床旁临时心脏起搏治疗急性心肌梗死心律失常35例

2001年2月-2006年12月我们应用床旁临时心脏起搏器治疗各种急性心肌梗死(AMI)后心律失常35例,取得了良好的临床效果,现报告如下. 1 资料和方法1.1 一般资料 35例急性心肌梗死中,男24例,女11例,平均年龄(55.06±4.3)岁.其中下壁AMI 23例,合并右室AMI 2例;前壁AMI 8例;前间壁AMI 2例;前侧壁AMI 2例.     

经胸壁穿刺环状钢丝电极紧急心脏起搏

经胸壁穿刺环状钢丝电极紧急心脏起搏５１００１０广州广州军区总医院黄洋浩何建新马骏俞宙关键词心脏起搏；器械革新中国图书资料分类号Ｒ３３１．３８自１９６５年Ｒｏｅ采用钩状钢丝电极起搏抢救３例难治性阿斯综合征获得成功后，该法已在临床上得到广泛应用。但临床应...     

紧急临时起搏抢救危重心律失常18例

<正> 1987年—2000年,我们用双极起搏导管电极在普通X光机下插管或床边盲目作紧急人工心脏临时起搏,成功抢救了18例严重心律失常患者,现报告如下。     

阔面电极体外无创心脏起搏18例

自80年代以来对体外无创起搏方法的不断改进，阔面电极起搏法因其致颤电流与最小电流之比平均为12．6：1，在起搏电流强度下不会诱发各种恶性心律失常，对心肌酶也无明显影响，在紧急情况下临床应用较多。1996—2000年我科共用阔面电极体外无创起搏18例，起搏效果较好，现将资料报告如下。     

无创经皮体外心脏起搏急诊抢救心脏骤停59例

对于心跳骤停（cardiacarrest,CA）心电图表现为室颤与无脉性室速的患者,尽早给予非同步直流电除颤已成为共识,它虽然具有抢救成功率低、病死率高的特点,但抢救技术、方法并无重大突破。尽管在常规心肺复苏的同时,使用人工临时心脏起搏技术可以保证心脏泵血功能,维持有效血流循环,满足脑、心脏等重要脏器的基本血流灌注,提高心肺复苏抢救成功率,但是经静脉心脏起搏术（transvenouscardiacpacing,TCP）耗时长,设备要求较高,且需要较高的操作技巧,限制了TCP在急诊抢救中的应用。     

无创性心脏起搏的心电活动及临床应用

采用无创性心脏起搏法同时描记心腔内及体表心电图以判定其电生理机制。结果表明通常情况下无创性心脏起搏只同时激动左右心室。当电流强度增加时,可同时激动心房与心室。临床上不仅可用于治疗过缓型心律失常,也可用于治疗除心房纤颤以外的房性或室性心动过速。     

经右颈内静脉球囊飘浮电极导管床旁快速心脏起搏25例

目的　探讨床旁快速起搏的方法。方法　采用Seldinger法穿刺右颈内静脉经鞘管插入顶端球囊飘浮电极导管直至右室起搏。结果　共2 5例在床旁无X线指引下迅速达到有效起搏,插入时间为5 10min(平均8min)。结论　采用Seldinger法穿刺右颈内静脉,沿鞘管送入顶端球囊飘浮电极导管,可在床边不需X线指引,安全快速地进行右心室起搏     

临时起搏器在非心脏手术中临床应用3例报告

人工心脏起搏是由心脏起搏器发生脉冲电流通过电极应激病变心脏,以维持或控制心脏节律或改善心脏功能。临时起搏器一般用于临时抢救或预防性起搏。合并有严重缓慢心律失常需外科手术患者,在术中应用临时起搏器可达到预防缓慢心律失常恶化,阿--斯综合征发作和抢救心脏骤停的目的。现附3例报告如下:1病例资料病例1男患,36岁,农民。因反复右上腹痛4年,高热、黄疸10月,加重2d于2002年3月7日入住我院外科。既往无慢性疾病及心脑血管病史。入院时查:体温39.5℃,血压105/60mmHg.。全身皮肤巩膜黄疸,肺部体征阴性,心率54bpm,右上腹压痛,肌紧张,肝脾…     

运动员左室假腱索与心律失常及左心功能的关系

目的:探讨运动员左室假腱索与心律失常和左心功能的关系。方法:1、通过对广东省体育运动技术学院1743名运动员进行心脏B超检查,调查运动员左室假腱索发生情况;2、将发现左室假腱索的93例运动员(排除心肌炎、心肌病等心脏疾患)作为一组,在无左室假腱索运动员中随机选取93名作为另一组,行心电图和心脏彩色多普勒检查,对比两组运动员心律失常和左心功能。结果:1743名无器质性心脏病运动员中,检测出93例左室假腱索,检出率为5.3%;其中Ⅰ型(横型)91例,Ⅱ型(纵型)2例。男、女运动员左心室假腱索发生率无明显差异。左心室假腱索运动员室性早搏发生率为74.19%,左心室无假腱索运动员室性早搏发生率为4.30%,二组差异有统计学意义(P<0.001);有、无左心室假腱索运动员左心功能指标之间无明显差异。结论:运动员左室假腱索与室性早搏明显相关。左室假腱索对运动员左心功能无明显影响。     

脉搏指示连续心排血量监测在危重烧伤患者中的应用效果分析

目的探讨脉搏指示连续心排血量(pulse index continuous cardiac output,PiCCO)监测在危重烧伤患者中的应用效果。方法对2018年5月至2019年5月河南大学附属南石医院收治的20例危重烧伤患者予以补液抗休克、抗感染、改善微循环、积极治疗原发病、营养支持等全身综合治疗以及负压封闭引流联合烧伤创疡再生医疗技术等局部创面治疗,治疗过程中采用PiCCO监测仪监测平均动脉压(mean arterial pressure,MAP)、外周血管阻力指数(systemic vascular resistance index,SVRI)、心功能指数(cardiac function index,CFI)、心脏指数(cardiac index,CI)、胸腔内血容量指数(intrathoracic blood volume index,ITBVI)、血管外肺水指数(extravascular lung water index,EVLWI)等血流动力学指标,观察各项指标变化情况。结果因患者血容量不足,烧伤后CFI、CI、ITBVI均显著降低,而SVRI则显著升高,随着治疗时...     

先天性心脏病患儿肺动脉内超声成像与右心导管检查的对比研究

目的:探讨在先心病合并重度肺动脉高压(PH)时,肺动脉血管内超声(IVUS)的临床应用价值。材料和方法:对12例合并PH的先心病患儿行右心导管检查的同时进行肺动脉IVUS成像。右心导管测定mPAP、TPR、Qp/Qs,IVUS观测肺动脉管腔大小、内膜和中层的厚度,计算肺动脉管壁厚度比(WTR)以及血管的搏动性。结果:吸入纯氧后mPAP及TPR明显降低,Qp/Qs则明显增高;高阻力组与低阻力组间,肺动脉搏动性在吸氧前后未见显著性差异;在吸氧前后,WTR与TPR具有直线相关。结论:IVUS可以应用于临床,其监测结果与右心导管监测的肺动脉血流动力学变化情况呈高度相关。     

图像距离变换方法用于心肌细胞中Ca2+浓度分布的研究

目的 通过分析细胞中Ca2 浓度的空间分布和时间分布,为建立心肌细胞收缩舒张周期运动的数学模型提供特性参数,从而在细胞级的水平上辅助心脏病病理药理的本质研究.方法 首先将心肌细胞图像进行图像分割,然后采用图像距离变换方法将细胞由细胞膜往里进行距离分层,再在每层细胞上检测Ca2 的浓度.结果 得到在连续时刻下每层细胞的Ca2 浓度,并计算出了心肌细胞中Ca2 浓度的空间分布和时间分布情况.结论 基于图像距离变换的方法能够快速、正确地分析心肌细胞弹性运动中的Ca2 浓度以及其它离子浓度的分布特性,该方法也可应用于其它弹性运动物体中的特性分析中.     

Endovenous Glue-Induced Thrombosis in Nonthermal Glue Closure Therapy for Greater Saphenous Vein Insufficiency: A Single-Center Experience

A retrospective analysis of endovenous glue-closure therapy (EVGC) performed in 76 greater saphenous veins (GSVs) from February 2016 to December 2017 was conducted to assess the incidence and characteristics of endovenous glue-induced thrombosis (EGIT), a phenomenon unique to nonthermal EVGC for GSV insufficiency. Kabnick and Lawrence classifications for endovenous heat-induced thrombosis were adopted. Seven instances of EGIT were detected among 54 patients (13%), with median/mode Kabnick and Lawrence classifications of 2/2 and 4/5, respectively. EGIT resolved with observation within an average of 5.2 wk after detection (range, 2–8 wk) without deep vein thrombosis or pulmonary embolism. EGIT was associated with significantly greater mean age (+7.75 y; P = .0308).     

Lung Infarction due to Pulmonary Vein Stenosis after Ablation Therapy for Atrial Fibrillation Misdiagnosed as Organizing Pneumonia: Sequential Changes on CT in Two Cases

Pulmonary vein (PV) stenosis is a complication of ablation therapy for arrhythmias. We report two cases with chronic lung parenchymal abnormalities showing no improvement and waxing and waning features, which were initially diagnosed as nonspecific pneumonias, and finally confirmed as PV stenosis. When a patient presents for nonspecific respiratory symptoms without evidence of infection after ablation therapy and image findings show chronic and repetitive parenchymal abnormalities confined in localized portion, the possibility of PV stenosis should be considered.     

Emergent Transjugular Intrahepatic Portosystemic Shunt as a First-Line Therapy in Patients with Cirrhosis with Acute Gastroesophageal Variceal Hemorrhage

PurposeTo investigate the safety and effectiveness of emergent transjugular intrahepatic portosystemic shunt (TIPS) as first-line therapy in patients with advanced cirrhosis with acute variceal hemorrhage.Materials and MethodsFrom July 2016 to June 2019, 76 patients with advanced cirrhosis and acute variceal hemorrhage were included in this retrospective study. All patients underwent emergent TIPS as first-line therapy within 24 hours. Gastroesophageal varices in patients with cirrhosis were diagnosed with contrast-enhanced computed tomography because emergent endoscopy has not been routinely performed in this center. The primary outcomes were the control rate of bleeding and the rate of rebleeding. Secondary outcomes were the technical success rate of procedure, transplantation-free survival, the mean hospitalization time, the time of stay in the intensive care unit, and adverse events.ResultsAll patients underwent TIPS creation successfully and were transferred to general wards. The median follow-up time was 21.7 months (interquartile range, 12.6–28.1 months). The control rate of bleeding (≤5 days) was 100%. The rates of early (>5 days to 6 weeks) and late (>6 weeks to 2 years) rebleeding were 6.6% and 1.3%, respectively. The 6-week, 1-year, and 2-year transplantation-free survival rates were 94.7%, 93.4%, and 84.6%, respectively. The incidences of acute liver failure, hepatic encephalopathy, and shunt dysfunction were 5.3%, 25%, and 5.3%, respectively.ConclusionsEmergent TIPS as a first-line therapy in patients with advanced cirrhosis with acute variceal hemorrhage is safe and effective. This study provides an alternative approach for medical centers without emergent endoscopy facility to manage the condition.