神经病与精神病护理

992015心电图对急性脑血管病护理的启发/汪继红//天津护理一1998,6(3)一96~97 该文对360例急性脑血管病患者心电图进行了分析,其总异常率为70%,说明急性脑血管病患者多伴有心功能异常。心电图是动态观察中风病人心功能变化的最简便、有效的方法,启示护理人员应具有一定心电图知识,才能提高抢救成功率。参4(原文摘要)992016急性小脑梗塞伴大脑多发性梗塞的抢救与护理/杨桂英//齐鲁护理杂志一1”8,4(3)一25~26992017天普洛欣静脉溶栓治疗急性脑梗塞的观察及护理/卢洪敏//实用护理杂志一1998,14(5)一244~245992018脑出血急性期护理中姗注意的几…     

急性脑血管病100例心电图变化分析

目的探讨急性脑血管病的心电图异常的表现及特征。方法对100例急性脑血管病患者的心电图资料进行回顾性分析,找出其心电图表现的主要特征及其与临床表现的相关性。结果 100例急性脑血管病患者中心电图异常者68例,正常32例。结论急性脑血管患者的心电图异常发生率高,应引起足够重视。     

急性脑血管病209例心电图分析

目的:探讨急性脑血管病患者的心电图变化和机制.方法:回顾性分析急性脑血管病患者209例常规12导联心电图结果.结果:急性脑血管病发生心电图变化率为63.6%,心脏损害主要表现为复极异常及心律失常.结论:急性脑血管病可引起心电图改变,应同时进行心脏方面的治疗.     

急性脑血管病心电图分析

急性脑血管病常并发心电图异常。作分析了184例急性脑血管病患心电图表现，进一步探讨急性脑血管病与心电图异常的关系。     

急性重型脑血管病236例心电图分析

目的:通过对236例急性重型脑血管病变患者心电图异常改变的分析,预测患者病情的预后。方法:对经头颅CT证实有急性重型脑血管病变及心电图有异常改变的患者进行跟踪分析研究。结果:本组心电图有异常改变的患者236例,死亡44例,好转192例。多表现恶性室性心律失常、ST段抬高或下移、J波等。结论:急性重型脑血管病变患者心电图的异常改变大部分可随着脑部病变的好转而逐渐恢复,一旦出现一过性ST段抬高或下移、J波、并伴有恶性室性心律失常,提示预后不佳。     

急性脑血管病心电图特点及分析论著

目的分析急性脑血管病心电图异常的特点,并讨论其发生的机制。方法对249例经头颅CT确诊为急性脑血管病患者在入院24 h内做标准导联心电图检查。结果 249例患者心电图的异常率为69.1%(172/249),其中脑出血异常率64.3%(18/28);脑梗死异常率69.7%(154/221),两者比较差异无统计学意义(P<0.05)。ST-T改变的发生率最高,其次为传导阻滞,与Q-T间期延长、p波增宽、左心室肥厚、心律失常、低电压比较差异有统计学意义(P<0.05)。心电图正常组病死率1.3%(1/77),心电图异常组病死率7.6%(13/172),两组病死率比较差异有统计学意义(P<0.05)。结论急性脑血管病患者中心电图异常发生率较高,以心肌缺血和传导阻滞为主。心电图异常组病死率高,临床工作中应关注急性脑血管病患者的心电图改变,及时给予适当处理。     

急性脑血管病131例心电图分析

目的:探讨急性脑血管病心电图改变特点。方法:对131例急性脑血管病病人的心电图检查结果进行统计分析。结果:131例急性脑血管病心电图异常者占77.9%,心电图多表现为ST-T改变达55%,其次为左室肥大和心律失常,心律失常以窦性心动过速,快速房颤,室性早搏二联律,房性早搏多见。结论:急性脑血管病患者心电图异常的程度及变化情况,对病情及预后判断有一定价值,同时对脑卒中患者进行心电方面的检查和监测是很有必要的。     

急性脑血管病伴发心血管异常32例临床分析

选取本院2011年1月-2012年1月收治的急性脑血管病伴发心血管异常患者32例，对患者的临床指征进行分析和心电图异常比较，对患者的临床特点及影响因素进行分析。心电图异常达29例，影响患者的因素主要包括年龄87.5%（28/32）、高血压病史81.2%（26/32）、并存糖尿病46.8%（15/32）。急性脑血管病病伴发心血管异常心电图异常较为明显且异常程度与患者转归具有一定相关性。     

心电图及超声心动图在老年急性缺血性脑血管病患者诊断中的应用价值

目的:探究心电图和超声心电图在老年急性缺血性脑血管患者诊断中的应用价值。方法:选择本院2015年5月到2018年5月的急性缺血性脑血管病患者100例,这100例病患为观察组;并且同时期选择本院的非缺血性脑血管病患者100例,这100例为对照组;同时使用心电图和超声心动图检查观察组和对照组,同时分析诊断结果。结果:通过这次探究显示,观察组的心电图异常率是80%,对照组低于观察组5%。观察组的超声心动图异常率是75%,诊断特征为心功能减弱、室壁运动异常等。并且左室射血功能异常者的心电图异常要高于左室射血功能正常者的心电图,两组进行对比,统计学上有明显的意义,(P0.05)。结论:老年急性缺血性脑血管疾病运用心电图和超声心动图的应用价值比较高,能为此类的疾病诊断提供相关的参考。所以,在临床实践中,可以将心电图和超声心动图相结合进行临床上的诊断,这样能有效的提高诊断的准确率。     

脑心综合征研究进展

心脏损害在脑血管病时非常常见.Burch在1954年首先报道了急性脑血管病患者心电图的异常[1].最初的脑心综合征即指急性脑血管病时引起的继发冠状动脉疾患.现在认为脑心综合征是指因急性脑病,主要是急性脑卒中、颅脑外伤、颅内肿瘤、颅内感染等病变时,下丘脑、脑干、自主神经系统受累而出现类似急性心肌梗死(心梗)、心肌缺血、心律失常、心力衰竭的临床表现[2].通常伴随出现心电图、心肌酶谱的异常.当急性脑病平稳或好转时,心脏病症状及心电图、心肌酶谱的异常也随之好转或消失.     

Chest pain in a young female

Acute Coronary Syndrome (ACS) is a common diagnosis in the emergency department (ED), the most severe manifestation of which is ST elevation on electrocardiogram (ECG). ST elevation reflects obstruction of flow through the coronary arteries, most commonly due to coronary atherosclerotic plaque rupture. However, alternative causes of coronary obstruction causing ST elevation are possible. Spontaneous coronary artery dissection (SCAD) is an unusual cause of ST elevation in ED patients which providers may encounter in patients without traditional atherosclerosis risk factors. Patients presenting with SCAD as a cause of ST elevation require unique management from traditional ACS. Here we report a case of a 43?year old female presenting with chest pain and unusual ECG findings including accelerated idioventricular rhythm followed by subtle ST segment elevation and resolution of abnormalities. This case illustrates subtle clinical and ECG findings suggestive of SCAD which emergency physicians should consider when evaluating patients for ACS in the absence of traditional clinical presentations. Such considerations may prompt physicians to avoid therapy for coronary plaque rupture which is not indicated in patients with SCAD.     

基于IKAP理论的延续护理模式在脑血管介入术患者中的应用

目的探讨基于IKAP理论的延续护理模式在脑血管介入术患者中的应用效果。方法采取方便抽样法选取2018年1月—2019年3月海南医学院第二附属医院行介入治疗的急性脑血管病患者210例,按入院时间分为对照组和干预组各105例。对照组进行常规护理,干预组在此基础上基于IKAP理论进行出院后3个月的延续护理,基本流程为收集信息(I)、传授知识(K)、加强观念(A)、促使行动(P),并通过微信开展随访。干预前后分别采用急性脑血管病知识调查问卷、Barthel指数评分量表、脑血管病自我管理量表进行测评。结果干预后,干预组患者知识知晓率为90.48%(95/105),高于对照组的80.00%(84/105),差异有统计学意义(P<0.05)。干预1、2、3个月时,干预组Barthel指数为(58.37±10.36)、(67.52±9.44)、(81.24±10.59)分,分别高于对照组的(55.39±11.34)、(64.30±11.34)、(77.93±9.82)分,差异有统计学意义(P<0.05)。干预后,干预组脑血管病自我管理量表总得分为(3.80±0.62)分,高于对照组的(3.60±0.65)分,差异有统计学意义(P<0.05)。结论对脑血管介入术患者进行基于IKAP理论的延续护理,可以提高患者疾病知识水平和自我管理能力,促进预后康复,进一步完善延续护理服务体系。     

Clinicofunctional characteristics of the heart in hemorrhagic fever with renal syndrome

A clinicofunctional analysis of the heart was made in 50 patients suffering from hemorrhagic fever with renal syndrome (HFRS) in the acute period and at the stage of outpatient rehabilitation. Comparison with healthy subjects was made by physical, ECG, echo-CG data, changes in the levels of creatinphosphokinase (MB-fraction) (CPK-MB), asparagine and alanine aminotransferase in the serum. Clinical symptoms of heart pathology, their incidence rate in different periods of the disease, dynamics of ECG deviations, state of heart chambers and left ventricular systolic function are described. The most manifest changes of the studied parameters were observed in acute disease and depended on the disease severity. The detected changes in the end part of the ventricular complex on ECG associated with a relative depression of left ventricular systolic function as well as a rise in the level of CPK-MB indicate affection of the myocardium. Variants of combination and dynamics of the above disorders allowed to single out the most probable syndromes of heart affection in HFRS.     

A Prospective Study of Heart Disease in Diabetes Mellitus

Six hundred and twenty-five patients with diabetes mellituswere studied by standardised clinical methods, resting andexerciseelectrocardiography (ECG) and digitised echocardio-graphy todetermine the prevalence of coronary and non-coronary heartdisease. Clincial evidence of coronary artery disease (anginaand infarction) was present in 110 (18 per cent) normotensivepatients. Hypertension (blood pressure >165/95 mmHg) waspresent in 172 (27 per cent) of whom 32 had cardiac symptoms.Heart failure or left ventricular dilatation was seen in 18of whom 11 had either hypertension or coronary artery diseaseand six asymptomatic patients had unexplained ventricular hypertrophy. Echocardiograms in 245 of 290 asymptomatic patients with normalECG showed that relaxation was prolonged (p<0.001) and mitralvalve opening delayed (p<0.001) from normal especially inthose with severe microangiopathy (proliferative retinopathyand/or heavy proteinuria). The peak rates of cavity dimensionincrease and posterior wall thinning were reduced from normal(both p<0.001) and patients with severe microangiopathy hadthe most marked changes. Redivision of these 245 diabetics byabnormalities of left ventricular function showed that 147 hadnormal function in whom only one of23 (random 15 per cent sample)had a positive exercise ECG. Prolonged relaxation or delayedmitral valve opening alone (anon-specific abnormality) was presentin 41 and only three of 28 had a positive exercise ECG. Thirty-onehad delayed mitral valve opening with inco-ordinate relaxation(abnormalities very suggestive of coronary artery disease) ofwhom 20 of 29 had a positive exercise ECG. Twenty-six had delayedmitral valve opening with slow cavity dimension increase orwall thinning (without hypertrophy) of whom 21 of 25 had a negativeexercise ECG. This is a relatively specific abnormality similarto that found in left ventricular hypertrophy. Coronary artery disease is common in symptomatic and asymptomaticforms in diabetes mellitus. Non-coronary left ventricular diseases,such as dilation and hypertrophy, are probably no more commonin diabetics than non-diabetics. A small number of diabeticswith severe microangiopathy had abnormal relaxation and reducedpeak rate of dimension increase or wallthinning which may representleft ventricular disease due to microangiopathy.     

Intra-aortic balloon pumping in acute mitral regurgitation reduces aortic impedance and regurgitant fraction

Acute mitral regurgitation (MR) is present in 10% of patients presenting with cardiogenic shock. To stabilize these patients, intra-aortic balloon pumping (IABP) is recommended, but the mechanism of IABP support in these patients is unknown. This animal study was designed to describe the hemodynamic effect of intra-aortic balloon pumping during cardiogenic shock induced by acute MR. In eight calves, left ventricular pressure-volume loops, aortic and left atrial pressure, and aortic, carotid artery, and coronary blood flow were recorded. Acute MR (range 36%-79%) was created by placing a metal cage in the mitral valve. Hemodynamic data was obtained at control, during acute MR, and during acute MR with 1:1 IABP support. Acute MR caused a decrease in cardiac output (-32%, P = 0.018), blood pressure, and carotid artery flow, whereas left ventricular output (+127%, P = 0.018), end-diastolic volume, and left atrial pressure all significantly increased. Stroke work, ejection fraction, and coronary blood flow were not significantly changed, and no signs of ischemia were seen on the ECG. The IABP raised average cardiac output by 31% (P = 0.012) and significantly raised blood pressure and flow to the brain while decreasing systemic vascular resistance. Left ventricular function and mean coronary blood flow did not change, but diastolic coronary flow became more important as shown by the increase in diastolic fraction from 64% to 95%. (P = 0.028). Average MR dropped by 7.5% (P = 0.025). In conclusion, application of the IABP during acute MR lowers aortic impedance, resulting in less MR and more output toward the aorta without changing left ventricular function.     

Thoracic impedance measurement in heart stimulation and cardiac arrhythmias

The electrocardiogram (ECG) interpretation in patients with implantable cardioverter defibrillator (ICD) is often a puzzling problem. The difficulty of the device function evaluation further increases in the presence of unfamiliar timing cycles and additional functions. We present an interesting ECG with a special function of a Biotronik ICD devices called the thoracic impedance monitoring, and demonstrate its behavior in a patient with atrial fibrillation, pacing beats, ventricular ectopic beats, and couple of ventricular beats. This report shows unexceptional occurrence of tricky ECG finding in patient with Biotronik ICDs.     

Predictors of unusual ECG characteristics in cavotricuspid isthmus-dependent atrial flutter ablation

Background: An unusual 12‐lead electrocardiographic pattern may be present in patients with cavotricuspid isthmus (CTI)‐dependent flutter. Objective: Using baseline patient characteristics and echocardiography, we sought to study predictors of unusual electrocardiogram (ECG) characteristics in patients with CTI‐dependent atrial flutter. Methods: This was a dual‐center, retrospective cohort study of 147 patients undergoing electrophysiology study and ablation for CTI‐dependent atrial flutter. Results: Among this cohort, 23 patients (16%) had unusual 12‐lead ECG characteristics. Using multivariate logistic regression, we found two clinical predictors for having an unusual ECG pattern. A clockwise (CW) pattern at time of electrophysiology study was the strongest predictor of an unusual ECG pattern (odds ratio 15.3, 95% confidence interval [CI] 4.0–59.4, P < 0.005). In addition, patients with decreased systolic function had a 3.5 greater odds (95% CI 1.1–11.5, P = 0.037) of having an unusual ECG pattern. Conclusions: Our data demonstrate that among patients suffering from CTI‐dependent atrial flutter who are referred for ablation, 16% will have unusual ECG patterns. Patients with CW atrial activation and left ventricle dysfunction have greater odds of manifesting unusual patterns by surface electrocardiogram. (PACE 2011; 34:1251–1257)     

颅脑疾病患者血清及脑脊液中心肌酶谱检测的意义

目的观察各种心肌酶在颅脑疾病患者血清及脑脊液中的变化,为临床颅脑疾病的鉴别诊断提供依据。方法采集结核性脑膜炎、病毒性脑膜炎、脑血管疾病、急性颅脑损伤和脑肿瘤患者的血清及脑脊液,检测其乳酸脱氢酶(LDH)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、羟丁酸脱氢酶(HBDH)、肌酸激酶(CK)和谷氨酰转移酶(GGT)值。结果 1)与健康对照组比较,各组脑脊液及血清中的心肌酶差异有统计学意义,均有不同程度升高(P0.05),其中以急性颅脑损伤组最高;2)结核性脑膜炎患者与病毒性脑膜炎患者比较,脑脊液中的GGT、LDH、HBDH、CK差异有统计学意义(P0.05)。结论同时检测脑脊液及血清中的心肌酶可用于鉴别诊断病毒性脑膜炎和结核性脑膜炎;脑脊液中心肌酶的测定可作为急性颅脑损伤的性质及预后的辅助诊断指标。     

Ventricular extrasystole as manifestation of viral myocarditis and myopericarditis in young patients

AIM: To investigate relationship between frequent and complicated ventricular extrasystole (VE) in young patients and previous viral myocarditis (VM); to study VE long-term prognosis. MATERIAL AND METHODS: We examined 75 patients with mild and moderate myocarditis which developed after acute respiratory infections and other viral diseases (Coxsackie infection was serologically confirmed in 49%; flu, paraflu and adenoviral infection--in 8%). Acute myocarditis was diagnosed basing on the data of ECG, activity of cardiospecific enzymes and isoenzymes, x-ray, echocardiography, Holter ECG monitoring, exercise tests. The patients were followed up from 3 to 26 years (mean 14.6 years). RESULTS: Bigeminal polymorphic extrasystoles and bigemia sites persisted for the whole periods of observation. They could disappear at resting ECG but were registered at 24-h ECG monitoring in all the cases. Echocardiography detected fibrous alterations of the pericardium with its thickening in 89% cases. Exercise tolerance test at the end of the study recorded normal physical performance in 89.3% patients. This suggests a favorable disease outcome. Low physical performance, moderate dilation of the left ventricle and ejection fraction lowering to 48% requiring medication were observed only in 4 patients who were capable to work. CONCLUSION: Frequent and complicated VE after viral myocarditis were present at resting ECG for many years in 42.3% patients. Holter 24-h ECG monitoring registered VE in all the examinees. 89% patients had fibrous lesions of the pericardium showing that viral myocarditis in most cases runs as myopericarditis, in some cases being subclinical.     

Atrioventricular Block in Situs Ambiguus and Left Isomerism (Polysplenia Syndrome)

Three patients are described who had situs ambiguus and left isomerism (polysplenia syndrome) and advanced atrioventricuiar block. One presented with a complex bradyarrhythmia with Wenckebach block. The other two had congenital atrioventricular block with a narrow QRS at a ventricular rate of 80 per minute, an atrial rate of 150' per minute, and both had a P wave axis directed superiorly and to the right in one, and superiorly to the left in the other. This ECG pattern was not observed in more than 400 adult patients with complete A-V block treated in our service. It is our opinion that in infants and children with heart disease the presence of complete A-V block with narrow QRS and an unusual P waves axis directed superiorly is strongly suggestive of left isomerism. The incidence rate of complete A-V block in left isomerism is nearly twenty percent of the cases described.