急诊PCI术对心肌梗死患者QTc、Tp-Te、Tp-Tec间期的影响

目的:观察急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(p PCI)前后心室肌跨壁复极离散度指标(QTc、Tp-Te、Tp-Tec间期)的差异。方法:回顾分析245例STEMI患者,其中行p PCI治疗(干预组)188例,未行p PCI(对照组)57例,采集其入院即刻及入院第3天标准12导联心电图进行分析。结果:(1)干预组患者入院第3天和入院即刻比较,QTc间期无明显变化(P=0.277),Tp-Te间期、Tp-Tec间期均明显减小(P<0.001);对照组患者入院第3天和入院即刻比较,QTc间期较前增大,Tp-Te间期、Tp-Tec间期均较前减小(P分别为:0.018,0.003,0.001);与对照组比较,干预组入院第3天Tp-Te、Tp-Tec间期减小更明显。(2)干预组与对照组相比,住院期间恶性心律失常事件发生率降低(P<0.05)。结论:急诊PCI术可使Tp-Te间期、Tp-Tec间期明显减小,比药物治疗可更有效地改善心室肌跨壁复极离散度,使恶性心律失常发生率降低。     

急性心肌梗死并发室性心律失常及心室重构患者12导联同步心电图监测及预后分析

目的 探究急性心肌梗死(AMI)并发室性心律失常及心室重构患者的12导联同步心电图检测结果及预后。方法 回顾性分析2018年2月至2020年1月高州市人民医院收治的80例AMI患者的临床资料。所有患者在入院24 h内进行12导联同步心电图监测，并于入院后第2天和出院后6个月进行超声心电图检查，根据是否发生室性心律失常分为室性心律失常组49例(包括室性心动过速28例，室性早搏21例)和非室性心律失常组31例，根据是否发生心室重构分为重构组33例和非重构组47例。所有患者在入院24 h内进行12导联同步心电图监测，对其Tp-Te值、校正后Tp-Te间期(Tp-Tec)、校正的QT间期(QTc)和Tp-Te/QT水平进行测定。比较不同组间患者的Tp-Te、Tp-Tec、QTc和Tp-Te/QT水平。从出院后6个月开始对所有患者进行为期24个月的随访调查，比较不同结局患者的Tp-Te、Tp-Tec、QTc和Tp-Te/QT水平。结果 室性心律失常组患者的Tp-Te、Tp-Tec和Tp-Te/QT水平分别为(137.34±23.92) ms、(128.48±21.35) ms、0.29±0.04...     

急性心肌梗死患者体表心电图T波峰-末间期(Tp-Te)与急性期室性心律失常的关系

目的 探讨急性心肌梗死患者体表心电图T波峰-末间期（Tp-Te）、经心率校正的Tp-Te间期（Tp-Tec）和Tp-Te间期离散度（Tp-Ted）与急性期室性心律失常发生的关系.方法 分析我院治疗的50例急性心肌梗死（AMI）患者急性期与恢复期的Tp-Te、Tp-Tec和Tp-Ted,观察其与心肌梗死不同时期的关系.根据急性心肌梗死患者急性期是否发生过室性心动过速（VT）或心室颤动（VF））分为室性心律失常组（31例）和无室性心律失常组（19例）,分析心肌梗死急性期发生室性心律失常组与无室性心律失常组Tp-Te、Tp-Tec和Tp-Ted的差别,分析Tp-Te及其相关指标与室性心律失常发生的关系.结果 急性心肌梗死急性期的Tp-Te、Tp-Tec及Tp-Ted长于心肌梗死恢复期,差异具有统计学意义（P＜0.05）;Tp-Te、Tp-Tec及Tp-Ted与AMI患者急性期室性心律失常的发生率呈正相关（r=0.671,P〈0.05;r=0.703,P〈0.05;r=0.694,P〈0.05）.结论 Tp-Te、Tp-Tec及Tp-Ted在AMI急性期较恢复期延长,Tp-Te、Tp-Tec及Tp-Ted可能成为预测AMI患者发生多种室性心律失常的一项重要指标.     

不稳定性心绞痛患者介入治疗前后T波峰末间期、QT离散度的变化及意义

目的探讨经皮冠状动脉介入治疗（PCI）对不稳定性心绞痛（UA）患者T波峰末间期（Tpeak-Tendinterval,Tp-Te间期）和QT离散度（QTd）的影响及其与室性心律失常（VA）的关系。方法纳入UA患者62例,分别于入院时、PCI术后第1天及术后第7天测算其12导联体表心电图最长Tp-Te间期、QTd值,记录人院24h及PCI术后第7天VA的发生情况。所有患者采用手术前后自身对照,比较所有患者手术前后Tp-Te、QTd及VA发生率等指标：根据冠脉造影结果．把UA患者进一步分为三组：单支血管病变组、双支病变组和1-支病变组,对二三组患者PCI术前后TD-Te、QTd及VA发生率等指标进行分析比较。结果与单支血管病变组相比,双支病变组和三支病变组Tp-Te间期、QTd值均增大（P〈0．05）;与PCI术前相比,单支血管病变组及双支病变组PCI术后24h和第7天rrp-Te间期、QTd值均减小（均P〈0．05）,三支血管病变组术后第7天Tp-Te间期、QTd值也均减小（均P〈0．05）,但PCI术后24hTp-Te间期、QTd值变化不明显（P〉0．05）。与入院24h相比,PCI术后第7天VA的发生率（20．97％vs8．06％）降低（P〈0．05）。结论PCI术可降低UA患者的Tp-Te间期、QTd值．从而降低UA患者VA的发生率。     

冠心病患者心电图复极离散度的研究

目的探讨冠心病患者心电图复极离散度的意义。方法非器质性心脏病对照组50例,冠心病组50例,描记两组的常规12导联心电图,测量QT间期（QT）、QTc间期（QTc）、QT离散度（QTd）、校正QT离散度（QTcd）、T波峰-T波末间期（Tp-Te）和T波峰-T波末间期离散度（Tp-Te间期离散度）,并进行统计学分析。结果冠心病组Tp-Te间期、Tp-Te间期离散度与对照组相比均有延长（P〈0.001）。结论 Tp-Te间期及Tp-Te间期离散度的延长对预测危险室性心律失常有一定意义。     

疑似冠心病患者运动平板试验中QT间期及T波峰末间期的变化研究

目的 探讨疑似冠心病患者运动平板试验中QT间期、心率校正的QT间期（QTc间期）、T波峰末间期（Tp-Te间期）、Tp-Te/QT、Tp-Te/RR、Tp-Te/QTc及其变化。方法 回顾性分析2006年1月-2014年5月既往无冠心病病史因胸痛来温州医科大学附属第一医院就诊的177例患者的临床资料,均行运动平板试验及冠状动脉造影,根据运动平板试验结果和冠状动脉造影结果分组：运动平板试验结果和冠状动脉造影结果均阴性（A组,20例）,运动平板试验结果阳性和冠状动脉造影结果阴性（B组,69例）,运动平板试验结果和冠状动脉造影结果均阳性（C组,88例）,记录3组患者一般资料、运动平板试验前与运动峰值时运动平板试验结果及Duke评分。结果 C组男性比例、吸烟率高于B组（P＜0.05）。A组患者运动峰值时QT间期、Tp-Te间期、Tp-Te/QTc较运动平板试验前降低（P＜0.05）。B组患者运动峰值时QT间期、Tp-Te间期、Tp-Te/QT、Tp-Te/RR、Tp-Te/QTc较运动平板试验前降低,QTc间期较运动平板试验前升高（P＜0.05）。C组患者运动峰值时QT间期、Tp-Te间期、Tp-Te/QTc较运动平板试验前降低,QTc间期、Tp-Te/QT、Tp-Te/RR较运动平板试验前升高（P＜0.05）。B组患者Tp-Te间期差值较A组升高（P＜0.05）;C组患者QT间期差值较A组升高（P＜0.05）;C组患者Tp-Te间期差值、Tp-Te/QT差值、Tp-Te/RR差值、Tp-Te/QTc差值较A组和B组升高（P＜0.05）。B组和C组患者Duke评分较A组降低（P＜0.05）;C组患者Duke评分较B组降低（P＜0.05）。Tp-Te间期差值（r=-0.26,P＜0.01）、Tp-Te/QT差值（r=-0.35,P＜0.01）、Tp-Te/RR差值（r=-0.32,P＜0.01）、Tp-Te/QTc差值（r=-0.17,P=0.03）均与Duke评分呈负相关。结论 冠心病和非冠心病患者运动前后QT间期、QTc间期、Tp-Te间期、Tp-Te/QT、Tp-Te/RR和Tp-Te/QTc变化不同,其可能具有一定的临床价值。     

Tp-Te、Tp-Tec的变化与急性心肌梗死并发室性心律失常的相关性分析

目的:分析心电图T波峰-末间期(Tp-Te)、经心率校正的Tp-Te间期(Tp-Tec)的变化与急性心肌梗死并发室性心律失常的相关性。方法:回顾性分析2015年10月至2017年12月收治的140例急性心肌梗死患者的临床资料,依据心肌梗死急性期间有无发生室性心律失常分组,将未发生室性心律失常的63例患者纳入对照组,将发生室性心律失常的77例患者纳入研究组。记录两组急性期、恢复期心电图Tp-Te、Tp-Tec水平;采用Pearson分析Tp-Te、Tp-Tec与急性心肌梗死并发室性心律失常的相关性。结果:两组急性期Tp-Te、Tp-Tec均较恢复期长,且研究组急性期、恢复期Tp-Te、Tp-Tec均较对照组长,差异有统计学意义(P<0.05);经双变量Pearson相关性分析检验证实,Tp-Te、Tp-Tec与急性心肌梗死并发室性心律失常的发生呈正相关(P<0.05)。结论:心电图Tp-Te、TpTec延长与急性心肌梗死并发室性心律失常呈正相关,可作为临床预测急性心肌梗死发生室性心律失常的一项重要指标。     

急性ST段抬高心肌梗死患者血清Ⅲ型前胶原氨基端肽与心室重构的关系

目的:观察急性ST段抬高心肌梗死(STEMI)患者血清Ⅲ型前胶原氨基端肽(PⅢNP)水平与心室重构和预后的关系。方法:100例STEMI患者入选,ELISA法测定入CCU即刻和发病第7天血清中PⅢNP含量。于发病第(7±2)天和6个月时行超声心动图检查,6个月复查超声△LVEDVI增加≥20%为重构组,△LVEDVI增加<20%为非重构组。结果:第7天时,STEMI患者血清PⅢNP浓度均明显高于入院水平[(7.95±3.61)ng/m1 vs(4.18±1.83)ng/ml,P<0.001],急诊PCI患者血清PⅢNP浓度明显低于未行急诊PCI者[(7.02±2.97)ng/ml vs(11.07±3.82)ng/ml,P<0.001]。6个月随访时左心室重构发生率为27.96%,急诊PCI患者22.78%,未急诊干预者57.14%,两组间有显著差异P=0.008。重构组患者第7天PⅢNP浓度明显高于非重构组[(10.82±3.91)ng/ml vs(6.86±2.83)ng/ml,P<0.001]。结论:STEMI患者第7天血清PⅢNP水平与半年时心室重构的发生密切相关。第7天血清PⅢNP水平升高者心室重构率高,预后差。     

急性心肌梗死患者Gensini评分及PCI术对Tp-Te间期的影响及意义

目的 ①探讨急性心肌梗死患者冠状动脉病变严重程度Gensini评分与Tp-Te间期的关系;②分析冠状动脉介入治疗(PCI)对Tp-Te间期及室性心律失常(VA)的影响。方法 选取174例临床诊断急性心肌梗死患者,其中行PCI术的患者102例为观察组,未行PCI术的患者72例为对照组,计算观察组患者Gensini评分,测量观察组和对照组入院时、治疗后第2天的Tp-Te间期并随访1周内的VA发生情况。结果 ①观察组患者随Gensini评分增加,Tp-Te间期相应增大(相关系数r=0.332,P=0.001),VA的发生率也有所提高。②与入院时比较,观察组和对照组治疗后第2天Tp-Te间期均较前降低(P<0.05),观察组治疗后第2天Tp-Te间期降低更明显(P<0.05)。③观察组1周内VA发生率较对照组降低。结论 Tp-Te间期对急性心肌梗死严重程度具有较好的预测价值,急诊PCI术能显著降低Tp-Te间期,减少VA的发生率。     

急性心肌梗死患者急性期体表心电图T波峰末间期与恶性室性心律失常的关系研究

目的探讨急性心肌梗死患者体表心电图T波峰末间期(TpTe)与急性期室性心律失常的关系。方法102例接受直接PCI(pPCI)治疗的急性心肌梗死患者中,共有46例出现室性心动过速(VT)和心室纤颤(VF),作为病例组。其余56例未出现室性心律失常,作为对照组。测量并比较两组pPCI前后12导联心电图的QT、TpTe、QT离散度(QTd)及经心率校正的QT间期(QTc间期)、TpTe(TpTec)。研究室性心律失常与QTc和TpTec各时段上限值的相关性并比较不同梗死部位的QT及TpTe值。结果 pPCI治疗前两组对象的QT间期、QTd间差异无统计学意义(P>0.05),但QTc和TpTec间差异有统计学意义(P<0.05)。经pPCI治疗后第3天,两组间QT和QTd间差异仍无统计学意义,而QTc、TpTe和TpTec间差异有统计学意义(P<0.05)。pPCI治疗后1周TpTe、QTc和TpTec间差异仍有统计学意义(P<0.05)。两组pPCI治疗前后的RR间期无差异(P>0.05)。QTc间期各时段上限值与VT+VF的发生率无相关性(r=0.376,P>0.05)。TpTe及TpTec间期各时段上限值与VT+VF的发生率呈正相关(r=0.677,P<0.05;r=0.698,P<0.05)。结论在急性期出现VT和VF的急性心肌梗死患者与不出现室性心律失常的患者相比,TpTe和TpTec明显延长,但QT和QTd则无明显差异。TpTe可能预示着心肌梗死急性期恶性心律失常。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.