应用呼吸阻抗图和肺阻抗图探讨肺心病与膈肌疲劳关系

目的 探讨,肺心病与膈肌疲劳的关系。方法 对６４例肺心病患者进行呼吸阻抗图和肺阻抗图检测,分组统计膈肌疲劳图形阳性率;并对阳悸 组和阴性一组进行肺阻抗图各参数比较。结果 （１）肺心病伴与不伴呼衰组膈肌疲劳图形阳性率分别为７５％与２１.9％;（2）肺心病伴与不伴心组膈肌疲劳图形阳性率分别为80％与46.3％;（3）膈肌疲劳阳性组与阴性组肺阻抗图各参数均值无显著性差异。结论 肺心病的呼衰、心衰与膈肌疲劳互为因果,但肺心病严重程度与膈肌疲劳不一定呈平行关系。     

肺循环阻抗图及其彩色环用于肺动脉压的评估

目的：在原有肺阻抗法基础上引入其彩色环，旨在提高诊断肺心病阳性率并使换算肺动脉压进一步准确。方法：对324例肺心病确诊者[平均(65&;#177;12)岁]和208例武汉市3506厂体检健康者[平均(58&;#177;9)岁]分别进行肺循环阻抗图检测，并对各指标进行两组间t检验。结果：发现正常组总环面积(Sz)平均为(1.92&;#177;0．62)u，肺心病组为(1．03&;#177;0．06)u。两组间差异有非常显著性的意义(t=25．66，P&;lt;0．001)。波幅(Hs)、上升速率(C)、射血前期／射血期(Q-B／B-Y)、I环面积(S1)、负荷后肺动脉压(P1)、肺动脉压(PAP)等指标两组间的差异也有非常显著性意义(P均&;lt;0．001)。58例经换算的P1平均为(4．66&;#177;1．20)kPa，其右心导管实测值平均为(5．05&;#177;1．85)kPa，两组间差异无显著意义(t=1．34．P&;gt;0．05)。结论：改进后的方法其诊断肺心病更敏感准确，换算的肺动脉压与实测值更接近。     

体位改变对脑阻抗血流图参数的影响

目的 观察人体位改变对脑阻抗血流图各参数的影响。方法 应用阻抗测试仪描记９０人静息状态下坐、卧位时的脑阻抗血流图并测量出图形特征参数值。通过性别、年龄分组,计算每组受检者不同体位９个指标的平均值及标准差,建成参考值范围表。对坐、卧位各参数值行配对t检验。结果 坐及卧位所测枕乳和额乳的大部分参数存在显著性差异。结论 在临 床实验中应注意体位改变对实验结果的影响。     

应用微分阻抗容积图诊断肺心病探讨

肺心病的发生发展必然导致心脏功能的变化。心微分阻抗图可以反映左心功能,肺阻抗图与肺动脉压的变化关系密切。而肺微分阻抗图能否反映右心功能的变化,本文拟就此进行探讨。我们于1980年1—6月应用心、肺微分阻抗图,分别观察了正常人、肺气肿、肺心病患者左右心功能变化规律,以探讨肺心病新的诊断方法。病例选择正常人组经体格检查、胸透或胸片及心电图检查正常者。其中,查左心功能者64人,查右心功能者45人,合计109人。男女之比为1:1.3。     

慢性肝炎及肝硬化患者肺阻抗血流图的临床意义

目的：探讨肺阻抗血流图（IPR）监测慢性肝火、肝硬化患者肺血管动态容积变化的临床意义。方法：选择32例慢性肝炎及肝硬化患者，分别测定其IPR及手指血氧饱和度（SaO2)。结果：32例患者和50例健康人两组之间IPR各主要参数差异有显著意义（P＜0．01）。提法慢性肝炎及肝硬化患者血肺血管弹性减低，肺血管顺应性减低，肺循环外周阻力增加。而慢性肝炎和肝硬化患者两组之间IPR各主要参数差异无显著意义（P＞0．05）。32例患者和50例健康人两组之间SaO2差异有显著意义（P＜0．01）。结论：IPR可以在一定程度上反映慢性肝炎及肝硬化患者的肺血管容积动态变化。     

矽肺患者肺阻抗图及其一阶微分图的临床观察

肺阻折图及其一阶微分图已广泛应用于临床，协助肺心病诊断和评价肺循环功能。本文检测２１０例矽肺患者肺阻抗图，发现阻抗容积图彼型多为单峰波，并出现多峰被，与健康组比较，有极显著性差异。矽肺组波幅值均随病变发展而逐渐降低，舒张指数（ｈＤ／ｈｓ）、ＲＶＥＴ亦随之下降，而ＰＥＰ及ＰＥＦ／ＲＶＥＴ则逐渐延长。因此，对评价矽肺病人肺血循环功能有一定参考价值。     

肺炎患儿膈肌疲劳的诊断研究

目的探讨电阻抗呼吸图仪对肺炎惠儿膈肌疲劳的诊断价值。方法用2K—V1型智能电阻抗呼吸图仪分别测定126例肺炎患儿和60例正常小儿的膈肌功能,并根据其一维图中胸腹运动曲线的变化及二维图中M值与a角度的变化判断其膈肌疲劳的程度。结果126例患儿中98例有膈肌疲劳,其中68例为I型膈肌疲劳,30例为Ⅱ型膈肌疲劳。Ⅰ型膈肌疲劳患儿M值为（46．1±8．4）％,α角为（136．7±12．0）°;Ⅱ型膈肌疲劳M值为（17．2±3．2）％,α角为（48．2±9．5）°;对照组M值为（4．3±1．0）％,α角为（31．7±5．2）°（P〈O．01）。膈肌疲劳的程度与临床诊断呼吸衰竭呈高度相关,与年龄的大小呈负相关。结论电阻抗呼吸图仪可作为肺炎膈肌疲劳的临床诊断方法,膈肌疲劳与肺炎患儿呼吸衰竭有相关性。     

老年人肾阻抗血流图初步分析

<正> 阻抗血流图(简称血流图)可用以记录脑、心、肺、肢、肾等部位的搏动性供血情况,作者应用XLJ—71—2型晶体管血流图仪接入心电图机进行描记对20例60岁以上老年人进行肾血流图的测记,并与24例青年人对照分析,检查结果报告如下: 一、一般资料本组20例老年人,男性13例,女性7例,年龄在60～68岁之间,平均62.5岁,对照的青年组男性17例,女性7例,年龄在20～30岁之间,平均26岁,测定前已作有关检查排除高血压、冠心病、肾脏及其血管疾病,检查时通过高频电流测两个电极间的肾电阻抗变化,联接心电图机,分左右两侧肾记录,电极采用镀银方形板。电极位置:右肾取第一腰     

脑阻抗血流图与中风预报120例对比分析

本文观察了120例缺血性脑血管病人的脑阻抗血流图改变,并与我院开展的“对缺血性脑血管病的预报研究(简称中风预报)的监察资料加以对比分析。结果示:中风预报值越高,脑阻抗血流图结果异常改变者所占比例越大。     

心阻抗血流图自动化处理的研究和临床应用

<正> 近十余年,无创伤性心功能检测技术取得了很大的进展,心阻抗血流图(ICG)即其中之一。ICG 的主要研究是从 Kubicek提出心阻抗血流图的微分和每搏量公式开始的。以后,Penhey 从理论上对 Kubicek 公式进行了阐明 Sramek 等对 Knbicek 公式进行了修正,Berstein 等提出新的每搏量公式,国内况明星等提出心阻抗图的园台园柱体组合模型理论以及与 Kubicek 公式不同的非线     

Assessment of peripheral hemodynamics using impedance plethysmography

Impedance plethysmography (IPG) is a safe, noninvasive method for measuring peripheral hemodynamics. The purpose of this article is to describe the IPG technique and its potential use by physical therapists in making hemodynamic evaluations. Impedance plethysmography requires the attachment of four circumferential Mylar band electrodes around a limb. We use a cardiograph to introduce a 4-mA current (I) at a frequency of 100 kHz in the two outer electrodes. The voltage (V) is sensed in the two center electrodes, and the resulting impedance (Z) is calculated using Ohm's law (Z = V/I). Arterial blood flow can be calculated using an impedance-related volume conduction equation. Impedance plethysmography has been shown to be economical, and any limb or limb segment can be evaluated. Applications are presented for the assessment of arterial blood flow, peripheral arterial disease, deep vein thrombosis, and venous insufficiency. Impedance plethysmography offers the physical therapist a safe and relatively simple technique to assess the peripheral vascular status of the patient.     

慢性充血性心力衰竭患者伴睡眠呼吸暂停综合征的临床研究

目的探讨慢性充血性心力衰竭（CHF）伴睡眠呼吸暂停综合征（SAS）患者对心功能能响及其血清瘦素（1eptin）水平和肿瘤坏死因子a（TNF—a）的变化与临床意义。方法22例心力衰竭扈（CHF组）和18例心力衰竭伴睡眠呼吸暂停综合征患者（CHF＋SAS组）,进行多导睡眠图（PSG）检查;抽取静脉血测定血清瘦素（放射免疫法）及TNF—a,sTNFR1水平（ELISA法）。结果①CHF＋SAS缍眠呼吸暂停低通气指数（AHI）,SpO2〈90％的时间占总睡眠时间的百分数（TSaO2〈90％）均显著高CHF组（P〈0．01）;②CHF＋SAS组血清瘦素水平及TNF-a,sTNFR1水平显著高于CHF组（P〈0．01）结论慢性充血性心力衰竭伴睡眠呼吸暂停综合征患者反复的夜间血氧饱和度降低可加重病情,血瘦素及TNF-a可能参与上述的发病过程。     

Deep venous thrombosis in high-risk hemiplegic patients: detection by impedance plethysmography

Clinically significant thromboembolic disease originating from the paralyzed leg of hemiplegic patients can occur unexpectedly and may affect morbidity and mortality in the rehabilitation setting. Impedance plethysmography (IPG), a simple, noninvasive technique, can accurately reveal deep vein thrombosis (DVT) in the large veins of the thigh. IPG studies were performed on the lower extremities of 20 hemiplegic patients considered at high risk for DVT. Each patient had one or several of the following potential risk factors: mild swelling, vague leg discomfort, loss of sensation, poor or absent muscle power at the ankle, at least one week of complete bedrest, repeated minor trauma. None of the patients had major signs or symptoms of DVT at the time of testing (ie, severe pain and tenderness, increased temperature or redness, a palpable venous cord, or positive Homans' sign). Seven patients had an abnormal IPG in the paralyzed lower limb and DVT was confirmed in each case by venography. After appropriate anticoagulation therapy, the seven patients resumed their rehabilitation programs. It was concluded that IPG can be successfully used in the early detection of DVT in high-risk hemiplegic patients, thus leading to prompt medical management, reduced morbidity and mortality, and improved rehabilitation outcome.     

血清可溶性ST2评价老年急性心力衰竭患者病情与预后的研究

目的 观察与讨论血清可溶性ST2(sST2)浓度在老年急性心力衰竭(AHF)病情严重程度以及预后评估中的价值.方法 选取AHF患者75例,并收集38例正常查体人员为对照,所有病例随访1年,记录患者生存是否或再次因心衰入院.临床资料应用SPSS19.0软件进行统计处理.结果 sST2 (pg/mL)在AHF组中较正常对照有明显升高(1 698.9±797.0 vs 596.9±181.2,P＜0.01),sST2水平在不同心功能临床分级(轻组-Ⅰ和Ⅱ级,重组-Ⅲ和Ⅳ级)间比较差异具有统计学意义[(1439.5±694.5) vs.(2 057.8±1 428.6),P=0.026];75例AHF患者中,发生终点不良事件组sST2明显高于非事件组[(2234.4±1 308.5) vs.(1 162.3±452.6),P=0.000].经独立危险因素非条件logistic二元回归模型分析,sST2、NT-proBNP和心功能临床分级三个协变量对AHF预后有独立预测意义,OR值分别为1.003、1.001、7.46;以sST2 1 760 pg/mL为cutoff值评估不良预后,其敏感性为64％、特异性为92％、阳性预测率89％,阴性预测率70％,正确率77％;若联合NT-proBNP评估预后,则结果更优,ROC曲线下面积为0.889.结论 sST2在老年AHF患者入院早期即有显著升高,并且随心功能临床分级而相应升高,提示sST2水平可评价AHF病情严重程度;发生心血管不良事件的AHF患者的sST2水平明显高于无事件发生者,表明sST2可以评估AHF患者的预后;若结合NT-proBNP等相关生物学标记物,sST2可以更好地进行危险分层和预后评估.     

急进高原青年人胸外按压时的生理反应和质量变化及心肺复苏反馈技术的干预效果

目的 探讨急进高原青年人生理反应和胸外按压质量的变化及心肺复苏反馈技术的干预效果.方法 本研究采用前瞻性单样本前后对照研究.纳入15例世居平原的健康青年人作为受试者,事先均接受过心肺复苏术培训.在重庆(海拔259 m),受试者先后实施4 min经验按压和4min反馈按压,每轮按压均通过AED PLUS记录按压深度、频率等按压质量参数.经验按压指受试者根据感觉经验进行胸外按压,反馈按压指受试者根据AED PLUS测量并实时反馈的按压质量数据调整按压深度和频率等.每轮按压前后均测量受试者的血压、脉率和经皮氧饱和度.所有受试者飞机进入拉萨(海拔3658 m)1周后重复上述测试.受试者监测参数干预前后的变化采用配对t检验或Wilcoxon符号秩检验.结果 受试者在拉萨比在重庆基线生理指标显著异常,收缩压(125.9±9.5) mmHg vs.(112.7±13.4)mmHg(1 mmHg=0.133 kPa),舒张压(75.3±7.7)mmHg vs.(64.2±7.3)mmHg,心率(86.3±13.0)次/min vs.(72.7±11.6)次/min,氧饱和度(90.4±1.7)％ vs.(97.8±0.9)％,均P ＜0.01.在拉萨,经验按压仅造成心率增快(91.1±14.9)次/min vs.(86.3±13.0)次/min,P＜0.01;反馈按压则造成心率增快(87.9±17.5)次/min vs.(80.9±11.7)次/min,P＜0.05,收缩压升高(130.9±11.7) mmHg vs.(120.1 ±11.9)mmHg,P＜0.05,和氧饱和度下降(88.3±3.4)％ vs.(90.6±1.9)％,P＜0.01.在拉萨,反馈按压比经验按压更接近指南要求,综合合标率中位数(四分位间距)43.6％ (55.9％) vs.0.6％(5.3％),P＜0.01.结论 高原环境使急进高原青年人心肺复苏术质量下降.心肺复苏反馈技术可有效引导施救者改善胸外按压质量,可能是以刺激施救者消耗更多体能为代价的.     

急性左心功能衰竭时不同呼吸机参数的治疗效果分析

目的 探讨急性左心功能衰竭时不同呼吸机参数的临床效果.方法 选择急性左心功能衰竭患者119例随机分为A、B、C、D组,分别采用更高气压、高气压、中气压、低气压治疗,观察四组患者临床疗效和心率（HR）、PaO2、SpO2、PaCO2、pH值等指标变化情况.结果 4组治疗后HR、PaO2、SpO2、PaCO2、pH值比较差异均有统计学意义（F值分别为32.21、29.46、12.34、36.47、18.38,P均＜0.05）,其中B组治疗后与A、C、D组HR、PaO2、SpO2、PaCO2、pH,各指标比较差异均有统计学意义（P均＜0.05）,且B组内治疗前后相应指标比较,差异均有统计学意义（t值分别为12.25、13.46、8.75、9.83、2.58,P均＜0.05）.4组治疗总有效率比较差异有统计学意义（x2 =0.97,P=0.012）,且B组总有效率高于A、C、D组（93.1％与71.0％、65.6％、51.8％）差异均有统计学意义（P均＜0.05）.结论 急性左心功能衰竭正压通气治疗中,采用参数设定为10～15 cmH2O,FiO2为55％ ～75％,随后FiO2减小到30％ ～40％的高吸气压较低吸气压治疗的效果更好,值得临床推广.     

平板运动试验结合动态心电图对冠心病的诊断价值

目的 探讨24h动态心电图(DCG)及平板运动试验(TET)在冠心病诊断中的应用,并对冠状动脉造影(CAG)与平板运动试验相关指标进行分析.方法 选择有不典型胸痛或可疑冠心病患者149例,在CAG前行DCG和TET检查,分析DCG及TET两种检查方法各自对冠心病的诊断价值,以及两者联合对冠心病的诊断价值,并根据CAG的结果分为冠心病组和非冠心病组,记录TET运动开始后第1分钟心率的增加量(△HR1min)及运动后收缩压(SBP)恢复等指标,与冠状动脉造影结果相比较.结果 DCG诊断冠心病的敏感性为61.90％,特异性为66.15％;TET诊断冠心病的敏感性为78.57％,特异性为70.77％;两者联合并联试验时敏感性为95.23％,特异性为55.38％,阳性预测值为73.39％,阴性预测值为90.00％;敏感性、阴性预测值较单独DCG、TET提高;两者联合串联试验时敏感性为52.38％,特异性为95.38％,阳性预测值为93.62％,阴性预测值为60.78％,特异性、阳性预测值较单独DCG、TET提高;冠心病患者男性比例高于非冠心病组[72例(85.71％)与35例(53.85％),x2=18.385,P＜0.01],收缩压恢复比异常增高[ 46.43％( 39/84)与15.38％( 10/65),x2=16.001,P＜0.01].结论 DCG与TET两者结合可提高对冠心病诊断的敏感性和特异性,冠心病组患者运动后收缩压恢复延迟,该指标可作为冠心病诊断的辅助标准.     

Defibrillation probability and impedance change between shocks during resuscitation from out-of-hospital cardiac arrest

Objective

Technical data now gathered by automated external defibrillators (AEDs) allows closer evaluation of the behavior of defibrillation shocks administered during out-of-hospital cardiac arrest. We analyzed technical data from a large case series to evaluate the change in transthoracic impedance between shocks, and to assess the heterogeneity of the probability of successful defibrillation across the population.

Methods

We analyzed a series of consecutive cases where AEDs delivered shocks to treat ventricular fibrillation (VF) during out-of-hospital cardiac arrest. Impedance measurements and VF termination efficacy were extracted from electronic records downloaded from biphasic AEDs deployed in three EMS systems. All patients received 200 J first shocks; second shocks were 200 J or 300 J, depending on local protocols. Results presented are median (25th, 75th percentiles).

Results

Of 863 cases with defibrillation shocks, 467 contained multiple shocks because the first shock failed to terminate VF (n = 61) or VF recurred (n = 406). Defibrillation efficacy of subsequent shocks was significantly lower in patients that failed to defibrillate on first shock than in patients that did defibrillate on first shock (162/234 = 69% vs. 955/1027 = 93%; p < 0.0001). The failed VF terminations were distributed heterogeneously across the population; 5% of patients accounted for 71% of failed shocks. Shock impedance decreased by 1% [0%, 4%] and peak current increased by 1% [0%, 4%] between 200 J first and 200 J second shocks. Shock impedance decreased 4% [2%, 6%] and current increased 27% [25%, 29%] between 200 J first and 300 J second shocks. In all 499 pairs of same-energy consecutive shocks, impedance changed by less than 1% in 226 (45%), increased >1% in 124 (25%) and decreased >1% in 149 (30%).

Conclusions

Impedance change between consecutive shocks is minimal and inconsistent. Therefore, to increase current of a subsequent shock requires an increase of the energy setting. Distribution of failed shocks is far from random. First shock defibrillation failure is often predictive of low efficacy for subsequent shocks.     

Variation in pacing impedance: impact of implant site and measurement method

BACKGROUND: Variations in pacing impedance may be observed during implantation of various active fixation pacing leads. However, these variations can be influenced by the nature of the fixation, the implant site, or the measurement method. Here we describe implant dynamics for a 4.1F, catheter-delivered pacemaker lead. METHODS: Endocardial active fixation leads were implanted under direct intracardiac visualization in two right atrial sites and three right ventricular sites in isolated swine (n = 6) and human (n = 4) hearts. Impedance measurements were recorded at each site employing three different measurement techniques-Pacing System Analyzer (PSA) 5311, PSA 2090, and the Impedance Tone Box (Medtronic, Inc., Minneapolis, MN, USA)-with four different degrees of lead fixation: helix touching, one turn fixed (1 TF), two turns fixed (2 TF), and overtorqued. RESULTS: Pacing impedances increased from touching to 1 TF to 2 TF at all implant sites in both swine and human hearts. Overtorquing applied to leads was associated with visible distortion at the endocardial tissue-lead interface in at least 60% of swine (18 of 30 implants) and human hearts (nine of 14 implants). Impedance values in the right atrial high septum were significantly larger than in any other implant site (P < 0.05). The three measurement methods did not yield significantly different impedance measurements. CONCLUSIONS: Variations in measured impedances were associated with the nature of implant fixation at all sites in both swine and human hearts.     

单检及16份混样检测模式对献血者核酸检测效果的比较研究

目的 探讨单份及16份混合标本2种检测模式对献血者血液病毒核酸检测(nucleic acid test,NAT)效果的影响.方法 2009年2至6月顺序留取北京无偿献血者标本,用诺华Procleix ULTRIO Assay进行单份(ID)或16份混合标本(P16)乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)和人类免疫缺陷病毒-1( HIV-1)三项联合核酸检测.单份NAT反应性同时HBsAg、抗-HCV或抗-HIV血清学不合格的标本,血清学合格的单份NAT反应性经双孔NAT复检阳性的标本,以及混合NAT反应性/拆分NAT为阳性的标本,进一步用诺华Procleix HBV、HCV和HIV-1鉴别试剂进行鉴别试验.血清学合格、HBV NAT单独阳性标本进一步用Roche HBV定量实验加以验证和进行病毒含量测定、血清学分析、并进行稀释以模拟是否能被P16-NAT检出.阳性检出率进行四格表连续校正的x2检验.结果 (1)在7613份单份NAT (ID-NAT)标本中,检出NAT阳性26份,ID-NAT阳性率0.34％(26/7613);(2)在16 064份共1004份P16混合标本NAT(P16-NAT)中,检出NAT阳性27份,P16-NAT阳性率为0.17％ (27/16 064);(3)在血清学合格标本中,单份检测的NAT单独阳性检出率为0.12％ (9/7438),高于16份混样检测的NAT单独阳性检出率0.01％ (2/15 750)(x2=11.880,P＜0.05).9份ID-NAT及2份P16-NAT单独阳性标本经鉴别均为HBV NAT阳性,未检出 HCV NAT单独阳性或HIV NAT单独阳性;(4)9份ID-NAT HBV单独阳性血样模拟P16-NAT,仅有2份可被检出;(5)对8份ID-NAT及2份P16-NAT单独阳性标本进行Roche HBV定量测定,均可确证其核酸检测结果,但病毒含量很低.其中2份HBV病毒含量为472 IU/ml及15 IU/ml,6份含量＜12 IU/ml,另2份原倍不能定量经10倍浓缩处理后测得含量为＜ 12 IU/ml和14.3 IU/ml;(6)11份HBV NAT单独阳性标本中,3份(27.3％)为潜在的窗口期感染,其余8份(72.7％)抗-HBc阳性或抗-HBe阳性,但抗-HBc-IgM均为阴性,为隐匿性感染;(7) P16-NAT初检呈反应性需要进行拆分试验的混合样本比率为2.49％ (25/1004),其中由血清学合格标本所致初检反应性的混合样本比率为0.20％ (2/1004).结论 ID-NAT单独阳性检出率高于P16-NAT单独阳性检出率.为避免低病毒含量HBV的漏检,应选用灵敏度高的核酸检测试剂,并尽量采用小标本量混合检测,甚至采用单份检测方式.