以晕厥为表现的心血管疾病

晕厥是一种常见的临床症状。30％～60％的患经各方面检查，包括神经系统和心血管系统能够找到明确的原因，属器质性疾病的一种表现；40％～70％的患则属心脏神经反射性晕厥。近年来，以晕厥为表现的心血管疾病献屡有报道，现综述如下。     

大学生入学体检中晕厥的发生及原因分析

选取我校2011年9月~2014年9月参加入学体检的大学生16582例,其中晕厥大学生190例,对本次晕厥的大学生进行救治并分析晕厥原因。结果参检16582例,晕厥190例,男8603例,女7979例,晕厥发病率1.15%;2011、2012、2013年的晕厥总发病率之间比较,差异无统计学意义(P0.05)。2014年晕厥总发病率降低,差异有统计学意义(P0.05)。男性晕厥发病率1.14%,女性晕厥发病率1.15%,男性与女性晕厥发病率比较,差异无统计学意义(P0.05)。晕厥的发病原因最常见为蹲下,或者休息后马上站立,占35.26%,其次是等待时间长,晕针晕血,占24.21%,剧烈运动后马上停止占10.53%,空腹的时间过长,造成疲劳及饥饿占4.21%,心动过缓占1.58%。大学生入学体检晕厥发生率较低,且无规律,多为反射性晕厥,采取相关预防措施可降低晕厥发生率,同时医师应在晕厥发生后高度重视,确保学生安全。     

超声引导穿刺术致血管迷走神经性晕厥的诱因分析

作为微创诊疗手段,超声引导下穿刺术已广泛应用于临床[1];血管迷走神经性晕厥是其主要并发症[2],以反射性的血管舒张和心动过缓间断发作为主要特征.本病虽然预后较好,但反复发作可造成患者心理困扰和身体机能下降[3],晕厥所致的创伤性并发症也时见报道.本研究对我院超声引导下穿刺致血管迷走神经性晕厥的诱因及相关临床特点进行分析.     

脑源性晕厥的病因分析及诊断探讨

晕厥是常见的临床症状,其中反射性晕厥和心源性晕厥是最常见的原因.脑源性晕厥是晕厥比较少见的病因,约占10%(包括严重脑血管闭塞疾病、主动脉弓综合征、高血压脑病及脑干病变等)[1,2],国内外相关的报道较少.本文总结12例脑源性晕厥的临床资料,分析其病因及探讨诊断方法,提高临床对脑源性晕厥的重视.     

类风湿性关节炎与动脉粥样硬化

类风湿性关节炎(rlleumaloid arthritis,RA)患者动脉粥样硬化的发病率高于一般人群.以往许多研究都证实了RA会加快患者动脉粥样硬化的形成.有研究发现,自RA发病开始,动脉粥样硬化就加速形成,并且RA病情持续越长,动脉粥样硬化就越严重,增加了RA患者患心血管疾病的风险[1].本文对RA患者中动脉粥样硬化加速形成的相关机制,以及药物对动脉粥样硬化形成的影响进行文献回顾,以期为RA患者的心血管疾病诊治提供相关的资料.     

51例门诊患者晕厥原因分析及防范对策

回顾性分析2010年1月—2011年12月门诊就诊过程中51例患者发生晕厥的原因有:环境因素,如候诊时间长,候诊环境嘈杂,空气流动性差、闷热等;疾病因素,如心源性晕厥、脑源性晕厥、反射性晕厥、代谢性晕厥、药物过敏性晕厥,以及体位性晕厥.针对疾病发生机理与特点,提出护理措施,在门诊护理工作中,选择有经验的、责任心强的护士加强巡诊,以预见性防范各类型晕厥的发生,并对晕厥患者进行有效的急救护理,为患者赢得宝贵的抢救时间.     

老年人室上性心动过速药物治疗与射频消融

室上性心动过速 (ＳＶＴ)中最为常见的是阵发性室上性心动过速 (ＰＳＶＴ)。随着临床电生理学的发展 ,有关老年ＰＳＶＴ的患者报道日渐增多。本文就我院 1994～ 1998年收治的 41例ＰＳＶＴ老年患者的药物治疗与射频消融 ,报道如下。1　资料与方法1.1　病例选择　本文 41例患者 ,年龄 60～ 78岁 ,平均 64 .8岁 ,男 3 2例 ,女 9例。 41例中 ,2 3例无器质性心血管疾病 (正常组 ) ,18例合并有心血管疾病 (合并症组 ) ,分别为高血压 11例 ,老年钙化性心脏瓣膜病 2例 ,冠心病 2例 ,心肌病 2例 ,心包积液 1例。发作ＳＶＴ时 ,5例患者出现晕厥 ,4例…     

cTCD与TEE结合ASCE在反射性晕厥伴PFO患者中的应用

目的 探讨对比增强经颅多普勒(cTCD)、经食管超声心动图(TEE)结合右心声学造影(ASCE)在反射性晕厥伴卵圆孔未闭(PFO)患者中的应用。方法 病例组(22例)为咳嗽、吞咽、用力排便、大笑或运动诱发的情境性晕厥患者,对照组(21例)为血管迷走性晕厥患者。收集一般资料、PFO结构和右向左分流(RLS)分级进行回顾性分析。结果 病例组大量分流患者显著多于对照组,PFO直径显著大于对照组(P<0.05)。相关性分析发现RLS分级和PFO直径呈正相关(P<0.001)。结论 cTCD、TEE结合ASCE在反射性晕厥伴PFO患者中有重要意义。     

直立倾斜试验诊断不明原因晕厥的价值

目的探讨直立倾斜试验在不明原因晕厥诊断中的价值。方法不明原因晕厥患者366例,均行直立倾斜试验检查。结果直立倾斜试验阳性252例,阳性率68．9％;直立性不耐受综合征类型中以血管迷走性晕厥多见,其次为体位性心动过速、直立性低血压;血管迷走性晕厥中血管减压型比例女性高于男性（P〈O．05）;年龄≥60岁15例患者中直立倾斜试验阳性10例,均表现为血管迷走性晕厥;13例发生假性晕厥。结论直立倾斜试验阳性者并非为反射性晕厥,直立位3～45min发生晕厥的阳性患者,须结合年龄、性别及病史确诊是体位性晕厥或反射性晕厥。     

小儿屏气发作误诊30例分析

小儿屏气发作(Breath-Holding Spells,BHS)是婴幼儿时期较常见的神经官能症,是一常见行为问题,发生率4%～5%,1600年Nicolas Culpeper首次描述了本症的主要特征.文献常称为紫绀型婴儿晕厥、缺氧性晕厥、反射性缺氧发作、非癫痫性迷走神经发作以及白色反射性晕厥[1].对我院1999-01～2001-05误诊30例分析如下.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.