Myocardial injury resulting from radiofrequency catheter ablation: comparison of circumferential pulmonary vein isolation and complex fractionated atrial electrograms ablation

Background  Radiofrequency catheter ablation (RFCA) necessarily produces an area of myocardial necrosis. However, the difference of the extent of myocardial injury between circumferential pulmonary vein isolation (CPVI) and complex fractionated atrial electrograms (CFAE) ablation in patients with atrial fibrillation (AF) has not been investigated before.

Methods  Twenty-nine consecutive male patients (n=29) with either paroxysmal or persistent AF were selected for CPVI or CFAE ablation. The CPVI or CFAE ablation was performed with a three-dimensional electroanatomical mapping system (CARTO). Serum cardiac biomarkers, for example, cardiac troponin T (cTnT), aspartate transaminase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase myocardial bound (CKMB) were determined by the Elecsys STATE immunoassay. Cardiac structure and function were measured with echocardiography.

Results  Echocardiography showed that there was no significant difference of atrioventricular structure or function parameters between the CPVI group and the CFAE ablation group. Serum cTnT showed a significant increase in the CFAE ablation group over the CPVI group at 12 and 24 hours after the procedure (P <0.05, respectively), and then it was reduced to a normal level after 48 hours. Serum AST showed a significant increase in the CFAE ablation group over the CPVI group at post-procedure, 4 and 12 hours after the procedure (P <0.05, respectively), and then it reached to a normal level after 24 hours. There was no significant difference in LDH, CK, or CKMB levels between the CFAE ablation group and the CPVI group at any time point (P >0.05).

Conclusions  cTnT and AST other than LDH, total CK or CKMB activity significantly increased more in the CFAE ablation group than the CPVI group. However, the difference of the serum levels of cTnT, AST between two groups was temporary.

     

Comparison of hemodynamic changes after endotracheal intubation by using the lighted stylet and the laryngoscope in patients

Objective To compared the effects of the lighted stylet technique on hemodynamic responses, time- to- intubation, number of attempts, and complications during tracheal intubation with those of direct- vision laryngoscopy in patients. Methods Forty patients were randomly assigned to one of the following two groups: 1) patients intubated by using the laryngoscope (A group, n = 20); 2) patients intubated by using the lighted stylet( B group, n= 20). Lighted styletor laryngoscopic oral endotracheal in- tubation was performed after the induction of anesthesia with fentanyl and propofol and muscle relaxation. Systolic blood pressure, diastolic blood pressure, and heart rate were recorded, and the change from "be- fore intubation"to "immediately after intubation"in each variable was calculated. Results In two groups , SBP and DBP were significantly decreased from the baseline level by the induction of anesthesia (P< 0.05). In Bgroup, SBP and DBP were increased transiently to the level of baseline by intubation. Heart rate (HR) increased transiently after intubation in both A and B groups. Significantly higher changes from "before intubation"to "immediately after intubation"in SBP were observed in the A group compared with the B group (P<0.05). Values of SBP and DBP were significantly greater in the A group than in the B group, respectively, in immediately after tracheal intubation and 1min after tracheal intubation . Conclu- sions We conclude that the lighted stylet technique required significantly a longer time to intubation than the laryngoscopic technique in patients. However, the lighted style ttechnique significantly attenuated hemodynamic changes tointubation in comparison with the laryngoscopic technique in patients.     

非体外冠状动脉旁路移植术后ICU时间延长的危险因素分析

目的 分析非体外冠状动脉旁路移植术(OPCAB)后患者住重症监护病房(ICU)时间延长的危险因素.方法 将2008年1月至2010年5月间247例施行非体外冠状动脉旁路移植手术患者,根据术后住ICU时间是否延长(住ICU时间延长定义为≥5 d)分为两组,Ⅰ组34例,术后住ICU时间延长; Ⅱ组213例,术后住ICU时间未延长.先对各变量进行单因素分析,然后将单因素分析有意义的变量纳入Logistic回归进行多因素分析. 结果术后住ICU时间延长34例. 单因素分析结果显示:Ⅰ组中年龄、手术时间、糖尿病及心律失常发生率均大于或长于Ⅱ组,心功能、左心室射血分数(LVEF)均低于或差于Ⅱ组(P＜0.05).Logistic多因素分析结果显示:术前年龄≥70岁(OR=17.736)、LVEF≤0.50(OR=5.850)、糖尿病(OR=4.081)为术后住ICU时间延长的独立危险因素.结论 临床上可根据术前年龄、LVEF、糖尿病预测术后住ICU时间是否延长.对具有上述危险因素的患者采取相应的预防措施,可降低术后并发症发生率和病死率. Abstract： Objective To analyze risk factors for prolonged stay in intensive care unit after off-pump coronary artery bypass grafting. Methods Between January 2008 and May 2010, 247 consecutive patients undergone off-pump coronary artery bypass grafting were divided into two groups based on if their length of ICU stay more than 5 days (prolonged stay in ICU was defined as 5 days or more). GroupⅠ:Thirty-four patients required prolonged ICU stay. Group Ⅱ: 213 patients did not require prolonged ICU stay. Univariate and multivariate analysis (logistic regression) were used to identify the risk factors.Results Thirty-four patients required prolonged ICU stay. Univariate risk factors showed age, the operation time, incidence of diabetes millitus and arrhythmia of groupⅠwere higher or longer than those of groupⅡ. The heart function, left ventricular ejection fraction (LVEF) in groupⅠwere worse than those in groupⅡ(P<0.05). Logistic regression identified that preoperative age≥70(OR=17.736), LVEF≤0.50(OR=5.850), diabetes melllitus(OR=4.081) were final risk factors for prolonged ICU stay. Conclusions Prolonged ICU stay after off-pump CABG can be predicted through age, LVEF, diabetes melllitus. The patients with these risk factors need corresponding preoperative care and postoperative care to reduce mortality, morbidity and avoid prolonged ICU stay after off-pump CABG.     

THE EFFECT EARLY VERSUS LATE CORONARY STENT PLACEMENT IN PATIENTS WITH INFARCT-RELATED ARTERY OCCLUSION ON LEFT VENTRICULAR FUNCTIONAL RECOVERY

Objective To evaluate the effect of early versus late revascularization of asynptomatic patients with a totally occluded infarct-related artery (IRA) on left ventricular ( LV) functional recovery.Methods Sixty-four consecutive asymptomatic patients after a first Q wave anterior wall myocardial infarction (MI) with persistent left anterior descending artery occlusion and infarct-zone akinesia were studied. Coronary stenting was performed 2～ 3 weeks after infarction in 34 patients (group Ⅰ ), and 3 ～ 6 months after acute event in 30 patients (grout Ⅱ ). Resting two-dimensional echocardiographic examinations were made before the procedure and during 4 ～ 6 months of follow-up. Results In group Ⅰ , the occluded left anterior descending artery could be reopened, and full anterograde flow was restored in all patients. In group Ⅱ , stent implantation was successful in 26 patients (100% vs 86. 7%, P = 0. 04 ), and was not possible in 4 patients ( guidewire failed to pass the lesion and no vessel stump visible ). No complications occurred and residual stenosis was ≤30% after stenting in two groups. In group Ⅰ , LV ejection fraction increased from (55 ± 14 )% to (62 ± 13)% (P＜ 0. 001 ) and L V end-systolic volume had a decrease, but the end-diastolic volume remained unchanged. In group Ⅱ LV ejection fraction, infarct zone wall motion and LV volume did not improve.Conclusion The study indicates that myocardial viability (hibernation) may persists for 2 to 3 weeks but notfor 3 months after acute MI. During the time, restoration of patency of IRA artery after a Q-wave MI is benefi-cial even for asymptomatic patients.     

Comparison of Shenfu Injection(参附注射液) and Epinephrine on Catecholamine Levels in A Porcine Model of Prolonged Cardiac Arrest

Objective:To compare the effects of Shenfu Injection(SFI) and epinephrine(EPI) on catecholamine levels in a porcine model of prolonged cardiac arrest(CA).Methods:After 8 min of untreated ventricular fibrillation,24 Wuzhishan miniature pigs were randomly assigned to one of the three groups(n=8 per group) and received central venous injection,respectively:SFI group(1 mL/kg),EPI group(20 μg/kg EPI),and normal saline(NS) group.Cardiac output(CO),maximum rate of increase/decrease in left ventricular pressure(±dp/dt),serum levels of EPI,norepinephrine(NE),and dopamine(DA) were determined at baseline and at 0.5,1,2,and 4 h after restoration of spontaneous circulation.Results:The duration of cardiopulmonary resuscitation was shorter in the EPI and SFI groups than in the NS group(P0.05).The EPI level increased significantly after restoration of spontaneous circulation(ROSC) in all three groups,and was significantly different between the EPI group and the other two groups immediately after ROSC(both P0.01),but these differences gradually disappeared over time.There were no significant differences in NE or DA levels among the three groups,and there were no correlations between catecholamine levels and CO or dp/dt(P0.05).Conclusions:SFI did not significantly affect endogenous catecholamine levels during cardiopulmonary resuscitation after prolonged ventricular fibrillation.However,SFI improved oxygen metabolism,and produced a better hemodynamic status compared with EPI.SFI might be a potentially vasopressor drug for the treatment of CA.     

Relationship among eye condition sensitivities, photosensitivity and epileptic syndromes

Background Electroencephalogram （EEG） activity in normal subjects and epileptic patients is often closely related to the eye＇s status such as eye opened （EO）, eye closure （ECL） and eyes closed （EC）. ECL is the period immediately after closing of the eyes and only lasts for less than 3 seconds if the eyes remain closed. EC is the period as long as the eyes are closed. Epileptiform changes on EEG induced by ECL or EC are called the changes of ECL sensitivity （ECLS） or EC sensitivity （ECS）. ECLS occurs mainly but not exclusively in photosensitive patients and ECS has been seen rarely in photosensitive patients. This study aimed to investigate the relationships among ECLS, ECS, photosensitivity and epilepsy syndromes in children. Methods EEG records from child patients in the EEG Department of Peking University First Hospital during the period of May 2005 to May 2007 were examined for the presence of ECLS or ECS. Open-close eye tests and intermittent photic stimulations were carried out during video-EEG monitoring for examining ECLS, ECS and photosensitivity. Results Based on ECLS and ECS on their EEGs, 30 patients were divided into ECLS group （16 cases） and ECS group （14 cases）. There were more boys than girls in the two groups. The mean age of initial detection of ECLS and ECS was 10 years, and the average onset age of seizures was 9 years. The epilepsy syndromes in the ECLS group included idiopathic photosensitive occipital lobe epilepsy, Panayiotopoulos syndrome, symptomatic occipital lobe epilepsy, juvenile myoclonic epilepsy, juvenile absence epilepsy, eyelid myoclonia with absences, epilepsy with grand mal on awakening and pure photosensitive epilepsy with mainly generalized tonic clonic seizures. Those in the ECS group were juvenile myoclonic epilepsy, idiopathic photosensitive occipital lobe epilepsy, Panayiotopoulos syndrome and Gastaut type-idiopathic children occipital epilepsy. Photosensitivity was detected in 88% of patients with ECLS and 29% of patients with ECS. Concl     

Evaluation of serum troponin T measurement in acute myocardial infarction.

The release kinetics of the cardiac specific troponin T (cTnT), measured by an immunosorbent assay, in 32 patients with acute myocardial infarction (AMI) was evaluated. In 8 AMI patients (25%), the release kinetics of serum cTnT showed biphasic serum concentration curves with a large peak at 10 to 18 hours after onset and the serum cTnT concentrations were up to 30 to 120 times of the normal upper limit-detected (0.2 μg / ml), and another samll cTnT peak at 70 to 100 hours after onset of pain. The serum cTnT measurements in the remaining 24 AMI patients (75%) gave only one large peak which was around 32 to 108 hours after onset of pain. cTnT appeared in serum as early as 3 to 4 hours and remained elevated until 240 hours after the infarctions. The results indicated that (1) cTnT was a sensitive and specific marker of AMI; (2) the biphasic curve of cTnT releae in general, the ratio of cTnT at around 14 to 32 (14/32)>1 in particular, may be a useful marker suggesting early reperfusion; (3) the continuous     

Clinical Research and Surgical Treatment of Posttraumatic Epilepsy

In order to investigate the susceptible factors of posttraumatic epilepsy (PTE) and the surgical treatment, the relative factors of 18 cases of intractable PTE and 35 cases of non-PTE patients with posttraumatic seizures (PTS) and the surgical treatment of PTE patients were studiedret rospectively. The results showed that there was significant difference in the degree of unconsciousness after head injury, incidence of intracerebral hematoma and acute subdural hematoma between PTE group and non-PTE group. Of the 18 cases of PTE undergoing surgical treatment, the effectiveness of 11 cases was satisfactory and that of the remaining 7 was not. Between the two groups, there was difference in the localization of interictal epileptic discharge (IED) and ictal discharge (ID) as demonstrated by preoperative EEG. It was concluded that PTE was associated with the severity of head injury and intracrania[ hematoma. The localization of epileptogenic loci by preoperative EEG presumably contributed to the PTE surgical effects.     

Lipiodolization with or without gelatin sponge in hepatic arterial chemoembolization for hepatocellular carcinoma.

Fifty-two patients with unresectable hapatocelluar carcinoma were divided into 2 groups. Group A (n=24) received lipiodolization with gelatin sponge and group B (n=28) lipiodolization alone. Angiography after hepatic arterial chemoembolization revealed a satisfactory accumulation of lipiodol and obliteration of the micovasculature in the tumors in both groups. However, prolonged obliteration of proximal hepatic arteries was noted in 70%-80% of patients in group A, in contrast to the patency of the arteries in group B. Collateral circulation was found more frequently in group A than in group B, in which recanalization of tumor vessels and phenomenon of iodized oil "wash-out" were seen. There were no significant differences in therapeutic effects in patients with low risk. In those with high risk, the response rates were 28.6% and 64.2%. The half-year survival rates were 28.5% and 62.8%, 1-year survival rates 7.1% and 27.5%, and 2-year survival rates 0% and 13.7% in group A and B respectively. The differen     

The Therapeutic Effect of Xiaopi-Ⅰ(消痞Ⅰ号) on Functional Dyspepsia

Objective: To observe the therapeutic efficacy of Xiaopi-Ⅰ(消痞Ⅰ号) on functional dyspepsia and its effects on gastric emptying. Methods: A total of 134 patients with functional dyspepsia were randomly assigned to 2 groups. The patients in the Xiaopi-Ⅰ group (66 cases) and the Domperidone group (68 cases) were given Xiaopi-Ⅰ granules and Domperidone 10 mg, 3 times a day, respectively. Another 20 healthy volunteers were chosen as the negative control group. The severity scores of the symptoms, as well as the gastric emptying, were detected before and after 4-week treatment by barium strip-trial meal. Results: During therapy, 6 cases from the Xiaopi-Ⅰ group and 8 cases from the Domperidone group were lost to follow, and 120 cases finally finished the study. Statistical differences were observed from both groups in terms of the symptoms of postprandial fullness early satiety, epigastric pain, and epigastric burning after 4-week treatment (P<0.01). The symptomatic severity scores of the Xiaopi-Ⅰ group before and after the treatment were 7.48±1.64 and 2.16±1.26, respectively (P<0.01). Gastric emptying rates were also improved in the patients with delayed gastric emptying, and the effective rates were 91.3% and 75.8% in the Xiaopi-Ⅰ and Domperidone groups, respectively. No obvious adverse effects were found from both groups. Conclusion: Xiaopi-Ⅰ was an effective and safe agent in the treatment of functional dyspepsia and was worth of further development in clinical.     

七氟醚预处理对大鼠心肌缺血再灌注损伤保护作用的机制研究

目的：了解非受体酪氨酸激酶 c-Src 在七氟醚预处理减轻大鼠心肌缺血再灌注损伤中的作用。方法将健康雄性 Wistar 大鼠50只,随机分为5组（n＝10）,假手术组（Ⅰ组）、缺血再灌注组（Ⅱ组）、七氟醚预处理组（Ⅲ组）、七氟醚预处理加二甲基亚砜（DMSO）组（Ⅳ组）和七氟醚预处理加 c-Src 特异性抑制剂 SU6656组（Ⅴ组）。Ⅲ、Ⅳ、Ⅴ组于再灌注前1 min 进行七氟醚后处理;Ⅴ组于再灌注前5 min 静脉注射 SU6656;Ⅳ组给予等容量 DMSO。再灌注120 min 后,采集动脉血样,检测血清乳酸脱氢酶（LDH）、肌酸磷酸激酶同工酶（CK-MB）的活性。取小鼠心脏并分离左心室,计算心肌梗死面积;检测 Src、磷酸化 Src（p-Src）、心肌过氧化氢酶（CAT）、超氧化物歧化酶（SOD）的表达水平。结果与Ⅰ组比较,其余4组血清 CK-MB、LDH 的活性、心肌梗死面积、心肌 p-Src／Src、CAT、SOD 升高（P ＜0．05）;与Ⅲ、Ⅳ组比较,Ⅱ、Ⅴ组血清 CK-MB、LDH 的活性、心肌梗死体积、CAT 升高,SOD 活性降低,同时心肌 p-Src／Src 显著下降（P ＜0．05）。结论c-Src-活性氧（ROS）信号通路可能介导了七氟醚预处理减轻大鼠心肌缺血再灌注损伤作用。     

血清心肌酶及肌钙蛋白检测在肺栓塞中的应用研究

目的探讨血清心肌酶及肌钙蛋白检测在肺栓塞中的应用。方法回顾性分析58例肺栓塞病人心肌酶(AST、CK、CK-MB、LD、LD-1、α-HBDH)及肌钙蛋白T(cTnT)结果。结果 58例PE中肌钙蛋白T升高44例(占75.9%)。LDH升高38例(65.5%),AST、α-HBD升高各40例(69.0%);而CK、CK-MB升高10例(17.2%),大面积、次大面积肺栓塞与非大面积肺栓塞心肌酶及肌钙蛋白T改变有统计学差异。结论肺栓塞常伴有心肌细胞损伤,对该类患者应常规行血清心肌酶及肌钙蛋白T测定,血清心肌酶及肌钙蛋白T测定有助于危险分层。     

窒息新生儿心肌酶谱水平变化的临床分析

目的:通过测定不同程度、不同日龄窒息新生儿心肌酶谱水平的变化情况,了解窒息新生儿缺氧性心肌损伤的严重程度和临床意义,为寻找更客观、敏感地反应缺氧后心肌损害的指标提供理论依据,以利于临床及时地判断病情、指导治疗、改善预后。方法:采用全自动生化分析仪,选择58例窒息新生儿,分为两组,重度窒息组36例,轻度窒息组22例,分别于生后12 h内及生后第3天测定血清天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)活性,并将同期住院的无缺氧新生儿43例作为对照组进行比较分析。结果:窒息新生儿AST、LDH、CK、CK-MB、α-HBDH水平均有不同程度的升高,尤以CK-MB、AST较灵敏,且与缺氧程度呈正相关,生后第3天心肌酶水平大部分恢复,LDH水平恢复较慢。结论:血清心肌酶水平能较及时地反映窒息新生儿缺氧性心肌损伤的程度,生后第1天尽早测定其水平的变化,对判断病情、指导治疗有重要的临床意义。窒息后心肌损害为一过性,经及时复苏,保护心肌等治疗,心肌酶水平常在3 d内逐渐恢复,预后良好。     

参麦注射液佐治轮状病毒性心肌损害的疗效观察

目的：探讨参麦注射液治疗轮状病毒性心肌损害的临床疗效。方法：将本院儿科66例轮状病毒性肠炎并心肌损害患儿随机分为治疗组和对照组，两组均给予常规治疗，治疗组在常规治疗基础上加用参麦注射液。两组治疗前后检测心肌酶。结果：治疗后治疗组的心肌酶谱中CK—MB（19．09±6．64）、AST（24．41±9．99）、α-HBDH（122．56±31．64）各值均明显低于对照组（CK—MB为26．50±8．09，AST为36．69±14．79，α-HBDH为180．06±59．80），差异有统计学意义（P〈0．05）。结论：参麦注射液佐治轮状病毒性心肌损害疗效好，不良反应少。     

手足口病患儿血清心肌酶和超敏C反应蛋白的临床应用

目的探讨心肌酶和超敏C反应蛋白(hs-CRP)在手足口病患儿血清中的变化规律及其诊疗价值。方法应用日立7600全自动生化分析仪检测50例手足口病患儿的血清心肌酶和hs-CRP,并与30名健康体检儿童作对照。结果手足口病患儿乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶、α-羟丁酸脱氢酶和hs-CRP在血清中的含量分别为(350.98±82.52)U/L、(177.36±130.29)U/L、(40.74±9.91)U/L、(281.14±68.05)U/L和(23.74±22.65)mg/L,异常率分别为52.0%、14.0%、56.0%、24.0%和76.0%,均高于对照组,差异有统计学意义(P0.05)。结论及时检测手足口病患儿血清心肌酶和hs-CRP能尽早发现其心肌损伤情况,指导临床诊疗。     

两种不同麻醉方法对老年高血压患者心血管相关因素的影响

目的比较全麻与硬膜外麻醉复合全麻两种不同的方法对老年高血压患者围术期血清肌酸激酶（CK）和肌酸激酶同工酶（CK-MB）等心血管相关因子的影响。方法上腹部择期手术老年高血压患者60例,ASAⅡ～Ⅲ级,随机分成丙泊酚靶控输注全麻组（P组,n=30）与硬膜外麻醉复合丙泊酚靶控输注全麻组（PE组,n=30）。记录麻醉前（T0）、术毕（T1）、术后6 h（T2）,24 h（T3）,48 h（T4）的血压、心率,并检测血清CK、CK-MB、乳酸脱氢酶（LDH）、谷草转氨酶（AST）及心肌肌钙蛋白-Ⅰ（cTn-Ⅰ）的变化。结果与T0比较,PE组各时点血压显著降低;P组舒张压显著增高,T1～T4时点显著高于PE组（P〈0.05或0.01）。与T0比较,两组T1～T4时CK均显著增高,T3、T4时P组显著高于PE组（P〈0.05或0.01）。T2时P组CK-MB显著高于PE组（P〈0.05）。与T0比较,两组T1～T3时LDH显著增高（P〈0.05或0.01）。P组AST在T1～T4时和PE组在T3时显著增高（P〈0.05或0.01）,T2时P组显著高于PE组（P〈0.05或0.01）。与T0比较,P组T1～T4时点cTn-Ⅰ显著增高（P〈0.05或0.01）,PE组T1时显著降低（P〈0.05）,T1、T3时P组cTn-Ⅰ显著高于PE组（P〈0.05或0.01）。结论与全麻比较,硬膜外麻醉复合全麻用于老年高血压患者非心脏手术时更能够减少围手术期心肌的损害。     

手足口病患儿血清心肌酶变化及其临床意义

目的研究手足口病（Hand,foot and mouth disease,HFMD）患儿血清心肌酶的变化,以便在诊治过程中采取综合措施。方法选择HFMD患儿110例,其中轻症80例,重症30例。另选22例健康儿童作为对照组。采用OlympusAU 2700型全自动生化分析仪测定HFMD患儿急性期、恢复期及对照组儿童血清天门冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）、α-羟丁酸脱氢酶（α—HBDH）、肌酸激酶（CK）及其同功酶（CK—MB）等多项心肌酶指标。结果与对照组相比,轻症及重症HFMD组患儿血清AST、LDH、α—HBDH、CK、CK—MB水平均明显升高（P〈0．01）。重症HFMD组上述指标明显高于轻症HFMD组（P〈0．01）。与急性期相比,恢复期心肌酶指标均趋向正常水平。结论婴幼儿HFMD血清心肌酶有不同程度升高,病情越重,心肌酶升高越明显。     

急性白血病患者血清乳酸脱氢酶与α-羟丁酸脱氢酶变化的临床意义

目的研究血清乳酸脱氢酶(LDH)与α-羟丁酸脱氢酶(α-HBDH)的变化与急性白血病(AL)患者疗效、预后的关系。方法用全自动生化分析仪检测56例初发或复发AL患者治疗前后血清LDH与α-HBDH浓度。同时纳入健康体检者35例为健康对照组,观察比较2组LDH、α-HBDH含量。结果AL患者血清LDH及α-HBDH初发或复发时明显增高,与健康对照组比较差异有非常显著统计学意义(P<0.01);治疗后达完全缓解与部分缓解者LDH和α-HBDH含量下降,治疗前后比较差异有统计学意义(P<0.01);复发后较复发前有明显上升(P<0.01);外周血幼稚细胞绝对数与血清LDH和α-HB-DH含量呈正相关(r值分别为0.5587和0.5411,P<0.01)。结论动态检查血清LDH及α-HBDH变化有助于监测AL患者的病情变化,高水平血清LDH及α-HBDH提示预后差。     

不同创伤严重程度的多发伤患者血清心肌酶谱指标水平变化及对MODS中心功能障碍的预测价值

目的 探讨不同创伤严重程度的多发伤患者血清心肌酶谱指标［乳酸脱氢酶（lactate dehydrogenase,LDH）、天冬氨酸转氨酶（aspartate aminotransferase,AST）、肌酸激酶同工酶（creatine kinase isoenzyme,CK-MB）、肌酸激酶（creatine kinase,CK）］水平变化及对多器官功能障碍综合征（multiple organ dysfunction syndrome,MODS）中心功能障碍的预测价值。 方法 选择多发伤患者67例,根据多发伤患者入院创伤危重评分（injury severity score,ISS）标准将其分为轻度多发伤组（20例）、中度多发伤组（26例）及重度多发伤组（21例）;并根据MODS标准,将其分为MODS组及非MODS组。比较创伤后第1、2、3天重度多发伤组、中度多发伤组及轻度多发伤组LDH、AST、CK-MB、CK水平。比较创伤后第1、2、3天MODS组及非MODS组LDH、AST、CK-MB、CK水平比较。采用Spearman秩相关分析LDH、AST、CK-MB、CK与多发伤患者病情严重程度、多发伤患者合并胸腹部位、多发伤患者伴MODS中的心功能障碍的相关性。分析LDH、AST、CK-MB、CK对多发伤患者伴MODS中的心功能障碍的预测价值。 结果 重度多发伤组APACHEⅡ评分、MODS例数及MODS评分高于中度多发伤组及轻度多发伤组,中度多发伤组APACHEⅡ评分、MODS例数及MODS评分高于轻度多发伤组（P＜0.05）。创伤后第1天、第2天、第3天,重度多发伤组、中度多发伤组、轻度多发伤组LDH、AST、CK-MB、CK水平均呈逐渐降低趋势,重度多发伤组LDH、AST、CK-MB、CK水平均高于中度多发伤组、轻度多发伤组,中度多发伤组LDH、AST、CK-MB、CK水平均高于轻度多发伤组;MODS组和非MODS组LDH、AST、CK-MB、CK水平均呈逐渐降低趋势,MODS组LDH、AST、CK-MB、CK水平均高于非MODS组,组间、时点间、组间·时点间交互作用差异有统计学意义（P＜0.05）。采用 Spearman 秩相关分析结果显示,第1天、第2天、第3天,LDH、AST、CK-MB、CK水平与多发伤患者病情严重程度、多发伤患者合并胸腹部位呈正相关、多发伤患者伴MODS中的心功能障碍均呈正相关（P＜0.05）。第1天,多发伤患者伴MODS中的心功能障碍ROC曲线显示,LDH、AST、CK-MB、CK对多发伤患者伴MODS中的心功能障碍有预测价值（P＜0.05）。 结论 血清心肌酶谱指标水平随多发伤患者病情加重而升高,其与多发伤患者创伤严重程度、胸腹部位及发生MODS中的心功能障碍呈正相关,且是多发伤患者发生MODS中的心功能障碍的危险因素。     

心肌梗塞后伴发室性心律失常的程度与心室晚电位的关系

目的：观察心肌梗塞后伴发的室性心律失常与心室晚电位之间的关系。方法：采用高频心电检测仪记录４１例心肌梗塞后病人的体表心室晚电位，并于心室晚电位检查前或后一周内行２４小时动态心电图检查，用于评价室性心律失常的程度。结果：室性早搏Ｌｏｗｎ分级大于或等于Ⅲ级的病人和Ｌｏｗｎ分级Ⅰ Ⅱ级的病人比较，其ＱＲＳＴ、Ｄ４０显著延长而Ｖ４０明显降低（Ｐ＜０．０５及Ｐ＜０．０１）。Ｌｏｗｎ分级大于或等于Ⅲ级组的心室晚电位阳性检出率要显著高于Ｌｏｗｎ分级Ⅰ Ⅱ级组和未检出室性早搏组。Ｌｏｗｎ分级Ⅰ Ⅱ级组和未检出室性早搏组比较，二者的心室晚电位阳性检出率无显著差异。结论：室性早搏的严重程度反映了心肌梗塞后心肌缺血或心脏电生理改变的程度。