论七叶皂苷钠,心先安合用治疗心力衰竭疗效确切,安全,无毒副作用。     

心先安治疗病态窦房结综合征疗效观察

目的 探讨心先安治疗病态窦房结综合征(SSS)的临床效果。方法 将120例SSS患者随机分为治疗组(A组)60例和观察组(B组)60例,A组用心先安120-180mg加入5％G.S 250ml中静滴。每日1次;B组用烟酰胺200-400mg加入5％G.S 250ml中静滴,每日1次,疗程均为2W。对比观察两组间临床症状、心电图表现和食管电生理检查结果。结果 临床症状的总有效率两组无差异(P>0.05);心电图表现A组优于B组(P<0.05);食管电生理检查窦房结功能,窦房传导时间(SACT)两组无差异(P>0.05),窦房结恢复时间(SNRT)A组优于B组(P<0.05)。结论 心先安治疗SSS有显著疗效。     

窦房结功能不良与传导阻滞患者植入双腔起搏器后动态心电图的表现及其意义

目的 探讨窦房结功能不良与传导阻滞患者植入双腔起搏器后动态心电图的表现及临床意义。 方法 分析植入DDD型双腔起搏器的160例患者的动态心电图,其中窦房结功能不良组80例,传导阻滞组80例,比较2组患者植入双腔起搏器后的动态心电图表现、主要的工作模式、心室起搏情况、自身心律失常及起搏器所致的心律失常。 结果 窦房结功能不良组与传导阻滞组起搏比例≥60%者均多于起搏比例<60%者（82%比18%、85%比15%）,组间差异无统计学意义。窦房结功能不良组心房按需起搏工作模式显著高于传导阻滞组（31%比2%,P<0.01）,而心室按需起搏/心房同步心室起搏工作模式显著低于传导阻滞组（19%比50%,P<0.01）;组间比较,双腔按需起搏工作模式检出率二者无统计学差异（50%比48%）。窦房结功能不良组心室安全起搏检出率显著高于传导阻滞组（25%比12%,P<0.05）,而心室起搏融合波的检出率则显著低于传导阻滞组（35%比51%,P<0.05）。窦房结功能不良组起搏介导性心动过速及感知房性心动过速触发快速型心室起搏的检出率显著高于传导阻滞组（12%比2%,24%比11%,P<0.05）,房性心动过速和频发房性早搏的检出率亦显著高于传导阻滞组（38%比18%,22%比4%,均P<0.05）。 结论 窦房结功能不良与传导阻滞患者植入双腔起搏器后对应的主要工作模式可以通过动态心电图的各种表现进行识别,全面了解起搏器的工作状态,为起搏器的合理程控以及自身心律失常提供可靠的依据。     

The sinus node function: normal and pathological

To determine the evolution with age, of extrinsic and intrinsicsinus node electrophysiological parameters and to assess therole of each component of the autonomic nervous system relativeto age in patients with and without sick sinus syndrome, electrophysiologicalstudies of sinus node function were performed in 223 patientssubdivided into four groups according to the results of theirelectrophysiological testings: group I included patients withnormal extrinsic and intrinsic sinus node function, group IIpatients with exclusive extrinsic sinus dysfunction, group IIIpatients with exclusive intrinsic sinus dysfunction and groupIV patients with extrinsic and intrinsic sinus node dysfunction.The electrophysiological study was performed twice: at basalstate and after autonomic blockade. Whatever the sinus node function (normal or abnormal) the extrinsicsinus node electrophysiological variables did not correlatewith age; inversely all the electrophysiological measurementsof the intrinsic sinus node (normal or abnormal) lengthenedprogressively with age, suggesting an ageing phenomenon of theintrinsic sinus node throughout life. Moreover, the study ofthe percentage of chronotropy of the sinus node electrophysiologicalvariables shows a predominance of vagal tone in young subjects,whereas sympathetic activity is most prominent in elderly patientswith and without sick sinus syndrome. The sinus node (normal or pathological) represents an equilibratedsystem: the age-related modification of the autonomic nervoussystem counterbalances the senescence of the intrinsic sinusnode in such a way that the basal electrophysiological characteristicsremain stable throughout life.     

A case of pseudoxanthoma elasticum associated with sick sinus syndrome

Typical angioid streaks were found on routine ophthalmologic examination in a 42-year-old female with yellowish, coalescing papules on her neck without any symptoms. Biopsy of the cutaneous lesion showed degeneration and fragmentation of the elastic fibers and many basophilic-stained calcifications in mid-dermis, which are consistent with pseudoxanthoma elasticum. Twenty-four-hour Holter electrocardiography (ECG) showed sinus arrest for 2.5 seconds, and an electrophysiological study revealed sinus nodal dysfunction (sick sinus syndrome), whereas all of the coronary arteries were intact, despite a treadmill stress ECG test showing significant ST depressions. The association of pseudoxanthoma elasticum and sick sinus syndrome is very rare. One possible explanation for this association here is that the degeneration of elastic fiber in endomysium of the sino-atrial node may have affected heart conduction systems, resulting in sick sinus syndrome.Part of this work was presented at the 76th Japanese Circulation Society Kyushu Meeting, Japan, June 18, 1994     

Electrophysiological studies after the Mustard and Senning operations for complete transposition. Do they have prognostic value?

Overall, long-term survival after the Mustard or Senning operation is good, but late arrhythmias remain a concern. Whether postoperative electrophysiological investigations can identify patients at risk of developing serious arrhythmias is unknown. In this study, 16 children who underwent electrophysiological study after the Mustard or Senning operation for complete transposition (the combination of a concordant atrioventricular and a discordant ventriculo-arterial connexion) were followed up for one month to 9 years (mean 4.33 years) after this investigation. At the electrophysiological study, sinus nodal dysfunction was diagnosed in 9/16 patients, and abnormalities of atrial conduction and refractoriness in 7/13. During follow-up, 7 children developed clinical evidence of the sick sinus syndrome. When considering corrected sinus node recovery time as the only electrophysiological parameter, the sensitivity of predicting sick sinus syndrome from the electrophysiological study was 42%, and specificity 66%. The sensitivity increased to 71% if additional electrophysiological criteria of sinus node dysfunction were included, such as sinuatrial conduction time or sinus node entrance block, but specificity dropped to 55%. Atrioventricular conduction disturbances were rare. Thus, abnormalities at electrophysiological studies after the Mustard or Senning operations are frequent, but identification of patients at risk of developing sick sinus syndrome remains difficult.     

Pre-operative sinus node function in adult patients with atrial septal defect (ostium secundum type)

The authors studied, pre-operatively, the sinus node functionin adult patients with secundum atrial septal defect and largeleft-right shunts, using Holter ECG and electrophysiologicaltests. Sinus node electrophysiological tests were found abnormal in17 out of 26 patients; on the contrary, Holter monitoring wasalways within normal limits. The authors believe that concealed sinus node dysfunction existingbefore surgical correction may be a cause of early, acute, andreversible, post-operative sick sinus syndrome.     

青年军人显著性窦性心动过缓的无创性电生理研究

目的观察青年军人显著性窦性心动过缓（OSB）临床电生理特点。方法采用常规及24小时动态心电图、经食管心房调搏、阿托品试验等无创检查观察青年军人中有症状（a组）、无症状（b组）OSB患者及健康志愿者（c组）各30例。结果a、b、c组早期复极综合征患者分别为9、8、2例（a、b与c组比较P<0.05）;a、b 2组平均心率<60次/m in且显著低于c组（P<0.01）,a、b 2组间平均心率、最慢心率、最快心率差异均无显著性。a、b、c组心率变异性时域指标及频域指标高频成分递减。经食管心房调搏示a、b 2组迷走神经张力增高,但注射阿托品后与c组比较无统计学差异。3组阿托品试验均阴性,但达峰值心率时间a组明显慢于b、c 2组（P<0.01）。结论青年军人OSB患者电生理改变与高迷走神经张力有关,对迷走神经改变反应性慢可能为其不适症状的原因之一。     

Value of physical and pharmacological tests in predicting intrinsic and extrinsic sick sinus syndrome

We studied 13 patients with sick sinus syndrome using various physical (postural reflex testing. Valsalva manoeuvre, carotid sinus massage), pharmacological (intravenous isoprenaline, atropine, neostigmine and total autonomic blockade) and electrophysiological tests in order to identify simple non-invasive markers of intrinsic sick sinus syndrome. Following autonomic blockade, 6 patients had normal and the remaining 7 had an abnormal intrinsic heart rate. Electrophysiological testing revealed abnormal sinus node parameters in 8 (62%) subjects in the basal state and 11 (85%) after autonomic blockade. Carotid sinus massage was abnormal in all patients (100%) with an abnormal intrinsic heart rate, and in only 2 of the 6 (33%) with normal intrinsic heart rate (P less than 0.05). The heart rate response to isoprenaline was abnormal in 5 of the 6 (83%) patients with normal as compared to only 1 of the 7 with abnormal intrinsic heart rate. With isoprenaline there was a significantly (P less than 0.05) higher increase in heart rate in patients with abnormal as compared to those with normal intrinsic heart rate. The other physical and drug tests were not helpful to differentiate between intrinsic and extrinsic mechanisms. Thus, carotid sinus massage and, to some extent, isoprenaline administration appear simple bedside tests which may be helpful in identifying the underlying mechanism of sick sinus syndrome.     

病态窦房结综合征患者心脏变时功能不全的临床研究

目的探讨病态窦房结综合征患者心脏的变时功能。方法对60例病态窦房结综合征患者（观察组）和40例正常窦性心律者（对照组）作运动平板试验，测定静息心率、运动时的最大心率、运动时间、代谢当量；计算2级运动时的心率变时性指数（CRI）、运动后1min心率恢复值。结果观察组静息心率、最大心率、CRI明显低于对照组，差异有显著统计学意义（P〈0．01），观察组心率上升幅度、运动时间、代谢当量、运动后1min心率恢复值均低于对照组，差异有统计学意义（P〈O．05）；观察组心脏变时功能不全31例（517％），明显多于对照组4例（10％），差异有显著统计学意义（P〈0．01）。结论病态窦房结综合征患者常发生心脏变时功能不全。     

黄连素与钙剂伍用治疗病态窦房结综合征初步观察

目的探讨黄连素与钙剂伍用对病态窦房结综合征的治疗作用。方法对符合病态窦房结综合征患者21例,口服黄连素片0．5～0.8g,每天3次,1周后同时加用10％葡萄糖酸钙10ml加5％葡萄糖或0．9％氯化钠液稀释静脉滴注8～10d。治疗前后分别作动态心电图检查,观察窦性最长R-R间期、窦性最短R-R间期、24h平均心率、24h总心搏数、长R-R间期(≥2s)、长R-R间期发生次数。结果治疗后最长窦性R-R间期、最短窦性R-R间期分别由(1．86±0．42)s、(0．76±0．15)s缩短至(1.67±0．63)s(P<0．05)、(0．66±0．10)s(P<0．01)。24h平均心率、24h总心搏数分别由(53．20±5．63)次／min、(73974．60±8234．85)次增至(55．73±5．05)次／min(P<0．05)、(78934．00±7194．21)次(P<0．01)。≥2s的长R-R间期由(2．79±1．54)s缩短至(2．22±1.17)s(P<0．05)、长R-R间期发作次数由(16．60±12．70)次减少至(5．10±5．38)次(P<0．01)。11例有持续较长时间的交界区逸搏心律者,其中7例交界区逸搏心律消失。结论黄连素与钙剂伍用对窦房结功能改善有一定作用,且无明显副作用。     

起搏胶囊治疗家兔病态窦房结综合征的实验研究

目的:观察起搏胶囊对病态窦房结综合征(SSS)家兔的心率、心电图、电生理影响。方法:采用随机、平行对照的研究方法,选用30只家兔制备SSS模型,随机分为3组:模型组、起搏胶囊组、心宝丸组,给予相应的药物干预,10d后观察家兔心率、电生理的情况。结果:起搏胶囊组SSS家兔的平均窦性心动周期、窦房传导时间、窦房结恢复时间、校正窦房结恢复时间、心率较模型组均差异有统计学意义(P<0.05或P<0.01),与心宝丸组比较差异无统计学意义(均P>0.05)。结论:起搏胶囊对窦房结功能损伤的恢复有一定作用,对窦房结损伤心肌组织有一定的修复作用。在改善SSS家兔窦房结功能方面是安全有效的。