对慢阻肺、肺心病自然病程与肺动脉压、血气、ECG、右肺下动脉横径相关性的探讨

为了探讨可能影响慢阻肺、肺心病预后的因素,我们对1980年以来曾住我院呼吸科进行右心微漂浮导管检测肺动脉压力的23例慢阻肺、肺心病患者随访观察9年。回顾性研究结果提示,肺动脉平均压(PAP)、PaO_2以及 ECG 出现肺性 P 波,胸前导联呈极度顺钟向转位、V_1导联、R/S>1及/或 RV_1+SV_5≥1.05mV 以及 V_1呈现 qRs 波型,以及后前位胸片右下肺动脉横径宽度可做为判断预后有价值的指标。     

两点半综合征5例分析

T波改变在临床上十分常见 ,既可能为器质性 ,也常见功能性改变。正常人心电图额面QRS T电轴夹角不超过 4 5° ,因此在以R波为主导联中 ,T波是直立的 ,但一部分正常人额面QRS电轴可为 90° (假定为钟表的长分针 ) ,T电轴若为- 30° (假定为钟表的短时针 ) ,则被称为两点半综合征。这种心电除极与复极在额面六轴系统投影 ,表现在体表心电图电轴 90°时 (I导联R/S =1) ,Ⅱ、Ⅲ、aVF以R波为主导联 ,T波倒置 ,临床上有时会将此类心电图改变误诊为心肌缺血、心肌炎。本文选择 15 0例我院 2 0 0 1年门诊体检者 ,其中检出两点半综合征 5例 ,…     

左心室舒张功能减退是冠心病吗

我今年55岁,2003年发现自己患心脏病,同年9月查心电图提示电轴右偏、完全性右束支传导阻滞（CRBBB）,脉搏55～60次/分。2008年8月检查心电图结果基本同前,QRS波情况如下：V1呈R型,RV1=1.6mV（毫伏）,升支粗钝,     

"心电图形态学标准"在原有束支阻滞伴宽QRS波群心动过速鉴别诊断中的特异性评价

目的探讨心电图形态标准是否适用于原有束支阻滞(BBB)或心肌梗死患者合并宽QRS波群心动过速(WRT)的鉴别诊断.方法选择窦性心律时呈BBB的患者359例[左束支阻滞(LBBB)98例,右束支阻滞(RBBB)261例],分析心电图形态标准用于鉴别WRT的特异性.结果胸前导联图形一致,胸前导联无RS图形;RBBB时电轴重度右偏(-90～±180°)、V1导联呈左兔耳征(Rsr'.Rr')、V6导联呈QR、QS、R形或R/S＜1、aVF导联呈Qr、QR、QS形;LBBB时V1～V2导联S波降支钝挫、V6导联q(Q)波、aVF导联呈QS、qR形,Ⅰ导联呈qR、rS、Rs形等11项标准特异性较高(87.7～100%).另8项标准特异性较低.心肌梗死并WRT(尤其QRS呈RBBB)时采用上述标准鉴别诊断有一定局限性.结论部分心电图形态标准适用于原有BBB伴WRT的鉴别诊断,但对心肌梗死并WRT的鉴别价值有限.     

房室隔缺损心电图特点及其与血流动力学关系

为总结房室隔缺损心电图改变特点及其与血流动力学的关系,对153例部分型房室隔缺损（PAVC）和38例完全型房室隔缺损（CAVC）术前常规描记12导联心电图,对其中100例PAVC和30例CAVC测定血流动力学参数。结果表明,①PAVC心电图特点是QRS电轴左偏（79．7％）,I度AVB（66．7％）和RBBB（85％）;CAVC电轴左偏84．2％,I度AVB81．6％,RBBB39．5％,呈R和Rs占42．1％。②血流动力学显示PAVC为低压、低阻、大分流;CAVC为高压、高阻、大分流。③肺动脉收缩压（PSP）不影响QRS电轴左偏和I度AVB的发生率,但高的PSP明显增加右房大（RAH）、右室肥厚（RVH）和双室肥厚（BVH）的比例。④若心电图有RAH,则心胸比例均≥0．60,并常同时存在I度AVB,主要为P－A延长（92．3％）。结论：①房室隔缺损心电图特点是QRS电轴左偏和I度AVB的联合存在,除RBBB外不受血流动力学影响。②RAH增加I度AVB的发生率,主要表现为P－A延长。     

完全性左束支传导阻滞并急性心肌梗死的心电图分析

目的提高完全性左束支传导阻滞(CLBBB)合并急性心肌梗死(AMI)的心电图诊断准确性。方法对首次发现218例CLBBB患者，急查心肌酶检出14例(6．42％)AMI者，分析其心电图特征。结果前间壁心肌梗死9例，8例V1、V2，V3，导联呈QS型，7例V1、V2、V3导联ST段呈单向弓背向上抬高0．4～0．8mV，T波直立，其J点不易识别，2例ST段垂直抬高与T波相融呈似一大“R”型。广泛性前壁心肌梗死1例，其V1～V3导联呈rS型，V6导联QRS波群呈现宽阔而顶端粗钝的R波，V1～V4ST段弓背向上抬高0．3～0．5mV，STV5、V6、1、aVL导联斜向上抬高0．1～0．2mV。4例下壁心肌梗死，3例Ⅱ、Ⅲ、aVF导联均呈QS型，ST段弓背向上抬高0．3～0．5mV，T波直立。结论心电图中异常Q波及QRS主波向下时ST段呈单向弓背向上抬高0．3～0．8mV或QRS主波向上时ST段斜向上抬高0．1～0．2mV对CLBBB并AMI均有重要的诊断价值。     

慢性肺源性心脏病的Doll-Bilger指数研究

Doll- Bilger指数是指心电图 V5导联 a/ b<1,其中 a为 V5导联之 QRS离开等电位线到 R波下行支与等电位线之交点的距离 ,即 R波之时限 ;b为 V5a的终点到 S波上行支与等电位线之交点 ,即 S波的时限。本文对 4 0例肺心病患者 Doll- Bilger指数进行研究分析 ,报道如下。1　资料与方法1.1　病例选择 :肺心病组 :4 0例 ,男 3 1例 ,女 9例 ,年龄 4 1～ 83岁 ,平均 ( 65± 9)岁 ,均为我院 1994年 2月至 1998年2月住院病例 ,诊断符合 1977年全国肺心病会议修订的肺心病诊断标准 ,本文选择的肺心病都是从慢支、肺气肿发展而来的。肺气肿对照组 :…     

66例悬垂位心心电图分析

目的 探讨悬垂位心心电图的特征及与气胸心电图等的鉴别要点,以减少误诊.方法 从今年病案中找出X线胸片符合悬垂位心患者的心电图,分析其心电图特征及与其它有类似心电图表现的疾病差别.结果 66例悬垂位心患者心电图表现为RV3＞RV4＞RV5和或＞RV6共18例(占27.3%),RV2＞RV3＞RV4＞RV5和或＞RV6共42例(占63.6%),其中R波递减幅度＜25%共36例,≥25%又＜50%共27例,＞50%共3例;V2～V5导联QRS波平均电压呈递减现象39例;左侧导联低电压(I、aVL＜0.5mV,V5、V6＜1.0 mV)18例;额面电轴右偏27例(40.9%),左侧导联低电压18例(27.3%),T波改变6例(9.1%).结论 正常悬垂位心患者由于左心缘变相对垂直,左心缘离左胸壁距离增加,使心电图大部分表现为胸导联R波递减,表现为RV3＞RV4＞RV5＞RV6,容易与左胸腔积气或积液,甚至不典型前壁心肌梗死混淆,应注意鉴别.     

Daniel心电图评分在急性非大面积肺血栓栓塞症早期预后评估中的价值

目的:探讨Daniel心电图评分在急性非大面积肺血栓栓塞症(PTE)早期预后评估中的价值。方法:收集经CT肺动脉造影确诊的急性非大面积PTE患者158例,根据心电图评分将患者分为A组(心电图评分≥6分)89例和B组(心电图评分<6分)69例。在确诊PTE24h内完成心电图、动脉血气分析、血浆B型钠尿肽(BNP)、血肌钙蛋白I(TnI)以及超声心动图等检查,随后在治疗开始14d后复查动脉血气分析、超声心动图检查,并观察住院30d临床重点事件。分析心电图评分与患者右心室功能、呼吸功能以及住院30d内预后的关系。结果:A组与B组的动脉血p(O2)、动脉血p(CO2)、氧合指数[p(O2)/FiO2]、BNP、TnI、右室舒张末期内径(RVD)、肺动脉内径(PAD)、三尖瓣反流速率(TR)和肺动脉收缩压(PASP)的差异有统计学意义。A组与B组心电图表现在窦性心动过速、电轴右偏>90°、SIQIIITIII、V5导联R/S≤1、avR导联R波>0.5mV和胸导联T波倒置的差异有统计学意义。Daniel心电图评分≥6分预测非大面积PTE右心室功能异常的敏感度和特异度分别为89.8%和85.7%;2组住院30d内出现低碳酸血症和肺动脉高压的发生率差异有统计学意义,其中A组有4例死亡,B组无死亡病例。结论:Daniel心电图评分有助于对急性非大面积PTE患者早期预后进行评估。     

预激症侯群合并大房间隔缺损症的电生理及根治

预激症候群系在房室间存在异常副传导通路,从而发作严重心律紊乱产生严重临床过程。自1968年Durrer 开始有报导手术切断此异常房室传导通路可治愈本症。日本施行此种治疗系自1973年开始。国内尚未见报导材料。我院心血管组于1978年5月15日为一例B型预激症候群合并第二孔型大房缺手术切断异常房室副传导通路肯特氏束取得成功。病例报告: 张×云,女,20岁,住院号61—009598,因突然发作心悸晕倒并伴有心前区剧痛,阵发心动过速5小时于1961年12月14日急诊第一次入院。血压70/50mmHg听诊肺瓣区Sm,P_2亢宽分裂,心电图RRO.22秒心率272/分,QRS呈完全性左束支传导阻滞图形。住院前5年常有同样发作历1～3日可自愈,每次发作均因心跳太快心前区剧痛而晕倒,伴有冷汗休克。X线摄片心脏后前位右心房极度增大肺充血重,肺动脉于搏动强烈全心脏呈离心性右心容量负荷,心电图电轴左偏,心导管检查;以Fick'S计算,左→右分流7.5％。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.