心律失常现代治疗的展望

处理心律失常的主要目标是:(1)转复或维持窦性心律;(2)消除或降低异位起搏点的活动,或在心房扑动、颤动中维持适当的心室率。内科医师在用抗心律失常药物或其它措施治疗心律失常病人之前,应询问并回答下列一系列问题:病人是否有心律失常(有时所治疗的病人确会无心律失常)?如果确实有,是哪种心律失常?此心律失常的重要性如何?是否需要治疗?最有效的治疗方法是什么?指导心律失常诊断治疗的各种因素中,认识其发病机理最为重要。对有些心律失常,尤其是室上性心律失常或房室交接处性心律     

抗心律失常药物的评价与选择

近年来,新的抗心律失常药物不断问世。面对这繁多的抗心律失常新药,临床医生应如何选用呢?对传统的抗心律失常药物,又该如何看待呢?为此,笔者根据有限的临床经验、体会,并结合有关文献作一讨论。在决定采用抗心律失常药物之前,应弄清以下三个问题:①有无药物治疗的指征?不少心律失常既不引起明显症状,又不会演变成更严重的心律失常,则不需药物治疗。②有无可去除的诱因或病因?有相当一部分心律失常有明显的诱因或病因,对于此类患     

β阻滞剂美托洛尔注射液在急性心肌梗塞中的应用

抗心律失常药物的促心律失常作用尤其是CAST(心律失常阻抑试验)结果的公布,引起医学界很大震动,本文就此问题作了文献综述,可供参考。但是抗心律失常药物为何反而引起严重心律失常而致死,其机制是什么?这是远远没有搞清楚的。心律失常阻抑试验选用的观察病例是心肌梗塞后有室性心律失常短期应用恩卡尼(Encainide)、氟卡尼(Flecainide)或莫雷西嗪(Moricizine)有效的患者,为何短期应用有效,长期应用却起了相反的作用?长期应用过程中发生了什么变化?是药代动力学或是电生理作用或是其它发生了很大改变?这些都是值得深入研究的问题。但是CAST的结果不能否定这些药物对室性心律失常的治疗作用。临床实践已经证明,这些药物治疗室性心律失常的短期疗效是好的,只是长期应用预防复发出了问题。文章提出了应用抗心律失常药物应注意的问题。这是很重要的,值得重视。但是抗心律失常药物的促心律失常作用是否就限于这些原因,尚难定论,有待于临床进一步研究。     

抗心律失常治疗

问 :病人因心律失常症状来就诊时 ,应做什么检查 ?答 :病史、问发生心律失常的次数、每次持续时间、每次怎么发作、怎么停止、自己有什么感觉、用了什么药。检查 :BP、脉搏、周围血管搏动、颈静脉搏动、心脏听诊有无奔马律、S1大小 ,有无心脏大、心衰、甲状腺功能。实验室检查 :电解质检查 (钙 ,钾 ,镁 )、抗心律失常药物血浓度、甲状腺功能、胸片、ECG (长时间记录 )、Holter监护。问 :应当如何决定心律失常病人的治疗 ?答 :可根据下列检查考虑治疗 :(1)心电图 :房性 ,窦性 ,房 -室传导 ,心律失常是否持续性 ;(2 )临床情况 :是急性心律…     

重视心律失常的药物治疗

心律失常药物治疗至今还是一个难题.新开发的药物不多,已有的药物还在受到指责.在心律失常的治疗上既有抗心律失常治疗的愿望,但又有促心律失常的顾虑,处于进退维谷.也有在心律失常治疗的安全性、有效性上考虑欠周,不断发生不良反应,因此心律失常药物治疗,实在是一个急待提高的领域.     

AMI时药物的选择

1.AMI患者进入急症室后,你认为最重要的处理是什么?吸氧、吗啡止痛及抗心律失常药物防止室性心     

选择抗心律失常药物和评定疗效

心脏起搏与心电生理技术的迅速发展,使许多心律失常患者从心脏的电治疗中受益,且可以彻底治愈患者的心律失常.但是临床中仍有许多心律失常患者需要药物治疗,特别是急性发作快速心律失常、临床症状明显的心律失常、不适宜电治疗的患者,需要急诊或相应的抗心律失常药物治疗处理.临床症状明显和/或影响预后的心律失常,是抗心律失常药物干预的明确适应证.     

心律失常治疗的现代进展(4)抗心律失常药物在当今的作用与不足(续3)

一般情况下,心律失常并非一种独立的疾病,对患者的治疗应是综合治疗,其中病因治疗是基础.目前药物治疗仍是心律失常患者治疗的基本方式.在治疗前应对患者进行全面评估,确定:①患者的心律失常是否需要治疗;②采取何种治疗方式.现有抗心律失常药物品种有限,有较大副作用,而疗效并不尽如人意.在应用时应注意评估抗心律失常药物在整体治疗方案中的意义和地位,确定合理现实的治疗目标,选择有效而不干扰整体治疗的抗心律失常药物.     

心律失常治疗须知

心律失常治疗方法有多种,但应用药物还是基本的治疗。什么样的心律失常要治疗,选用什么方法治疗,选用什么药物,如何加强治疗的安全性等等,都是治疗中的关键问题,笔者希望给读者一个简要的现在共识,以供治疗参考。     

心律失常治疗与循证医学

心律失常的治疗目标是什么?这一看似简单的问题却在心血管界经历过十分曲折的路程.这一问题的解答,完全是循证医学的功绩.如果倒退到20年前.一个心律失常的患者来诊,医生治疗的目标似乎只有一个:使心律失常消失.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.