健康人心率变异性分析

心率变异性（ＨＲＶ）分析是一种无创性检测心脏自主神经张力的方法,对指导疾病的治疗及某些疾病的预后判断有重要价值,它受多种因素的影响。ＨＲＶ测定由于操作方法,仪器,指标不尽相同,缺乏可比性,目前国内缺乏统一的正常值,为此,中华心血管病杂志编委会ＨＲＶ专题对策组于１９９７年参考了欧美两会拟定的标准化方案制定了全国ＨＲＶ分析研究协作组研究方案,并几经修改完善。作为该协作成员之一,该研究进行了健康人的ＨＲ     

健康人心率变异性的初步探讨

心率变异性（ＨＲＶ）是指心电图中连续正常ＱＲＳ波群之间变化的变异数。ＨＲＶ分析是一种无创的，可定量检测心脏植物神经系统活性的方法［１］；是一项预测心原性猝死的独立、敏感的指标［２］。但是，目前尚缺乏ＨＲＶ正常值的大样本研究。本文拟对健康人２４ｈＨＲＶ正常值进行研究，并初步探讨年龄、性别、昼夜因素对ＨＲＶ的影响。１对象与方法１．１对象　健康人选自１９９２年１０月～１９９４年５月来我院进行体检及部分自愿者，共１０６例，其中男７２例，女３４例，年龄２２～６３岁，平均４２．２岁。其中青中年组（＜４５岁）…     

年龄因素对健康人心率变异性的影响

目的探讨年龄因素对健康人心率变异性（ＨＲＶ）的影响。材料与方法将２３６例健康人分为五个年龄组，使用美国先进医用设备公司５．０版本ＨＲＶ软件做短时时域及频域ＨＲＶ分析。结果年龄因素对健康人ＨＲＶ短时时域和频域分析的多项指标产生显著影响，随着年龄增大，时域指标中的ＨＲＳＤ、ＳＤＡＮＮ、ｒＭＳＳＤ及ＰＮＮ５０均逐渐降低；随着年龄增长，频域指标中各频段下的绝对面积，即：ＶＬＦ、ＬＦ、ＭＦ及ＨＦ均逐渐降低；而频域指标中各频段下的相对面积，即：ＶＬＦＰ、ＬＦＰ、ＭＦＰ、ＨＦＰ随着年龄增长呈不同的发展趋势。ＬＦ／ＨＦ随着年龄的增加而逐渐升高。结论ＨＲＶ随着年龄的增加而下降，尤以迷走神经活性下降为显著。频域指标中各频段的相对面积较绝对面积能更敏感地反映交感、迷走神经张力的消长。     

阻塞性睡眠呼吸暂停综合征者心率变异的分析

０　引　　言阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）患者常可发生心律失常等心血管并发症,成为夜间猝死的主要原因［１］。其发生机制认为与ＯＳＡＳ患者夜间睡眠期心交感神经与副交感神经的张力紊乱有关［２］。心率变异性（ｈｅａｒｔｒａｔｅｖａｒｉａｂｉｌｉｔｙ,ＨＲＶ）是近年来发展起来的一项无创、定量、能反映心交感与副交感神经张力状况的重要指标,国外已有研究提示,ＯＳＡＳ患者死亡率增高与ＨＲＶ的降低有关［３］。本研究就国人ＯＳＡＳ患者的ＨＲＶ状况作…     

不同年龄冠心病患者心率变异分析

为了分析不同年龄冠心病患者及正常人心率变异特点，本文对５６例冠心病患者及７２例健康人按年龄进行分组检测ＨＲＶ参数，并进行对比分析，结果：（１）年龄组冠心病民同组健康人比较，ＨＲＶ各参数显著降低；（２）老年冠心病患者ＨＲＶ较年轻冠心病患者亦明显降低；（３）健康人随关年龄的增加ＨＲＶ降低。     

高血压患者心率变异性的临床分析

心率变异性（ＨＲＶ）分析作为反映植物神经系统对心脏和血管调节动态平衡的无创指标已被人们公认,许多临床研究已证实ＨＲＶ的改变与多种疾病有联系。本文对５１例高血压病（ＥＨ）患者和３６例正常人的ＨＲＶ分析,以探讨高血压对心脏植物神经活动的影响,期望对预防和...     

小儿心率变异性的研究进展

心率变异性 (ＨＲＶ)是指连续心动周期间的时间变异数 ,即分析连续出现的正常Ｒ Ｒ间期之间的细微的时间变化及其规律。作为一种无创性的检测方法 ,ＨＲＶ可定量地反映心脏自主神经功能。目前关于成人ＨＲＶ已做了大量工作 ,并已证明ＨＲＶ在心肌梗死、糖尿病性神经病变、心力衰竭、阵发性心律失常、血管神经性晕厥、心脏移植等方面有重要的临床价值。但ＨＲＶ在儿科领域的研究与应用很少。本文主要对小儿ＨＲＶ的研究进展作一综述。　　ＨＲＶ的测定一、线性分析法　可分为时域法与频域法。(一 )时域法常用的指标　①统计法指标 :包括正常…     

心律变异非线性动力学分析的随机因素研究

本文结合生理意义讨论了外部噪声对心律变异（ＨＲＶ）非线性动力学分析的影响和ＨＲＶ 的自身随机性。分析了采样率、平稳性、非均匀时间间隔等因素的影响和去除,提出一种针对心动周期信号的内插算法。实验表明这些措施能改善分析效果。文中还从替代数据、交互信息、非线性预测等非线性动力学角度研究了ＨＲＶ的自身随机性,指出ＨＲＶ 是确定性混沌与随机过程的综合体。     

急性心肌梗塞后不同时期心率变异分析及其临床意义

近年来，自主神经对急性心肌梗塞（ａｃｕｔｅｍｙｏｃａｒｄｉａｌｉｎｆａｒｃｔｉｏｎ，ＡＭＩ）、心源性猝死的影响愈来愈引起人们的关注，目前，心率变异（ｈｅａｒｔｒａｔｅｖａｒｉａｂｉｌｉｔｙ，ＨＲＶ）分析作为定量分析自主神经活性的方法已被公认［１］...     

赞比亚妇科病人HIV感染及其与妇科疾患的关系

获得性免疫缺陷综合症（ＳＴＤｓ）对女性的危害已愈来愈引起人们的重视。近年来随着人类免疫缺陷病毒（ＨＩＶ）通过性传播危害的增加,女性的ＨＩＶ感染者呈逐年上升趋势［１］。已有研究表明,某些妇科疾患如性传播疾病（ＳＴＤｓ）与ＨＩＶ的传播有关［２］且ＨＩＶ感染可混淆某些妇科疾病的症状或加速疾病发展进程［３］。由于无症状的ＨＩＶ感染妇女缺乏特异临床表现,要把她们从普通妇科病人中分辨出来很困难。已有研究证实,一般妇科病人中确实存在未被意识的ＨＩＶ感染。因此对顽固的妇科病症是否合并无症状的ＨＩＶ感染应引起我们…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.