静脉注射胺碘酮转复阵发性心房颤动的临床观察

目的：观察静脉注射胺碘酮转复阵发性心房颤动（PAF）的疗效和安全性。方法：80例发作1～24h的PAF患者,随机分为两组。胺碘酮组（40例）：胺碘酮150mg静脉注射,继以1mg／min静脉泵入．维持6h,去乙酰毛花苷组（40例）：去乙酰毛花苷0．4mg静脉注射,2h后追加0．2mg。观察PAF转复情况,心率、QTe是期变化及副作用。结果：胺碘酮组复律29例（72％）,去乙酰毛花苷组复律18例（45％）,P〈0．05。复律时间分别为（215±58）min。（253±39）min．P〈0．05。未转复者心率分别下降26％和11％。P〈0．05。QTc间期两组复律前后比较差异无显著性。两组均无严重副作用。结论：静脉注射胺碘酮转复PAF有效且安全。     

胺碘酮对急性心肌梗死合并房颤患者的疗效

目的:研究胺碘酮对急性心肌梗死(AMI)合并心房颤动(AF)患者的临床疗效和AF控制效果。方法:本院2015年1月～2019年6月间收治的120例AMI+AF患者被随机均分为毛花苷丙组和胺碘酮组,两组均接受常规治疗。观察比较两组治疗后6h、12h、24h、48h的AF控制率,随访30d时的窦性心律维持率,治疗72h后的临床疗效、心率、P-R间期、QTc间期和LVEF,以及治疗期间的不良反应发生率。结果:与毛花苷丙组比较,胺碘酮组治疗后6h、12h、24h、48h时AF控制率(10.00%比30.00%;16.67%比53.33%;36.67%比73.33%;56.67%比90.00%)均显著升高,随访30d时的窦性心律维持率(48.33%比86.67%)亦显著升高,P均0.01。治疗72h后,与毛花苷丙组比较,胺碘酮组心率[(82.81±10.65)次/min比(75.69±9.71)次/min]显著降低,P-R间期[(142.71±15.32)ms比(149.18±16.13)ms]、QTc间期[(402.08±17.41)ms比(418.25±19.65)ms]和LVEF[(45.12±6.28)%比(51.96±7.14)%]均显著升高,P0.05或0.01。治疗期间,胺碘酮组的不良反应发生率显著低于毛花苷丙组(6.67%比36.67%),P=0.001。结论:胺碘酮能够显著提高急性心肌梗死合并房颤患者的房颤控制率与临床疗效,并可显著提高窦性心律维持率,且用药安全性高,值得推广。     

艾司洛尔与毛花苷控制快速房颤心室率的疗效及安全性比较

目的：比较艾司洛尔与毛花苷控制快速心房颤动心室率的即时疗效及安全性。方法：72例快速心房颤动患者，心室率≥120次/min，被随机分为艾司洛尔组、毛花苷组各36例。艾司洛尔组首次剂量给予0.5mg/kg，1 min静注，观察5min，若心室率仍＞100次/min或下降＜20％，则追加0.5mg/kg，同时以0.05mg·kg^-1·min^-1微量泵起始维持，维持量最大可加至0.3mg· kg^-1·min^-1；毛花苷组首次剂量给予毛花苷0.4mg或0.2mg缓慢静注，若心室率仍＞100次/min或下降＜20％，可追加0.2mg。记录药物起效时间及不良反应。结果：艾司洛组平均起效时间显著低于毛花苷组[（5.6±3.1）min比（39.2±8.7）min]（P＜0.01）；两组患者用药后心室率均明显降低（P＜0.05或＜0.01），用药2h后艾司洛尔组心室率下降幅度显著大于毛花苷组（39％比29％，P＜0.05）；两组总有效率，不良反应发生率均无统计学差异（P＞0.05）。结论：静脉应用艾司洛尔作用迅速，安全有效，可作为控制快速心房颤动心室率的首选治疗。     

伊布利特与胺碘酮转复持续性心房颤动的疗效和安全性对比研究

目的 比较伊布利特和胺碘酮转复持续性心房颤动（PAF）的疗效和安全性.方法 2012年3月至2014年5月选取郑州市第十人民医院心内科住院的72例PAF患者,随机分为2组.伊布利特组（33例）采用伊布利特静脉注射转复窦性心律,用量：体质量≥60kg的患者,首次剂量1 mg,体质量＜60kg的患者,首次剂量0.01 mg/kg.胺碘酮组（39例）采用胺碘酮静脉注射转复窦性心律,用量：体质量≥60 kg的患者,首次剂量300 mg,体质量＜60 kg的患者,首次剂量5 mg/kg.比较两组患者用药后30 min内、3h内、12 h内、24h内的转复率,并记录两组患者用药过程中的不良反应.结果 伊布利特组患者用药后30 min内、3h内、12h内、24h内转复率均明显高于胺碘酮组（x2=10.7330,10.6500,8.4538,5.1932,P＜0.01或P＜0.05）;伊布利特组患者的平均转复时间明显短于胺碘酮组（t=7.9009,P＜0.01）;伊布利特QTc平均恢复时间短于胺碘酮（t=15.783,P＜0.01）;两组患者不良反应发生率比较差异无统计学意义（x2=0.4690,P＞0.05）,但伊布利特组的不良反应持续时间较胺碘酮组更短[（0.38±0.10）h比（16.75±8.39）h,t=11.195,P＜0.01].结论 与胺碘酮相比,伊布利特对持续性房颤的转复率高,转复时间短,不良反应消失快.     

胺碘酮治疗呼吸系统疾病合并快速心律失常的临床疗效

目的分析胺碘酮治疗呼吸系统疾病合并快速心律失常的临床疗效。方法选择2012—2013年我院收治的呼吸系统疾病合并快速心律失常患者163例,按照随机数字表法将患者分为治疗组(56例)、对照1组(53例)和对照2组(54例)。3组患者均予以原发病常规治疗,在此基础上治疗组加用胺碘酮治疗,对照1组加用普罗帕酮治疗,对照2组加用去乙酰毛花苷治疗。记录患者用药前,用药后30 min、12 h及24 h心室率,比较3组临床疗效。结果对照1组总有效率为84.9%(45/53),对照2组为81.5%(44/54),治疗组为100.0%(56/56),治疗组总有效率高于对照1组和对照2组(P0.05);对照1组和对照2组总有效率比较,差异无统计学意义(P0.05)。用药前3组患者心室率比较,差异无统计学意义(P0.05)。用药后30 min、12 h及24 h治疗组患者心室率低于对照1组和对照2组(P0.05)。3组患者均未发现严重不良反应。结论胺碘酮治疗呼吸系统疾病合并快速心律失常疗效显著,能有效控制心室率且安全。     

静脉胺碘酮治疗冠状动脉旁路移植术后心房颤动伴快速心室率的疗效和安全性

观察静脉胺碘酮对冠状动脉旁路移植术(CABG)后心房颤动(AF)伴快速心室率的疗效及安全性。回顾我院CABG术后3日内发生AF伴快速心室率患者159例,AF发作时心室率147.75次±41.02次/分;30～60min内静脉注射负荷量胺碘酮300mg,转复窦性心律或心室率<120次/分后给予胺碘酮0.5～1mg/min持续静脉泵入;心室率仍>120次/分再追加负荷量150～300mg,30～60min内静脉注入。结果:胺碘酮负荷量300～450mg转复窦性心律119例,占75%,仍为AF但心室率<120次/分18例,占11%;负荷量600mg仍为AF且心率>120次/分8例,占5%,出现一过性窦性心动过缓伴窦性停搏2例,占2%。结论:静脉胺碘酮治疗CABG术后AF伴快速心室率安全,有效,副作用少。     

美托洛尔与毛花苷快速控制心房颤动心室率的比较

目的：比较静脉应用美托洛尔与毛花（f4地黄）苷快速控制心房颤动患者心室率的疗效和安全性。方法：68例快速心房颤动患者（心室率≥120次／min）．随机分为美托洛尔组、毛花苷组各34例。美托洛尔组首次剂量给予5mg缓慢静注，观察15min。若心室率〉100次／min或下降〈20％，则追加5mg。最多给药10mg。若血压〈90／60mmHg，则停止试验；毛花苷组首次剂量给予毛花苷0．4mg或0．2mg缓慢静注，若心室率〉100次／min或下降％20％，则追加0．2mg。观察两组用药后10min、30min、60min、90min和120min心率，血压及临床表现；同时记录用药后药物起效时间及不良反应。结果：两组患者用药后2h内的心室率与用药前比较均明显降低（P〈0．05）．用药2h后美托洛尔组心室率下降幅度大于毛花苷组（P〈O．05）；美托洛尔、毛花苷组平均起效时间分别为（12．4±6．7）min和（41．6士11．2）min．两者差异有显著性（P〈0.01）；美托洛尔、毛花苷组总有效率分别为88％和76％无显著性差异（P〉0．05）；两组不良反应发生率均为12％。结论：静脉应用美托洛尔控制快速心房颤动患者心室率的短时疗效显著，患者安全性好。     

伊布利特在房性心律失常中的临床应用

目的观察伊布利特转复心房颤动(atrial fibrillation,AF)和心房扑动(atrial flutter,AFL)的有效性及安全性。方法选取2016年1月~2017年12月在聊城市第二人民医院心内一科住院的持续时间≤3个月的AF、AFL患者32例,随机分为伊布利特组(17例)与胺碘酮组(15例)。伊布利特组首次剂量1mg伊布利特稀释于5%葡萄糖注射液10ml静脉推注,如无效10min后再给予1mg;胺碘酮组首次剂量150mg胺碘酮稀释于5%葡萄糖注射液10ml静脉推注,如无效10min后再给予150mg。结果伊布利特组的AF和AFL转复及总转复率分别为64.3%、66.7%和64.7%,胺碘酮组的AF和AFL转复及总转复率分别为41.7%、33.3%和40.0%,2组比较差异有统计学意义(P0.05)。伊布利特组平均转复时间为(29.28±12.57)min,胺碘酮组平均转复时间为(70.59±16.83)min,2组比较差异有统计学意义(P0.01)。治疗前后2组血压、心率比较无统计学差异(P0.05)。2组不良反应发生率比较无显著差异(17.6%vs 26.7%,P0.05)。结论伊布利特转复AF、AFL具有起效快,成功率高,安全性好的特点,其疗效优于胺碘酮。     

艾司洛尔与胺碘酮治疗房颤伴快速心室率合并Ⅰ至Ⅲ级心衰患者的有效性和安全性的Meta分析

【摘要】 目的 通过Meta分析评价艾司洛尔与胺碘酮治疗房颤伴快速心室率合并Ⅰ至Ⅲ级心衰患者的有效性和安全性。方法 通过计算机检索英文数据库Pubmed、Embase、Cochrane，中文数据库CNKI、VIP、Wanfang数据库等在线电子数据库，检索时限是从建库至2020年10月21日，获取艾司洛尔和胺碘酮治疗房颤伴快速心室率合并Ⅰ至Ⅲ级心衰的随机对照研究（randomized controllled trial,RCT）。应用RevMan5.4软件对药物有效率和不良反应率进行Meta分析。将纳入患者分为艾司洛尔组和胺碘酮组，研究终点为心室率降低大于20%、心室率降至100次/min以下、心室率降低小于20%或心室率仍在100次/min以上。比较房颤伴快速心室率合并Ⅰ至Ⅲ级心衰患者经艾司洛尔和胺碘酮治疗的有效率及安全性。结果 共纳入7项RCT研究，包括576例患者，其中艾司洛尔组238例（50%）， 胺碘酮组238例（50%）。Meta分析结果显示，在用药的5-15分钟中，艾司洛尔组的治疗有效率(51.66%)高于胺碘酮组(9.96%）（RR=4.92,95%CI:3.34-7.27,P<0.00001）；在用药30分钟时，艾司洛尔组的治疗有效率（73.52%）高于胺碘酮组（49.16%）（RR=1.48,95%CI:1.25-1.74,P<0.00001）；在用药的120分钟时，艾司洛尔组的治疗有效率（86.74%）与胺碘酮组（89.2%）差异无统计学意义（RR=0.99,95%CI:0.92-1.06，P=0.86）；在整个治疗过程中，艾司洛尔组和胺碘酮组出现低血压、低心率、胃肠道症状等不良反应事件率的差异无统计学意义（RR=1.65，95%CI:0.92-2.84，P=0.80）。结论 艾司洛尔组和胺碘酮组在治疗房颤伴快速心室率合并Ⅰ至Ⅲ级心衰患者中，用药30分钟内，艾司洛尔组控制心室率的有效率显著高于胺碘酮组，但总有效率（用药120分钟时）无差异，且两组在治疗过程中出现低血压、低心率及胃肠道症状等不良反应事件率也无差异。     

大剂量静脉和口服胺碘酮治疗快速心房颤动临床观察

观察静脉、口服胺碘酮治疗快速心房颤动(简称房颤)的临床疗效及安全性。48例快速房颤患者首先给予胺碘酮150mg静脉推注之后以1mg/min静脉维持6h,改为0.5mg/min静脉点滴24～48h;同时用药当天给予口服胺碘酮1200mg,第二天为600mg,3天后改为200mg/d维持。结果:24h内房颤转复9例,转复率39.6%;3天内45例转复率93.8%。应用胺碘酮后心室率明显下降,随时间延长,呈减慢趋势。结论:负荷静脉、口服胺碘酮用药治疗快速房颤可明显减慢心室率,转复房颤安全有效。     

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.