心电图伪差误诊断为快速性室性心律失常的分析

目的 分析室性心律失常心电图伪差特征,试图为临床鉴别诊断提供帮助。方法 收集误诊为快速性室性心律失常来院就诊的8例伪差心电图,分析伪差启动及终止特征,伪差发生时有无QRS波征象。结果 8例患者,3例误诊为快速性室性心动过速,5例为心室扑动。所有患者伪差中均可找到正常的QRS波征象;3例误诊为心室扑动患者的伪差信号起始于QRS波群起始部,此时为心室绝对不应期,据此可以排除心律失常;3例伪差终止时未观察到明显的ST-T波形亦可排除心室扑动。     

分支性室性心动过速后一过性P波改变1例

患者男性,23岁.因反复突发性胸闷、心悸1年,再发3天入院.每次发作持续时间数h～1周.体检:BP12/7kPa(90/53mmHg),心界不大,心率160次/min,心律齐,各瓣膜区未闻及病理性杂音.X线胸片及超声心动描记术检查示心脏无异常.心电图(图1左)示:P波与QRS波群各自按其自身频率出现,心房率107次/min,心室率167次/min,QRS波群呈右束支传导阻滞型,QRS时间0.12s,心电轴:-75°.心电图诊断:窦性心动过速,分支性室性心动过速伴完全性干扰性房室分离.快速静脉注射利多卡因100mg,当注射至75mg时,呈窦性心律伴室性     

伪差性心律失常

伪差性心律失常 (ａｒｔｉｆａｃｔａｒｒｈｙｔｈｍｉａ)是指心电图在描记时因各种干扰因素所产生的貌似心律失常的图形 ,又称伪心律失常 (ｐｓｅｕｄｏａｒｒｈｙｔｈｍｉａ)。若未能及时识别这种特殊类型的心律失常 ,有时可导致对患者进行不必要的药物治疗、介入性心血管系统检查、植入心脏起搏器甚或植入心律转复除颤器等不良后果[1,2 ] 。　　一、伪差性心律失常的表现形式　　 (1)伪单形、多形或扭转性室性心动过速 (室速 ) [1,2 ](图 1) ;(2 )伪心室颤动 (室颤 ) [3 ] (图 2 ) ;(3)伪室上性心动过速 (室上速 ) [4 ] (图 3) ;(4 )伪频…     

分支性室性心动过速8例报告

分支性室性心动过速(分支性室速)是室性心动过速的一种少见的特殊类型。近10年来我们收治8例,现报告如下。1 临床资料 本组男4例,女4例;年龄18～49岁,平均27.5岁。7例有反复发作心动过速史(8个月～13年,平均5.8年),1例为首次发病。临床诊断为扩张型心肌病(DCM)、病毒性心肌炎(VMC)及可疑心肌病各1例,5例无器质性心脏病改变。诱发因素:剧烈活动或劳累3例,饮酒1例,上呼吸道感染1例,无明显诱因3例。1.1 临床表现 心动过速发作时均有心慌、胸闷、气短,伴恶心3例、头晕2例、晕厥及低血压各1例。查体见心界轻度扩大1例,心前区Ⅱ～Ⅲ级吹风样SM2例。1.2 心电图改变 ①心动过速发作时,心率130～194次/min,平均169次/min(6例160～180次/min)。QRS波时限≤0.12s者6例,0.13s者2例。QRS形态呈右束支阻     

双重性室性逸搏所致伪束支文氏现象1例

患者男性,80岁.因心动过缓10年、晕厥2次入院.图IA、B为连续同步记录,示窦性P-P间期0.58s,心房率103次/min,R-R间期1.25～1.32s,心室率45～48次/min,两者无传导关系.R_2呈右束支传导阻滞型,时间0.12s,R_3近似正常波形,时间0.11s,R_2-R_3貌似右束支不全性隐匿型反文氏周期;其余QRS波群呈不同程度左束支传导阻滞型,R_7-R_9 QRS时间分别为0.10、0.12和0.14s,R_7-R_9貌似左束支直接显示型正文氏周期.除R_2来自左心室的激动,R_1、R_5和R_9来自右心室的激动外,其余均为两者不等比例组合而成的室-室融合波群.心电图诊断:窦性心动过速,三度房室传导阻滞,双重性室性逸搏心律及室性融合波群构成伪双束支文氏     

反复单形室性心动过速的导管射频消融治疗

目的对18例反复单形室性心动过速的消融情况进行分析,并对消融同形室性早搏根治反复单形室性心动过速的可行性、安全性及有效性进行分析.方法18例患者,男性4例,女性14例,年龄19～45岁.心电图及动态心电图均有频发室性早搏和非持续性室性心动过速.征得患者的知情同意书后,电生理检查和消融一次进行,标测和消融同形的室性早搏,采用起搏标测和激动标测相结合的方法,确定室性心动过速的起源处(消融靶点).靶点定位后进行射频消融,温度50～60度,能量30～40W.即刻成功标准为放电后10 s内同形室性早搏和非持续性室性心动过速消失,且静脉滴注异丙肾上腺素不能诱发,观察30 min窦性心律稳定.随访成功标准为术后动态心电图24h室性早搏少于100个,无室性心动过速发作.结果18例患者起源于右心室流出道17例,其中1例存在2种形态的室性心动过速,分别于肺动脉瓣上及瓣下消融成功.起源于左心室流出道1例,于主动脉瓣上左Valsalva窦内消融成功.即刻成功17例.随访平均(23±14)个月,无心动过速复发16例,复发2例,1例于术后3个月复发,再次消融成功,另1例于术后6个月复发,未接受第2次消融.1例术后出现少量心包积液,经放置引流管后好转,无其他并发症.结论消融同形室性早搏是根治反复单形室性心动过速安全和有效的方法.     

短阵室性心动过速25例24小时动态心电图分析

短阵室性心动过速 (室速 ) ,在常规心电图上难以测得。1999年 1月～ 2 0 0 2年 12月 ,我们对 2 5例室性心动过速患者采用 2 4小时动态心电图监测 ,并对其资料进行分析 ,报告如下。临床资料 :室性心动过速 2 5例患者 ,男 18例 ,女 7例 ,年龄 45～ 78岁 ,平均年龄 62岁。每例均在 1次动态心电图记录中发现连续 3次以上室性早搏。本组早搏型 16例 ,并行心律型 2例 ,室性自主节律型 7例。本组室速均为单源性。 2 5例患者室速发生时 ,出现头晕、黑朦 2例 ,心悸、胸闷 4例 ,其余患者均无症状出现。2 5例中 ,15例发生在睡眠时 (其中 2例发生在午睡 …     

QT离散度在预测急性心肌梗死并发快速室性心律失常中的应用

1　资料与方法1.1　临床资料　正常组 2 0例 ,男 15例 ,女 5例 ,年龄 42岁～69岁 (5 3 .5 2岁± 8.64岁 ) ,所有正常者无心脏病病史 ,经体格检查、超声心动图、心电图、活动平板试验等排除各种心脏病。试验组 49例 ,其中男 41例 ,女 8例 ,年龄 3 7岁～ 84岁 (64 .98岁± 11.2 3岁 ) ,均选自我院 1995年— 2 0 0 3年住院的急性心肌梗死病人 ,在住院 1月内 2 4例无室性心动过速形成 ,2 5例并发室性心动过速 ,其中 9例为短阵室速 (室速波形大于 5个 ,但持续时间少于 3 0s) ,16例并发持续室性心动过速、心室颤动 (持续时间大于 3 0s) ,6例死亡 ,…     

分支性室性心动过速3例

分支性室性心动过速(FT),也称为特发性室性心动过速。临床较为少见。既往认为是一种良性室速,预后较好。近来文献报道具猝死率在5—12.5％。因此,对其临床表现,心电图及治疗特点应有一正确认识,本文报告3例。1 临床资料 例1 男性,46岁。因胸闷,四肢乏力12小时,于1992年7月第1次就诊。血压16/9.3KPa。心电图示:心率160次/min,QRS宽大畸形,时间 0.13s,节律规     

预激综合征合并尖端扭转性室性心动过速和房室阻滞一例

患者男性 ,5 0岁。反复心悸、晕厥、抽搐 3年余。 1996年1月 2日晕厥发作时心电图示窦性心律、完全性左束支阻滞。动态心电图检查除左束支阻滞外未发现其它异常。 1999年 2月 9日查体时突然发作晕厥、抽搐。立即描记心电图示 :窦性心动过速、尖端扭转性室性心动过速、房室阻滞伴室性逸搏、预激综合征 (图 1)。经胸外心脏叩击及异丙肾上腺素 2μg/ m in静脉滴注处理后 ,心电图由三度房室阻滞转至二度房室阻滞、3∶ 2旁路下传心室 (图 2 )。 1h内晕厥、抽搐发作8次 ,每次持续 2～ 3 min,心室停搏 7～ 9s。 1h后进行右心室临时起搏。3 d后植入…     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.