磷酸肌酸钠对急性心肌梗死后室性心律失常的影响

目的探讨磷酸肌酸钠对急性心肌梗死（AMI）后室性心律失常的影响,为临床治疗提供依据。方法选择2012年1月至2012年11月住院的AMI患者112例,随机分为两组,各56例。所有患者均给予AMI常规治疗（抗血小板、抗凝、他汀类药物、β受体阻滞剂、血管紧张素转化酶抑制剂、硝酸酯类药物）,有适应证者应用尿激酶溶栓。治疗组在此基础上静脉应用磷酸肌酸钠。观察治疗期间两组患者室性心律失常的发生情况及治疗前后QT间期离散度（QTd）和校正的QT间期离散度（QTcd）的变化。结果治疗组频发室早、短阵室速、持续性室速和室颤发生率均稍低于对照组,但差异无统计学意义（P均﹥0.05）。两组治疗后QTd和QTcd均低于治疗前（P均〈0.05）。治疗组治疗后QTd和QTcd为（64.17±4.14）ms及（71.33±6.52）ms,低于对照组治疗后的（71.30±5.22）ms及（77.82±7.65）ms,差异具有统计学意义（P均〈0.05）。结论磷酸肌酸钠可使AMI患者QTd和QTcd显著降低,能否确实减少AMI后室性心律失常的发生,有待扩大样本量进一步观察。     

急诊静脉溶栓治疗对老年急性心肌梗死QTd和CVA的影响

[目的]观察尿激酶溶栓治疗对老年急性心肌梗死（AMI）QT离散度（QTd）和复杂室性心律失常（CVA）的影响。[方法]对55例老年AMI患者在发病6h内予以尿激酶溶栓治疗,比较AMI溶栓再通组与溶栓非再通组治疗前后QTd和QT离散度校正值（QTcd）以及两组溶栓前和溶栓治疗后7d内CVA事件发生率。[结果]AMI溶栓再通组治疗7d后QTd和QTcd较非再通组显著减少（P〈0．05）,非再通组治疗前后QTd、QTed相比较差异无统计学意义（P〉0．05）。再通组CVA事件的发生率亦显著低于溶栓非再通组（P〈0．05）,非再通组治疗前后CVA的发生率差异无统计学意义（P〉0．05）。[结论]尿激酶溶栓治疗可减小AMI患者的QTd或QTcd,减少CVA的发生;QTd或QTcd可作为观察溶栓和再灌注效果的一个有效指标。     

急性心肌梗死患者静脉溶栓对QTd的影响及其临床意义

【目的】探讨急性心肌梗死（AMI）患者静脉溶栓对QT离散度（QTd）的影响,并评价其与近期恶性室性心律失常的相关性。【方法】将158例AMI静脉溶栓的患者分为再通组和未再通组,比较溶栓前、溶栓后24h的QTd变化,同时观察两组患者溶栓治疗后一周内恶性室性心律失常的发生情况,分析其与QTd的相关性。【结果】静脉溶栓再通组QTd明显减少（P〈0．01）,未再通组无明显变化（P〉0．05）;再通组恶性室性心律失常发生率明显低于未再通组（12．7％比32．1％,P〈0．01）。AMI伴恶性室性心律失常者的QTd明显大于无恶性室性心律失常者（P〈0．01）。【结论】成功的静脉溶栓能显著减少AMI患者的QTd,降低恶性室性心律失常的发生率;QTd对判断静脉溶栓疗效、评价AMI近期预后具有一定的临床参考价值。     

心肌梗死患者溶栓治疗疗效与D-二聚体水平的关系

目的评价血浆D-二聚体（DD）在判断急性心肌梗死（AMI）溶栓治疗疗效中的应用价值。方法采用酶联免疫吸附试验（ELISA）检测健康人（对照组）心绞痛、陈旧性心肌梗死（OMI）及AMI患者血浆DD含量（AMI患者发病后进行连续测定），并比较其结果。结果对照组、心绞痛患者、OMI患者、未接受溶栓的AMI患者、接受溶栓治疗的AMI患者DD含量分别为0．41±0．30mg／L、0．55±0．36mg／L、0．60±0．48mg／L、1．01±0．52mg／L和2．91±1．04mg／L。与对照组相比较，心绞痛组和OMI组DD含量差异无显著性（P〉0．05），而未溶AMI组和溶栓AMI组DD含量明显升高，差异具有非常显著性（P〈0．001）。溶栓AMI组DD含量显著高于未溶AMI组，差异具有显著性（P〈0．001）。结论血浆DD测定不仅可作为观察心肌梗死病情的指标，对溶栓药物的疗效监测也具有重要价值。     

急性心肌梗死合并Ⅲ度房室传导阻滞106例治疗体会

目的探讨急性心肌梗死（AMI）合并Ⅲ度房室传导阻滞（AVB）患者的临床特征。方法分析AMI合并Ⅲ度AVB106例患者的临床资料。结果①AMI并发Ⅲ度AVB以下壁多见，为85例（85／106），治愈73例（73／85），死亡12例（12／85）；前壁及广泛前壁21例，治愈10例（10／21），死亡11例（11／21）；两者病死率差异有统计学意义（P〈0、05）。②74例下壁AMI经保守治疗死亡12例（12／74），11例经介入治疗均治愈，但两者间差异无统计学意义（P〉0．05）；11例前壁AMI经保守治疗均死亡，而10例经介入治疗均治愈，两者间差异有统计学意义（P〈0．05）。结论前壁AMI合并Ⅲ度AVB患者病死率高，介入治疗降低病死率，尤以前壁明显。     

室性心律失常Q-T间期离散度的临床价值探讨

为了评价室性心律失常患者Q－T间期离散度（QTd）的临床应用价值，本文观察了180例室性心律失常患者的QTd，其中持续性室速组（n＝55）QTd为106.85±28．74ms，并行性室速组（n＝60）QTd为38．56±12．05ms，频发室早组（n＝65）QTd为41．44±15.16ms。结果显示持续性室速组QTd显著高于并行性室速及频发室早组，差异极显著性（P＜0.01）。QTd＞75ms者，持续性室速检出率为94．3％，而QTd≤75ms者，持续性室速检出率反为3．9％。两者之间差异非常显著（P＜0．01），本文提示QTd与室性心律失常有一定的关系，能准确反映心室肌复极离散程度，持续性室速患者，QTd明显增加；QTd增加（＞75ms）易发生持续性室速，甚至室颤。认为QTd可作为判断室性心律失常危险性及评估其预后的有效简单的参考指标。     

急性心肌梗死患者溶栓前后QT离散度的变化

目的:观察急性心肌梗死(AMI)患者溶栓前后QT离散度(QTdispersion,QTd)的变化及早期再灌注对QTd的影响。方法:对61例AMI患者给予尿激酶静脉溶栓治疗,予溶栓前及溶栓2h后同步记录18导联心电图,分别测量成功组及失败组的QTd,并进行前后比较。结果:溶栓后再通41例,溶栓后未通20例。血管未通组其QTd较前减少,但无统计学意义(P>0.05),溶栓后再通组其QTd较血管未通组降低程度更大,有统计学意义(P<0.01)。结论:QTd可作为评价AMI患者溶栓后判断溶栓成功与否的一项临床早期参考指标。     

急性心肌梗塞静脉溶栓治疗对QTcd的影响及其意义

目的:为探讨溶栓治疗对急性心肌梗塞(AMI)心率校正QT离散度(QTcd)的影响。方法:回顾分析12例 AMI静脉溶栓成功者溶栓前与溶栓24h后心电图以及同期12例未行溶栓治疗的AMI患者入院时与入院24h后 心电图,测定QTcd。结果:溶栓组治疗前后QTcd分别为(70.6±15.2)ms和(46.7±16.2)ms,差异有非常显著性 意义(P<0.01),未溶栓组为(71.2±16.0)ms和(70.8±15.4)ms,差异无显著性意义(P>0.05)。两组治疗24h 后QTcd差异有非常显著性意义(P<0.01)。结论:成功的溶栓能显著缩短AMI的QTcd,改善预后。QTcd可以 作为一种简单、可靠的判定AMI再通的临床指标。     

QT间期离散度增加与急性心肌梗塞预后的关系 (附30例AMI病例分析)

目的：探讨AMI近期预后的预测价值。方法：对30例急性心肌梗塞（AMI）患者的QT间期离散度（QTd)进行分析，结果：室性心动过速（VT）、心室颤动（Vf）及猝死者的QTd明显长于无VT、Vf及非猝死者（P＜0．01），前壁心肌梗塞组QTd明显长于后壁心肌梗塞组（P＜0．01）。结论：QTd是预测AMI近期预后的一项敏感指标。     

急性冠状动脉综合征早期诊断中血清Mb、CK-MB和CTnI水平测定的临床应用

目的探讨血清Mb、CK-MB和CTnI水平测定在急性冠状动脉综合征（ACS）发病早期诊断和溶栓再通效果监测的临床应用。方法利用生化和化学发光方法测定了96例ACS患者（包括52例UAP和44例AMI）血清中的Mb、CK—MB和CTnI的水平,在监测溶栓治疗的44例AMl中,测定了32例通畅组和12例持续闭塞组溶栓治疗后60min和溶栓治疗前的浓度比值,并进行了比较分析。结果在96例ACS患者中,44例AMI患者血清Mb、CK—MB和CTnI水平分别为181±102μg／L,55±32U／L和0．560±0．310/L,显著高于52例UAP患者和42名正常对照组（P〈0．05）,UAP患者和正常对照组无明显差异（P〉0．05）。在监测44例AMI患者相关动脉的溶栓治疗中,32例AMI患者通畅组溶栓治疗后60min与治疗前的浓度比值分别为7．4±1．5、20．2±2．4和3．0±0．4,较之12例持续闭塞组明显增高（P〈0．05）。结论血清Mb、CK—MB和CTnI水平的联合测定是早期诊断ACS有效方法,并且是监测AMI患者溶栓治疗效果的有意义指标。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.