犬心外膜脂肪垫在持续性心房颤动中的作用

目的 探讨心外膜重要结构心外膜脂肪垫在持续性心房颤动(房颤)维持中的作用及机制.方法 22只健康杂种犬,随机分为2组:12只犬通过心外膜快速起搏8周建立持续性房颤模型(A组),10只犬为假手术组(B组).分别刺激右前脂肪垫、下腔静脉-心房下部脂肪垫、左房背侧脂肪垫,采用心外膜标测技术比较刺激前后标测部位房颤周长变化.消融下腔静脉-心房下部脂肪垫后再次诱发房颤,重复刺激右前脂肪垫并记录刺激前后房颤周长变化.取A组和B组犬脂肪垫标本做组织学检查.结果 右侧入路诱发持续性房颤后,刺激右前脂肪垫,发现右上肺静脉、右下肺静脉和右肺静脉前庭房颤周长缩短(P＜0.05),右房顶与左房顶房颤周长无明显变化;刺激下腔静脉-心房下部脂肪垫,发现右上肺静脉、右下肺静脉和右肺静脉前庭房颤周长缩短(P＜0.05),右房顶与左房顶房颤周长无明显变化.左侧入路诱发持续性房颤后,刺激左房背侧脂肪垫,发现左上肺静脉、左下肺静脉和左肺静脉前庭房颤周长缩短(P＜0.05),左房顶与右房顶房颤周长无明显变化.下腔静脉-心房下部脂肪垫消融后,重复诱发房颤,刺激右前脂肪垫时右上肺静脉、右肺静脉前庭房颤周长缩短(P＜0.05),右下肺静脉房颤周长无变化.结论 持续性房颤犬右前脂肪垫、下腔静脉-心房下部脂肪垫和左房背侧脂肪垫3个脂肪垫通过诱发同侧肺静脉及其前庭快速激动来参与房颤的维持.在持续性房颤时右前脂肪垫主要影响右上肺静脉的房颤周长,并通过下腔静脉-心房下部脂肪垫来影响右下肺静脉;下腔静脉-心房下部脂肪垫对于右下肺静脉的影响要大于右上肺静脉.     

充分发挥学术期刊在全科医生培养中的作用

2002年9月,中华医学会主办并编辑出版的《中华全科医师杂志》创刊,是中华医学会推动我国全科医学发展和社区卫生服务,为我国医学事业培养高素质全科人才的具体行动;以“全科医师”为刊名,即体现了我刊以培养高素质的全科医生为己任.自创刊以来,我刊始终致力于在全方位培养全科医生中发挥专业媒体的作用.全科医生队伍的壮大及全科医生服务水平的全面提高,是全科医学学科发展和建设的最重要目标,《中华全科医师杂志》作为全科医学专业媒体在其中应有广阔的作用空间.今年值中华医学会成立一百周年,作为中华医学会系列杂志成员之一,《中华全科医师杂志》将依托中华医学会专家荟萃、学术领先的优势,继续在培养全科医生、探索学科方向、推动学科建设发展上发挥重要作用.     

全科医生在糖尿病社区防治中的作用

近年来,随着国民生活水平的日益提高,人们的生活方式也发生巨大转变,在这一过程中,很多人都患上了各种各样的慢性疾病,其中又以糖尿病的发病率居高.目前,糖尿病已被公认为是威胁人类健康的几种重大疾病之一.为此,加强对糖尿病的防治工作已经势在必行.基于此,本文就全科医生在社区糖尿病防治中的作用进行浅谈.     

社区癌症病人的综合管理

全科医生需了解影响癌症治疗的多种因素及多种治疗方法,以适应不同情况的患者。本文介绍了全科医生可采取的多种治疗对策,针对影响癌症患者康复的诸多因素,因人而异,综合,灵活采用,使患者有信心,有能力坚持治疗,从而改善其生存质量,延长寿命,乃至治愈。     

高校在全科医生培训中的作用之浅析

高等医学院校在全科医生的培养中起着举足轻重的作用,通过对全科医生的理论和实践培训,使高等医学院校的教育职能得到充分发挥。     

综合管理在减少院内感染中的作用

随着医学和现代医院的发展,医院感染问题变得日益严重和复杂。在医疗活动中,预防感染已是当务之急。据不完全统计,近几年全国有38起医院感染流行事件,而且有些事件是恶性的。比如某市发生的志贺氏痢疾流行及某两个市发生的柯萨奇B族病毒感染竟致36个婴儿死亡,给社会造成巨大的影响。1998年深圳市妇儿医院因戊二醛的配置错误未达到灭菌效果,自4月份至8月份发生以龟型分枝杆菌为主的混合感染168例,可以说性质严重、损失巨大、影响深远。从这些血的教训中,人们逐渐认识到,医院感染是影响医疗质量,增加病人痛苦,加大医疗经费开支,致病人非正常…     

全科医生在社区糖尿病防治中的作用

糖尿病是当前严重威胁人类健康的重要疾病之一,预防和控制糖尿病的发生、发展对提高全人群的健康具有重要意义。本文就全科医生在社区糖尿病防治中的作用加以论述。     

高等医学院校在全科医生培养中的地位与作用

加强全科医学教育，既顺应全球医学教育发展潮流，又与当前中国医疗卫生事业发展现状相适应，是中国医学发展的重要任务之一。本文从分析高等医学院校在全科医生培养中的突出地位和重要作用入手，对当前我国高等医学院校加快全科医生培养的原则进行初步探讨。     

移动智能终端在心房颤动的诊治应用中的研究进展

随着我国人口老龄化进程的不断进展,我国罹患心房颤动的人口数量也在逐年增加.随着互联网与智能化技术的不断发展,移动智能终端为心房颤动的诊治提供了全新的思路.本文系统阐述了目前用于心房颤动筛查的检查方法,归纳总结了近年来移动智能终端在心房颤动诊治应用中的研究进展,客观评价了移动智能终端在心房颤动领域中的临床应用价值及未来发...     

病案综合管理在医院管理中的作用

一、病案资料的收集:我院是本地区唯一规模较大的医院,床位420张,日均门诊量460人次,年出院病人数1.1444万次。为了提高我院病案资料的收集工作,每大科室有专人负责到各科室回收出院病案及日报,做到工作日誌,病人入院日表、回收销号现场核对,及时催收,确保病案资料的及时性,真实性和完整性。     

Role of general practitioners in cancer management

In the scenario of increasing incidence of malignancies and lack of specialist centres, the role of general practitioners is increasing, especially in India. It is estimated that above 50% cancers are curable if they are detected early and treated in appropriate algorithm. Screening has got a major role in early diagnosis. Supportive care to alleviate the symptoms of cancer and its treatment is important for continuation of curative treatment and greater ailment-free survival. Psychological support, assurance and proper information to patients and family members and forming a healthy network between different levels of medical professionals can form the gateway to combat the disease.     

Contemporary approaches to managing atrial fibrillation: A survey of Australian general practitioners

Background

Recent attention to the management of atrial fibrillation (AF) and stroke prevention has emphasised the need to support the use of existing pharmacotherapy through available services and resources, in preference to using the new, more expensive, novel oral anticoagulants. In this regard, general practitioners (GPs) are at the core of care.

Aims

To survey Australian GPs regarding their approach to managing AF, particularly in relation to stroke prevention therapy, and to identify the range of services to support patient care.

Methods

A structured questionnaire, comprising quantitative and qualitative responses, was administered to participating GPs within four geographical regions of NSW (metropolitan, regional, rural areas).

Results

Fifty GPs (mean age 53.74±9.94 years) participated. Most (98 per cent) GPs regarded themselves as primarily responsible for the management of AF, only referring patients to specialists when needed. However, only 10 per cent of GPs specialised in “heart/vascular health”. Most (76 per cent) GPs offered point-of-care international normalised ratio (INR) testing, with 90 per cent also offering patient support via practice nurses and home visits. Overall, key determinants influencing GPs’ initiation of antithrombotic therapy were: “stroke risk”/”CHADS₂ score”, followed by “patients’ adherence/compliance”. GPs focused more on medication safety considerations and the day-to-day management of therapy than on the risk of bleeding.

Conclusion

Australian GPs are actively engaged in managing AF, and appear to be well resourced. Importantly, there is a greater focus on the benefits of therapy during decision-making, rather than on the risks. However, medication safety considerations affecting routine management of therapy remain key concerns, with patients’ adherence to therapy a major determinant in decision-making.     

Emergency management of atrial fibrillation

Atrial fibrillation is the most common cardiac arrhythmia managed by emergency and acute general physicians. There is increasing evidence that selected patients with acute atrial fibrillation can be safely managed in the emergency department without the need for hospital admission. Meanwhile, there is significant variation in the current emergency management of acute atrial fibrillation. This review discusses evidence based emergency management of atrial fibrillation. The principles of emergency management of acute atrial fibrillation and the subset of patients who may not need hospital admission are reviewed. Finally, the need for evidence based guidelines before emergency department based clinical pathways for the management of acute atrial fibrillation becomes routine clinical practice is highlighted.     

血清半乳凝集素3 介导心房颤动机制的相关研究

目的 研究心房颤动（AF）患者血清半乳凝集素3（Gal-3）水平与心肌纤维化指标的关系,探 讨Gal-3 介导心房颤动的机制。方法 选取盛京医院心血管内科住院心功能正常的40 例房颤患者作为房颤 组,同期在选取本院20 例健康体检者作为对照组。采用酶联免疫吸附法（ELISA）检测患者血清中Gal-3、 转化生长因子β1（TGF-β1）、Smad3 蛋白及I 型前胶原羧基端肽（PICP）浓度;比较两组各指标差异,并 分别对Gal-3 与其他指标进行相关性分析。结果 与对照组比较,房颤组Gal-3、TGF-β1、Smad3、PICP 增 高（P <0.05）;房颤组Gal-3 与PICP、Gal-3 与TGF-β1、TGF-β1 与Smad3 及TGF-β1 与PICP 均呈正相 关（r =0.695、0.760、0.890 及0.829,均P =0.001）。结论 房颤患者血清Gal-3 及心肌纤维化指标水平增高, Gal-3 可通过加速TGF-β1/Smad3 信号通路的传导促进心肌纤维化,最终导致心房颤动的发生。     

Implementation of antithrombotic management in atrial fibrillation

The aim of the study was to assess the extent to which published recommendations on the antithrombotic management of atrial fibrillation had been adopted into clinical practice in a busy district general hospital, and the impact of clinical audit on subsequent management. In the initial audit, 185 consecutive patients with atrial fibrillation were studied using their case notes to identify any further clinical risk factors for stroke. A management algorithm stratified patients with atrial fibrillation into high, moderate, or low risk of stroke according to the individual stroke risk factors. For patients at high risk, the correct treatment is warfarin unless there are specific contraindications. For patients at moderate risk, the correct management is aspirin unless there are specific contraindications. Patients at low risk should receive no thromboprophylaxis. The clinical risks of stroke and thromboprophylaxis on discharge from hospital were recorded. An extensive education programme on stroke prevention in atrial fibrillation was undertaken. Six months later a further 185 consecutive patients with atrial fibrillation were audited. Overall, a large proportion (306/370; 83%) of patients were at high risk of stroke. In the initial audit, antithrombotic management was correct in 89 patients (48%). In the follow up audit, antithrombotic management was correct in 135 patients (73%) (p < 0. 00001). If this improvement in management were extrapolated to all hospital patients in the United Kingdom, approximately 1400 strokes/year could be avoided. Despite broad consensus in recent publications, antithrombotic management of atrial fibrillation remains imperfect, with many patients exposed to unnecessarily high risk of stroke.     

数字化综合管理对射频消融术后心房颤动负荷及症状的影响

目的 评估数字化管理对射频消融术后患者心房颤动（以下简称房颤）负荷、胃肠道症状和睡眠质量的影响。方法 采用自身前后对照研究设计,选取2022年7月至11月于江苏省人民医院行房颤射频消融术的患者250例。纳入患者均接受数字化管理,应用48h单导联心电监护仪监测记录房颤负荷,采用胃肠道症状评定量表（gastrointestinal symptom rating scale,GSRS）评估胃肠道症状发生频率与严重程度,匹兹堡睡眠质量指数（Pittsburgh sleep quality index,PSQI）评估睡眠质量。结果 250例房颤患者,男154例,女96例,平均年龄（60.23±11.69）岁,阵发性房颤171例,持续性房颤79例。干预1个月后失访21例,最终纳入229例患者进行自身前后对照分析。结果显示,干预1个月后,患者房颤负荷显著低于术后3d（P<0.05）,未发生恶性心律失常;患者反酸、上腹部紧抽感、恶心呕吐、排气增多、稀便、排便紧迫感症状发生频率均显著下降,GSRS总分及腹痛、反流和腹泻评分均显著低于术后3d（P<0.05）;PSQI评分显著低于术后3d（P<0.05）。结论 数字化综合管理对降低房颤射频消融术后患者的房颤负荷、缓解整体胃肠道症状和睡眠障碍具有积极的促进作用。