急性乌头碱中毒13例临床分析

目的:总结乌头碱中毒的临床特征和治疗方法,以提高其抢救成功率.方法:回顾性分析我科2010年1月～2011年12月收治的13例乌头碱中毒患者的临床资料.结果:13例均出现心律失常,其中室性早搏10例,频发多源性室早8例,反复室速、室颤3例,窦性心动过缓、房室传导阻滞2例;治愈12例,死亡1例.结论:尽快清除体内毒物、及早血液灌流、积极有效控制各类心律失常等综合治疗是提高乌头碱中毒抢救成功率的关键.     

43例急性乌头碱中毒的心电图及临床检验分析

目的 探讨急性乌头碱中毒致心律失常病例的心电图和实验室检查特点。方法 对43例急性乌头碱中毒病例进行分析,总结其临床表现、心电图改变、实验室检查及救治要点。结果 43例患者均发生心律失常,室性期前收缩最为多见。恶性心律失常均出现在临床重度中毒患者中。其中2例重度中毒患者行急诊床旁血液灌注联合血液透析治疗,临床效果较好。中度和重度中毒患者均出现心肌酶谱升高,血清K+、Mg2+浓度降低。所有患者经积极治疗后心电图、心肌酶谱、电解质恢复正常,均治愈出院。结论 乌头碱中毒所致心肌损害程度与血浆毒性成分浓度呈正相关,心电图表现多样化,严重者出现致命性的严重心律失常。积极对症支持治疗,早期及时应用抗胆碱能药物,根据心律失常类型选用抗心律失常药物,重度中毒患者采用床旁血液灌注联合血液透析治疗可迅速纠正心律失常,提高抢救成功率。     

65例急性乌头碱中毒临床症状及心律失常分析

目的探讨急性乌头碱中毒患者的各种临床表现及心律失常情况。方法收集65例急性乌头碱中毒患者的临床资料,总结分析其临床表现及心电图改变。结果 65例乌头碱中毒患者心电图异常58例,心律失常发生率达89.23%,每例均表现有1~3种不同类型心律失常。58例患者中共发生心律失常102例次,其中频发室性期前收缩23例次(22.55%),完全性右束支传导阻滞18例次(17.65%),窦性心动过速13例次(12.75%),口舌及四肢麻木100%(65/65),心悸、胸闷41.54%(27/65),恶心、呕吐70.77%(46/65),头昏、眼花、视物模糊66.15%(43/65),腹痛、腹泻6.15%(4/65),低血压15.38%(10/65),意识障碍13.85%(9/65)。结论乌头碱中毒患者临床症状以口舌、四肢麻木为主要表现,其次是恶心、呕吐、心悸、胸闷,血压下降,心律失常以频发室性期前收缩多见,同一患者可以存在多种不同类型心律失常。     

口服胺碘酮治疗室性期前收缩与QT间期关系

期前收缩是临床上最常见的一种异位心律,可发生在窦性或异位性心律（如心房纤颤）的基础上。而病理性的期前收缩,尤其是频发和复杂的室性期前收缩,如室性期前收缩连发、多源性室性期前收缩、R在T上的室性期前收缩,演变为室速及室颤的可能性很大。胺碘酮是临床上治疗室性期前收缩的药物之一,该药对QT间期的影响目前存有争论。其对心脏能产生一定的不良反应,而引起相应的临床症状。本研究观察口服胺碘酮治疗室性期前收缩QT间期的变化及其与不良反应的关系,以指导临床用药。     

动态心电图与常规心电图对冠心病心律失常的诊断价值分析

目的:探讨动态心电图与常规心电图对冠心病心律失常的诊断价值。方法:选择本院2015年1月至2018年12月收治的46例冠心病心律失常患者,所有患者均行常规心电图及动态心电图检查,分析两种方法的阳性诊断率,对比两种检查方法的具体检查结果。结果:常规心电图和动态心电图对冠心病心律失常的诊断阳性率分别为52.1%和60.9%,组间对比无统计学意义,P>0.05。动态心电图对房性期前收缩二、三联律,室性期前收缩二、三联律,室性期前收缩成对,房性期前收缩成对,短阵室上速,房室传导阻滞的阳性诊断率明显高于常规心电图,P<0.05;两种方法对室性期前收缩早发及房性期前收缩早发的阳性诊断率对比无统计学意义,P>0.05。结论:动态心电图对冠心病心律失常的诊断更为有效。     

扩张型心肌病室性心律失常及其与多普勒超声指标相关关系研究

对56例扩张型心肌病(DCM)病人临床研究发现室性心律失常是DCM病人的常见合并症,且分级程度高,Lown氏Ⅲ级以上病人占92%,频发室性期前收缩占43%,成对室性期前收缩占39%,室速占39%,仅靠临床症状不能准确反映室性心律失常的严重程度.室性心律失常的严重性与多普勒超声指标有关.统计学分析频发室性期前收缩、室速出现与左室时血分数下降、舒张末径扩大、E峰速下降、EA比值降低相关.多形性室性期前收缩与左室舒张末经扩大、E峰速下降、EA比值降低相关.     

胺碘酮对室性心律失常患者QTc离散度的影响及临床意义

受国际多中心心律失常抑制试验 (CAST)的影响 , 类抗心律失常药物的应用受到限制 ,近年来 类抗心律失常药物 (如胺碘酮、索他洛尔 )临床应用逐渐增多。本文观察了胺碘酮对室性心律失常的疗效及近期致心律失常作用 ,测量了用药前后QTc离散度 (QTcd)的变化 ,以探讨二者之间的关系。1　对象与方法1.1　患者选择　入选患者具备下述条件 :1具有器质性心脏病的基础 ;2经动态心电图检查为 L own分级 级以上的室性期前收缩或非持续性室速 ;3具有轻中度的心功能不全 (心功能 ～ 级 ) ;4常规心电图检查剔除束支阻滞、频发室性期前收缩二联律或…     

急性乌头碱中毒心电图变化与治疗分析

目的：分析54例急性乌头碱中毒病例的临床心电图及治疗资料,探讨其心电图表现及治疗方法。方法：对54例急性乌头碱中毒病例进行心电图特征分析;54例患者均给予适量的阿托品治疗,对室性心律失常患者加用利多卡因治疗。结果：54例中毒患者中心电图异常48例（88．9％）,其中以室性心律失常最多见,有30例（55．6％）,室上性心律失常11例（20．4％）,房室传导阻滞7例（22．2％）,ST-T改变7例（13．1％）,有26例（48．1％）同时出现2种及2种以上心电图改变。经3～7d抢救治疗,54例患者临床症状消失,48例异常心电图患者中46例心电图恢复正常窦性心律,2例尚遗留有异常心电图改变。死亡1例。结论：乌头碱中毒易致多种心律失常,心电图图主要表现为室性心律失常和窦性心动过缓及房室传导阻滞,而应用阿托品、利多卡因可有效控制心律失常。     

扩张型心肌病室性心律失常及其与多普勒超声指标相关关系研究

对５６例扩张型心肌病（ＤＣＭ）病人临床研究发现室性心律失常是ＤＣＭ病人的常见合并症，且分级程度高，Ｌｏｗｎ氏Ⅲ级以上病人占９２％，频发室性期前收缩占４３％，成对室性期前收缩占３９％，室速占３９％，仅靠临床症状不能准确反映室性心律失常的严重程度。室性心律失常的严重性与式普勒超声指标有关。统计学分析频发室性期前收缩、室速出现与左室射血分数下降、舒张末径扩大、Ｅ峰速下降、ＥＡ比值降低相关。多形性室性期前     

Q-Td、J-Td与室性心律失常关系探讨

1985年Campbell等提出Q－Td的概念（Q－Tdispersfon），此后国内外学者对Q－Td各种情况均有报告。本文观察45例经DCG检查发现室性心率失常的患者在发作前5天内常规心电图所记Q－Td、J－Td，旨在探讨Q－Td及J－Td与室性心律失常的关系。1临床资料1992年5月～1996年12月发生室住心律失常的住院病人，其中男34例，女11例，年龄39～78岁，平均59．12土19．32岁。将患者分为A组即恶性室性心律失常组（出现室颤，多形室性心动过速或持续性室性心动过速），B组即潜在恶性室性心律失常组（出现偶发、频发、多源或成对室性期前收缩或非持续性…     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.