不同心电图检查在诊断冠心病心律失常中的应用对比

目的 对比动态心电图(DCG)与常规心电图(ECG)诊断冠心病心律失常的价值,为临床诊断提供指导意见.方法 选取冠心痛患者85例,均行DCG及ECG检查,分析DCG与ECG心肌缺血阳性检出情况、不同心律失常检出结果、DCG检查正常窦性R-R期间总体标准差(SDNN)评估患者心率变异性、检查舒适度.结果 DCG检查心肌缺血阳性检出率77.65％高于ECG检查48.24％(P＜0.05);DCG检查短阵室上速、室性早搏成对、房性早搏成对、房性早搏二/三联、室性早搏二/三联检出率高于ECG检查(P＜0.05);不稳定型心绞痛患者SDNN水平低于稳定型心绞痛患者(P＜0.05);DCG检查舒适度评分低于ECG检查(P＜0.05).结论 与ECG检查相比,DCG检查在冠心病患者中有较高诊断价值,对心肌缺血、心律失常检出率更高,且对心绞痛发作类型有更好辨别能力,具有更高诊断价值,可指导临床治疗,但在临床实际应用中应注意对患者日常生活的影响,降低患者不适感.     

冠心病心律失常动态心电图检测的意义

本文对87例冠状动脉性心脏病(CHD)患者进行了动态心电图(DCG)检查,并与常规心电图(ECG)对比分析,结果示DCG对于多种心律失常的检出率显著高于ECG,并发现DCG不仅对心律失常诊断有重要意义,而且对判断心律失常的严重性及预后,对观察心肌缺血与心律失常的关系均有重要价值。     

70例婴幼儿病毒性心肌炎动态心电图诊断及治疗价值探讨

目的通过对病毒性心肌炎（VMC）患儿的动态心电图（DCG）与常规心电图（ECG）结果比较,为临床诊断婴幼儿病毒性心肌炎提供重要方法和依据,通过指导心律失常的用药,改善了婴幼儿VMC的治疗效果。方法比较我院70例临床诊断病毒性心肌炎患儿的DCG与ECG结果。结果 DCG心律失常检出率为84.29%,ECG心律失常检出率为31.43%,使用DCG后患儿VMC明确诊断时间及平均住院时间均有明显缩短。结论婴幼儿使用动态心电图对婴幼儿临床诊断病毒性心肌炎和发现心律失常提供了重要的诊断价值,对指导心律失常用药,改善VMC治疗效果有重要意义。     

动态心电图在冠心病心肌缺血诊断中的应用价值

目的分析动态心电图在冠心病心肌缺血诊断中的应用价值。方法112例冠心病患者均予动态心电图（DCG）检查，再予常规心电图检查（ECG），最后予冠状动脉造影检查。以冠状动脉造影检查结果为金标准，比较DCG和ECG对无症状心肌缺血（SMI）的诊断率及漏诊率。结果DCG对SMI检测阳性率高于ECG，漏诊率低于ECG，差异均有统计学意义（P〈0．05）。结论对冠心病患者予DCG检查，可提高SMI诊断率，减少漏诊误诊情况的发生，对改善SMI患者的预后有重要意义，值得临床推广应用。     

动态心电图对心脏病患者心律失常的诊断意义

目的：比较24h 动态心电图（ DCG ）和常规心电图对心肌缺血和心律失常的临床诊断价值。方法选取医院2011年10月＿2013年10月收治的心脏病、高血压等患者120例,分别采用常规心电图（ ECG）检查和24h动态心电图（DCG）监测,对患者的不同检查结果进行对比分析。结果采用24h 动态心电图监测出室性早搏48例,房性早搏59例,室早二联律18例,房早二联律20例,阵发房性心动过速8例,窦性停搏3例,心肌缺血51例。采用常规心电图检查出室性早搏26例,房性早搏30例,室早二联律6例,房早二联律7例,阵发房性心动过速0例,窦性停搏0例,心肌缺血32例,明显低于24h 动态心电图的检出率,两者相比,差异有显著统计学意义（P ＜0.05）。结论24h 动态心电图能够发现常规心电图检查过程中不易发现的问题,对心律失常和心肌缺血具有重要的临床诊断价值。     

急性脑血管病患者的心电图变化

目的：了解急性脑血管病患者的心电图变化与临床的关系。方法：全部病例均经头CT或MRI证实为急性脑血管病，且既往无心电图异常及电解质紊乱。并在发病的24h内行十二导联心电图检查。各组数据统计ECG异常例数计算百分比，组间差异χ^2检验。结果：55例急性脑血管病出现继发心电图改变39例占81．2％，以心肌缺血的发生率最高（61．6％）。ECG异常率脑出血比脑梗死高（P＜0．05）；病灶位于内囊、基底节、丘脑等邻近中线结构者比其它部位高（P＜0．05）；老年组高于非老年组（P＜0．05）；死亡组高于存活组（P＜0．05）。结论：心电图检查有助于对急性脑血管病人心肌受损程度及其预后作出判断，并指导治疗。     

糖尿病患者动态心电图改变及临床意义

目的 探讨糖尿病患者动态心电图的改变及临床意义.方法 随机选取60例糖尿病患者,另取50例健康者为对照组（两组无年龄、性别统计学差异）,对比观察动态心电图指标（心率、心律、HRV、SDNN、RMSSD、PNN50、LF、HF、LF/HF、ST-T）改变.结果 糖尿病组心率较对照组显著增快（P＜0.05）;糖尿病组心率变异指标较对照组明显降低（P＜0.05）;各种心律失常及ST-T发生率糖尿病组也明显高于对照组（P＜0.01）.结论 糖尿病患者心律失常发生率明显增高,HRV显著降低,心脏迷走神经损伤明显;动态心电图检查对于预测糖尿病患者合并神经及心脏受损有显著意义.     

探析24h动态心电图对心律失常患者的临床监测价值

目的观察动态心电图(DCG)24h连续检测心律失常患者心电图的结果,探讨其临床价值。方法疑为一过性心源性症状患者232例自愿接受本次调查,均作普通心电图和12通道动态心电图,对比两种监测方法的检出率。结果 24h动态心电图对多种异位心率失常的检出率显著高于常规心电图,经χ2检验P<0.05;各系统疾病患者心律失常是常见的现象,各类心律失常中以房性心律失常发生率最高。结论心律失常的发生率较高,采用24h DCG无创检测心律失常,能够为心血管疾病的诊断及治疗提供重要信息,具有临床推广价值。     

163例酒依赖患者的心电图检测分析

目的：了解酒精对心电图（ECG）变化的影响与心功能之间的关系。方法：对符合CCMD-3酒精所致酒依赖诊断标准的163例酒依赖患者进行ECG检查，并与128例对照组对比分析。结果：酒依赖患者的ECG改变发生率显著高于对照组。ECG改变的顺序为：ST段及T波改变、窦性心律失常、左心室高电压、传导阻滞、心脏顺钟向转位、Q-T间期延长。结论：过度饮酒对ECG有影响并与心血管损害有关。     

扩张型心肌病患者心力衰竭时心律失常类型的分析

目的探讨扩张型心肌病（DCM）出现心力衰竭时所发生的心律失常及其与心力衰竭程度的关系。方法选择临床已确诊为DCM心力衰竭患者93例,分别实施6min步行试验,并根据试验结果按心力衰竭程度不同将其分为A、B、C三组,随后进行动态心电图（DCG）检查。结果上述每组病例DCG至少检出2类心律失常,以室性心律失常最多见,其次是房性心律失常和传导阻滞。A、B、C三组心力衰竭的恶性室性心律失常发生率排序依次为C组〉B组〉A组,经方差分析,C组、B组与A组之间有显著差异,而c组与B组之间无显著差异（F=3．67,P〈0．05）。结论DCM心力衰竭患者心律失常发生率高,且类型多样,多为复合型,其严重程度与心力衰竭程度密切有关。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.     

Disease control in asthmatic children seen in private practice in Switzerland

ABSTRACT

Background: Asthma is the most common chronic childhood disease in Switzerland with a prevalence of 10%. Asthma has a high economic burden accounting for high medical costs. Assessment of disease control is likely to be of help in the implementation of strategies to improve asthma. Therefore, we aimed to evaluate asthma control and therapy regimens among children in private practice.

Methods: We assessed asthma control as well as therapy regimens in 575 asthmatic children in an experience programme in Switzerland by using an abbreviated questionnaire based on the asthma control questionnaire and the child health questionnaire on Visit 1 and Visit 2.

Results: Good asthma control at Visit 1 was only present in 25.7% of asthmatic children. Occasional asthma symptoms, limitation of physical activity, nocturnal awakening and anxiety of the parent was present in 80.5%, 41.2%, 46.8% and 57% of the children, respectively. After adjustment of therapy regimens at Visit 1, mainly by adding a leukotriene receptor antagonist, asthma control was reported to be much better in 53.4% of the children at Visit 2.

Conclusions: As asthma control is inadequately achieved within a major portion of asthmatic children, it is imperative to find measures to improve asthma control and hence, to reduce the burden of disease.