麝香保心丸对冠心病心绞痛患者QT离散度 心率变异性及心功能的影响

目的探讨麝香保心丸对冠心病心绞痛患者QT离散度、心率变异性及心功能的影响。方法将2015-03~2016-08收治的冠心病心绞痛患者106例纳入研究,根据抽签法分为对照组和观察组各53例。对照组予以硝酸异山梨酯+辛伐他汀+阿司匹林治疗,观察组在对照组基础上加服麝香保心丸,治疗4个月。比较两组治疗后QT离散度、心率变异性及心功能。结果观察组QT离散度低于对照组,短时程平均NN间期的标准差(SDANN)、NN间期标准差(SDNN)、连续NN间期均方差值的均方根(RMSSD)、心肌缺血总负荷、心绞痛发作频率及心绞痛持续时间等均优于对照组,差异有统计学意义(P0.05)。结论对冠心病心绞痛患者予以麝香保心丸治疗的效果确切,可以明显改善患者的心功能及心率变异性,降低QT离散度。     

尿毒症患者Q—T离散度和T波峰末间期的研究

目的探讨行维持性血液透析的尿毒症患者是否存在区域性和跨心室壁复极离散度（TDR）增大。方法分别测量行维持性血液透析的尿毒症患者（尿毒症组,n=35例）和正常健康者（对照组,n=40例）体表心电图的Q—T间期、R—R间期、丁波峰末问期（Tp—e）,进而计算Q-T离散度（Q—Td=Q—Tmax—Q—Tmin）、心率校正的Q—T离散度（Q—Td／R√R--R）,心率校正的最大Tp—e间期（Tp—emax／√R-R）、T波峰末问期离散度（Tp—ed=Tp—emax—Tp—emin）、心率校正的Tp—e间期离散度（Tp—ed／√R—R）。结果尿毒症组的Q—T离散度及校正的Q—T离散度较对照组明显延长（66．3±15．9VS40．2±12．4,681±14．8VS44．5±13．1。均P〈0．05）;尿毒症组的最大Tp—e间期及最大校正Tp—e间期较对照组明显延长（98．34-14．6VS77．6±12．1,94．2±12．6VS72,54-11．4,均P〈O．05）,Tp—e间期离散度及校正的Tp—e问期离散度也较对照组明显延长（48．4±16．3VS32．1±12．3,44．3±12．2VS30．2±12．5,P〈0．05）。结论尿毒症患者的Q—T离散度和Tp—e间期及其离散度较正常者明显延长,表明尿毒症患者区域性和TDR增大。     

运动康复对AMI患者QT离散度的影响

目的：探讨运动康复对急性心肌梗塞（AMI）患者预后的影响。方法：观察了40例作运动康复治疗的AMI患者（康复组）康复前后心电图Q－T离散度（Q－Td）的变化，并与未行运动康复的AMI患者（对照组）进行了比较。结果：运动康复后Q－Tcmax、Q－Td和Q－Tcd（校正Q－T离散度）三项指标均比运动康复前明显减少（P＜0．05或＜0．01）。并且患者出院时康复组Q－Td比对照组显著减少。结论：运动康复能够降低AMI患者Q－T离散度，可改善病人的预后。     

辅酶Q10联合曲美他嗪治疗对缺血性心力衰竭患者心率变异性的影响

目的评价辅酶Q10联合曲美他嗪治疗对缺血性心力衰竭患者心率变异性的影响。方法选择缺血性心肌病心衰患者28例,在常规抗心衰治疗基础上加服辅酶Q10和曲美他嗪各20mg,每日3次,连用3个月。以超声心动图和24h动态心电图分别观察治疗前、治疗后3个月的心脏功能和心率变异性的改变情况。结果辅酶Q10和曲美他嗪联合使用3个月后左室射血分数显著增加[(32.5±5.1)%vs(37.6±5.3)%,P<0.05]。心率变异性分析表明,使用辅酶Q10和曲美他嗪3个月后,连续5min正常R-R间期均值的标准差(SDANN)、连续5min正常R-R间期标准差(SDNN)均值显著增加(P<0.05)。结论辅酶Q10联合曲美他嗪能够在一定程度上改善缺血性心肌病心衰患者心率变异性,明显改善心脏功能。     

急性心肌梗塞早期康复运动耐量与心率变异性分析

目的 :探讨急性心肌梗塞 (AMI)患者早期运动康复对运动耐量的影响以及心率变异性的变化。方法 :对 35例 AMI患者出院前行活动平板运动试验和心率变异性测定 ,其中 2 0例 AMI患者进行了两周运动康复程序治疗。结果 :康复组平均运动耐量为 5.3± 2 .5METs,未康复组为 2 .87± 0 .83METs,两组间有显著差异 (P<0 .0 1)。 35例 AMI患者心率变异性较正常对照组明显降低 ,AMI康复组的心率变异较非康复组有明显的改善。结论 :早期运动康复治疗可增加 AMI患者运动耐量 ,明显改善其心率变异性 ,并可能降低 AMI死亡率 ,改善其预后     

心脏康复对慢性心衰患者心率变异性的影响

目的：观察在标准抗心衰药物治疗的基础上联合心脏康复对慢性力衰竭（CHF）患者心率变异性的影响.方法：本院68例心力衰竭住院患者随机分为对照组34例和治疗组34例,对照组采用标准的抗心衰治疗方案;治疗组采用标准抗心衰治疗＋心脏康复;两组均规范用药6个月.所有患者治疗前后进行24h动态心电图检查心率变异性（HRV）.结果：治疗后,治疗组R-R间期的标准差（SDNN）、每5min窦性R-R平均值的标准差（SDANN）、R-R间期差值的均方根（rMSSD）、相邻两正常窦性R-R间期差值＞50ms的个数所占的百分率（PNN50）较对照组显著增加（P＜0.05）.结论：在标准抗心衰药物治疗的基础上联合心脏康复治疗,可降低交感神经过度激活,增加迷走神经的功能,显著改善HRV,从而改善患者的预后.     

束支传导阻滞对充血性心力衰竭复极离散度的影响

目的：探讨充血性心力衰竭合并束支传导阻滞患者Q－T离散度测定的影响因素。方法：分析62例充血性心力衰竭患者合并束支付导阻滞（Ⅰ组）、94例不合并束支传导阻滞（Ⅱ组）及40例正常组（Ⅲ组）Q－T离散度，Q－T离散度以12导联体表心电图上最长与最短Q－T间期之差（绝对离散度）及其变异系数（相对离散度）计算。结果：Ⅰ组Q－T、Q－Tc间期及其绝对离散度比Ⅱ组显著延长，但相对离散度相近；J－T、J－Tc绝对和相对离散度均显著长于Ⅱ组和Ⅲ组。结论：束支传导阻滞可影响充血性心力衰竭患者复极离散度的测定，但其离散程度主要与潜在的基础心脏疾病相关。     

阿托伐他汀联合贝那普利对慢性心力衰竭患者QT离散度及心率变异性的影响

目的探讨阿托伐他汀联合贝那普利对慢性心力衰竭(CHF)患者QT离散度(QTd及心率变异性的影响。方法选择2017年4月至2018年9月在江苏省靖江市人民医院收治的CHF患者96例为研究对象,采用随机数字表法分为观察组52例、对照组44例。在常规强心、利尿等基础治疗的同时,对照组给予盐酸贝那普利口服治疗,观察组给予阿托伐他汀联合贝那普利治疗。治疗6个月,比较两组临床疗效、QTd与QRS波群、心率变异性、心室功能等指标。结果治疗6个月后观察组CHF患者有效率94.23%明显高于对照组79.55%(χ~2=4.699,P 0.05);QTd、校正QT离散度(QTcd)、QRS明显低于对照组(t=5.865、3.897、2.884,P 0.05);窦性心律R-R间期总体标准差、相邻正常R-R间期差值均方根、连续5 min正常R-R间期均值标准差明显高于对照组(t=7.345、5.129、8.178,P 0.05,P 0.01);左心室射血分数明显高于对照组,左室舒张末期内径、左室收缩末期内径明显低于对照组(t=6.364、3.012、3.475,P 0.05)。结论阿托伐他汀联合贝那普利有助于降低CHF患者QTd,改善心率变异性及心室功能,提高临床疗效。     

维奥欣对冠心病缺血心肌的保护作用

目的观察维奥欣对冠心病患者Q—T间期离散的干预作用。方法收集了本院的68例冠心病患者随机分为2组进行对比观察。结果对治疗结果进行统计学分析，维奥欣对冠心病的Q—T间期离散度有明显的干预作用。结论维奥欣对心肌有保护作用，且具有降血脂作用，是临床上治疗冠心病的一种很有价值的药物。     

急性心肌梗死再灌注的QT间期离散度及心率变异性分析

目的探讨急性心肌梗死(AMI)直接经皮腔内冠状动脉成形术(PTCA)后QT间期离散度(QTd)与心率变异性变化的特点。方法63例行直接PTCA治疗的AMI患者，于术前、术后2h、12h、24h、48h作同步12导联心电图检查，测量QTd，术后3～6d查24h动态心电图的QT间期变异度(QTv)和心率变异性(SDNN)，与36例用药物治疗组的AMI患者进行比较。结果治疗后二组之间相对应时间段的QTd对比均有显著差异，PTCA组的QTd最高值提前，QTv的昼夜节律性消失。结论QT离散度的变化可作为判断急性心肌梗死再灌注疗效的有效指标。     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

Preservation of the pylorus in resection of the head of the pancreas

Pylorus preservation has been advocated to decrease the morbidity associated with the classical or standard pancreaticoduodenectomy. The proposed advantages are decreased incidence of peptic ulceration, dumping syndrome, and nutritional problems. However, after an initial period of enthusiasm for the procedure, it is now being found that marginal ulceration at the duodenojejunal anastomosis is encountered with increasing frequency. Delay in gastric emptying occurs frequently, with an overall incidence of 30%. With the availability of better pancreatic enzyme supplements, the current incidence of nutritional problems and weight loss after the standard Whipple procedure is unknown. Whether there is a difference in long-term survival after the two procedures performed for adenocarcinoma of the head of the pancreas is still debatable. A controlled trial is needed to answer many of these questions, and pylorus-preserving pancreaticoduodenectomy should be used cautiously until further data become available.