急性肺栓塞患者治疗前后心电图改变及其意义

目的分析急性肺栓塞患者治疗前后心电图改变及其意义。方法选择2010—2013年在我院诊断为急性肺栓塞的住院患者46例,回顾性分析其治疗前后心电图的改变。结果治疗后46例患者窦性心动过速、SⅠQⅢTⅢ、RavR0.06 m V、Ⅰ导联出现S波(0.1 m V)、Ⅲ导联T波倒置、Ⅲ导联出现Q波及T波倒置、Ⅰ导联出现S波和Ⅲ导联出现Q波及T波倒置、V1导联T波倒置、V1~V2导联T波倒置、V1~V3导联T波倒置、V1~V5导联T波倒置、完全性右束支传导阻滞、不完全性右束支传导阻滞、电轴右偏、顺时针转位及肺型P波的发生率均低于治疗前(P0.05)。结论急性肺栓塞患者治疗前后心电图改变具有多变性,但仍有一些特征可循,其对急性肺栓塞的诊断及鉴别诊断、疗效观察具有重要意义,且具有操作简便的特点。     

急性肺栓塞药物治疗前后的心电图观察

目的探讨急性肺栓塞(PE)患者药物治疗前后心电图改变及临床意义。方法回顾性分析23例PE患者治疗前后心电图的改变。结果急性肺栓塞经治疗后窦性心动过速、SⅠQⅢTⅢ、胸前导联T波倒置加深、aVR导联出现终末R波增高、顺钟向转位、电轴右偏、期前收缩等心电图指标较治疗前有明显改善,差异有显著意义(p<0.05)。结论心电图在急性肺栓塞诊断中虽然是非特异性的,但如能结合临床症状并及时仔细观察心电图改变,对急性肺栓塞的诊断有重要意义。     

溶栓治疗对急性肺栓塞患者心电图的影响

目的探讨溶栓治疗对急性肺栓塞患者心电图的影响。方法入选自2014年1月~2014年12月于武汉大学中南医院心内科收治的急性肺栓塞患者65例,男42例,女23例,年龄33~76岁,平均(52.3±11.2)岁。对比溶栓治疗前后心电图变化,包括电轴右偏、右束支传导阻滞、肺型P波、胸前导联T波倒置、a VR导联R波振幅增高、窦性心动过速、SⅠQⅢTⅢ(Ⅰ导联S波Ⅲ导联Q波T波)、SⅠQⅢ(Ⅰ导联S波Ⅲ导联Q波)、SⅠ(Ⅰ导联S波)、Tv1~v5倒置。结果与溶栓治疗前比较,溶栓治疗后电轴右偏、SⅠQⅢTⅢ型、窦性心动过速发生率减少,为23.1%vs.9.2%、53.8%vs.27.7%、49.2%vs.23.1%,差异有统计学意义(P均0.05)。结论溶栓治疗能够改善急性肺栓塞患者的心电图指标。     

急性肺栓塞患者心电图特征分析

目的通过对急性肺栓塞患者的心电图资料进行研究分析,掌握其心电图特征,提高心电图诊断肺栓塞水平。方法对在我院住院期间被确诊为急性肺栓塞的56例患者的心电图资料进行回顾性分析。结果 56例急性肺栓塞患者中,心电图正常5例,异常51例。心电图主要表现有心电图动态改变46例(82.1%)、V1~V4导联(至少两个导联)T波改变21例(37.5%)、窦性心动过速18例(32.1%)、不完全性右束支传导阻滞9例(16.1%)以及完全性右束支传导阻滞、显著顺钟转、SⅠQⅢTⅢ、右偏电轴、QⅢTⅢ、SⅠ图形(≥0.15 mv)、QⅢ图形、频发房性期前收缩、心房纤颤、QRS波低电压、a VR导联R波电压增高等,患者心电图改变无特异性。结论急性肺栓塞患者心电图异常表现多种多样,缺乏特异性,正确掌握肺栓塞的心电图变化规律,结合病史、临床表现、D-二聚体检测、CT肺动脉造影、超声心动图等各种检查进行综合判断,可以减少误诊漏诊。     

急性肺栓塞的心电图变化

目的 　 探讨心电图在诊断急性肺栓塞中的作用。　方法　回顾性分析近两年收治的 13例急性肺栓塞患者入院时、溶栓后及治疗 2～ 4周后心电图的变化。　结果　 (1)入院时心电图变化 :心动过速 8例 ,右束支阻滞 3例 ,V1 导联T波、V1 ～V2 导联T波、V1 ～V3导联T波、V1 ～V4 导联T波、V1 ～V5导联T波、V1 ～V6 导联T波倒置为 10、 6、 4、 3、 2和 1例 ,SⅠ >0 1mV、TⅢ 、QⅢ 、SⅠQⅢTⅢ 分别为 7、 7、 9和 7例 ;(2 )溶栓后心电图变化 :心动过速消失 7例 ,右束支阻滞消失 1例 ,胸前导联T波倒置加深 4例 ,SⅠ 变浅 ,QⅢ 减小或消失 ,TⅢ 倒置变浅或直立 3～ 4例 :(3)治疗 2～ 4周后心电图变化 :心动过速消失 ;胸前导联T波直立数增加 ,ST段回基线 ,QⅢ 进一步减小或消失 ,TⅢ 倒置变浅或直立。　结论　急性肺栓塞心电图变化是多变的 ,需动态观察并密切结合临床加以识别。     

心电图对急性大面积肺栓塞的预测价值

目的 探讨急性肺栓塞患者心电图(ECG)改变与肺栓塞严重度的相关性.方法 选择2000年12月至2004年11月,所有经肺螺旋CT证实为急性肺栓塞,并且符合入选标准的40例住院患者.评价他们的心电图改变与肺血管成像、血流动力学及血气改变之间的相关性.结果 胸前导联T波倒置和S Ⅰ QⅢTⅢ与肺栓塞的严重度具有很强的相关性,随着胸前导联T波倒置范围的左移,肺栓塞的严重程度可能在逐渐加重.肺血管床阻塞面积百分比(POPAB)＞49%的大面积肺栓塞患者中,心电图出现胸前导联(V1-2)T波倒置的患者占83%,显著高于非大面积肺栓塞组.通过分析15种急性肺栓塞(APE)常见的ECG改变,结果 发现这些ECG改变数目≥5个时或胸前导联T波倒置数目≥3个时,对大面积肺栓塞的筛查更有意义.结论 ECG改变对筛查大面积肺栓塞具有重要的临床价值.     

53例急性肺栓塞心电图分析

目的分析和总结肺栓塞时的心电图特点及其在急性肺栓塞的诊断与鉴别诊断中的应用。方法回顾性分析6年来我院确诊的53例急性肺栓塞患者住院期间的心电图表现并对每位患者治疗前后的心电图形进行对比。结果 53例患者中,出现心电图改变者占98.14%,窦性心动过速最多占77.35%,其次是ST-T改变(ST段改变占64.15%,T波改变占62.26%),典型SⅠQⅢTⅢ征者占22.64%,肺型P波占7.55%,完全性或不完全性右束支阻滞的占18.87%,aVR导联出现终末R波占28.30%。经溶栓抗凝治疗后,比对原有心电图上述项目皆发生了动态变化过程。结论心电图对于提示肺栓塞的诊断有一定的临床价值重大意义。     

急性肺栓塞药物治疗前后心电图观察

目的 探讨急性肺栓塞(PE)患者药物治疗前后心电图改变及临床意义.方法 回顾性分析23例PE患者治疗前后心电图的改变.结果 PE经治疗后窦性心动过速、SⅠQ(x)T(i)、胸前导联T波倒置加深、aVR导联出现终末R波增高、顺钟向转位、电轴右偏、期前收缩等心电图指标较治疗前有明显改善,差异有统计学意义(P＜0.05).结...     

急性肺动脉栓塞与急性冠脉综合征心电图负性T波的比较

目的比较急性肺动脉栓塞(APE)和非ST段抬高急性冠脉综合征(NSTE-ACS)患者心电图前壁导联负性T波,发现两者的差异,提高心电图(ECG)在两种疾病鉴别诊断中的价值。方法回顾分析首都医科大学附属北京朝阳医院2006年7月至2007年12月住院的33例APE患者和67例NSTE-ACS患者的ECG,比较两组ECG的肺性P波、SⅠSⅡSⅢ、SⅠQⅢTⅢ和前壁导联的负性T波。结果肺性P波、SⅠSⅡSⅢ、SⅠQⅢTⅢ是诊断APE的特异性指标,但是敏感性低。APE患者的负性T波通常出现在Ⅱ、Ⅲ、aVF、V1和V2,较少出现在Ⅰ、aVL和V3～V6(P<0.05)。78.8%的APE患者Ⅲ和V1同时出现负性T波,仅有3%的NSTE-ACS患者Ⅲ和V1同时出现负性T波(P<0.01)。结论可以通过ECG前壁导联的负性T波初步鉴别前壁缺血的NSTE-ACS与APE,Ⅲ和V1导联同时出现负性T波高度提示APE。     

急性肺动脉栓塞的心电图演变

为探讨心电图在急性肺动脉栓塞 (简称肺栓塞 )诊断与对治疗效果评价中的作用 ,回顾性分析 18例急性肺栓塞患者入院时、溶栓后及治疗 2～ 4周后的心电图变化。研究显示 :①急性大块肺栓塞后即可出现sⅠqⅢ 及右束支阻滞的心电图表现 ;②TⅢ 及TV1 ～V3倒置往往在发病 1～ 2h后按一定的顺序相继出现 ,依次为TV1 →TV2 →TV3→TV4 ,倒置的深度TV1 →TV2 →TV3→TV4 ;经适当的治疗 ,随病情好转 ,上述导联倒置T波恢复的顺序则相反 ;③经溶栓或抗凝治疗后 ,下列心电图变化是病情缓解或肺动脉开通的征象 :a .窦性心动过速消失 ;b .Ⅰ和V5～V6导联的s波明显缩小甚至消失 ;c.V1～V3 (V4)导联T波倒置加深 ;d .右束支阻滞消失 ;e .TⅢ 、qⅢ 及rⅢ 的变化则呈双向性 ,当肺栓塞发病后数小时至 3天内即溶栓者溶栓后rⅢ 递减、qⅢ 进行性加深增宽、TⅢ 倒置进行性加深 ;反之 ,肺栓塞发病一周后进行溶栓者溶栓后qⅢ 明显缩小、TⅢ 由倒置很快变直立。结论 :急性肺栓塞的心电图变化呈一过性及多变性 ,动态观察心电图演变有助于诊断及对疗效的判断。     

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.     

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.     

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.     

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.