小儿心律失常心电图163例临床分析

本文分析了１６３例次小儿心律失常心电图及其病因．窦性心律失常９９例次（６０．７３％）；异位心律失常４３例次（２６．３０％）；其中以定性早搏最常见；传导阻滞２１例次（１２．８８％）。病因主要是病毒性心肌炎、风湿病、心肌病和先天性心脏病。文中对心律失常发生机理和室性早搏的临床意义的判断进行了讨论。     

CHANGES IN ETIOLOGIC TYPES OF HEART DISEASE IN SHANGHAI DURING THE PAST 32 YEARS AN ANALYSIS OF 15,696 PATIENTS

A series of 15,696 cardiac patients admitted to our two hospitals were studied for changes in etio- logic types of heart disease in the past 32 years. They were divided int0 3 groups representing roughly cases seen in the 50's, 60's and 70's. Heart disease accounted for 9.8'70, 15.69To and 20.9To of all admis sions respectively. The frequency of common etiologic types was in the following order: In the 50's, theumatic heart disease (RHD), hypertensive heart disease (HHD), syphilitic cardiovascular disease, chronic pulmonary heart disease (PHD), coronary heart disease (CHD), congenital cardiovascular disease (CCD), thyroid heart disease and pericarditis; in the 60's, RHD, CHD, CCD, PHD, HHD, syphilitic cardiovasculardisease, cardiac arrhythmia of undetcrmined cause, pericarditis and myocarditis; and in the 70's, CHD, RHD, CCD, PHD, myocarditis, cardiac arrhythmia of undetermined cause, HHD, idiopathic cardiomyo pathy and pericarditis. RHD ranked first among the etiologic types in all the 3 decades. However, the percentage declined tremendously in the 70's and its leading position was substituted by CHD in the past 4 years. PHD was common and had a steady percentage throughout the 3 decades. Prevalence of hypertension was in creasing in the past 2 decades whereas HHD disease became less common in the 70's. Possible causes of the foregoing changes are discussed.     

SUDDEN CARDIAC DEATH AMONG AUTOPSIED CASES

Sixty-eight sudden cardiac deaths (10.6%) in 642 autopsied cases of cardiovascular diseases were studied. The incidence was highest in ischemic heart disease (29.6%). Cardiac arrest was the most frequent direct cause of death in ischemic heart disease with or without acute myocardial infarction. Embolism was an important immediate cause of sudden death in theumatic heart disease, pulmonary heart disease and infectious endocarditis.     

原发性心肌病42例

本文对42例原发性心肌病进行了分析和讨论。临床表现以心律失常、全心大、心力衰竭为主。心律失常以室性早博、室内束支传导阻滞、房室传导阻滞最为常见。对本病的诊断须结合临床表现、心电图、X线、超声心动图等项检查综合判断,否则易造成误诊。     

DIAGNOSIS OF ENDOCARDIAL CUSHION TYPE ATRIAL SE,PTAL DEFECTS CLINICAL ANALYSIS OF 18 CASES

18 cases of endocardial cushion type atrial septal defect are classified in this paper int0 4 categories according to their pathologic changes: ostium primum type, portional common atrioven- tricular canal, complete common atrioventricular canal and single atrium (common atrium). Analysis is also made of the clinical symptoms, signs and features manifested in ECG, X-ray, cardiac catheterization and angiocardiography. A brief account is given of the diagnostic charac- teristics of each type of endocardial cushion defect as well as the basis for differential diagnosis from ostium secundum type atrial defects, Lutembacher syndrome (ostium secun- dum type atrial defects with mitral valve lesions), theumatic mitral disease and total anomalous pulmonary venous drainage. Finally, the mode of operation on endocardial cushion defects and the treatment of mitral insufficiency caused by mitral leaflet clefts are discussed.     

1014例老年人的心电图分析

本文对1014例住院老年患者心电图进行分析,表明老年人的异常心电图发生率明显增高。异常心电图的发生率在60岁以上的3个年龄组中随年龄的增大而逐渐增高;但与性别无关。异常心电图中,心律失常发病率最高,占39.20％,其次是低电压,ST-T变化,U波异常,左室肥大,Q-T延长等。室内传导阻滞,室性异位搏动多见于冠心病;房室传导阻滞,心房颤动则多见于风心病,并对其机制作了分析。     

CHANGING PREVALENCE AND PATTERN OFCARDIOVASCULAR DISEASES IN HONG KONG A PERSPECTIVE IN THE 1990s

The prevalence and pattern of cardiovascularproblems in Hong Kong are basicaliy those of an ageing subtropical Chinese community, influenced by the impact of westernization and urbanization. Their trends over the past decades have been hall-marked by a decreasing prevalence of theumatic and corr genital heart disease, and a plunging incidence of theumatic fever, associated with a rapidly increasing prevalence of ischemic and degenerative type of cardiovascular diseases. In the 1990s, theumatic heart disease will be less prevalent but may still account for tOTo of the problem. Ischemic heart disease and degenerative type of Icsions will certain- ly be more commonly seen and accottnt for 40% and 25U/o respectively, while the prevaleuce of hyperten- sive diseases and congenital heart disease may hope fully stays at 10% and 5% levels, respectively.     

TRENDS IN RHEUMATIC FEVER DURING THE PAST 10 YEARS LONG TERM FOLLOW UP OF 156 CASES

156 patients with initial theumatic fever (RF) attacks were followed up an average 10 years, it is found that the incidence of carditis in RF is not. declining significantly in China. The severity of carditis clinical symptoms (as evidenced by cardiac failure and pericarditis) has decreased and the mortality has been greatly reduced. Recurrence rate and morbidity of re- sidual theumatic valvular deformities are greatly diminished as well. The most important risk factor influencing the formation of chronic theumatic valvular disease (CRVD) is the severity of valvular lesions at the acute phase. Formation of mitral stenosis is more frequent in the female. Enlarge- ment of cardiac silhouette, ECG abnormalities, joint lesions, cutaneous lesions, recurrence rate and use of steroid medication seem to be irrele- vant to CRVD development. It seems that the severity of the RF clinical course and the results of long term follow up in this study lie between the 2 extremes of results in the West and other developing countries. In China the incidence of RF comp'icating cardiac lesion is not decreasing significantly, the percentage of complicating cardiac failure is si- milar to that of the West in the 1950s, but the lowered mortality, recurrence rate and CRVD incidence are approaching world levels.     

慢性肺源性心脏病并发心律失常临床分析

目的：对慢性肺源性心脏病并发心律失常的临床特征、发作类型和病因进行观察分析。方法收集开封市中心医院2009年5月至2013年5月收治的慢性肺源性心脏病患者193例进行24 h 心电监护或反复常规12导联心电图检查。发现并发心律失常120例,未并发心律失常73例,对所有患者进行常规治疗,观察心律失常类型和并发症发生情况。结果在193例慢性肺源性心脏病患者中有120例并发心律失常,其中窦性心动过速52例,房室早搏26例,房性心动过速11例,心房颤动10例,室性早搏 6例,右束支传导阻滞4例,左束支传导阻滞3例,房室传导阻滞3例,心房扑动5例;心律失常患者并发肺部感染、心力衰竭、低氧血症、电解质紊乱及酸碱平衡失调发生率均高于未并发心律失常患者,差异有统计学意义（P 〈0.05）。结论慢性肺源性心脏病并发心律失常比例较高,以窦性心律过速和房室早搏较多,其常见诱因为肺部感染、低氧血症、心力衰竭、电解质紊乱等,给予相应治疗可有效降低慢性肺源性心脏病并发心率失常发生率。     

TUBERCULOUS AFFECTIONS UNDER THE MASK OF RHEUMATIC CONDITIONS*

Attention was called to the relation between tuberculosis and theumatism in 1897 by Poncet, who described for the first time the so-called tuberculous theumatism. Since then the studies of Melchior, Russelor and Ancilloti have further addcd to our knowledge of the disease. However, the disease has been regarded as an entity by itself and no attempt has been made to include all cases of theumatic arthritis under tuberculous etiology.     

高原地区2142例心律失常心电图特点及分析

统计分析我院（西宁，海拔2260m）1989～1995年间2142例心律失常心电图，其中临床诊断器质性心脏病1650例，非器质性心脏病492例。结果显示：主动性异位心律为52．24％；传导阻滞为37．53％；窦性心律失常为33．05％，而被动性异位心律及其它心律失常仅为6．02％。与平原地区资料相比较，发现2260m及以上高原地区心律失常以主动性心律失常及传导阻滞的发生显著高于宁夏地区这两种心律失常的发生（P＜0．01）。提示高原缺氧对心肌自律性、兴奋性和传导性有特殊影响，这对本地区心律失常患者给氧治疗提供了依据。     

PRIMARY CARDIOMYOPATHY CLINICAL ANALYSIS OF 74 CASES I. CONGESTIVE CARDlOMYOPATHY

Of .4 cases of primary cardiomyopaihy seen over a period of ZO years, 52 (70.2%) were diag- nosed as congcstive cardiomyopathy, 14 (19%) as obstructive cardtomyopathy and S (lO.8%) as restrictive cardiomyopathy. In this paper the 52 cascs (37 males and 15 females) af eongestive cardiomyopathy are analyzed. Of these. 26 were admitted for hearf, failure, 24 for cardiac arrhytlirnia, 1 for cardiogenic shock and l for cardiac enlargement. Roentgcnol09ic cxamin-a- tion revealed enlargement of heart shadow in 48 cases. Elecf,rocardiogram djsplayed sinus thytluu in 44 cases in which various cardiac arrhythmias appearecl on and off and ectopic rhythm in 8. ThromboeWaoli phenomena were seldom seen . The hOSPital fatality rate was hjgh, being 42.3clo among cases witli heart failure and S.3rtr among cases with cardiae arrhythmia. The ctiology of this disease is unknown. The prog- nosis was poor in c:vses with congestive heart failure. The meztn duration of cardiac enlarge- ment prior to onsct of symptoms was 4.5 years. Differential diagliosis between congestive cardiomyopathy and pericardial effusion and8.3% caronary, theumatic, pulmonary. and; congenital heart diseases are emphasized. Maintaining heart function in the compensatory stage is con: sideretl effective in the prevention ot this dis order. Treatment is as a rW.e paUiative, cori- sisting of rapid-acting glucosides and diuretics.     

300例冠心病患者心律失常分析

目的 :探讨冠心病患者心律失常的类型、机理。方法 :以标准 12导联心电图检查 ,分析 30 0例冠心病患者心律失常的发病类型、机理。结果 :心律失常类型 :包括房颤占 36 6 7%,房性早搏 35 33%,室性早搏 30 0 0 %,窦性心动过速 3 33%,室上性心动过速 1 33%,室性心动过速 0 6 7%,窦性心动过缓 4 0 0 %,房室传导阻滞 3 0 0 %,左前分支传导阻滞 1 6 7%,右束支传导阻滞 3 33%,左束支传导阻滞 0 6 7%,窦房阻滞 0 6 7%。结论 :冠心病患者心律失常类型多变 ,其中以房颤的发病率最高。     

DIAGNOSIS OF ATRIAL MYXOMA A CLINICAL ANALYSIS OF 10 CASES

10 cases of atrial myxom.a, left 9 and right 1, are anaiysed with emphasis on the clinical symptoms and signs and laboratory findings. The differentiation of left atrial myxoma from theumatic mitral stenosis and of right atrial myxoma from pericarditis and tricuspid mal- formation (Ebstein's anomaly) are discussed, as is the diagnostic value of angiocardiography, echocardiography and cardiac catheterization.     

冠心病患者3986例动态心电图与常规心电图心律失常结果对比分析

探讨动态心电图在心律失常方面的诊断意义。方法：将冠心病患者３９８６例动态心电图与常规心电图心律失常结果进行对比分析。结果：动态心电图在心律失常的诊断方面明显优于常规心电图；窦房传导阻滞和房室传导阻滞随年龄增高而增加。结论：动态心电图比常规心电图为临床诊断各种心律失常提供更加可靠的依据。冠心病患者年龄愈大愈应行此项检查。     

小儿手足口病的发病特点以及护理进展

小儿手足口病是儿科常见的传染性疾病,对小儿影响较大,积极做好护理工作有利于促进疾病痊愈。本文从对该疾病的基础护理、心理护理、健康教育等方面的进展进行综述,旨在为小儿手足口病的治疗提供必要的护理依据。     

EPIDEMIOLOGY AND COMMUNITY CONTROL OF RHEUMATIC HEART DISEASE IN PANYU COUNTY

A practical method of carrying out rural survey and control of theumatic and other heart diseases is presented.     

普通电极紧急心脏起搏在急诊心律失常中的应用

目的探讨普通电极导管行紧急床边临时心脏起搏在急诊心律失常中的价值。方法应用普通电极导管对91例心律失常急症行紧急床边临时心脏起搏,其中严重窦性心动过缓46例,高度～Ⅲ度房室传导阻滞30例,心脏骤停11例,室速3例。结果起搏成功89例,占97.8%;窦性心动过缓者、房室传导阻滞、室速者全部成功,11例心跳骤停9例成功。结论普通电极紧急床边临时心脏起搏是治疗心律失常急症安全、有效的方法。     

慢性肺心病心律失常的临床特征

目的：探讨肺心痛心律失常的临床特征及治疗原则。方法：本组病例总共136例,全部于入院后48h内通过24h心电监护或反复常规12导联心电图检查,及时地发现心律失常类型并加以分析。结果：本组肺心病患者合并心律失常率迭67．64％(92例),其心律失常类型以房性心律失常最多,占42．08％,其次为窭性心动过速及室性心律失常。严重心律失常如室上性心动过速、多源室早、房宣传导阻滞、房扑等也常出现。心律失常的出现及严重程度与患者病情的严重程度相关性明显,如心衰程度、肺部感染、低氧血症、水电解质紊乱等密切相关。结论：肺心病心律失常发生率较高,且与肺心病患者病情严重程度密切相关,而心律失常治疗应通过积极的病因及合并症治疗,使用抗心律失常药物不是最佳办法。     

ETIOLOGY AND MANAGEMENT OF CHRONIC COR PULMONALE IN CHILDREN

This paper presents 30 cases of cor pulmonale in children, showing that the condition has poor prognosis, progresses rapidly and death occurs in 40.0'/o within a short period of hospitalization. In our country the most common causes of pediatric cor pulmonale are chronic pneumonia, bronchiectasis and pulmonary tuberculosis after measles and whooping cough. The fundamental measures to be taken in the prevention of pedia- tric cor pulmonale are therefore prevention and treatment of measles, whooping cough and other infectious diseases aiming at complete resolution of pulmonary complications.