短PR间期综合征患者的食管电生理特点及临床意义

目的:探讨短PR综合征PR缩短的电生理机制及临床意义。方法:对具有短PR(PR<0.12秒)和QRS波正常的15例患者进行食管电生理检查并分析,并与对照组进行对比。结果:15例短PR患者能保持1∶1房室传导之最快S1S1频率,均≥200次/m in。S1R间期均≤200m s,其中11例S1R随着心房起搏频率增快,间期有所延长,但延长值≤70 m s,4例S1R长度固定不变。3例S2R跳跃延长≥70 m s,其中1例有心房回波,1例发生折返性室上性心动过速,AVERP平均值<250 m s。与对照组相比S1R、S2R明显缩短,差异有显著性(P<0.01)。结论:PR缩短的原因是由房室结的解剖或电生理特性所决定的,短PR与折返性心动过速的形成无关,但心房扑动、颤动时,可引起极快的心室反应。     

短PR间期综合征的临床电生理特点研究

报道6例短PR间期综合征患者的临床和食管电生理检查的特点，检查时5例应用自主神经阻滞剂，结果显示：①PR间期≤0.10s；②1：1房室传导≥200b/min；③心房起搏时S1RI≤200ms，变化小或固定不变；④心房早搏刺激时S2RI固定或变化小，2例有跳跃；⑤1例有心房回波，1例有心室回波，未诱发出心动过速。并讨论了与加速房室结传导的关系。     

食道调搏对室上性心动过速的诊断

目的 探讨阵发性室上性心动过速的发病机理.方法 经食道心房调搏,程序刺激心房(S1S2 法),S1S2比例为8:1,采用反扫,每次缩短10ms,观察S2R间期的变化结果 对28例病人进行经食道心房调搏检查,27例诱发出室上性心动过速,均可被程序刺激终止,其中17例(6例常规心电图为显性预激)为房室旁道,余 10例检测到房室结双径路,不应期平均为295ms.     

经食道心电监测42例临床分析

目的探讨经食道心电监测心律失常的可行性、安全性和临床意义。方法开启心电监护仪，42例患者经前鼻孔插入食道电极35～40cm，用中继线连接食道电极和心电监护仪，选择导联，以观察到P波正负双向且振幅最大、QRS波呈Qr型、T波倒置（即食道心电图）处为最佳位置，胶布固定电极，观察食道心电图P、QRS、T波关系。结果42例患者术前常规心电图诊断阵发性室上性心动过速30例，阵发性室性心动过速10例，频发室性早搏2例。食道心电监测示，原2例频发室性早搏中1例早搏的P波隐藏于其前窦性心搏的T波尖端初，该早搏为房性早搏伴差异性传导；30例阵发性室上性心动过速中11例患者的R—P’间期＞70ms，为房室折返性心动过速，7例患者的R—P’间期＜70ms，为房室结折返性心动过速，5例为心房率为360次·min^-1（2：1下传心室）的心房扑动，4例为房性心动过速，3例患者为心房颤动；10例阵发性室性心动过速中3例患者R—P’间期＞70ms，为房室旁道前传的房室折返性心动过速，2例患者的R—P’间期＜70ms，为房室结折返性心动过速伴差异性传导。结论经食道心电监测是一种无创伤性、安全可靠、操作简单、痛苦小、实用性强、无并发症的心内科诊疗新技术，可广泛推广应用。     

房室折返性心动过速及反复心搏伴房室结双径路前向结导一例

患者,女性,52岁。反复发作心动过速十余年,无心电图记录,体检、胸片、超声心动图检查未见异常。于1991年4月5日作食道电生理检查,调搏前心电图为窦性心律,B型预激征(图1,图1～4见封三)。检查过程中短阵快速刺激诱发室上速二次。心速频率187次/分,QRS波正常,PⅡ、Ⅲ、avF负向(图2)。食道导联见高尖P波,PR/RP>1,RP=100ms(图3)。符合顺向型房室折返性心动过速(OAVRT)。结合调搏前心电图,考虑为右侧kent′s束所致。诱发室上速均以短阵超速起搏终止。心房程序刺激固定S_1S=705ms,S_1S_2从550ms起以步长5ms反扫,示S_2R固定为200ms,均显示典型预激图形,当S_1S_2达325ms时S_2R突然延长达320ms,继后QRS正常。且出现连续四次的     

房室折返性心动过速伴房室传导孔隙现象1例

患者女性,37岁。因反复发作性心悸5年,加重半年就诊。体检无阳性体征。心电图示窦性心律,无预激波形。行食管电生理检查,给予基础周长400 ms的S1S2刺激。当S1-S2间期400 ms,P2-R间期0.2 s(见图1);当S1-S2间期为260 ms、255 ms(见图2 A、B)时R2脱漏,表明房室结进入有效不应期。而S1-S2间期递减至245 ms(见图3)时却见到正常波形的R2,P2-R2间期0.46 s。且R2后又继以逆行的P′波,折回P′波又下传引起QRS波,并如此诱发室上性心动过速。频率150次/分,Ⅱ导联P′倒置(见图4),R～P′间期＜P′-R间期,P-P′间期80 ms。电生理诊断：(1)房室折返性心动过速(AVRT);(2)房室传导孔隙现象。     

经食道调搏诱发室上性心动过速22例心电图分析

目的:探讨阵发性室上性心动过速的发病机理。方法:经食道心房调搏,程序刺激心房(S1-S2法),S1S2比例为8∶1,采用反扫,每次缩短10ms,观察S2R间期的变化。结果:对22例患者进行经食道心房调搏检查,食道调搏过程中诱发室上性心动过速,且可被程序刺激终止。结论:经食道调搏诱发性室上性心动过速,显示室上性心动过速主要由AVNRT和AVRT引起,部分房室结功能减退,其他显示隐性预激,为进一步射频消融提供参考价值。为临床提供抗心律失常药物疗效的判定及调整。     

△RP间期在鉴别阵发性室上性心动过速中的临床意义

目的测量发作心动过速时△RP间期在鉴别阵发性室上性心动过速(PSVT)类型中的临床意义。方法回顾性分析312例有发作时心电图、心内电生理检查诊断明确并成功行射频消融术的PSVT患者,测量发作心动过速时RPV1、RPⅢ、△RP间期,比较不同类型PSVT患者RPV1、RPⅢ、△RP间期差异。结果心动过速发作时RP间期≥110 ms的93例患者均为室折返性心动过速(AVRT),RPV1间期≤80 ms的103例患者均为房室结折返性心动过速(AVNRT);在93例RP间期≥110 ms患者中,其中△RP间期≥40 ms的5例患者均为后间隔旁路,而<20 ms的59例患者均为非后间隔旁道。RP间期90 ms≤RPV1<110 ms的77例患者中,△RP间期≥40 ms的12例患者均为AVRT,其中后间隔旁道11例,非后间隔旁道1例。△RP间期<20 ms的29例患者中,2例为AVRT,均为非后间隔旁道,27例为AVNRT。结论心动过速发作时△RP间期有助于鉴别后间隔旁路和AVNRT。     

经导管射频消融改良房室结致迟发性房室传导阻滞2例

1病例报告病例1,女,26岁,因"因阵发性心悸10年,加重2个月"就诊。心悸发作时心电图示室上性心动过速,入院后行心内电生理检查:心室S1S1280ms出现文氏传导,心房S1S2500/400ms出现跳跃性传导,未诱发心动过速,予异丙基肾上腺素静点后行心房刺激于S1S1220ms诱发心动过速。心内传导顺序呈向心性,希氏束的逆传心房波最为提前,诊断房室结折返性心动过速,房室结双径路。采用下位法,RAO30°投照下,于His与CSO中下1/3处标测到小A大V波,A波碎裂处在温控55℃25W下放电消融,10s内出现交界性心律,继续放     

房室结折返性心动过速的可激动间隙及分区

目的探讨典型的房室结双径路引起的房室结折返性心动过速(AVNRT)可激动间隙的特点及其分区.方法 25例AVNRT患者心动过速发作后,分别在右室心尖部和高位右房给予VS2和AS2早搏刺激,从心动过速周长-10 ms开始刺激,相隔8个心动过速周期,以-10 ms的步长进行递减扫描,测定可激动间隙,并与41例房室折返性心动过速(AVRT)患者比较.结果 25例AVNRT患者中,2例经右心房AS2刺激可以使心动过速重整,仅2例患者可经心房AS2刺激使心动过速终止,3例经心室VS2刺激可以使心动过速重整,经心室VS2刺激均未能使心动过速终止,与AVRT患者比较有显著性差异(P＜0.05).心动过速重整时,偶联间期与回归间期之和可小于心动过速周长的2倍,亦可等于心动过速周长的2倍.结论刺激部位不同,折返环不同,所暴露的可激动间隙可能不同.刺激的偶联间期与回归间期之和等于心动过速周长的2倍,不能排除心动过速的重整.     

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.