电脑自动控制电动胸外心脏按压、体温、心电监护系统的研制及其应用

本文报告了电脑自动控制电动胸外心脏按压、体温心电监护系统的研制及其应用。介绍了该系统的性能和特点以及临床应用效果,其有效率为96.6％。同时与国内外类似机器进行了对比分析。     

交感神经节与心肌细胞联合培养的光镜和扫描电镜观察

目的：为了研究体外培养中交感神经纤维或神经终末与心肌细胞之间的关系。方法：将新生大鼠的交感神经节与心肌细胞进行联合培养,用相差显微镜观察神经元的生长,用扫描电子显微镜观察神经肌肉连接的形成。结果：交感神经节与心肌细胞联合培养７２￣９６小时,在相差显微镜下可观察到神经突起终止于搏动的心肌细胞表面。在扫描电子显微镜下可观察到神经纤维粗细不一,在心肌细胞表面交织成网状。有的神经纤维末端膨大并贴于心肌细胞     

STUDY AND PREPARATION ON “PAIN TAN NING” AND ITS CLINICAL APPLICATION AND STUDY ON BRAIN ATLAS

Objective:To observe clinical effect of combined mixture of traditional chineses and western medicine " PIAN TAN NING" in treatment of ischemic cerebrovascular diseases and change of brain atlas. Methods: In 6660 patients with ischemic cerebrovascular disease, the curative effect of "PIAN TAN NING" and brain atlas were observed and other 30 cases were compared with treatment of Dextran. Results: After treatment,patient's clinical symptoms and recovered degree of myodynamia and brain atlas improved significantly. Total effective rate was 96.7%. But the contral group was 80.0%. There was a significant difference between them ( p < 0. 05). Conclusion: The " PIAN TAN NING" produced a good clinical curative effect in treatment of ischemic cerebrovascular diseases and the side effect was only a few. So it can be applied very well in patients with ischemic cerebrovascular disease. The applied value of brain atlas was very good.     

脑电地形图电脑专家助诊系统的研制及其应用

本文报告了脑电地形图电脑专家助诊系统研制和临床应用。介绍了此助诊系统的原理、程序设计及临床应用效果,并对其临床应用价值进行了讨论。文章认为,此系统不仅于用于临床诊断,而且为科学研究工作奠定了基础。     

偏瘫宁的研制及其临床应用和脑电地形图研究

目的观察中西药配伍合剂"偏瘫宁"治疗缺血性脑血管病的临床疗效及脑电地形图改变.方法对6660例缺血性脑血管病患者进行了"偏瘫宁"疗效及脑电地形图观察,并与采用脉通治疗的30例结果对比.结果临床症状和肌力恢复程度及脑电地形图治疗后有明显改善,总有效率为96.7%,而对照组脉通治疗的有效率为80.0%,两组对比,有显著性差异(P＜0.05).结论"偏瘫宁"对缺血性脑血管病有较好的临床疗效,无毒副作用,可推广应用.脑电地形图有很好应用价值.     

STUDY ON COMPUETD APPARATUS FOR EXTERNAL CARDIAC MASSAGE AND ITS CLINICAL APPLICATION

为了帮助提高读者和作者的英文水平和进行国际交流,自本期开始,将每期刊登1～2篇英文稿,供同志们参考。     

运动试验观察指标R波振幅改变的分析及其机制探讨

本文通过对31例冠心病患者,21例心肌梗塞患者及30例正常对照者的运动试验R波振幅改变及其与心脏泵血功能,心输出量储备之间的关系进行对照分析,提示:1.△R波阳性作为诊断冠心病的一项参考指标具有应用价值。2.R波振幅的改变与心输出量及心脏的泵血功能,尤其是肺动脉楔压之间无明显关系。3.E系统可安全、简便地测定心储备力及心脏的泵血功能。对疗效评价和预后估测及对心电图运动试验多项参考标准产生机制的研究都具有重要的应用价值,值得推广使用。     

大鼠压力负荷性肥大心肌中TNF-α mRNA表达变化

目的：探讨大鼠压力负荷性肥大心肌中TNF-α mRNA表达的变化及卡托普利（captopril）对其的影响。方法：采用腹主动脉缩窄法复制压力超负荷心肌肥大模型，于术后42 d采血、摘取心脏，测定心肌肥大指数并采用酶联免疫法测定血清及左心室肌TNF-α含量；应用心肌原位杂交法结合图像分析系统检测心肌组织中TNF-α mRNA表达的变化，并观测TNF-α mRNA在心肌组织中的定位。结果：术后42 d心肌明显肥大，以左心室为主；主动脉缩窄（aorta-constriction, AC）组心室肌TNF-α含量比假手术（sham-operation, SO）组高98%（P<0.01）；卡托普利干预使心室肌TNF-α含量比AC组低64.14%（P<0.01），但未达到对照水平；心肌组织原位杂交显示TNF-α mRNA表达主要在心肌间质部位，假手术组心肌TNF-α mRNA表达水平极低，明显低于AC术后（P<0.01），captopril干预虽明显抑制AC术后心肌组织中TNF-α mRNA表达，但并未使其达到SO组水平。结论：心肌组织内源性TNF-α的表达增加在压力负荷性心肌肥大中具有重要的调控作用，其过表达可能与RAS激活促心肌间质TNF-α mRNA表达上调有关。     

北京市三甲医院心内科护士开展早期心脏康复知信行的现况调查及影响因素分析

目的 探讨心内科护士学习早期心脏康复的知识、态度和行为及其影响因素。方法 采用横断面调查研究,以北京市3所三级甲等医院心内科护士作为调查对象进行问卷调查,内容包括护士一般资料、护士的早期心脏康复培训情况以及感兴趣程度;护士对急性心肌梗死早期心脏康复的知识掌握、态度和行为情况及影响因素。结果 2017年3月~6月共154名心内科护士完成问卷。心内科护士早期心脏康复知识得分（29.47±3.68）分,态度得分（7.64±2.66）分,行为得分（34.14±11.79）分。知识及态度得分与护士的兴趣程度呈正相关（r2=0.449,P＜0.05;r2=0.328,P＜0.05）;行为与护士的兴趣程度、聘用制度、是否接受培训以及接受培训次数呈正相关（r2=0.458,P＜0.05）。影响护士开展早期心脏康复的前三位原因分别是:护士缺少早期心脏康复意外情况的法律保护（85.71%）,患者住院周转率快（81.82%）,护士日常工作量大（75.32%）。结论 临床护理工作中应该强化心脏康复的培训,普及早期心脏康复的重要性,尤其是远期效果,提高护士对心脏康复的兴趣,尽快推出心脏康复护理指南,并应用于护理常规工作中。     

Beta-adrenergic blockade may prolong life in post-infarction patients in part by increasing vagal cardiac inhibition

Beta-adrenergic blocking drugs prolong lives of post-infarction patients primarily by preventing sudden cardiac death. The mechanisms responsible for this beneficial effect are not understood clearly, since beta-blockers, in doses used in most clinical trials, are only weakly effective against stable ventricular arrhythmias. Arrhythmias during myocardial ischemia may differ from arrhythmias in other clinical settings in that they depend importantly upon autonomic neural factors, including the balance between levels of sympathetic cardiac stimulation and parasympathetic cardiac inhibition. Beta-blockers reduce sympathetic cardiac stimulation, and they may influence this balance favorably in another important way: a well documented, but not generally appreciated property of beta-blocking drugs is that they also increase levels of vagal cardiac inhibition. I propose that beta-blockade prevents arrhythmic deaths in post-infarction patients in part by increasing levels of vagal cardiac inhibition.     

脑电地形图在西比灵治疗血管性头晕前后的应用研究

目的：探讨西比灵的临床疗效和脑电地形图的应用价值。方法：应用西比灵治疗３００例缺血性血管性头晕患,通过临床症征和脑电地形图观察其疗效。结果：西比灵治疗缺血性血客性头晕有效率为１００．０％,脑电地形图在治疗前后有明显改变。结论：西比灵是治疗缺血必血管性头晕的理想药物,脑电地形图是观察西比灵疗效和作用机理的有效指标。     

APPLIED STUDY ON BRAIN ATLAS AFTER AND BEFORE TREATMENT BY SIBELIUM IN ISCHEMIC VASCULAR DIZZINESS

目的:探讨西比灵的临床疗效和脑电地形图的应用价值。方法:应用西比灵治疗300例缺血性血管性头晕患者,通过临床症征和脑电地形图观察其疗效。结果:西比灵治疗缺血性血管性头晕有效率为100％,脑电地形图在治疗前后有明显改变。结论:西比灵是治疗缺血性血管性头晕的较理想药物。脑电地形图是观察西比灵疗效和作用机理的有效指标。     

交互信息在心脏状态和心率研究中的应用

交互信息是一种检测系统之间相依性的方法 ,它可以同时检测线性和非线性相关。本文介绍了交互信息的计算方法和性质 ,讨论了它在单个时间序列上的应用 ,并将它应用于心脏状态研究上。利用实验动物的数据 ,我们发现了心搏的运动既不是随机的也不是周期的 ;并且 ,不同心脏状态下的交互信息有很大的差别 ,浅麻 ,机控呼吸和开胸状态下交互信息都相对较小 ,心肌损伤后有明显增大 ,提示心搏的交互信息与心脏健康程度有很大关系     

腺苷预处理培养大鼠心肌细胞后酶活性变化和超微结构观察

目的 :应用组化方法和透射电镜 ,观察腺苷预处理培养大鼠心肌细胞琥珀酸脱氢酶、细胞色素氧化酶及Ca2 +,Mg2 +依赖性ATP酶活性细胞超微结构的变化。方法 :取SD大鼠乳鼠心室肌细胞在无菌状态下 ,用DMEM常规培养 5天后分四组 :正常对照组、拟缺血再灌注组、拟缺血预处理组、腺苷预处理组 ,用组化方法检测心肌酶活性 ;以透射电镜观察细胞形态结构变化。结果 :在缺血预处理组和腺苷预处理组琥珀酸脱氢酶、细胞色素氧化酶、Ca2 +,Mg2 +依赖性ATP酶活性均高于拟缺血再灌注组 ,且细胞结构保存良好 ;缺血预处理组、腺苷预处理组与正常对照组无显著性差异。结论 :腺苷预处理对缺血再灌注心肌细胞具有类似缺血预处理的保护作用     

Effect of left ventricular assist device on circulatory autonomic nervous activity

PURPOSE: For evaluation of the autonomic nervous system (ANS) activity of patients with mechanical circulatory support including LVAD, IABP and PCPS, arterial pressure variability (APV) was examined. APV is the power density values of pressure signals. High frequency (0.15 to 0.4 Hz) and low frequency (0.04 to 0.15 Hz) components of APV are regarded as a function of the autonomic nervous system. METHODS: Arterial pressure signals were acquired every 2 hours at 100 Hz for 6 minutes. Power spectral analysis was carried out, and APV was observed in 18 patients with IABP and/or PCPS. APV was also observed in 3 patients with LVADs (Xemex, Zeon Medical, Japan) before their discharge from ICU for transfer to another hospital for cardiac transplantation. RESULTS: Although the value gradually increased in 18 patients with IABP and/or PCPS, sustained low values of LFAnorm of APV in 6 patients were related to prolonged mechanical support, and 4 patients among them died consequently. The normalized power spectral component with low frequency (LFAnorm) was maintained at relatively high values in 3 patients with LVADs. CONCLUSION: The study results suggest that power spectral analysis of systemic arterial pressure offers a reasonable means for the evaluation of the severity of patient cardiovascular condition and for the prediction of clinical outcome. It also suggested that LVAD support exerts a favorable effect on ANS in patients with severe heart failure before cardiac transplantation.     

苓桂术甘汤加减联合西医治疗对慢性心力衰竭患者炎性因子、T淋巴细胞亚群及心功能的影响

目的：探讨苓桂术甘汤联合西医治疗对慢性心力衰竭患者炎性因子、T淋巴细胞亚群及心功能的影响。方法：选择2016年1月~2017年7月收治的慢性心力衰竭患者112例为研究对象,采用随机数字表法分为观察组和对照组各56例。对照组给予慢性心力衰竭患者西医常规治疗,观察组联合应用苓桂术甘汤加减治疗。治疗2周末,比较两组患者血清炎性因子、T淋巴细胞亚群、心功能、临床疗效等指标。结果：观察组中医症状、心功能有效率明显高于对照组(P<0.05）;血清IL-6、IL-18、肿瘤坏死因子-α（TNF-α）含量明显低于对照组(P<0.01）;T淋巴细胞CD3⁺T细胞、CD4⁺ T细胞、CD4⁺ T细胞/CD8⁺ T细胞均明显高于对照组,CD8⁺ T细胞明显低于对照组(P<0.05,P<0.01）;左室舒张末内径（LVED）明显低于对照组,左室射血分数（LVEF）明显高于对照组(P<0.05）。结论：苓桂术甘汤加减联合西医治疗有助于改善慢性心力衰竭患者心功能,提高临床疗效,可能与抑制患者炎症反应、改善细胞免疫功能等因素有关。     

Early atherosclerotic lesions of the cardiac conduction system arteries in infants.

INTRODUCTION: Although several studies have described initial atherosclerotic lesions of the coronary arteries, already detectable in infancy and even during the intrauterine life, little, if any, attention has been given to the possible involvement of the cardiac conduction system arteries. In particular, to the best of our knowledge, none has considered the lesions of the cardiac conduction arteries as an initial stage of atherosclerosis. METHODS: The cardiac conduction system of 70 infants dying suddenly and unexpectedly was removed in two blocks for paraffin embedding and serially cut. RESULTS: The histological study of the cardiac conduction arteries of the 70 cases examined showed a normal structure in 55 cases (78.57%). In 15 cases (21.43%), there was a thickening of the sinoatrial node and/or atrioventricular artery associated with a thickening of varying severity in coronary artery walls. The lesions were marked by thickening and deposits of amorphous material and mainly lipids in the intima, as well as fragmentation of the elastic fiber system. A significant correlation was evident between early atherosclerotic lesions and both formula feeding and parental cigarette smoking (P<.05, chi(2) test). CONCLUSIONS: The combination of both the considered risk factors seems to increase the early atherogenic effect of each noxa because the coronary lesions were more diffused in formula-fed infants whose parents both smoked.     

云南不明原因聚集性猝死中心肌炎病例的病理特点分析

目的观察分析云南不明原因聚集性猝死病例心肌炎的病理改变特点,探讨心肌炎在这类猝死中的作用。方法心肌炎的病理诊断参照Dallas和世界心脏联合会的标准。分析云南省1991—2006年进行猝死监测期间收集的尸检病例29例,其中14例为心肌炎病例。心肌炎患者年龄8～68岁,平均30岁。男9例、女5例。回顾流行病学资料,核查心脏标本,观察心脏等器官的组织切片,其中3例做了心脏传导系统检查。结果心肌炎共14例,占尸检病例的48％。其中淋巴细胞性心肌炎11例,中性粒细胞性心肌炎3例。心肌炎均表现为局灶性,未见弥漫性心肌炎。仅20％（8％～42％）的心肌组织切片可检出炎性病灶,病灶多分布在左心室侧壁,少数在室间隔和右心室部心肌。病灶区心肌细胞形态损伤多数较轻微,个别病例出现片状心肌溶解或凝固性坏死。多数病变为急性炎,也可见机化和急性损伤共存。4例还伴有心包炎,1例伴亚急性心内膜炎,3例行传导系统检查者中1例炎症波及房室结。心脏外观多无异常,仅2例左室或全心扩大。5例伴有呼吸道和肺部感染。结论心肌炎是云南不明原因聚集性猝死的主要病变之一,病理表现以局灶性为主,病变形态提示病毒和细菌性感染均有可能,但是,尚不能确定心肌炎症与中毒的关系。心肌炎的病因及其与猝死聚集性的关系值得进一步研究。     

利多卡因对心脏术后脑保护效果的Meta分析

背景：虽然心脏手术日趋成熟,但术后认知障碍发生率仍然较高。利多卡因对脑的保护效应的研究结果不一。 目的：分析利多卡对心脏术后脑保护效果。 方法：在PubMed,Cochrane databases,CNKI和Ovid等数据库中系统检索有关利多卡因、心脏手术及脑保护的前瞻性的随机对照研究。提取术后认知障碍发生率及脑代谢相关的指标用于疗效评价,结果以优势比(OR)、加权均数差(WMD)和 95%可信区间(CI)表示。提取的资料采用Review Manager Version 5软件进行分析。 结果与结论：共有5篇含有术前和术后的神经心理学测试的文献及2篇关于术中脑代谢测量的文献入选。合并后的结果显示认术后的认知障碍和术前的差异无显著性意义,但在亚组分析中显示低年龄组和低剂量组的术后认知障碍较术前减少 (P < 0.05)。术中应用利多卡因能够在手术中降低动脉-颈内静脉血氧含量差,脑氧摄取率)及脑乳酸产生量(P < 0.05)。死亡及退出患者总数差异无显著性意义。结果说明现有证据不足以证明利多卡因有脑保护的作用,但应用在合适的临床情况下,利多卡因是有脑保护的作用的。