心动过速发作时不同剂量的三磷酸腺苷对房室 …

在心动过速发作时,观察不同剂量的三磷酸腺苷（ＡＴＰ）对房室结（ＡＶＮ）快、慢径的阻断作用,进一步探讨快、慢径的电生理特性。对符合诊断的２４例房室结双径且可诱发出房室结折返性心动过速（ＡＶＮＲＴ）的病人进行研究,用食调搏或心内电生理检查方法重复诱发心动过速。静脉给予不同剂量ＡＴＰ,以０．０５ｍｇ／ｋｇ为起始剂量,０．０２５ｍｇ／ｋｇ为递增量,直至ＡＴＰ用量达０．２０ｍｇ／ｋｇ。在ＡＶＮＲＴ发作时,观     

地氟病黄牛红细胞膜Na-K-ATP酶活性的研究

对宁夏青酮峡广武地区饮用水、土壤水溶性氟、饲（料）草和黄牛血清氟含量进行检测，结果分别为３．２７ｍｇ／Ｌ、８．００ｍｇ／ｋｇ、５１．９７ｍｇ／ｋｇ和０．６２ｍｇ／Ｌ，均超出国家最高标准的上限。高氟黄牛红细胞膜Ｎａ－Ｋ－ＡＴＰ酶活性为０．１７８ｕｍｏｌｐｉ／ｍｇｐｒｏｔ·ｈ－１显著低于非高氟区奶牛０．２４６ｕｍｏｌｐｉ／ｍｇｐｒｏｔ·ｈ－１（Ｐ＜０．０５）。通过高氟黄牛饲料①组添加０．２５ｍｇ／ｋｇ亚硒酸钠；②组添加１５ｍｇ／ｋｇ硫酸铜；③组添加０．２５ｍｇ／ｋｇ亚硒酸钠＋１５ｍｇ／ｋｇ硫酸铜＋１ｍｇ／ｋｇ硫酸镁，进行饲喂，分别于试验的第３０天和第８３天采样分析，结果表明：高氟黄牛加硒组和加硒铜镁组血清氟含量最后与第０天的测值相比，下降极显著（Ｐ＜０．０１），红细胞膜Ｎａ－Ｋ－ＡＴＰ酶活性上升显著（Ｐ＜０．０５）和极显著（Ｐ＜０．０１）；高氟加铜组黄牛血清氟含量降低显著（Ｐ＜０．０５），但对红细胞膜Ｎａ－Ｋ－ＡＴＰ酶活性没有激活作用（Ｐ＞０．０５）。从而揭示适宜剂量的硒、镁联合作用能确保细胞膜免受高氟毒害，并促进体氟排泄     

射频导管消融改良房室结术中发生一过性完全性房室传导阻滞的预后意义

目的：探讨射频导管消融改良房室结术中发生一过性完全性房室传导阻滞（ＴＣＡＶＢ）的预后意义。方法：对５６例房室结折返性心动过速病人行射频导管消融治疗。在射频导管消融术中发生ＴＣＡＶＢ者为Ｉ组（ｎ＝６），无ＴＣＡＶＢ者为Ｉ组（ｎ＝５０）。用ｔ检验和χ２检验对所有指标进行统计学分析。结果：两组的平均放电次数、释放能量、放电时间及Ａ／Ｖ比值均无显著差异（Ｐ＞０．０５），但消融电极位置偏高者Ｉ组占６６．７％，Ｉ组占１２．０％（Ｐ＜０．００１）。在随访期间，Ｉ组２例（３３．３％）发生迟发性房室传导阻滞，Ｉ组则无迟发性房室传导阻滞发生（Ｐ＜０．００１）。结论：射频导管消融术中出现的ＴＣＡＶＢ与术后发生的迟发性房室传导阻滞密切相关。     

房室结双径路合并房室旁路的折返性心动过速及射频消融治疗

目的本研究旨在探讨房室结双径路（ＤＡＶＮＰ）合并房室旁路（ＡＰ）的电生理特征和射频消融要求。方法对２１８例阵发性室上性心动过速（ＰＳＶＴ）进行电生理检查，观察ＰＳＶＴ的前传和逆传途径，然后对ＡＰ或房室结慢径（ＳＰ）进行消融治疗。结果２１８例ＰＳＶＴ中检出ＤＡＶＮＰ＋ＡＰ１０例，检出率为４．６％。其中ＳＰ前传、ＡＰ逆传（ＳＰ－ＡＰ折返）４例，快径（ＦＰ）前传、ＡＰ逆传（ＦＰ－ＡＰ折返）１例，ＳＰ－ＡＰ折返并ＦＰ－ＡＰ折返或ＳＰ／ＦＰ交替前传折返４例，ＳＰ前传、ＦＰ逆传（ＡＰ旁观）１例。１０例患者均作ＡＰ消融，诱发房室结折返性心动过速（ＡＶＮＲＴ）的３例加作ＳＰ消融，术后随访均无复发。结论ＤＡＶＮＰ合并ＡＰ者ＡＰ均作为逆传途径，阻断ＡＰ是消融关键；ＡＰ旁观者也应作ＡＰ消融；仅有ＡＨ跳跃延长者不必接受房室结改良；ＡＰ消融者应作ＤＡＶＮＰ电生理检查。     

红花总黄素抑制血小板激活因子所致毛细血管通透性增加的研究

本文研究了红花总黄素（ＳＹ） 拮抗血小板激活因子（ＰＡＦ） 诱导的小鼠毛细血管通透性增加的作用。小鼠随机分为正常动物空白对照组（Ａ）,模型动物对照组（Ｂ） ,模型动物大剂量（Ｃ） ,中剂量（Ｄ） ,低剂量（Ｅ） 药物组共五组（ｎ ＝ １２） 。Ａ,Ｂ组腹注ＮＳ,Ｃ,Ｄ,Ｅ组腹腔注射ＳＹ;３０ｍｉｎ 后,各组尾静脉注射伊文斯蓝;尾注后３０ｍｉｎ,Ａ组腿部肌肉注射ＮＳ,Ｂ,Ｃ,Ｄ,Ｅ组肌注ＰＡＦ造模;肌注３０ｍｉｎ 后处死小鼠。提取腿部肌肉中的染料,测定提取液６２０ｎｍ 的吸收度反映毛细血管通透性。比色结果：Ａ 组０－０８０ ±０－０４５ ,Ｂ组０－４５６ ±０－１５６（ 与Ａ组比较,Ｐ＜ ０－０１） ,Ｃ 组（１００ｍｇ／ｋｇ ＳＹ）０－２２２ ±０－０７１ ,Ｄ 组（７０ｍｇ／ｋｇ ＳＹ）０－３２２ ±０－１３５ ,Ｅ 组（５０ｍｇ／ｋｇ ＳＹ）０－３４２ ±０－１２９ ,（Ｃ,Ｄ,Ｅ,组与Ｂ 组比较依次为,Ｐ＜ ０－０１ ,０－０５ ,０－０５） ,提示ＳＹ 具有明显抑制ＰＡＦ诱发的小鼠毛细血管通透性增加的作用,并且这种作用随着ＳＹ 剂量增加而加强     

影响房室旁路导管射频消融术复发因素的分析

对１３例导管射频消融术（ＲＦＣＡ）后复发病例资料进行回顾性分析并与２３７例未复发者进行比较，旨在为进一步降低复发率提供线索．结果：性别、心动过速病史及心动过速频率与复发率无关（Ｐ＞０．０５）；成年组复发率高于童年及老年组（Ｐ＜０．０５）；前５０例ＲＦＣＡ患者复发率高于后２００例（Ｐ＜０．０５）复发组的房室波比值、房室融合波时限、融合波提前程度与对照组有显著差异性（Ｐ＜０．０５）；慢旁路的复发率高于普通旁路（Ｐ＜０．０５）；普通旁路之间、不同部位的旁路之间的复发率无显著差异性（Ｐ＞０．０５）；复发组的手术时间、Ｘ线曝光时间、放电有效时间、放电次数、射频电流的功率及能量均高于对照组（Ｐ＜０．０５），阻抗无显著差异性（Ｐ＞０．０５）．结论：术者的经验及靶点图特点是影响复发的主要因素；放电有效所需时间越长，复发可能越大．     

射频消融房室旁路的复发原因分析

总结了１２２例１２４条房室旁路（ＡＰ）射频消融术（ＲＦＣＡ）的复发率，并对复发的可能原因作了初步分析。结果为：１２４条ＡＰ经２～２５（１３．５±７．１）个月随访５条复发，复发率为４．０３％（５／１２４）。其中显性与隐性ＡＰ复发率分别为１．２３％（１／８１）和９．３０％（４／４３），Ｐ＜０．０５；左游离壁与间隔分别为２．５％（２／８０）和７．５％（３／４０），Ｐ＞０．０５；左侧与右侧分别为３．３％（３／９０）和３．１％（１／３２），Ｐ＞０．０５。复发时间为０．５～６０（１５．４±２５．４）天。复发可能与消融点不够精确、ＡＰ粗大位置深在、ＡＰ功能特性与部位、消融能量不足、观察时间不够等因素有关。提示需对行ＲＦＣＡ患者进行随访。     

单极标测左侧房室旁路指导射频消蚀治疗房室折返性心动过速

２５例左侧房室旁路引起的房室折返性心动过速病人在单极标测指导下行射频消蚀治疗，２３例成功阻断房室旁路（ＡＰ）。分析有效消蚀靶点的单极心内膜标测特点为：（１）单极标测可准确定位ＡＰ。显性ＡＰ者在窦性心律时单极标测图上显示“ＰＱＳ”复合波是前传ＡＰ定位点的可靠指标；隐匿ＡＰ心室起搏或诱发顺向型房室折返性心动过速时逆传Ｐ波最早激动是逆传ＡＰ定位点指标。（２）消蚀点单极图形类同标测点单极图形是有效靶点的可靠依据。（３）消蚀单极图Ｓ－Ｔ段抬高可能预示放电发生阻抗升高。     

房室折返性心动过速合并房室结双径现象

目的 分析射频消融术证实的房室帝道（ＡＰ）合并房室结双径（ＤＡＶＮＰ），以了解其电生理特点。方法 以食管心房调博及心内电生理检查，确诊室上速合并房室结双径１２例，并行射频消融枚。结果 ＡＰ合并ＤＡＶＮＰ占ＡＰ的１６．４％（１２／７３），多为陷匿性ＡＰ（１０／１２），其折返途径多为ＡＰ逆传（１０／１２），房室结单一径路前传，房室结快径道不应期及心动过速时ＲＰ’（ＶＡ）与ＲＰ意期，在食道电生理与心内电     

兔内毒素休克模型中秋水仙碱对血清肿瘤坏死因子活性的影响

目的观察秋水仙碱（Ｃｏｌ）对兔受内毒素（ＬＰＳ）刺激后血清肿瘤坏死因子（ＴＮＦ）活性改变的影响。方法将１２只新西兰兔随机分为Ａ、Ｂ两组,Ａ组动物分别于ＬＰＳ注射前６７小时起腹腔注射生理盐水（ＮＳ）０．２ｍｌ／ｋｇ作为空白对照,Ｂ组则按相同时间间隔腹腔注射Ｃｏｌ０．５ｍｇ／ｋｇ。所有动物经卡介苗（ＢＣＧ）致敏后静脉注射ＬＰＳ２μｇ／ｋｇ诱发休克。结果预先注射Ｃｏｌ能显著降低动物血清ＴＮＦ峰值浓度（Ｐ＜０．０５）;治疗组平均动脉压（ＭＡＰ）和全血白细胞数（ＷＢＣ）下降程度也较对照组明显减轻。结论Ｃｏｌ对动物体内ＴＮＦ的合成或分泌具有抑制作用     

心动过速发作时不同剂量的三磷酸腺苷对房室结快、慢径阻断作用的研究

在心动过速发作时 ,观察不同剂量的三磷酸腺苷 (ATP)对房室结 (AVN)快、慢径的阻断作用 ,进一步探讨快、慢径的电生理特性。对符合诊断的 2 4例房室结双径且可诱发出房室结折返性心动过速 (AVNRT)的病人进行研究 ,用食管调搏或心内电生理检查方法重复诱发心动过速。静脉给予不同剂量ATP ,以 0 .0 5mg/kg为起始剂量 ,0 .0 2 5mg/kg为递增量 ,直至ATP用量达 0 .2 0mg/kg。在AVNRT发作时 ,观察不同剂量的ATP对同一病人房室结快、慢径的阻断情况。在 2 0例 (83.3% )的患者中 ,ATP终止AVNRT于前传慢径 ,其ATP用量为 0 .119± 0 .0 43mg/kg;在 3例(12 .5 % )的患者中 ,ATP终止AVNRT于逆传快径 ,其用量为 0 .175± 0 .0 2 9mg/kg;在 1例 (4 .2 % )的患者中 ,较小剂量ATP终止AVNRT于前传慢径 ,递增剂量则终止于逆传快径。结论 :心动过速发作时较小剂量的ATP多使前传慢径阻断而较大剂量的ATP多使逆传快径阻断     

Injectable and oral propafenone in nodal reentry and pathways of ventricular preexcitation

Propafenone, an antiarrhythmic drug of IC type, was applied to 10 patients with supraventricular tachycardia (SVT) produced by intranodal reentry (group I) and in 14 patients with reentry by an accessory atrioventricular (AV) pathway (group II), 10 of them suffering from orthodromic SVT. Propafenone given intravenously depresses or blocks the antegrade or retrograde conduction in the AV node and in the accessory AV pathway. The same effect is observed with orally given propafenone: 66% of antegrade blocking and 54% of retrograde blocking of the accessory conduction pathway. Intravenously given propafenone reduces within 2 to 3 min by antegrade or retrograde blocking 70% of SVT produced by intranodal reentry and by 85% of SVT produced by reentry by the accessory pathway. After injection it becomes impossible to induce intranodal SVT in 60% of cases and SVT by the accessory pathway reentry in 28% of cases. With oral treatment (600 mg/day) reinduction of intranodal SVT becomes impossible in 66% of cases and of SVT produced by reentry by the accessory pathway in 42% of cases. Long-term oral administration (17 +/- 3.7 months) of the same dose prevents 88% of SVT produced by internodal reentry and 80% of spontaneous SVT produced by reentry by the accessory pathway. Cardiologic tolerance is satisfactory: one case of atrioventricular and intraventricular dysrhythmia is observed. The same holds true for general tolerance: in 2 cases drug administration is discontinued and 11 patients present neurologic and digestive troubles improving after lowering the dosage or increasing the fractionation.(ABSTRACT TRUNCATED AT 250 WORDS)     

旁道合并房室结双径路的电生理特征

采用经食管心房起搏和心内电生理检查方法，证实旁道（AP）合并房室给双径路（DAVNP）6例。心房程控起搏经房室结（AVN）前传有跳跃延长现象；诱发阵发性室上性心动过速（PSVT）时，表现为R－R间期长短交替或有两种频率的PSVT，其折返途径均为AVN前传，AP逆传。AP射频消融后，心房程控起搏经AVN仍有跳跃现象传导，但不能诱发PSVT，随访6～24月均无PSVT发作。     

Clinical electrophysiologic effects of lorcainide in patients and its effect on the conduction of accessory pathway in Wolff-Parkinson-White syndrome

The electrophysiologic effects of the intravenous administration of a new antiarrhythmic drug, lorcainide, were evaluated by programmed electrical stimulation of the heart in 20 patients with and without Wolff-Parkinson-White (WPW) syndromes. Lorcainide shortened the sinus cycle length from 721.0 +/- 125.9 to 649.5 +/- 100.1 ms (P less than 0.001), but did not influence sinus node function and AV node conduction and refractoriness, slightly increased atrial effective period (ERP) (P less than 0.02) and did not change ventricular ERP (P less than 0.2), obviously lengthened atrial conduction time, H, H-V interval and the width of V wave. Lorcainide caused complete antegrade block of the accessory pathway (AP) in six of 9 WPW patients and resulted in exclusive conduction over the AV nodal. His conduction in two patients with atrial flutter. It also prolonged the retrograde conduction time and refractoriness of AP, and prevented initiation of orthodromic atrioventricular tachycardia (O-AVRT) in six of 12 patients by blocking of the retrograde conduction of the AP, increased the cycle length of tachycardia from 321.7 +/- 43.6 to 361.7 +/- 54.9 ms (P less than 0.005) by marked prolongation of retrograde AP conduction time in 6 patients in whom O-AVRT could still be induced. It is concluded that intravenous lorcainide does not affect sinus node and AV node function, slightly influences atrial and ventricular refractoriness, obviously suppresses atrial, His bundle and intraventricular conduction, and is an effective antiarrhythmic drug for patients with WPW by blocking both the antegrade and retrograde conduction of the AP.     

Electrophysiologic properties of cibenzoline in Wolff-Parkinson-White syndrome and atrioventricular nodal reentry tachycardia

The electrophysiologic effects of the new class-1 antiarrhythmic drug cibenzoline (1.5 mg/kg within 10 min, followed by an infusion of 0.5 mg for 30 min) were investigated in six patients with atrioventricular (av) nodal reentrant tachycardia and nine patients with atrioventricular tachycardia. Sinus cycle length, sinus node recovery time, effective refractory period (ERP) of the atrium and the ventricle as well as the ERP of the av node were not significantly affected by cibenzoline. Retrograde conduction via the av node was prevented by cibenzoline in 6/15 patients, retrograde ERP was increased in 4/15 patients and in 5/15 patients determination of the retrograde ERP of the AV node was impossible. Intranodal conduction time (AH-interval) and infranodal conduction time (HV-interval) was increased from 96 +/- 27 ms to 117 +/- 40 ms (p less than 0.01) and 36 +/- 12 ms to 62 +/- 12 ms (p less than 0.01), respectively. In four patients with antegrade conduction along the accessory pathway no antegrade conduction was seen after the application of cibenzoline. Retrograde ERP of the accessory pathway was increased in two patients, it was unchanged in three patients, and no retrograde conduction along the accessory pathway was seen in four patients. AV nodal reentrant tachycardia was not inducible, after cibenzoline in 4/6 patients and in 5/9 patients with AV reentrant tachycardia. If tachycardia remained inducible, an increase in tachycardia cycle length from 333 +/- 46 ms to 402 +/- 24 ms was observed (p less than 0.01). In conclusion the electrophysiologic effects of cibenzoline make it a suitable drug for the treatment of av nodal reentrant tachycardia and atrioventricular tachycardia.     

Clinical implications of “pure” Hisian pacing in addition to para-Hisian pacing for the diagnosis of supraventricular tachycardia

BACKGROUND: Para-Hisian pacing is an effective method of differentiating between pathways for retrograde conduction over the accessory pathway (AP) and over the atrioventricular node (AVN). When performing para-Hisian pacing, the pacing spike sometimes captures only the His bundle, which we named "pure" Hisian pacing (Hc). OBJECTIVE: We evaluated the significance of pure Hisian pacing for predicting the pathways of ventriculoatrial conduction. METHODS: In 62 patients with supraventricular tachycardia, both para-Hisian and pure Hisian pacing were carried out during the sinus rhythm, resulting in three different types of electrocardiographic complexes with wide (local ventricular myocardial capture), slightly narrow (both local myocardial and His bundle capture), and very narrow QRS widths (Hc). A change of atrial activation sequence as demonstrated by these pacing modes indicated the presence of multiple retrograde pathways. The diagnosis of retrograde pathways by para-Hisian pacing with or without Hc was evaluated. RESULTS: In 22 patients with AVN reentrant tachycardia, para-Hisian pacing alone was able to correctly predict ventriculo-atrial conduction exclusively through the AVN without requiring findings from Hc. In 40 AP patients, para-Hisian pacing showed a pattern of retrograde conduction through the AVN in six, through both the AVN and AP in 10, and through an AP in 24 patients. Four of these 24 patients were diagnosed as having multiple pathways (AP+AVN or dual APs) by the addition of Hc. CONCLUSION: Pure Hisian pacing can help disclose another pathway for retrograde conduction in AP patients, which is unpredicted by ordinary para-Hisian pacing.     

Diagnostic significance of the morphological change in the atrial electrogram during Para-Hisian pacing

Para-Hisian pacing (PHP), a pacing method to differentiate between conduction occurring over an accessory pathway (AP) from that over the atrioventricular node (AVN), is assessed essentially by comparing the timing in the atrial electrogams. Morphological change in the atrial electrograms is often observed during PHP, but its significance has not been investigated. Prior to the catheter ablation procedure, PHP was performed in 52 patients with an AP and in 36 patients with AV nodal reentrant tachycardia (AVNRT). The morphological change in the atrial electrograms, which was retrospectively assessed between the His bundle and proximal right bundle branch (HB-RB) captured and non-captured beats, was identified in 15 of 52 patients with an AP and in 26 of 36 patients with AVNRT. The atrial electrogram in the 6 of these 15 AP patients changed its morphology without overlapping the ventricular electrogram. All 6 AP patients exhibited a PHP pattern with the presence of 2 retrograde conduction routes, an AP and the AVN. In the patients demonstrating no morphological change in the atrial electrogram, 33 of 37 AP patients and all 10 AVNRT patients had only one retrograde conduction route. Morphological change in the atrial electrogram without overlapping the ventricular electrogram seems to have diagnostic significance indicating the presence of both AP and AVN conduction.     

三磷酸腺苷在射频消融术中的临床应用研究

目的探讨射频消融术中三磷酸腺苷(ATP)对鉴别是否存在房室旁道的最佳剂量，以提高射频消融术的成功率，减少对多旁道病人的漏诊率。方法通过对37例具有逆向传导功能非房室旁路病例与45例隐匿性房室旁路在心室起搏下分别应用ATP0.2mg/kg、0.25mg/kg和0.3mg/kg，观察ATP对房室结和旁道的作用，评价其在射频消融术中的应用价值。结果0.25mg/kg的ATP对评价旁道存在与否的敏感性为83.71%，特异性97.78%，阳性预测值96.88%，阴性预测值88.00%，准确度91.46%。结论0.25mg/kg的ATP对鉴别同时存在房室结逆向传导的房室旁道有重要的指导价值，过大地增加剂量并不能提高诊断价值。     

Effect of adenosine triphosphate on the accessory pathways

To determine the site of the anterograde and retrograde conductionin the Wolff-Parkinson- While syndrome (WPW), 40 mg of adenosinetriphosphate (ATP) was injected during electrophysiologicalstudies in 53 patients with ventricular preexcitation. In 40cases, the accessory pathway was evident (group 1) and in 13cases it was concealed (group 2). In 10 cases in group 1, anterogradeconduction was abolished with disappearance of the featuresof preexcitation. In 7 patients of group 1 and in 4 patientsof group 2, retrograde conduction in the accessory pathway wasprolonged or abolished. These effects were unexpected becauseATP is a parasympathomimelic drug. There was a correlation between the Kent effective refractoryperiod (ERP) and the action of ATP. When the drug did not changethe anterograde and retrograde conduction in the Kent bundle,the anterograde accessory pathway ERP was always less than 230ms. When ATP only decreased retrograde conduction in the Kentbundle, anterograde accessory pathway ERP was always more than280 ms.