人工生理性心脏起搏器的现代治疗功能

随着起搏器设计和工艺水平不断提高,心脏起搏作为一项诊断与治疗心血管疾病的重要技术得到了非常显著的发展.新一代的生理性心脏起搏器可感知体内生理、生化信息,并根据机体代谢需求自动调整起搏参数,模拟正常心脏电激动过程及顺序,可维持房室顺序收缩,增强房室收缩协调性,进行频率适应性起搏,限制心室率跟踪,防止起搏器介入性心动过速等,这些现代治疗功能可使起搏后的心脏更接近于生理状态,满足患者不同情况下的生理需要.生理性心脏起搏是目前人工心脏起搏的发展方向.     

动态起搏心电图自动分析

本文综述了起搏心电监护的发展过程及国内外现状，并结合起搏心电监护的内容，讨论了制约其自动分析技术发展的三个因素，并提出了相应的解决方法。     

经胸肌的临时心脏起搏方法的实验研究

目的：本文探讨一种新的体外临时心脏临时心脏起搏方法。方法：本项研究利用作者自行研制的起搏方式、起搏频率、起搏脉宽和起搏电流均可调的微机化多功能体外临时心脏起搏装置发送起搏信号；在雄性杂交犬的心前区的胸肌插入一根针状阴起搏电极，在它的背部靠近心脏的相关位置贴上一场阳性起搏电极；在实验雄性杂交犬的静脉注射异搏定５ｍｇ，５分钟后实验雄性杂交犬的自主心律突然停止；此时进行临时心脏起搏实验并观察起搏效果。结     

动态起搏心电图自动分析

本文综述了起搏心电监护的发展过程及国内外现状，并结合起搏心电监护的内容，讨论了制约其自动分析技术发展的三个因素，并提出了相应的解决方法。     

组织多谱勒在心脏起搏中的应用

自1958年第一台人工心脏起搏器植入人体以来，起搏器正越来越多的应用于心力衰竭、心电紊乱和部分非心电性心脏病治疗。为适应治疗不同疾病的需要，起搏模式从单一的单腔、非生理性起搏发展到双腔、双心室、生理性、频率适应性等多种起搏模式，这些起搏模式不仅对心电活动产生影响，也对心脏机械活动、     

起搏心电图计算机分析的几个问题

通过分析起搏心电图的复杂性 ,指出一般的Holter系统难以对起搏心电图进行分析 ,并在此基础之上提出起搏Holter分析系统。然后介绍了起搏心电图计算机分析的几个关键问题 :起搏脉冲检测、QRS检出、起搏脉冲与QRS的配对、起搏器过感知、低感知、起搏失败的检测。最后结合临床 ,分析了几种起搏器异常及起搏心电图表现     

胃肠道Cajal间质细胞起搏功能的研究进展

正正常的胃肠运动功能依赖于节律性的胃肠蠕动,这种规律性的蠕动目前主要认为与肠神经系统及众多的神经递质有关,但其具体的调控机制目前尚有争议,主要争论的焦点在于肠神经系统所释放的神经递质是否直接作用于平滑肌细胞~([1-2])。近年来,越来越多的研究发现,Cajal间质细胞(interstitial cells of Cajal,ICC)在胃肠动力调节方面扮演着至关重要的作用~([3])。因此,本文拟就从生理结构基础、起     

胃肠起搏

胃的肌电活动可从体表描记，其图形称胃电图（ＥＧＧ），在人胃，为３次／ｍｉｎ的正弦形慢波，如慢波上叠加快波，则可伴有与慢波呈１：１的收缩运动。慢波控制着胃蠕动的时间、频率、地点及扩布方向。ＥＧＧ异常时，常伴有消化道症状，如恶性、呕吐、饱胀等。ＥＧＧ可用于消化道功能性疾患的诊断。     

起搏心电图分析

由于起搏心电图的复杂性，使得HOLTER系统难以对其进行分析，为此提出新的起搏HOLTER分析系统硬件方案与软件算法、并加以实现。最后进行了临床测试。实践证明本研究在起搏脉冲检测、QRS波检出、起搏脉冲与QRS波的配对和起搏心电图的判定方面做了一定的创新。     

A microcomputer-based system to evaluate cardiac pacing for the treatment of tachycardias

A microcomputer-based pacemaker system for the evaluation of pacemaker treatment of tachycardia is described. The system may be used to study tachycardia initiation, tachycardia termination or a combination of the two. The software incorporates a visual display unit screen handling package which provides the user-system interface. System-patient interfacing is performed by a separate pacing and sensing unit which communicates with the computer via standard digital input/output lines. Several pacing options are available, selectable from a screen-displayed menu. Each selection also has an associated set of programmable parameters which may be adjusted, within allowed limits, to suit particular studies. Examples of the use of the system for tachycardia termination are given. The main programming language for the controlling software was Fortran IV. Some routines were necessarily written in assembly language. The system is useful for evaluation purposes and forms the basis of a cardiac pacemaker development tool.     

用扫描仪从生理波形记录纸提取生理信号数据的方法

本文以起搏心电图为例,介绍了一种既经济又简便的获取生理信号数据的方法.首先用通用扫描仪从已有的生理波形记录纸获得图形文件(如.bmp文件等),并用图形软件除去非波形的杂点,然后读取有关图形文件信息和波形信息,用平均的方法得到波形的位置坐标,经定标后,得到生理信号的电压值,适当放大后,以压缩格式存储为数据文件.如果由此过程得到的数据采样频率与数据库要求的采样频率不同,则经插值转换得到要求的采样频率.读取由此方法得到的数据文件,并画出波形,与原波形比较,较为一致,说明此方法可行.这种方法对于收集经过专家评审过的"权威"数据,建立数据库很有意义.     

主动固定电极在右室流出道间隔部起搏的临床研究

目的 评价主动固定电极在右室流出道间隔部起搏应用中的可行性和稳定性。方法 64例患者随机分为两组，每组32例，一组采用主动固定电极行右室流出道间隔部起搏。另一组应用被动电极行右室心尖部起搏，观察电极置人时X线曝光时间和心电图QRS波宽度，电极置人后随访观察起搏阈值、感知、阻抗．电极脱位及相关并发症。结果 主动固定电极组的X线曝光时间均长于被动固定电极（18．76±4．35 vs 9．03±3．23．P〈0．01），主动固定电极组的QRS波时限较被动固定电极组短（0．13±0．03 vs 0．16±0．04，P〈0．01）。术后随访1月两组间的起搏阈值、感知、阻抗均无差异，主动固定电极组未见电极脱位等并发症。结论 主动固定电极在右室流出道间隔部起搏中的应用是可行和稳定的。     

心力衰竭治疗新方法研究进展

心力衰竭治疗方法近年来发展较为迅速,出现了抗细胞因子治疗、基因治疗以及心脏起搏器治疗等新的治疗方法和技术。本文综述分析了这些心力衰竭治疗新方法的作用机制、疗效及其局限性,并对今后发展方向作出展望。     

Heart rate and body temperature sensitive diaphragm pacing

Two ways of rate control for diaphragm pacing are proposed. One is rate control using only the patients' body temperature (method I). The other is rate control by both the patients' heart rate and body temperature (method II). To test the effectiveness of these methods, a diaphragm pacemaker which can be controlled by both heart rate and body temperature has been developed. It was applied to nine mongrel dogs. The pacing rate is controlled by atrial blood temperature (method I) or by both heart rate and temperature (method II). The animal's metabolism was elevated by the administration of a pyrogenic drug. It was found that method I is not suited to rapid changes in metabolism; however, it is useful in extreme metabolic elevation. An animal's metabolism was supported by using method II in all ranges of metabolism. This method proved more effective than method I for rate-responsive diaphragm pacing.     

Effects of Different Right Ventricular Pacing Sites on QRS Duration in Patients Receiving Permanent Dual Chamber Pacemakers

Objective:To investigate the influence of different right ventricular (RV) pacing sites on QRS width, and to provide a potential reference site for permanent right ventricular pacing in patients implanted with permanent pacemakers. Pacing at the site with the shortest QRS duration may reduce the deleterious effects of RV pacing on LV function, and thus having beneficial effects on patient's outcome. Methods: All consecutive patients who were planned to have permanent pacemaker implantation for a ClassI or IIaindication atour departmentfromOctober 2010 toJuly2012 werescreened for the participation in this prospective, single center, non-randomized study. The baseline surface ECG was analyzed for QRS width and morphology, respectively. During the implantation procedure patients were transiently paced at different RV locations(right ventricular apex, right ventricular inflow tract [RVIT], mid septum, high septum and right ventricular outflow tract [RVOT]) before the lead was placed at its final position. During pacing at the different positions the surface 12-leads ECG was recorded. Based on the surface of ECG QRS duration and morphology of the different right ventricular pacing sites were analyzed and compared with baseline and to each other. Results: A total of 216 patients(39% female, mean age 69±13 years, higher degreeAV block 30.5%)wasenrolled in thestudy. Paced QRS duration wassignificantly different between all right ventricular pacing sites compared with the baseline ECG(baseline: 106 ms±21 ms; mean paced: 158 ms±16 ms; p0.001). RVA pacing showed the widest QRS(168 ms±16 ms). QRS duration with RVIT pacing was 166 ms±15 ms,and that with RVOT pacing was 165 ms±15 ms, respectively. QRS duration was not significantly different between these three positions. Mid-septal pacing showed the narrowest QRS(139 ms±19 ms) compared to all other pacing sites(p0.001). Pacing at the high-septum showed a broader QRS (153 ms±14 ms) than that pacing at the mid-septum. Compared to other right ventricular pacing sites, QRS morphology at the mid-septum was close to normal, and electrical axis was unchanged as compared to baseline. Conclusion: Pacing at different right ventricular sites showed the significant widening of QRS compared to baseline. The shortest QRS duration was seen with mid-septal pacing. Therefore, mid-septal pacing may have less deleterious effect on LV function compared to other RV pacing locations, which may be the optimal right ventricular pacingsite in permanent pacemaker recipients.