胺碘酮治疗急性心肌梗死并发快速室上性心律失常临床疗效与安全性探讨

目的：评价胺碘酮治疗急性心肌梗死患者并发室上性心动过速（PSVT）或心房颤动（AF）的临床疗效与安全性。方法：28例AMI后并发PSVT（n=8）或AF（n=20）患者,静脉应用胺碘酮负荷量（75-150mg）后,继发静滴（0.5-1.0mg/min）维持,观察PSVT或AF转复窦律疗效及副作用。结果：22例患者（PSVT8例、AF14例）用药后24h内转复为窦律（78.6%）。7例曾出现低血压,均经用升压药或减少胺碘酮剂量后纠治,轻度头昏6例,呕吐3例,静脉炎2例。结论：胺碘酮治疗AMI并发PSVT和AF临床疗效良好,其副作用较少,安全性较好。     

飞行人员运动试验T波正常化心电图特点分析

目的探讨飞行人员运动试验T波正常化心电图特点厦临床意义，为其健康鉴定提供参考依据。方法时72名功能性T波改变的男性飞行人员进行活动平板运动试验，分析运动前、中、后12导联同步心电图和临床体检资料。结果48例（66．7％）随着运动负荷加大T波振幅逐渐增高，24例（33.3％）在低运动负荷时T波振幅反而较运动前低。持续3-5min后随运动负荷加大逐渐增高。T波在运动这次极量心率时恢复正常1例（14％），运动终止1min恢复正常6例（8．3％）、2min正常62例（86．1％）、3min正常3例（4．2％）。运动终止2min T波又转低平1例（1．4％）、3min转低平22例（30．6％）、4min转低平39例（54．2％）、5min转低平7例（9．7％），运动后6min T波仍呈正常直立3例（4．2％）。结论飞行人员无器质性心脏病和心肌缺血发作史，仅出现单纯运动性T波正常化无明确临床价值．但应注意与病理性T波改变相鉴别。     

缬沙坦治疗原发性高血压并阵发性心房纤颤的临床观察

目的：探讨缬沙坦对原发性高血压合并阵发性心房纤颤患者的治疗效果。方法：将35例合并阵发性心房纤颤的原发性高血压患者随机分成治疗组20例和对照组15例。两组均予常规降压治疗,治疗组加用缬沙坦80 mg/d,1周后依据血压变化将其剂量调整为80-160 mg/d。比较2组治疗前及治疗1年后左室重量、左房内径、P波离散度、夜间平均收缩压、A波最大速度和房颤平均持续时间的差异。结果：治疗1年后,治疗组左室重量、左室内径、A波最大速度和P波离散度均有明显改善（P均〈0.01）,而对照组无明显改善（P均〉0.05）;夜间平均收缩压在对照组和治疗组均明显下降（P均〈0.01）;治疗组房颤的平均持续时间缩短（P〈0.05）。结论：缬沙坦治疗原发性高血压合并阵发性心房纤颤能显著改善预测房颤发生的各项指标。     

射频消融治疗阵发性室上性心动过速303例分析

目的；回顾分析我院2006年303例阵发性室上性心动过速（PSVT）患者的电生理机制特点、射频消融术（RFCA）治疗的有效性与安全性。方法：入选我院近1a内的射频消融（RFCA）治疗阵发性室上性心动过速（PSVT）303例，均先行电生理检查确定PSVT的类型和消融靶点，并成功实施RFCA治疗。结果：经电生理证实，在303例PSVT患者中，房室折返性心动过速（AVRT）占53．14％、房室结折返性心动过速（AVNRT）45．54％、预激综合征14．85％，AVRT与AVNRT并存者占1．32％。RFCA治疗的总成功率100％，并发症发生率1．98％，其中气胸发生3例，心包填塞1例，假性动脉瘤1例，无一例因并发症死亡。结论：AVRT、AVNRT是PVST的主要机制。RFCA是治疗PSVT的有效方法。术者的熟练程度、消融靶点的位置、患者的配合等是减少术后并发症的主要因素。     

冠状动脉搭桥术后异常Q波误诊为急性心肌梗死3例分析

目的：探讨冠心病患者冠状动脉搭桥术（CABG）后心电图下壁Ⅱ、Ⅲ、AVF导联出现异常Q波的临床意义。方法：分析冠心病CABG成功者术后出现异常Q波3例患者术前、术后1周、2~3周、2个月及3个月等不同阶段12导联心电图的变化,并监测CABG术后心酶的变化。超声心动图观察心室室壁运动。结果：与术前心电图比较,术后第1周出现异常Q波和T波低平、双向,此后,异常Q波振幅逐渐减低,T波低平或双向的发生则持续到第2~3周后恢复到术前水平。监测CABG术后心酶的变化正常。超声心动图检查心室下壁运动无减弱。结论：CABG术后出现异常Q波并非合并急性下壁心肌梗死。     

胺碘酮与心律平治疗阵发性室上速的疗效观察

目的：比较胺碘酮与心律平静脉注射治疗阵发性室上性心动过速（PSVT）的临床疗效。方法：使用胺碘酮150mg、心律平70mg静注治疗PSVT各25例。首剂治疗无效者隔15-20分钟重复1次。结果：胺碘酮组23例PSVT发作终止，心律平组22例PSVT发作终止，都恢复窦性心律。两组复律成功率分别为92％和88％（P〉0．05）。结论：静注胺碘酮与心律平治疗PSVT疗效满意，可作为抢救PSVT患者的首选药物之一。     

食管心房调搏治疗阵发性室上性心动过速的价值

【目的】提高阵发性室上性心动过速（PSVT）治疗的疗效与安全性。【方法】对107例PSVT急诊患者分成食管心房调搏治疗组（调搏组）与药物治疗组（药物纽），并观察两组成功终止率，10min内PSVT终止率，终止人数内严重不良反应发生率。【结果】两组成功终止率无明显差异性（P〉0．05），调搏组10min内终止率显著高于药物组（P〈0．01），调搏组终止人数内严重不良反应发生率明显低于药物组（P〈0．05）。【结论】食管心房调搏治疗PSVT较药物治疗迅速、安全，值得临床推广。     

功能性消化不良600例胃电图变化分析

目的：通过胃电图检查探讨功能性消化不良（FD）患者胃肌电紊乱的发生率,证实胃动力异常在FD发生中的作用。方法：600例FD患者行餐前和餐后体表胃电图检查,对正常胃慢波百分比和胃电主功率两项参数进行分析。结果：根据正常胃慢波百分比,本组中胃电节律正常130例（21.7%）,胃动过缓390例（65.0%）,胃动过速80例（13.3%）和混合性胃电节律紊乱组100例（16.7%）。在胃电节律正常的FD患者中,43.1%（56例）存在餐后/餐前胃电主功率比异常。结论：胃动力异常在FD的发病机制中起有重要作用。     

肺癌患者手术治疗前后的细胞免疫功能指标变化

我们观察了59例原发性肺癌患者手术治疗前后细胞免疫功能指标变化，并与相同年龄、性别的正常人比较，现报道如和病理确诊的原发性肺癌患者；（2）确诊后未接受任何抗肿瘤治疗；（3）有手术切除适应证；（4）自愿接受各项实验室检查；（5）活动状态karnofsk评分（KPS）≥60分；（6）预期生存期〉12个月。排除标准：（1）心、肺、肾及骨髓功能异常；     

美托洛尔治疗阵发性室上性心动过速的疗效观察

目的观察并比较静脉用美托洛尔与维拉帕米转复阵发性室上性心动过速（PSVT）的有效性及安全性。方法2003年4月至2006年4月入选48例PSVT患者，分为两组，分别静脉用美托洛尔（25例）和维拉帕米（23例），观察转复疗效。结果美托洛尔组及维拉帕米组总有效率分别为80％和86％，差异无显著性意义（P〈0.05）。结论美托洛尔和维拉帕米均能有效、安全、快速地终止PSVT。     

心电图在肺栓塞诊断中的研究

目的 通过对肺栓塞及有相似临床表现的几组疾病心电图的对比,试图了解肺栓塞心电图的特点和心电图在肺栓塞诊断及鉴别诊断中的应用及意义.方法 共入选364例肺栓塞病例.其中肺栓塞组197例,对照组共167例.对照组分为:1组冠心病心力衰竭组70例,2组原发性高血压心力衰竭组47例,3组急性肺损伤/急性呼吸窘迫综合征组50例.对364例患者的心电图等临床资料进行分析.结果 肺栓塞组心电图出现电轴右偏、顺钟向转位、右束支传导阻滞、肺型P波、V1导联S波粗顿或挫折等与对照组相比明显增加,差异有统计学意义;S1Q3T3、胸前导联T波倒置出现的比率也是肺栓塞组最高,差异有统计学意义.结论 肺栓塞患者心电图的表现以右心负荷增加和反射性的冠状动脉缺血为主要表现;S1Q3T3可能是电轴右偏的表现;每一个指标的敏感性和特异性都难以承担诊断和鉴别诊断的重任;动态观察心电图对肺栓塞的诊断意义重大.     

Heart Rate During Spontaneous and Induced Paroxysmal Supraventricular Tachycardia

It is generally assumed that paroxysmal supraventricular tachycardia (PSVT) induced during invasive electrophysiological study reproduces the patient's spontaneous, clinical arrhythmia. Even in the absence of antiarrhythmic drugs, however, there may be significant differences in characteristics of the induced and spontaneous arrhythmias. We compared the heart rate of PSVT in 38 patients who had undergone electrophysiological study with induction of PSVT who also had a spontaneous episode of PSVT documented by transtelephonic ECG monitoring during a period when all antiarrhythmic drugs were withheld. The heart rate during spontaneous PSVT was faster than the heart rate of PSVT induced during electrophysiological study; the mean difference was 16 beats/min (P < 0.001). We conclude that heart rate of PSVT induced during electrophysiological study generally underestimates the heart rate of spontaneous PSVT in the antiarrhythmic drug-free state. This may be due to differences in the autonomic and hemodynamic states during spontaneous and induced arrhythmias.     

Electrocardiographic changes during migraine attacks

OBJECTIVES: To clarify whether electrocardiographic (ECG) changes can be identified during a migraine attack and to determine whether there are ECG differences between periods with and without headache. BACKGROUND: The clinical signs and symptoms of migraine point to involvement of the autonomic nervous system, and especially to disrupted regulation of the circulatory system and autonomic balance. This disruption may be more marked during a migraine attack. During a migraine attack, autonomic imbalance within the heart and its vessels conceivably may result in ECG abnormalities. METHODS: In 30 patients with migraine, the ECG variables of heart rate, abnormalities of rhythm, PR interval, QRS duration, corrected QT interval, T inversion, and ST-segment changes were recorded during migraine attacks and pain-free periods. RESULTS: Of the 30 patients studied during a migraine attack, 9 (30%) had one or more abnormalities of rhythm (including sinus arrhythmia, atrial premature contraction, and ventricular premature contraction), 20% had PR intervals greater than 0.20 seconds, 40% had corrected QT intervals greater than 0.44 seconds, 66% had T inversion, and 40% had ST-segment abnormalities. No patient had arrhythmia, PR intervals greater than 0.20 seconds, or corrected QT intervals greater than 0.44 seconds during a pain-free period. No differences were noted for ST-segment changes, T inversion, and total ECG changes between periods with and without headache, but both PR and corrected QT intervals were significantly longer during migraine attacks than during pain-free periods. CONCLUSIONS: We conclude that ECG abnormalities often are present during a migraine attack, and for most of these, particularly PR and corrected QT interval lengthening, these abnormalities will be absent or less prominent during pain-free intervals.     

高血压病的P波改变与左室舒张功能相关性研究

目的：研究高血压病的ＰＩ皮改变与左室舒张功能相关性,为早期估测高血压病的心功能变化提供依据,方法：对８７例高血压患者测量血压、描记标准１ ２导联心电图及进行超声心动图检查,对比Ｐ波指标正常与异常组的其他参数（包括血压、年龄、病程及左室舒张功能等）差异。计算Ｐ波指标与其他参数的相关系数。结果：Ｍａｃｒｕｚ指数、Ｐ波宽度及Ｖ１导联心房终末电势（ＰＴＦＶ１）异常分别为６６％、６０％和４８％,且高血压患者Ａ峰、Ａ／Ｅ比值升高。Ｍａｃｒｕｚ指数和Ｐ波宽度与Ａ峰、Ａ／Ｅ比值和病程正相关,ＰＴＦＶ１与Ａ／Ｅ比值负相关。结论：高血压病的Ｐ波异常是普遍存在的。它反映了左室舒张功能障碍。     

The acute effect of tropisetron on ECG parameters in cancer patients

OBJECTIVES: The 5-hydroxytryptamine 3 receptor antagonists, including tropisetron, ondansetron, granisetron, and dolasetron are agents used effectively for supportive care. They are used for the prevention and treatment of chemotherapy and radiotherapy-induced emesis. Despite their overall excellent safety profile, some electrocardiographic changes related to heart rate and repolarization were reported. Ondansetron, granisetron, and dolasetron were studied on this manner. But to our knowledge, there is no information about the cardiac side effects of tropisetron. In this study, we aimed to determine the acute effects of tropisetron on ECG parameters related to repolarization, heart rate, and systemic blood pressure. MATERIALS AND METHODS: Fifty-five cancer patients who received tropisetron for the prevention of acute chemotherapy-induced nausea and vomiting were enrolled into this single center, prospective study. Standard 12-lead ECG recordings were performed at baseline and 30 min after tropisetron (5 mg given over 1 min IV bolus) administration. P wave durations and corrected QT intervals were measured; P wave dispersion and QTc dispersion were calculated. RESULTS: In comparison with baseline, mean heart rate significantly decreased 30 min after administration of tropisetron. Tropisetron did not result in a significant change in P wave duration, corrected QT interval, P dispersion, and QTc dispersion. CONCLUSION: In this study, tropisetron did not show any ventricular and atrial arrhythmogenic effect because of repolarization abnormalities. Only it may cause a slight decrease in heart rate.     

心电监护在108例老年心血管患者拔牙中的应用研究

目的 研究心电监护在老年心血管患者拔牙中的应用。方法 采用便携式心电监护仪,对患者在麻醉前,麻醉后,术中,术后,术后10min,进行心率、血压、心电图的监测,将108例患者动态变化的数值进行记录、检验、统计、分析。结果108例患者均成功耐受拔牙,患者在术中的心率变化与麻醉前、术后10min相比均具有显著性差异(P<0.05)。患者的血压在术中与麻醉前或术后10min相比具有显著性差异(P<0.05)。108名患者在拔牙过程中,T波轻度改变的患者有15例(13.9%),T波严重改变的患者有45例(41.7%),T波改变的患者总人数占55.6%,所有患者在术后10min心电图恢复到术前水平。结论心电监护的引入可以很好的时刻观察患者术前、术中、术后心率、血压、心电图等方面各项指标的变化,有利于在治疗过程中将病人的不良反应控制在合理的范围内。     

心电图在急性肺动脉栓塞诊断中的价值

目的 评估心电图对急性肺动脉栓塞(肺栓塞)的诊断价值.方法 回顾性分析43例既往无心肺疾病的急性肺栓塞患者住院首次、溶栓后及出院前系列心电图变化.结果 ①入院时首次心电图:心动过速26例(60.47%),右束支传导阻滞10例(23.26%);V1导联和V1～V2导联、V1～V3导联、V1～V4导联、V1～V5导联、V1～v6导联T波倒置分别为34例(79.70%)、20例(46.52%)、12例(27.91%)、9例(20.93%)、7例(16.28%)和2例(4.65%);SⅠ＞0.1 mV、TⅢ倒置、QⅢ和SⅠQⅢTⅢ分别为23例(53.49%)、21例(48.84%)、27例(62.79%)和20例(46.52%).②溶栓后心电图:心动过速消失20例(76.9%),右束支传导阻滞消失4例(40%),胸前导联T波倒置加深4例,SⅠ变浅、QⅢ减小或消失、TⅢ倒置变浅或直立11例.③出院前心电图:心动过速消失;胸前导联T波直立数增加,ST段回基线,QⅢ进一步减小或消失,TⅢ倒置变浅或直立.结论 急性肺栓塞心电图变化多变,需动态观察并密切结合临床加以识别.     

原发性蛛网膜下腔出血患者心电图改变及其对预后的影响

目的探讨蛛网膜下腔出血（SAH）患者的心电活动变化,并比较不同预后患者的差别。方法回顾性分析2007年1月至2010年10月入住我院的87例SAH患者出现心电图（ECG）改变和相关临床资料。结果有50例出现ECG改变,发生率为57.47%,其中复极异常36例（73.47%）,传导异常5例（10.20%）,节律异常18例（36.73%）,病理性Q波3例（6.12%）;格拉斯哥预后评分（GOS）小于或等于3分者EEG改变明显高于GOS大于3分者。结论 SAH后ECG改变以复极异常为主,预后差者ECG改变更明显。     

脑心综合征病人临床分析及护理

目的:探讨脑心综合征的临床特征和护理。方法:结合文献,对143例脑心综合征病人的临床资料进行回顾性分析。结果:脑心综合征发生率为76.9%,意识障碍病人发病率最高。心脏损害主要表现为ST-T改变、心律失常和假性心梗样图形,以及心肌酶谱增高。结论:加强对急性脑血管病病人的心脏情况观察及护理,是预防脑心综合征病人心脏进一步损害的重要措施。     

Effects of Propafenone on Induction and Maintenance of Atrioventricular Nodal Reentrant Tachycardia

Electrophysiologic studies were performed in 10 patients with atrioventricular (A-V) nodal reentrant paroxysmal supraventricular tachycardias (PSVT), before and after intravenous administration of propafenone (1.5 mg/kg). All patients utilized an A-V nodal slow pathway for anterograde conduction and an A-V nodal fast pathway for retrograde conduction of the reentrant impulse. Propafenone depressed retrograde fast pathway conduction which was manifested by: 1) complete V-A block at all ventricular paced cycle lengths after propafenone in 3 cases; 2) increase in mean +/- SD of ventricular paced cycle length producing V-A block from less than 308 +/- 37 ms to 432 +/- 63 ms in the remaining 7 patients. Nine of the 10 patients had induction of sustained PSVT before propafenone. In 7 of the 9, PSVT could not be induced or sustained after propafenone, reflecting depression of the retrograde fast pathway conduction with either absence of atrial echoes (5 patients) or induction of nonsustained PSVT, with termination occurring after the QRS (2 patients). In 1 patient, single atrial echoes were induced before propafenone but none were noted after the drug. In only 2 patients was a sustained PSVT inducible after propafenone. In conclusion, propafenone inhibited induction of sustained A-V nodal reentrant PSVT in most patients, reflecting depression of retrograde A-V nodal fast pathway conduction.