心律失常电脑教学系统的研制

<正> 一、概述 监护学是利用先进的监护手段对危重病人进行监测的一门新兴学科。心电监护是监护学的重要内容之一。 心律图象对于诊断心血管疾病十分重要。先进的监护仪器的出现,要求医护人员对心律失常应有较强的识别能力。目前,监护病房的监测设备尚不具备内存贮器,临床典型的心律失常波形的采集和再现受到了限制。心电监护教学仍沿用静态图谱教学方式或把心律失常信号转录到磁带上,磁带回放出     

基于TMS320VC5402的便携式心电监护仪的研制

目的 研制一种便携性好、功能强大的心电监护仪。方法 以DSP芯片TMS320VC5402为核心,设计硬件系统及控制程序,并嵌入心律失常检测算法。结果 该监护仪能够检测出4种心律失常,存储7段各64k字节的心电信号,还能够为每段存储的心电信号标记采集时间,并能将存储的心电数据以数字和模拟两种方式传送给医院中心站;其功耗低,采用可充电锂离子电池,可以进行连续监护。结论 该监护仪达到设计要求,实用性好。     

利用文本识别及图形显示技术实现微孔板实验数据的快速分析

目的：利用文本识别及图形显示技术建立微孔板实验数据便捷分析的方法。方法：首先利用文本识别软件将常用酶标仪输出到普通纸张上的微孔板（96孔或384孔）实验数据扫描并识别为数值,通过Visual BASIC编程（即宏功能）在PowerPoint中采用极值法利用直线回归从微孔板数据（最小值~最大值）推导出相应的灰度值（0~255）,并在PowerPoint中实现微孔板数据的平面图形显示,或利用插值法通过三次方程内插在MatLab中实现微孔板数据的三维图形显示。结果：通过文本识别及Visual BASIC脚本两级质控可使文本识别的正确率达100%,并且在PowerPoint中实现了微孔板数据的直观平面显示,同时利用插值法在MatLab中实现了微孔板数据的三维图形显示,为批量进行微孔板实验数据的快速处理和分析提供了一种有效方法。其中的文本识别过程具有通用性（亦可用于ELISA数据的快速识别和录入）,而图形显示技术则可结合特定目的灵活使用（例如动态显示微生物或培养细胞的生长曲线等）。结论：该方法能够便捷地实现微孔板实验数据的批量分析,具有一定的实用性和推广价值。     

飞行员视力、对比视力和对比敏感度函数与目标识别的相关性研究

目的为探讨飞行人员的视觉功能指标与小视角目标识别能力的相关性，以便为制订定量标准提供依据。方法对61名视力正常男性飞行员的双眼常规视力、3个对比水平处（0．92、0．30和0．11）的对比视力和7个空间频率处（0．5、1．0、1．8、3．7、9．2、29．1和43．6cpd）的对比敏感度以及他们对5种视角（13．18’、10．31’、8．25’、6．67’和5．56’）、两个对比度（90．61和2．03）的飞机图形的识别正确率进行测量。测量数据输入微机进行多元相关分析。结果①常规视力与上述图形识别无相关性；②对比视力与低对比时的5种视角图形识别均有显著相关，与高对比时的3种视角图形识别存在显著相关；③对比敏感度函数与高、低对比时的3种视角图形识别存在显著相关。结论常规视力作为识别目标能力的评价在视力≥1的人员中是没有什么作用的。对比敏感度函数作为预示识别具有不同对比、不同大小目标的能力，对比视力作为预示识别具有不同对比的小目标能力均是有意义的。     

心血管病人的观察与护理

心血管疾病病情变化具有突发性和多变性的特点，往往来势凶险，病情变化常有诱发的因素，如情绪激动，精神紧张、饱餐、气候寒冷等，时常有医务人员未能预料的情况发生，因此医护人员要求既要细心，又有熟知心血管疾病急症的临床表现，能识别严重心律失常的心电图外，还要能掌握第一步的紧急处理，如心脏骤停时胸外心脏按摩和口对口呼吸技术，以争取时间，换回生命。     

埋藏式自动转律除颤起搏器安放术的护理体会

随着临床对高危心源性猝死患者辨识力的提高,过去数年内的抗心律失常治疗措施显著增加。如:药物,抗心动过速起搏器,射频消融及近年来发展的埋藏式自动心律转复除颤起搏器(automaticim plantablecardiobetrterdefibrillator ,AICD) ,对高危患者一旦发生室性快速心律失常,AICD可在数秒钟内转复为正常心律,不需要专门医护人员和医疗器械的参与。AICD的主要功能为预防由室颤和室速引起的心源性猝死,保护患者的生命安全。此系统主要由脉冲发生器和电极导联系统组成,通过发放电脉冲从而消除室颤或室速。同时具有感知分析功能,将感知电极传入…     

老年恶性心律失常先兆识别及护理体会

心律失常是老年器质性心脏病的常见并发症，其中恶性心律失常可威胁患者生命。老年人随着年龄增长，生理和病理特点均发生变化，常合并多器官病变，治疗难度加大；如果救治不及时或措施不当，可能危及生命。临床观察发现，老年恶性心律失常均有一个短暂的病理、生理演变过程，从而在临床上产生一系列的恶性心律失常的先兆症状，了解并掌握这些征兆有利于早期识别，及时处理，积极施以最佳的护理干预。我们对2001～2003年我院老年病房收治的老年心律失常患者采取了早期先兆识别、针对性的急救和护理干预措施，提高了抢救成功率。现将我们的经验报告如下。     

基于灰色关联度k-近邻法的房性心律失常识别

目的 研究用灰色理论的灰色关联度结合k-近邻法快速准确地识别窦性、房扑和房颤信号.方法 将心电信号分成训练集和测试集,首先用多尺度小波将心电信号变换到时频域,然后提取小波系数矩阵的奇异值作为信号的特征向量,将所有训练样本的特征向量作为标准模板,求出测试样本特征向量与标准模板之间的灰关联系数,最后结合k-近邻法对测试样本做出判断.分别用MIT-BIH心律失常数据库和犬心外膜信号数据库来评价提出的基于灰关联度的k-近邻法识别心律失常信号的特异性、敏感性和准确率.结果 实验结果表明:和常规灰关联度法、常规k-近邻法、BP神经网络相比,本方法对窦性、房扑和房颤信号有较好的识别性能,且具有识别速度快的优点.结论 本方法不需要大量的训练样本,计算简单,能较准确快速地识别窦性、房扑和房颤信号,有望应用于治疗心律失常的可植入装置.     

缺血性脑卒中后猝死的病理生理研究

急性缺血性脑卒中通过中枢自主神经功能障碍,引起心肌损伤、心律失常、心电图异常,甚至猝死,卒中后猝死和严重的致命性心脏事件可能是由于心血管和神经系统相互作用的结果。进一步探讨卒中后猝死的病理生理机制,对卒中后严重的心脏事件和猝死的干预以及对高危患者的识别具有重要的临床意义。     

模拟航天环境下一种应激情绪的语音识别研究

目的实现模拟航天环境下特定人、小词汇量的平静-烦躁语音情绪识别。方法在72h心理隔绝及睡眠剥夺实验、头低位60d模拟失重实验,及环控生保密闭舱60d实验中,录制志愿者的语音。采用基于Teager能量算子的非线性特征,运用HMM技术,实现烦躁情绪识别。结果 3项实验的平静-烦躁情绪平均识别率为98.6%。结论运用非线性特征可有效识别3种实验环境下的烦躁应激情绪,研究结果可为航天心理监测提供参考。     

慢性心力衰竭合并心律失常分析

目的分析慢性心力衰竭患者心律失常类型、发生率及与心脏形态功能的关系,为以后的临床治疗提供参考。方法通过收集5年内392例住院心衰患者的心电图、动态心电图、心脏超声心动图等资料,对患者的心律失常进行分析,明确其类型及发病率与原发病、心脏形态功能的关系。结果各种心律失常中房颤发病率最高,其次为室早及房早,原发病中以风湿性心脏病和扩张型心肌病最为多见,而心腔内径越大越容易发生心律失常。结论慢性心衰患者心律失常以房颤为主,风湿性心脏病及扩张性心肌病患者较其它患者更易发生心律失常,心腔内径大小与心律失常的发生呈正相关。     

Casualties from guided missile impact in warships from another point of view.

From Kamikaze to Exocet, by learning from history a tool for casualty calculation in modern naval warfare is available, indicating absolute casualty figures per SS guided missile hit. The figures 35 wounded and 30 killed per hit ought to be used.     

Modeling the consequences of bioterrorism response.

Military medicine is playing important roles in preparing for the possibility of a covert biological attack on the United States. The objective of this work was to develop a spreadsheet tool that allows planners to compare the consequences of different speeds of response to a covert bioterrorist attack using the metric of preventable deaths. Our model simulates the number of patients to be treated and the number of deaths by day. It allows planners to vary their assumptions, such as the biological agent used, treatment efficacy, and speed of providing initial treatment. Responding to an attack on a city would involve many steps, such as determining the agent used, determining the time and location of the attack and the affected population, obtaining and delivering antibiotics, and providing treatment. Our model is a useful tool for planning the necessary size and timing of bioterrorism response.     

动态心电图诊断变异性心绞痛的价值

目的探讨24 h动态心电图对变异性心绞痛诱发缺血性J波的临床意义。方法回顾性分析15例在动态心电图检测中发生变异性心绞痛诱发缺血性J波,对缺血性J波进行分析。结果缺血性J波发生的导联与冠状动脉病变血管基本相符;变异性心绞痛发作时伴有心律失常,以室性心律失常多见。15例均捕捉到与临床症状相关的一过性J波与ST段抬高伴对应导联ST段压低改变。结论变异性心绞痛合并缺血性J波是心肌严重缺血时伴发的一种超急性期心电图改变,可诱发恶性室性心律失常等, 应高度重视。24 h动态心电图可记录变异性心绞痛发作过程,对变异性心绞痛合并缺血性J波的诊断可以早期发现高危人群。     

Cardiac calcification causing arrhythmia detected by technetium-99m MDP and SPECT

SPECT was used to identify a focal accumulation of cardiac calcification using Tc-99m MDP in a patient with an arrhythmia and known metastatic calcification elsewhere.     

心律失常运动员心输出量的研究

近年来由于训练强度不断增大,高水平运动员心律失常的发生率显著增加。本文研究资料表明,男心律失常组安静时心搏量明显大于正常组(P<0.05),而运动后心搏量降低(正常组心搏量增加),说明心律失常的运动员心脏储备能力差,心脏泵血功能降低,应予慎重对待。     

Postmenopausal bleeding: value of imaging

Endovaginal sonography in combination with HSG is an effective screening tool in evaluating patients with postmenopausal bleeding. Endovaginal sonography is highly sensitive for detecting endometrial carcinoma and can identify patients at low risk for endometrial disease obviating the need for endometrial sampling in this subgroup of patients. In patients with abnormal findings at sonography, a detailed morphologic analysis can be used to determine which patients can undergo blind endometrial sampling successfully versus those who would benefit from hysteroscopic guidance. In patients in whom endovaginal sonography and HSG are inadequate, MRI may provide additional information on the appearance of the endometrium, particularly in patients in whom endometrial sampling is difficult (eg, patients with cervical stenosis).     

In vivo, in utero microscopic magnetic resonance imaging: application in a rat model of diaphragmatic hernia.

This article presents a microscopic MR technique for imaging small mammalian fetuses in utero and in vivo which can be used as a tool for studying normal and abnormal development in small animal fetal models, for targeting in utero intervention in such models, and for following development serially. This new method is applied to a rat model of congenital diaphragmatic hernia (CDH). Pregnant Sprague-Dawley rats were fed nitrofen at 9.5 days postcoitus to induce CDH in the fetuses. The dams were imaged to identify fetuses with CDH for targeted in utero intervention, which consisted of fetal tracheal ligation. Following tracheal ligation, the fetuses were followed serially with our MR technique. For MR imaging, the dam was anesthetized with intramuscular ketamine and intraperitoneal pentobarbital. In utero imaging was performed on a 4 Tesla MRI system using a multislice, fast spin echo sequence with a long TR and short effective TE. These results were validated by examining individual fetuses postmortem using high-resolution MR and anatomic dissection. The in utero, in vivo MR technique is highly accurate for diagnosing CDH and following the effects of surgical intervention, and shows promise as a tool for the study of embryogenesis in small animal models. Magn Reson Med 44:331-335, 2000.     

多重环介导等温扩增快速检测沙门菌、副溶血弧菌和单核细胞增生性李斯特菌方法的建立

目的：建立能够同时检测沙门菌、副溶血弧菌（VPH）和单核细胞增生性李斯特菌（LM）的多重环介导等温扩增（mLAMP）方法。方法分别针对沙门菌 bcfD 基因、VPH 的 tlh 基因和 LM的 iap 基因设计 mLAMP 引物,以LAMP 进行单重 LAMP 检测。实时浊度监测扩增结果,优化引物浓度配比,进而建立此3种食源性致病菌的mLAMP 检测体系,以 PCR 检测灵敏性作为比较,进行特异性和灵敏性分析。结果实时浊度监测表明,该 mLAMP体系具有良好特异性,可在45 min 内一次性检测以上3种致病菌,且无非特异扩增产生。这3种菌的检测最低限分别为300 fg／μl、4．2 pg／μl 和4．5 pg／μl,与 PCR 检测灵敏度相当。结论该多重 LAMP 可同时检测食品中的沙门菌、VPH 和 LM,可作为大规模样品的初筛或传统方法的辅助方法,用于快速判定样品中是否含有这3种致病菌。     

A mouse optical simulation environment (MOSE) to investigate bioluminescent phenomena in the living mouse with the Monte Carlo method

RATIONALE AND OBJECTIVES: As an important part of bioluminescence tomography, which is a newly developed optical imaging modality, mouse optical simulation environment (MOSE) is developed to simulate bioluminescent phenomena in the living mouse and to predict bioluminescent signals detectable outside the mouse. This simulator is dedicated to small animal optical imaging based on bioluminescence. MATERIALS AND METHODS: With the parameters of biological tissues, bioluminescent sources, and charge coupled device (CCD) detectors, the 2-dimensional/3-dimensional MOSE simulates the whole process of the light propagation in 2-dimensional/3-dimensional biological tissues using the Monte Carlo method. Both the implementation details and the software architecture are described in this article. RESULTS: The software system is implemented in the Visual C++ programming language with the OpenGL techniques and has a user-friendly interface facilitating interactions relevant to bioluminescent imaging. The accuracy of the system is verified by comparing the MOSE results with independent data from analytic solutions and commercial software. CONCLUSION: As shown in our simulation and analysis, the MOSE is accurate, flexible, and efficient to simulate the photon propagation for bioluminescence tomography. With graduate refinements and enhancements, it is hoped that the MOSE will become a standard tool for bioluminescence tomography.