动态心电图检测心房颤动伴长R-R间期48例临床分析

目的:探讨心房颤动伴长R-R间期48例的临床意义.方法:选择心房颤动48例合并长RR间期的患者检测12导联动态心电图,对结果以及发生时间和症状进行总结分析.结果:房颤病例中伴长R-R间期发生率男性患者略高于女性患者.发生频率夜间明显高于白天,心室率越快,长间期越少,心室率越慢,长间期越多.房颤合并Ⅱ度房室传导阻滞患者出现长间期持续时间长,且出现时间比较频繁.室性逸搏或交界性逸搏多出现于房颤合并Ⅱ度房室传导阻滞后.结论:房颤时凡心室率较慢,有长的R-R间期＞2.5 s,且长R-R间期出现次数明显增加并与睡眠不相关,又出现头晕或晕厥病史者,应考虑病理性房室传导阻滞,频发的持续性较长的长R-R间距,同时伴有脑缺血的症状,以及减慢心室率药物引起的症状性心动过缓,而该药物又不能停用则都是起搏器治疗的指征.     

30例心房颤动伴长R-R间期动态心电图临床分析

目的:探讨动态心电图对心房颤动伴长R-R间期合并房室传导阻滞的诊断价值。方法:对动态心电图(DCG)记录到的30例房颤伴>2.0s长R-R间期者进行相关分析,对心室率低于60次/min患者行重复检查动态心电图,统计长R-R间期发生的时间、年龄、阵次、平均心率及临床症状进行分析。结果:30例患者中,房颤病例中伴长R-R间期发生率高龄患者高于低龄患者。发生频率夜间明显高于白天,心室率越快,长间期越少,心室率越慢,长间期越多。房颤合并Ⅱ度房室传导阻滞患者出现长间期持续时间长,且出现比较频繁。结论:房颤时凡心室率较慢,平均心室率<60次/min,长R-R间期出现次数明显增加并与睡眠不相关,出现室性或交界性逸搏或伴交界性逸搏心律,出现头晕或晕厥病史者,应考虑病理性房室传导阻滞,男女发生率无显著差异。为明确诊断重复检查动态心电图对了解房颤合并房室传导阻滞及指导临床用药及预后均有重要意义。     

15例心房颤动伴长R-R间期动态心电图分析

目的 探讨心房颤动(Af)伴长R-R间期时是否合并II度房室传导阻滞(AVB)的诊断.方法 选择Af伴≥2.0s的长R-R间期住院患者15例,连续记录24h动态心电图(DOG),统计2.0s以上的长R-R同期发生时间及频度,最长R-R间期.Af时最快心率,最慢心率及平均心率,阵发性Af在监测同时记录到赛性心律时的房室传导情况.结果 15例患者共出现≥2.0s的长R-R间期196次,其中白天20次,夜间176次,Af时最快心率93～175(平均121.3±24.5)次/min,最慢心率40～57(平均48.2±5.3)次/min,平均心率59～95(平均72.8±12.1)次/min,24h最长R-R间期2.1～3.0s,转复后13例房室传导正常,2例仅P-R间期延长,井显示长R-R间期大多(89.8%)发生在夜间.结论 Af伴长R-R间期者不要轻易做出合并II度AVB诊断,可用"长R-R间期请结合临床"表述并由临床医生结合临床情况作出判断较为客观.     

动态心电图对200例房颤合并长R-R间期的临床分析

目的探讨动态心电图（DCG）对房颤合并长R-R间期（≥2.0 s）的诊断价值。方法将动态心电图记录到的200例房颤伴长R-R间期者分为睡眠相关组和睡眠无关组,并分析长R-R间期昼夜发生频度、平均心室率及伴随症状。结果睡眠无关组患者睡眠及非睡眠时平均心室率均小于睡眠相关组,其平均心室率〈60次/min,且心室率清醒时恢复不明显（P〈0.05）,睡眠相关组患者长间歇时不伴黑矇或晕厥,而睡眠无关组患者长间歇时有26例出现头晕、黑矇或晕厥,均发生在清醒活动时。结论动态心电图结合长R-R间期发生的频度、时间及临床症状,除外迷走神经作用及病窦可考虑心房颤动合并病理性房室传导阻滞。     

32例心房颤动伴长R-R间期动态心电图分析

目的探讨心房颤动伴长R-R间期时是否合并Ⅱ度房室传导阻滞的诊断。方法收集门诊及住院病人心房颤动伴≥1.5s的长R-R间期者32例,连续记录24h动态心电图,统计1.5s以上的长R-R间期发生时间及频度,最长R-R间期,心房颤动时最快心率、最慢心率及平均心率,阵发性心房颤动在监测同时记录到窦性心律时的房室传导情况。结果 32例患者共出现≥1.5s的长R-R间期386次,其中白天56次,夜间330次,心房颤动时最快心率100～180（平均120±25.5）次/min,最慢心率50～60（平均55±4.5）次/min,平均心率60～96（平均70±6.5）次/min,24h最长R-R间期1.5～3.0s,转复后29例房室传导正常,2例仅P-R间期延长,1例在夜间偶见Ⅱ度房室传导阻滞。并显示长R-R间期大多（90.3%）发生在夜间11时至次日凌晨6时的睡眠状态。结论心房颤动伴长R-R间期时,如果没有明显的自觉症状,不要轻易做出合并Ⅱ度房室传导阻滞的诊断,可用＂心房颤动伴长R-R间期请结合临床＂的表述,由临床医生结合临床情况作出判断。     

动态心电图对心房颤动伴房室阻滞的诊断价值

心房颤动(简称房颤)是临床上常见的心律失常,房颤时无法诊断Ⅰ°房室阻滞(AVB).近年来,房颤时Ⅱ°AVB的诊断亦受到质疑[1],争议的主要原因在于没有证实房颤患者房室传导的情况.本文通过动态心电图检查,对房颤伴长R-R 间期、逸搏及逸搏心律作进一步分析,以探讨其合并房室阻滞的诊断价值.     

12例永久性房颤/房扑超声引导下射频消融技术探讨

目的 永久性房颤/房扑经胸心脏超声引导心内射频的可行性,和安全性.方法 12例持续/永久性房颤/房扑拟行房室结消融加VVI起搏的患者.男6例,女6例,平均年龄66岁,经胸心脏彩超引导下,采取"多切面观察","导管运动中观察",密切结合心内电生理定位,尝试左锁骨下静脉永久起搏导管和右股静脉消融导管的心内定位和靶点消融.以出现稳定的房室分离判为消融成功.结果 12例患者的房室结消融及VVI起搏均顺利完成,手术成功率100%,随访期内患者恢复良好.结论 经胸切面超声引导某些房室结消融和VVI超搏安全简便,可行经济,有可能成为常规X线透视下心律失常介入术的重要替代.     

心房颤动伴房室阻滞

心房颤动的心电图特征为:窦性P波消失,代之以大小不等.形态不一的f波,心室律大多不齐.快、慢不均.单纯房颤多为洋地黄的适应症,如并发房室阻滞多表示洋地黄过量或心脏病情恶化,为此临床上应予识别.例1、2、3皆为慢性风湿性心脏病患者,有多年持续性房颤,长期服用维持量狄高辛,每日0.125~0.25毫克不等.图一为例1心电图:窦性P波消失,代之以f波,表明房颤存在,心室率慢约50次/分,第1、3、6个心动周期等长,均为1.14秒,其余R-R间期互不相等.提示房颤伴Ⅱ度房室阻滞,应     

心房颤动伴长R—R间歇的动态心电图分析

目的对房颤合并长R-R间歇的动态心电图进行分析以明确是否合并Ⅱ度AVB。方法采用3000动态心电图监测仪连续记录24h。结果在睡眠状态下心室率缓慢时房颤患者易出现长R-R间歇,并与是否应用洋地黄无明显关系。结论房颤伴长R-R间歇多为生理性,大多与是否应用洋地黄无关,诊断房颤是否合并Ⅱ度AVB应慎重。     

慢性肾衰患者的心律失常分析

目的 探讨慢性肾衰患者并发的心律失常.方法 对74例慢性肾衰住院患者进行动态心电图观察,分析心律失常发生率、类型与临床的关系.结果 慢性肾衰以缓慢心律失常为主,24 h平均心率低于60次/min共30例,Ⅱ°以上房室传导阻滞9例,房颤3例,1例窦性心率平均最慢47次/min,4例Ⅲ°房室阻滞平均心室率分别为52次/min、49次/min、47次/min、40次/min.14例窦性停搏中最长间期达6 s,≥3 s 9例,<3 s 5例.慢性肾衰血钾正常与高血钾的严重心律失常发生率有统计学差异(P<0.05),与肾功能减退程度明显相关(P<0.001).结论 慢性肾衰患者并发严重心律失常达54.05%,危险性心律失常多见,以缓慢型心率为主.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.