选择性部位起搏对左室收缩同步性的影响

目的 应用二维斑点追踪成像超声技术,通过计算起搏后左室各节段收缩时间的差异,比较右室心尖(RVA)起搏与右室流出道(RVOT)间隔起搏时对左室收缩同步性的影响.方法 入选符合起搏器植入适应证的患者60例,随机分为RVA组30例,RVOT组30例.RVA组患者右室电极植于右室心尖部,RVOT组患者右室电极植于右室流出道间隔部.所有患者术后程控心室电极100％起搏,应用二维斑点追踪成像技术,测量左室径向应变达峰时间的差异.结果 RVA组起搏后,左室6节段径向应变达峰时间的最大差、标准差分别为105.27士19.74 ms、42.71±17.63 ms;RVOT组起搏后6节段径向应变达峰时间的最大差、标准差分别为41.65±-12.17 ms、17.63±5.62 ms,两组比较各指标均有差异(P＜0.01).结论 RVOT间隔部起搏后的左室收缩同步性优于RVA起搏.     

右室不同部位起搏对二尖瓣功能的影响

目的比较右室心尖部（RVA）起搏与右室流出道间隔部（RVOT）起搏对二尖瓣功能的影响,探讨间隔部起搏的临床益处。方法选取因Ⅲ度或高度房室传导阻滞植入起搏器患者72例,随机分成RVA组40例和RVOT组32例,观察两组术前及术后6个月左室射血分数（LVEF）、左室舒张末期内径（LVDd）以及二尖瓣功能变化。结果术后6个月,RVA组LVEF较术前明显降低,而RVOT组与术前相比无明显变化,两组LVDd与术前相比均无明显变化。RVA组新发反流及反流加重比率较RVOT组明显增加。结论与RVA起搏相比,RVOT起搏对二尖瓣功能及左室功能影响较小,是安全有效的起搏部位。     

V3转换流出道室性心律失常的体表心电图定位

目的通过体表心电图定位室性早搏起源已有不少报道,但关于R/S转换在V3导联的左右定位报道较少,文中报道V3转换的特发性流出道室性心律失常(ventriculararrhythmia,VA)的体表心电图定位特征,进而指导射频导管消融。方法回顾性分析207例连续接受射频消融治疗、术中经电生理检查及心室造影证实起源于左心室流出道(left ventricle outflow tract,LVOT)或右心室流出道(right ventricle outflow tract,RVOT)患者体表心电图特点,胸前导联R/S转换在V3的VA患者75例,包括室性心动过速(ventricular tachycardia,VT)8例、特发性流出道频发室性早搏(premature ventricular contractions,PVCs)67例,均无器质性心脏病。结果 75例V3转换患者中,22例V2转换晚于窦性心律均起源于RVOT,VA时V2转换晚于窦性心律提示起源于RVOT的特异度、灵敏度、阳性预告值、阴性预告值分别为100%、32.35%、100%、13.21%。结论 V3转换的流出道VT/PVCs,V2转换晚于窦性心律时提示起源于RVOT的特异性与阳性预告值均高。     

体表心电图不同指标在预测流出道室性心律失常起源部位中的价值

目的：分析不同的体表心电图指标在鉴别流出道室性心律失常（OTVA）起源部位中的价值。方法：连续入组98例消融成功、靶点明确的OTVA患者,其中74例起源于右室流出道（RVOT）,另24例起源于左室流出道（LVOT）,术前记录标准12导联心电图,测量并计算胸导联移行区指数（TZI）、V2移行比率以及V2S/V3R指数,比较3种不同的心电图指标预测流出道室性心律失常起源部位的准确性。结果：V2S/V3R指数的ROC曲线下面积（AUC）最大,其敏感性及特异性（85.9%、94.3%）均优于V2移行比率（70.3%、90.1%）及胸导联移行指数TZI（62.5%、89.5%）。在心脏转位的亚组中,胸导联移行指数TZI预测价值最高,其敏感性、特异性及准确性分别为80%、93%、91%。在V3导联R/S移行的亚组中,V2移行比率预测价值最高,其敏感性、特异性及准确性分别为75%、66%、67%。结论：不同的心电图鉴别指标可相互补充以提高术前判断OTVA起源部位的准确性。     

特发性室性心动过速及室性早搏的射频消融治疗

目的：探讨特发性室性心动过速（IVT）的射频消融（RFCA）治疗效果。方法：对3例左室特发性室速（ILVT）、2例右室流出道室速（RVOT）及3例右室流出道室性早搏，分别采用激动顺序标测法及起搏标测法行射频消融治疗。结果：所有患者术中均成功消融室速或室早，术后随访3个月－2年，无一例复发。结论：射频消融治疗特发性室速或室早是安全、有效且成功率高的一种方法。     

不同部位起搏对心室间电机械同步性的对比观察

目的 比较右室心尖部(RVA)、右室流出道间隔部(RVS)和左室流出道间隔部(LNS)起搏对心室间电机械同步性的差异,评价出保持心室间电机械同步的理想起搏部位.方法 选择2008年1-12月在我院行射频消融术(左侧隐性旁道)后患者30例,术后分别将标测电极放置于左室后侧壁(LVPLW)及右室前侧壁(RVALW),大头消融电极依次放置于RVA、RVS、LVS起搏.通过测量起搏点至LVPLW及至RVALW的传导时间差来反映心室间电激动的同步性,不同部位起搏主动脉射血前间期(APEI)与肺动脉射血前间期(PPEI)差来反映心室间机械收缩同步性,并比较两者相关性.结果 RVA起搏时至LVPLW及至RVALW的传导时间差为(34±7)ms,RVS起搏为(18±4)ms,LVS为(12±4)ms,差异有统计学意义(P＜0.01).RVA起搏APEI-PPEI绝对值为(25±5)ms;RVS起搏为(13±4)ms,LVS为(11±3)ms,差异有统计学意义(P＜0.01).心室起搏后,LVPLWRVALW差值变化与APEI-PPEI绝对值增加呈正相关(r=0.993,P＜0.01).LVS起搏后主动脉压[(127±23)mm Hg]和左室收缩末压[(142±22)mm Hg]明显增加(P＜0.05),左室舒张压显著降低[(9±3)mm Hg,P＜0.05].结论 LVS起搏对心室间电机械同步性影响小,更符合生理性的起搏,心室间电激动与机械收缩同步相一致.

Abstract：

Objective To compare the different impacts of right ventricular apex, right ventricular outflow tract septum and left ventricular outflow tract septum region on interventricular electro-mechanical synchronization and assess the ideal pacing sites for maintaining the interventricular electro-mechanical synchronization. Methods A total of 30 patients without organic heart disease were operated with radiofrequency ablation at our hospital. The mapping electrodes were implanted post-operatively on the left ventricular posterior wall (LVPLW) and right ventricular anterior lateral wall (RVALW) respectively. And the ablation electrodes were placed subsequently in right ventricular apex, right ventricular outflow tract septum region and left ventricular outflow tract septum. The difference values were measured between transmission time from pacemaker to LVPLW, from pacemaker to RVALW and between aortic pre-ejection interval (APEI) and pulmonary artery pre-ejection interval (PPEI). Then their correlations were compared. Results When pacing at right ventricular apex, the difference value between transmission time from pacemaker to LNPLW and from pacemaker to RVALW was (34±7)ms. And it was (18 ±4)ms while pacing at right ventricular outflow tract septum region and ( 12 ± 4)ms at left ventricular outflow tract septum region. There was significant difference (P＜0.01). The absolute value of APEI-PPEI was (25 ±5) ms at right ventricular apex, (13±4) ms at right ventricular outflow tract septum region and (11±3) ms at left ventricular outflow tract septum region. And there was significant difference (P ＜0. 01 ). The absolute value of APEI-PPEI was positively correlated with the change of LNPLW-RVALW (r= 0. 993, P ＜ 0. 01 ). Left ventricular outflow tract septum pacing showed ABp and left ventricle end-systolic pressure significantly increased [(127±23) mm Hg, (142±22) mm Hg,P ＜0.05], left ventricular end-diastolic pressure was significantly lower [(9±3) mm Hg, P ＜ 0. 05]. Conclusion Compared with right ventricular apical pacing and right ventricular outflow tract ventricular septal pacing, left ventricular outflow tract septum has a smaller impact on the electro-mechanical synchronization. It conforms more closely to the physiological pacing so that there is a higher synchronization of electrical and mechanical ventricular contractions.     

单导管法射频消融顽固性右心室流出道室性早搏

目的:探讨只用1根大头导管射频消融治疗顽固性右室流出道室性早搏(室早)的临床意义。方法:选择右室流出道顽固性室早患者105例,男46例,女59例,年龄22～65岁,平均(39.3±10.9)岁,病史3～14年,平均6.8年,其中3例合并有右室流出道室速,有1例为双源性右室流出道室早,均无器质性心脏病。多种抗心律失常药物无效。体表心电图确定为右室流出道室性早搏,采用1根大头电极以起搏标测法确定消融靶点。以室性早搏在放电后消失为消融成功。结果:消融即刻成功率为100%,随访半年无一例复发,亦无其他任何并发症。结论:单导管消融顽固性右室流出道早搏安全有效。     

导管消融治疗肺动脉瓣上起源的室性早搏

 目的  分析肺动脉瓣上起源的室性早搏(premature ventricular contractions,PVCs)心电图特征和导管消融经验。 方法 回顾性分析4例在华山医院成功行导管射频消融治疗肺动脉瓣上起源PVCs的资料。 结果 体表心电图平均QRS波宽度为(151±3)ms(146~154 ms),下壁导联振幅之和的平均值为(4.79±0.93)mV(3.76~5.64 mV)。3例下壁导联中Ⅲ导联振幅最高,2例avL/avR导联的QS比值大于1,3例胸导联移行为V4导联。2例标测过程中出现两种流出道起源图形的PVCs。4例成功导管射频消融靶点经造影证实位于肺动脉瓣上,肺动脉瓣上双极靶点电图领先体表心电图QRS波起点平均为(24±3)ms(22~28 ms),4例患者均消融即刻获得成功,无消融相关并发症发生,远期随访中位数22个月无复发。结论 手术过程中出现多种右室流出道起源形态的PVCs要高度注意肺动脉瓣上起源可能,采用导管消融肺动脉瓣上起源PVCs安全、有效。       

单导管消融顽固性室性早搏伴室性心动过速1例体会

射频消融治疗右室流出道室性早搏(室早)或室性心动过速(室速)是一种安全有效的根治性治疗方法,消融手术时需常规置入RV,CS,RVOT-His等标准标测电极和大头消融电极,多电极导管置入带来的并发症较多,近年来报道以单导管消融RVOT室速的病例逐渐增多.现将我们单用大头电极成功标测消融RVOT顽固性室早并室速1例报告如下.     

射频消融治疗起源心室流出道室性早搏

目的:报道起源心室流出道频发室性早搏的导管射频消融治疗结果。方法:采用起搏标测与激动顺序标测结合的方法对23例非器质性心脏病患者频发室性早搏行射频消融治疗。结果:19例室早起源右室流出道,其中间隔部为13例,游离壁6例;4例室早起源于左室流出道,2例为左冠状动脉窦口内,2例为流出道主动脉瓣下。21例患者消融一次成功,平均放电(4.6±3.3)次。2例患者为二次消融成功。24h动态心电记录术前、术后室早总数为(20846±3288)次/24h和(102±62)次/24h(n=16,P<0.001),临床症状基本消失,无并发症,平均随访(12±4.5)个月。结论:起源心室流出道频发药物治疗无效的室性早搏可选择导管射频消融治疗。     

深呼吸时P—R间期,P—P间期变化的临床意义

目的：通过深呼吸心电图试验,探讨观察心脏自主神经功能的无创性方法。方法：１０９名健康成人,描记１２导联心电图,在Ⅱ导联上分别描记平卧平静呼吸、深呼吸时心电图。分析Ｐ－Ｒ间期、Ｐ－Ｐ间期的变化。结果：深吸气时Ｐ－Ｒ间期、Ｐ－Ｐ间期均较平静呼吸缩短,深呼气时Ｐ－Ｒ间期、Ｐ－Ｐ间期均较平静呼吸时延长,均Ｐ〈０．０１。结论：呼吸时Ｐ－Ｒ间期、Ｐ－Ｐ间期的变化可为评价心脏自主神经功能提供参考依据。     

健康人T波峰末间期及其离散度调查

目的 观察健康人T波峰末间期(TpTe)及其离散度和心率校正的TpTe(TpTe/√RR)及其离散度,分析TpTe和心率的关系,为临床进行TpTe 的研究提供适用的正常对照值.方法 选取1012名健康体检者,其12导联心电图T波在Ⅱ、Ⅴ3、Ⅴ4和Ⅴ5导联直立,终末部清晰可辨.分别测量标Ⅱ、V3、V4和V5导联QT间期、QTP间期(自QRS波群起点至T波最高点的时间),计算TpTe(TpTe = QT间期 - QTP间期)和TpTe 离散度,TpTe /√RR及其离散度.相关分析探究TpTe与心率的关系.结果 ① TpTe 各导联总均值为(84±10)ms,95%可信区间为64.87~103.71 ms.标Ⅱ导联TpTe 最短为(82±10)ms,Ⅴ4、Ⅴ5导联TpTe 相等且最长为(85±10)ms,标Ⅱ导联与Ⅴ3导联及Ⅴ4、Ⅴ5导联比较差异均有统计学意义(q=7.98,P＜0.01;q=8.07,P＜ 0.01),而Ⅴ3导联与Ⅴ4、V5导联比较差异无统计学意义(q=0.09,P＞0.05).TpTe离散度为(4±7)ms,95%可信区间为10.49~17.92 ms.TpTe及其离散度各导联性别和年龄组间差异均无统计学意义(P＞0.05).②TpTe/√RR各导联总均值为(92±12)ms,95%可信区间为69.07~114.47 ms.标Ⅱ导联TpTe/√RR最短为(89±11)ms,Ⅴ4、Ⅴ5导联TpTe/√RR相等且最长为(93±11)ms,标Ⅱ导联与Ⅴ3导联及Ⅴ4、Ⅴ5导联比较差异均有统计学意义(q=7.70,P＜0.01;q=7.58,P＜0.01),而Ⅴ3导联与Ⅴ4、Ⅴ5导联比较差异无统计学意义(q=0.124,P＞0.05).TpTe/√RR离散度为(4±8)ms,95%可信区间为11.95~19.64 ms.TpTe/√RR及其离散度各导联性别和年龄组间差异均无统计学意义(P＞0.05).③ 随着心率从60~100次/min渐次增快,QT间期逐渐缩短,二者呈显著负相关(r=-0.599,P＜0.01),而TpTe却无明显变化,与心率无相关性(标Ⅱ导联:r=-0.102,P＞0.05;Ⅴ3导联:r=-0.077,P＞0.05; Ⅴ4 =Ⅴ5导联:r=-0.084,P＞0.05).结论①得到了健康人TpTe及其离散度和TpTe/√RR及其离散度的参考值;②在正常心率范围,TpTe不受心率快慢的影响,不必进行心率校正. Abstract： Objective To investigate on the Tpeak-Tend interval (TpTe), the TpTe dispersion, the heart rate-corrected Tpeak-Tend interval (TpTe/√R-R), the TpTe/√R-R dispersion, and the relationship between the heart rates and the TpTe in healthy people. Methods One thousand and twelve healthy individals with T wave being positive and T wave end point being clear in limb leads Ⅱ and in chest leads Ⅴ3, Ⅴ4 and Ⅴ5 were included. 12 leads electrocardiogram was taken. QT interval and QTP interval (the distance from QRS complexs starting point to T wave end point) was measured in limb leads Ⅱ and in chest leads Ⅴ3, Ⅴ4 and Ⅴ5. TpTe (TpTe = QT interval - QTP interval ), TpTe dispersion, TpTe/√R-R and the TpTe/√R-R dispersion was calculated. The linear correlation was used to analyse (84±10)ms,95% confidence interval was 64.87-103.71 ms. TpTe was the shortest in lead Ⅱ [(82±10) ms] and the longest in chest leads V4 and Ⅴ5[Ⅴ4=Ⅴ5=(85±10) ms]. TpTe in lead Ⅱ was significantly shorter than those in lead Ⅴ3 and in leads Ⅴ4,V5(q=7.98,P＜0.01;q=8.07,P＜0.01). But TpTe was no significant different between lead Ⅴ3 and leads Ⅴ4,V5(q=0.09,P＞0.05). The TpTe dispersion was (4±7)ms,95% confidence interval was 10.49-17.92 ms. TpTe and the TpTe dispersion TpTe/√RR and the TpTe/√RR dispersion were (92±12) ms (69.07-114.47 ms, 95% confidence interval) and (4±8) ms(11.95-19.64 ms), respectively. TpTe / √RR was the shortest in lead Ⅱ [(89±11)ms] and the longest in chest leads Ⅴ4 and Ⅴ5[Ⅴ4 =Ⅴ5=(93±11) ms]. TpTe/√RR in lead Ⅱ was significantly shorter than those in lead Ⅴ3 and in leads Ⅴ4,V5(q=7.70,P＜0.01;q=7.58,P＜0.01). But TpTe / √RR was not significantly different between lead Ⅴ3 and leads Ⅴ4,V5(q=0.124,P＞0.05). TpTe/√RR and the TpTe/√RR dispersion were not obviously different in both sexes and the QT interval and there were no correlation between the heart rates and TpTe was identified in healthy people with the heart rates from 60 to 100 beats is not necessary that TpTe was corrected by the heart rates, when the heart rates are increasing from 60 to 100 beats per minute.     

急性心肌梗塞患者QT离散度和JT离散度的动态变化

目的 观察急性心肌梗塞患者QT离散度（QTd)和JT离散度（JTd)的动态变化,并探讨其临床意义。方法 在发病48h内、第7天、第21天分别对52例病人行12导联心电图检查,必要时加做右胸及V7－9导联,按QTd=QTmax-QTmin,JTd=JTmax-JTmin计算。结果 与48h内相比较、第7、21天QTd和JTd值明显降低,差异有极显著性;第7、21天QTd和JTd值明显比较,差异无显著性。QT离散度和JT离散度在心律失常组与无心律失常组间差异有显著性,猝死组QTd和JTd增加,QTd和JTd在预测急性心肌梗塞发生室性心律失常及预后具有重要临床应用价值。     

Birth interval and pregnancy outcome

615 Kenyan women who had experienced 2407 pregnancies and 1792 birth intervals were interviewed who had delivered at the Kenyatta National Hospital during the months of June and July, 1985. Birth intervals that were 25-36 months long were associated with the most favorable pregnancy outcome. Poor pregnancy outcome was followed by very short birth intervals with more than 75% of the birth intervals being 24 months long or less. When no contraceptives were used 58% of the birth intervals were 24 months long or less compared with only 25.5% when contraceptives were used. Breastfeeding alone is not very effective in prolonging the birth interval since 33.4% of women resumed regular menstruation by 4-6 months when they are still breastfeeding. Only 31% of married women were abstinent by 3 months postpartum and therefore in this group of women abstinence played no role in prolonging the birth interval. It is apparent that the use of effective modern contraceptive methods, good obstetrics and neonatal care and adequate breastfeeding are the key measures that can ensure the optimum birth interval and hence the most favorable pregnancy outcome.     

医学生心电图各波时间、P─R间期、Q─T间期的研究

为了探讨青年人心电图各波时间与少儿（青春期少年，下同）及成人正常值的区别，我们通过对140名医学生（17～20岁）正常心电图各渡时间及P－R间期、Q－T间期的侧量和统计学处理，发现上述各量与少儿和成年人比较均有显著差别。医学生心电图P波时间、P－R问期的平均值及变化范围介于少儿和成人正常值之间；QRS波时间95％上下限比少儿正常值上下限高，下限比成人正常值下限低。结果证明，正常心电图各波时间、P－R间期随年龄增长而延长或有增加趋势。     

Prolongation of the QT interval by ketanserin

In hypertensive patients single doses of ketanserin 40 mg prolonged the corrected QT interval (QTc) for at least 8 hours, with a maximal increase of 35 ms (P less than 0.001, n = 6) after 2 hours. During chronic dosing (20 and 40 mg b.d.) the QTc was further prolonged, by 46 and 45 ms respectively. QTc prolongation after treatment with a mean dose of 73 mg/day for 7 weeks (n = 26) was significantly related to body weight (r = -0.58, P less than 0.01), and to the dose of ketanserin corrected for body weight (r = 0.63, P less than 0.01), but not to plasma concentrations of ketanserin, ketanserinol, potassium or calcium. High doses of ketanserin (mean dose 167 mg/day, n = 9) increased the QTc by 40 ms (P less than 0.001), with prolongation of up to 80 ms in individual patients. Treatment with ketanserin at doses proposed for clinical use (40-80 mg/day) may carry a risk of ventricular arrhythmias.     

“区间指纹图谱”的构思与研究

目前指纹图谱已成为国际公认的控制中药或天然药物质量的有效手段。近年来对中药指纹图谱进行了很多探索性研究,但是真正将指纹图谱作为质量标准的只有中药注射剂,而其他的中药指纹图谱研究多只停留在研究阶段。造成中药指纹图谱研究瓶颈的原因很多,如天然产物成分的复杂性,指纹图谱的分析结果中往往有大量的杂质峰群存在,而现有的分析手段很难使这些杂质峰群达到很好的分离,为此提出了构建“区间指纹图谱”。对“区间指纹图谱”构建程序、建立方法、构建模式、应用问题等进行了较全面地研究和分析,并以神安颗粒为例进行了分析。