182例小儿先心病的心电图分析及临床价值探讨

目的探讨小儿先天性心脏病的心电图（ECG）改变特点及其临床价值。方法回顾性分析本院诊治的先天性心脏病患儿182例心电图完整临床资料。结果182例患儿进行心电图常规检查,心电图异常率72．5％（132／182）,患儿年龄越大,病情越严重,心电图异常就越明显,其比例就越高（P〈0．05）;先心病的类型不同,其心电图检查的异常率也不同,其差异有统计学意义（P＜0．05）,心电图改变多以心脏房室肥大、sT-T改变以及传导阻滞为特点。青紫型的先天性心脏病心电图异常率显著高于非青紫型的先天性心脏病患儿（P＜0．05）,其类型不同,心脏房室肥大的部位和程度各有侧重。结论心电图检查能分析先心病患儿的心脏扩大、传导异常等改变,小儿年龄增长病情越严重心电图表现越明显,提示先心病患儿心电图检查是不可缺的,仍是小儿先心病初筛的方法之一。     

高血压性心脏病合并急性心肌梗死的超声与预后研究

目的探讨高血压性心脏病合并急性心肌梗死患者的预后及其相关因素。方法选择原有高血压性心脏病,因急性心肌梗死住院患者38例（高血压性心脏病组）和42例无高血压性心脏病史,因急性心肌梗死住院患者（非高血压性心脏病组）。对照分析两组患者的年龄、性别、超声心动图结果,以及两组死亡病例特点等。结果EF〈50％＋E／A〈1发生率高血压性心脏病组较非高血压性心脏病组明显增高（P〈0．05）;高血压性心脏病组合并心瓣膜病变者较非高血压心脏病组明显增多（P〈0．05）;高血压性心脏病组死亡病例全部合并退行性钙化心瓣膜病,较非高血压性心脏病组明显增多（P〈0．05）;高血压性心脏病组死亡人数21例（55．3％）,较非高血压性心脏病组的10例（22．8％）显著增高（P〈0．01）。结论高血压性心脏病组患者出现退行性钙化心瓣膜病、心脏功能受损严重可能是高血压性心脏病合并急性心肌梗死患者的重要危险因素。提示临床应重视这些高危患者的起声心动图特征,给予及时、有效的处理,减少住院病死率。     

心脏神经症患者直立倾斜试验探讨

目的：探讨直立倾斜试验（HUTI＇）对心脏神经症的诊断价值。方法：对59例心脏神经症患者，在排除器质性心脏病后行HUTT。结果：43例呈阳性，阳性发生率为72．9％。不同性别间反应类型有显著差异（P〈0．05），女性多见血管抑制型（占76．9％）。不同反应类型间终末血压、心率有明显差异（P〈0．05）。结论：HUTT可作为心脏神经症有效的辅助诊断方法。     

青年动脉粥样硬化性颅内外血管狭窄的特征及危险因素分析

目的探讨青年动脉粥样硬化性颅内外血管狭窄的特征及危险因素。方法回顾性分析41例动脉粥样硬化性颅内外血管狭窄青年患者的临床资料,并选取46例无血管狭窄的青年患者作为对照组,收集所有患者临床资料。采用SPSS17．0统计学软件进行统计学分析,以P〈0．05为差异有统计学意义。结果狭窄组颅内段狭窄占明显优势（75．61％）,其中又以前循环为多（67．74％）。两组比较,高血压、糖尿病、高脂血症、吸烟、心脏病差异有统计学意义（P〈0．05）。其中高血压病（OR=4．93,P=0．001）,高脂血症（OR=4．46,P=0．004）和吸烟（OR=1．67,P=0．000）是青年动脉粥样硬化性颅内外血管狭窄的危险因素。结论青年颅内动脉狭窄率远高于颅外动脉。应对青年高血压、高脂血症、吸烟进行积极防治。     

张掖市高考体检学生心脏检查结果分析及其心脏病防治对策

对张掖市2010-2013年参加高考体检的20842名学生进行心脏听诊,结果发现听诊异常328名。对其中217名进行心电图检查,发现心电图正常123名。再对心电图异常的94名行彩色多普勒超声心动图检查,结果检出33名先天性心脏病。43名左室假腱索,两者共76名,占心脏听诊异常的23．17％;其余252名心脏听诊异常者,彩色多普勒超声心动图检查结果正常。结果提示,高考体检中,对心脏听诊有异常,尤其是心脏杂音〉~2／6级的收缩期杂音者进一步行心电图及彩色多普勒超声心动图检查,可早期发现无临床症状的先天性心脏病、左室假腱索等异常情况。教育主管部门及学校要重视高考体检结果分析,并制定相应的高中生健康及保健方案,从而为国家培养身体健康的青年学子。     

大面积与腔隙性脑梗死经颅多普勒超声血流动力学分析

目的：应用经颅多普勒超声（TCD）监测大面积脑梗死与腔隙性脑梗死血流动力学变化．并进行相关性分析,方法：选择2009年2月至2012年5月在广东省揭阳市人民医院及广州医学院附属第二医院收治的80例脑梗死患者作为研究对象,其中大面积脑梗死40例（A组）、腔隙性脑梗死40例（B组）,选择同期正常（C组）36例作为对照。应用TCD进行脑血管血流动力学监测．结果：A组脑血流异常率为95％（38／40）;B组脑血流异常率为75％（30／40）;c组脑血流异常率为33％（12／36）：A组血流异常率明显高于B、C组,差异有统计学意义（P〈0．05）,B组血流异常率明显高于C组（P〈0．05）、A、B、C组脑血管狭窄患者分别为2l、17、2例,A组、B组血管狭窄率较C组明显增多（P〈0．05）。A组、B组流速减慢发生率较C组增多（P〈0．05）。A组脑梗死病灶侧／CA、ICA、ACA的PI、RI较B、C组明显增大（P〈0．05）,结论：应用TCD有助了解大面积脑梗死患者颅内血管血流动力学情况,为治疗、判断病情及预后提供参考依据,也可作为常规的脑血管病的排查手段。     

ST段抬高性和非ST段抬高性心肌梗死临床特征和冠状动脉病变特点比较

目的分析ST段抬高急性心肌梗死（STEMI）和非ST段抬高急性心肌梗死（NSTEMI）临床特征和冠脉病变特点。方法对STEMI组125例和NSTEMI组42例患者冠心病危险因素、冠心病史、平时心绞痛症状、入院时临床表现、心肌损害指标、心脏超声和冠脉造影进行比较。结果STEMI组发病年龄及合并糖尿痛比例、冠心病史和平时心绞痛症状发生率均低于NSTEMI组（P分别〈0．05、0．05、0．05和0．01）,而吸烟、持续性胸痛及并发恶性心律失常的比例高于NSTEMI组（P分别〈0．05、0．01和0．05）;STEMI组肌酸激酶同工酶及肌钙蛋白Ⅰ水平均明显高于NSTEMI组（P均〈0．01）;STEMI组冠脉单支病变明显多于NSTEMI组（P〈0．01）,3支病变低于NSTEMI组（P〈0．05）,狭窄程度〈70％及70％～90％者比例低于NSTEMI组（P分别〈0．05和0．01）,狭窄程度〉90％及完全闭塞者明显高于NSTEMI组（P均〈0．05）;STEMI组形成侧支循环及具有基础TIMI血流3级比例明显低于NSTEMI组（P分别〈0．01和0．05）;超声心动图检查指标二组差异无统计学意义（P〉0．05）。结论NSTEMI患者发病年龄大,合并糖尿病比例相对较高,冠心病史长,平时多有心绞痛症状,心肌梗死时胸痛症状较轻,并发恶性心律失常的比例以及血中心肌损伤标记物较低,冠脉病变弥漫、累及多支,但阻塞程度相对较轻,有基础TIMI血流3级及形成侧支循环的比例高。     

胸部肿瘤调强放疗与常规放疗心脏放射线受量及动态心电图改变的比较分析

目的比较胸部肿瘤调强放疗（IMRT）与常规放疗（CRT）心脏放射线受量及动态心电图（DCG）的改变。方法选择2006年1月～2013年8月广西壮族自治区肿瘤医院放疗中心及广西壮族自治区人民医院肿瘤中心住院的胸部肿瘤患者100例,分为IMRT组和CRT组,每组各50例,分别于治疗前、受照30、60Gv时进行24hDCG监测,分析两组心脏放射线受量及DCG改变。结果①IMRT组心脏V30、V40、V50[（31．9±13．6）％、（22．1±9．4）％、（11．7±5．3）％]均明显低于CRT组[（42．1±14．9）％、（33．2±10．1）％、（20．5±7．6）％],差异有高度统计学意义（P〈0．01）;两组间心脏V10、V20、V60比较,差异无统计学意义（P〉0．05）。@IMRT组及CRT组治疗前、受照30、60Gv时DCG异常发生率比较,差异有高度统计学意义（P〈0．01）;治疗前两组DCG异常发生率比较,差异无统计学意义（P〉0．05）,受照30、60Gy时IMRT组DCG异常发生率均低于CRT组,差异有统计学意义（P〈0．05）。结论两种疗法均可引起DCG改变,但IMRT在相同剂量照射时,心脏受照体积更少,DCG异常发生率更低。     

经皮二尖瓣球囊成形术治疗老年二尖瓣狭窄的近期疗效

目的探讨老年风湿性心脏病（RHD）二尖瓣狭窄（MS）患者行经皮二尖瓣球囊成形术（PB-MV）的近期疗效及安全性。方法对32例老年风湿性心脏病MS患者进行PBMV并对结果进行分析。结果术后肺动脉平均压、左房平均压、二尖瓣跨瓣压显著下降（P〈0．001）,超声心动图检查示二尖瓣口面积显著扩大（P〈0．001）,心排量明显增加（P〈0．05）,左室射血分数显著上升（P〈0．001）,操作相关并发症少。结论PBMV治疗老年风湿性心脏病MS患者近期疗效好,成功率高,严重并发症少。     

小儿风湿热及风湿性心脏病的临床特点分析

目的探讨小儿风湿热及风湿性心脏病的特点,从而为临床诊断和治疗提供指导。方法将2007年1月～2012年1月期间在本院住院治疗的70例因风湿热致风湿性心脏病患儿根据症状典型与否分为观察组43例和对照组27例,回顾性分析和比较两组患儿临床体征和实验室指标。结果观察组心肌炎26例,发病率为60．47％,明显高于对照组的33．33％（χ2=4．513,P〈0．05）;对照组多发性关节炎合并心脏炎、心力衰竭、关节痛发病率分别为55．56％、11．1l％和81．48％,显著高于观察组的30．23％、0．0％和53．49％（χ2=4．304、3．879、3．962,均P〈0．05）;两组患儿ERS增快发生率与AS0阳性率比较无显著性差异（P〉0．05）;观察组GAS指标阳性人数显著高于对照组（χ2=5．026,P〈0．05）,而对照组CoxB阳性例数显著高于观察组（χ2=3．968,P〈0．05）,提示临床症状典型患儿CoxB与GAS指标与不典型患儿之间存在显著性差异（P〈0．05）。结论应加强对不典型性小儿风湿热的鉴别诊断,重视小儿风湿热及风湿性心脏病的治疗。     

心脏听诊模拟教学的应用与教学质量评价

目的：探讨规范心脏听诊模拟教学内容及增加学时对教学质量的影响。方法将112名临床医学专业学生分为对照组及实验组,采用床旁教学与模拟教学不同学时比例授课后进行考核,并进行问卷调查。结果实验组学生听诊模拟心尖区舒张期杂音以及主动脉瓣区舒张期杂音正确率均高于对照组,P〈0.05,差异具统计学意义。两组学生床旁考核正确率比较,P〉0.05,差异无统计学意义。问卷调查结果显示,实验组学生对心脏听诊模拟教学大多持肯定的态度。结论心脏听诊模拟教学的科学应用,有助于提高教学质量,可以有效缓解临床教学资源的不足。     

A novel multimedia tool to improve bedside teaching of cardiac auscultation

Training in cardiac auscultation is a core element of undergraduate teaching but recent studies have documented a remarkable decline in auscultatory skills. Therefore there is an interest in new ways to teach cardiac auscultation. In analogy to phonocardiography, an electronic system for simultaneous auscultation and visualisation of murmurs was sought. For this purpose, an electronic stethoscope was linked to a laptop computer and software created to visualise auscultatory findings. In a preliminary trial in undergraduate students, this approach greatly facilitated teaching. Amalgamating traditional phonocardiography with a multimedia approach, this system represents a novel tool for bedside teaching of cardiac auscultation.     

云南省基层医疗卫生工作者早期筛查先心病能力及培训效果

目的 为提高云南省农村地区先天性心脏病早期诊断率, 了解目前云南省基层医务人员先心病相关知识知晓度、筛查意识和能力, 探讨提高基层医务人员相关知识技能的有效方法.方法 2015年9月至2017年4月期间, 组建爱心流动学校, 选择云南省昆明市西山区、昭通市地区等8个地区作为调查及培训地点, 调查及培训共计1 022名县级及以下医疗卫生服务机构医护人员, 内容涵盖先心病筛查意识、相关知识和筛查技术, 并调查培训效果.结果 培训前、后共收回问卷2 044份, 培训后, 调查对象对先心病筛查的意愿、先心病发病情况、常见临床表现、艾森曼格综合征的概念、心脏听诊、血氧饱和度监测的认知和重症先心病的认知均较培训前提高, 差异均有统计学意义 (P<0.01) ;培训后, 共有563名调查对象参与先心筛查的实践技能检测, 对听诊顺序、杂音时期、杂音性质的判断正确率为98.22% (553人) 、30.55% (172人) 、28.60% (161人) , 对室间隔缺损、房间格缺损、动脉导管未闭的杂音识别的正确率分别为45.47% (256人) 、39.79% (224人) 、50.80% (286人) ;94.81% (968人) 的培训对象表示对培训评价优秀或良好.23.87% (244人) 的培训对象建议做网络培训, 63.80% (652人) .结论 建议增加先心病筛查经济投入, 进一步加强培训;云南省基层医务人员对先心筛查的意识;通过组建爱心流动学校, 对县级及以下医务人员进行先心病理论及操作培训, 提高云南省基层医务人员对先心筛查的意识、筛查知识、操作技能有效, 进一步提高基层先心病早期诊断率.     

北京市上地医院1年出生新生儿先天性心脏病筛查分析

目的研究北京市上地医院1年出生新生儿先心病的流行情况，探索先心病在基层医院筛查和管理方法。方法选择2006年7月1日～2007年6月30日北京市上地医院出生全部新生儿，住院期间每日均予体格检查、详细心脏听诊，出生第二天心电图检查，对有病理性杂音、青紫、气促等不能用呼吸神经等疾病解释及心电图提示先心病者，进一步心脏彩超检查，出院随访6月-1年。结果筛查5581例，发现听诊异常51例，其中彩超确诊先心病41例，诊断率80．4％，非先心病10例，为瓣膜返流或假腱索；2例新生儿除外心脏外原因青紫、气促，听诊异常，均确诊复杂心脏畸形；EKG提示先心病者4例，均确定诊断；X线诊断右位心2例。心脏彩超确诊先心病43例：室间隔缺损15例，占34．9％；房间隔缺损10例，占23．2％；单纯动脉导管未闭12例，占27．9％；镜像右位心2例，占4．7％；原发性肺动脉高压1例，占2．3％；复杂心脏畸形3例，占7．0％。死亡共4例，占9．3％。结论在基层医院做好新生儿体格检查、心脏听诊，合理选择心脏超声等检查，出院随访半年以上，能够廉价高效地早期发现先天性心脏病并降低婴儿死亡率。     

Graduate medical education in the United States

The annual surveys of residency programs on which this report is based have had a higher than 90% response rate for the past 5 years. The count of available residency positions is a fluid entity and seems to be dependent on many factors, including funding and the number of qualified candidates seen by program directors. The number of GY-1 positions has not changed significantly during the past 3 years. The number of reported unfilled positions, including GY-1 unfilled positions, has increased each year since 1985. The total number of residents on duty decreased slightly in 1988. This decrease may be due to a lower response rate. The number of new entry residents (GY-1) has been decreasing since 1985. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. The number and percent of women in residency programs have remained steady. The percentage of FMG residents decreased slightly to 15.3% in 1988. The number of black non-Hispanic residents decreased in 1988, and the percentage of all residents who are black decreased slightly. The number of graduates of osteopathic medical schools in ACGME programs has increased 39% since 1986. The number of institutions involved in graduate medical education has not changed significantly during the past 3 years, although the number of institutions that are not hospitals has increased since 1983. Ninety-five percent of all types of institutions have some type of affiliation with a US medical school.     

Screening for cancer by residents in an internal medicine program

A study was conducted by the authors to explore screening for cancer by internal medicine residents in a primary care clinic. The charts of 151 patients over 40 years of age followed by residents in the outpatient clinic of an innercity hospital were reviewed for documentation of screening on initial evaluation or on follow-up within 12 months of the initial visit. The residents were unaware of the chart review, and cancer screening had received no special emphasis in their training program. Screening was more frequently performed on male patients than female patients: smoking history (61 percent of males, 34 percent of females); alcohol history (64 percent of males, 26 percent of females); occupational history (48 percent of males, 15 percent of females); and testing for hidden blood in stools (73 percent of males, 41 percent of females). Breast examination and Pap smears were done on 33 percent and 29 percent of the women patients, respectively, with women residents performing them slightly more frequently than male residents. This low rate of cancer risk screening suggests the need for intensive education of residents on the potential for cancer prevention through early detection.     

Graduate medical education in the United States

1. The annual surveys of residency programs on which this report is based have had a response rate higher than 90% for the past five years. 2. The count of available residency positions is a fluid entity and seems to be dependent on many factors, including funding and the number of qualified candidates seen by program directors. 3. The number of GY-1 positions has not changed significantly over the past three years. The number of reported unfilled positions, including GY-1 unfilled positions, has increased each year since 1985. The total number of residents on duty decreased in 1985 but increased in 1986 and in 1987. This increase is due mainly to the number of residents on duty in the new internal medicine and pediatric subspecialty programs. 4. The number of new-entry (GY-1) residents decreased in 1985, 1986, and 1987. 5. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. 6. The number and percentage of women in residency programs continue to increase, as they have for the past several years. 7. The percentage of foreign medical graduate residents decreased slightly to 15.6% in 1987. 8. The number of black non-Hispanic residents increased in 1987, although the percentage of black residents remained about the same. 9. The number of graduates of osteopathic medical schools in ACGME programs has increased 59% since 1985. 10. The number of institutions involved in graduate medical education has not changed significantly over the past three years, although the number of institutions that are not hospitals has increased since 1983. Ninety percent of all types of institutions have some type of affiliation with a US medical school.     

河南省全球基金疟疾项目（NSA 项目）终期评估（二）：KAP 调查及结果分析

目的：了解河南省全球基金疟疾项目（NSA 项目）实施对项目覆盖人群的健康教育促进情况,评估项目实施效果。方法按照《国家全球基金疟疾项目终期评估方案》,采用现场问卷调查的方式在所有全球基金疟疾项目县开展疟疾防治知识知晓率、培训效果满意度及目标人群受益情况与满意度调查,对调查数据进行汇总、整理和分析。结果2012年对90个县（市、区）的26673名居民、17421名学生、3311名疟疾防控人员及2614名目标人群的调查结果显示,居民与学生的疟疾防治知识知晓率分别为94.65%和93.73%,较2010年基线调查数据分别上升72.18%和78.70%;知晓率居民高于学生（P<0.0001）;中学生（94.78%）高于小学生（92.81%）（P<0.001）;一类县居民和学生的知晓率分别为96.02%和95.64%,分别高于二类县居民（94.55%）和学生（93.57%）的知晓率（P<0.01）;受训人员对项目培训的目标、内容、方式、效果和总体评价的满意度为93.54%～98.34%;疟疾病人对免费抗疟药物服务的满意度为100%（203/203）;居民对疟防宣教材料的满意度为96.10%（2512/2614）。结论全球基金疟疾项目的执行使居民与学生疟疾防治知识知晓率大幅上升,基层医疗人员及居民的整体满意度高。     

心脏粘液瘤诊断及治疗的探讨

14例心脏粘液瘤,女8例,男6例,平均年龄36.4岁。左房12例,左及右房1例,右房并右室1例。重点探讨与风湿性心脏病二尖瓣狭窄异同之点:本病因心慌、气急、咯血、心脏杂音、低热、血沉快及X线表现易诊断风心二狭;本病发病急,病情发展迅速,晕厥与杂音可与体位有关,肺淤血症状重而X线表现轻,突然反复发生栓塞但心律为窦性。根据上述特点,经超声心动图检查即能确诊。及时手术预后良好,本文手术12例,死亡3例,其中2例恶性变,1例并发心律紊乱。