分析12导联心电图对冠心病心肌缺血的监测价值

目的分析12导联心电图对冠心病心肌缺血的监测价值。方法选取2017年5月至2019年4月我院接诊的老年冠心病患者90例为研究对象,均行12导联心电图与常规心电图检查,比较两种检查方法对冠心病检出率、检出部位及对心肌缺血检出率,分析两种方法对冠心病心肌缺血的监测价值。结果12导联心电图对冠心病检出率高于常规心电图(P<0.05),12导联心电图对下壁、侧壁的检出率高于常规心电图,且12导联心电图对ST段抬高、ST段压低的检出率也高于常规心电图(P<0.05);12导联心电图诊断冠心病心肌缺血的灵敏度明显高于常规心电图(P<0.05),两者诊断特异度、准确度比较差异无统计学意义(P>0.05)。结论12导联心电图用于冠心病心肌缺血的诊断中有较高价值,可较好检出心肌缺血及缺血部位,值得广泛应用。     

使用12导联与3导联分析动态心电图的优劣

目的:使用12导联与3导联分析动态心电图(Ambulatory eletrocrrdiograhy,AECG),明确12导联动态心电图在心肌缺血与心律失常检测上的优势.方法:采用随机,平行对照分组的方法对我院门诊及住院患者要求检测动态心电图进行分组:12导联组,3导联组,比较两组动态心电图表现.结果:①12导联与3导联患者的一般情况相似;②12导联发生缺血性ST-T下降的病例比例高于3导联;差异有统计学意义(P<0.05),缺血部位明确.③12导联室性期前收缩、室速,交界性逸搏低于3导联;房性期前收缩,心房扑动,房颤(包括短阵房颇、房扑),房性逸搏高于3导联,但P>0.05,差异无统计学意义.④12导联能对室性期前收缩定位.结论:12导联(AECG)能及时检出缺血性ST-T改变,并准确定位;12导联AECG由于P波清楚,对室上性与室性心律失常判定准确;对室性期前收缩的起源定位;以上结论为临床诊断提供了准确心电图诊断.     

12导联和3导联动态心电图在冠心病心肌缺血及心律失常老年患者诊断中的临床价值分析

目的:研究12导联和3导联动态心电图在冠心病心肌缺血及心律失常老年患者诊断中的临床价值.方法:选取2013年6月~2016年6月接诊的180例老年冠心病患者进行研究.按照随机数表法,随机均分为三组,分别采用12导联、3导联动态心电图和常规心电图进行检查.分析比较三种检查手段对心肌缺血、心律失常的诊断价值.结果:12导联组对心肌缺血、心律失常的检出率(78.33%、76.67%)明显高于3导联组(61.67%、63.33%)和常规组(46.67%、51.67%),3导联组明显高于常规组.12导联组对室性早搏二三联律、房性早搏二三联律、左束支阻滞、右束支阻滞及房室传导阻滞的检出率明显高于3导联组和常规组,3导联组明显高于常规组.12导联组对下壁、侧壁的检出率(16.67%、11.67%)明显高于3导联组,对ST段抬高、压低的检出率(46.67%、55.00%)明显高于3导联组(28.33%、26.67%).结论:12导联动态心电图在冠心病心肌缺血及心律失常老年患者中的诊断价值良好,可显著提高心肌缺血及心律失常的诊断率,且对心律失常分型的诊断效果良好,值得广泛应用.     

腹臂导联在房室传导阻滞诊断中的应用价值

目的 探讨腹臂导联对于房室传导阻滞的诊断价值.方法 选择180例既往心电图疑似房室传导阻滞的患者同步行常规导联和采用胎儿心电图机腹臂导联描记心电图,并进行对比分析.结果 (1)腹臂导联心电图P波振幅(6.96±1.31)mm,显著高于常规导联(1.12±0.28)mm;(2)腹臂导联心电图对房室传导阻滞的检出率(70.6%)高于常规导联(51.1%),2组差异有统计学意义(P＜0.05).结论 腹臂导联对房室传导阻滞的诊断具有临床实用价值.     

12导联动态心电图对心肌桥患者心肌缺血状况的评估分析

目的探讨12导联动态心电图对心肌桥患者心肌缺血状况的评估效果。方法选取2016年3月至2018年3月商丘市第一人民医院收治的经冠状动脉造影确诊的60例心肌桥患者,均实施12导联动态心电图检查,评估心肌缺血状况。结果 60例患者中,经冠状动脉造影确诊为单支病变27例,多支病变33例。经12导联动态心电图检查,单支病变组心肌缺血检出22例(81.48%),多支病变组检出33例(100%),总检出率为91.67%(55/60)。多支病变组心肌缺血发作次数、总持续时间、ST段压低幅度、肌桥长度、狭窄程度均高于单支病变组,差异有统计学意义(均P<0.05)。结论 12导联动态心电图可较为准确地评估心肌桥患者的心肌缺血状况,值得临床推广应用。     

冠状动脉造影与12导联动态心电图检出无症状性心肌缺血的对比分析

目的探讨12导联动态心电图对诊断无症状性心肌缺血的诊断价值.方法选择80例12导联动态心电图检出无症状性心肌缺血的患者,同期对其行冠脉造影检查,比较二者的结果.结果冠脉造影检出至少一支主要冠状动脉或其分支的内径狭窄≥50%患者66例,12导联动态心电图对无症状性心肌缺血的诊断与冠脉造影病变结果相符率为82.5%.结论 12导联24h动态心电图是诊断无症状心肌缺血的有效方法.     

常规心电图与动态心电图不同导联连接方式对ST-T的影响

目的 比较常规心电图(ECG)、动态心电图(AECG)采用Einthoven-Wilson12导联系统(A系统)和Mason-Likar12导联系统(B系统)不同连接方式时ST-T的差异性.方法 对100例接受ECG、AECG检查者,分别采用A系统和B系统描记,每例患者的4种描记方式在10 min内完成.结果 ECG检查中,与A系统比较,B系统Ⅲ、V1、V5导联的J点及Ⅲ、V1、V3、V4导联的ST段下移明显,aVR、V1～5导联的T波振幅降低,Ⅰ、Ⅱ导联的T波振幅增高,差异有统计学意义(P＜0.05).AECG检查中,与A系统比较,B系统Ⅱ、Ⅲ、aVR、V2、V6导联的J点下移,Ⅱ、Ⅲ、V1、V2、V6导联的ST段下移,aVR、V2、V3、V5、V6导联的T波振幅降低,aVR、aVL导联的ST段抬高,差异有统计学意义(P＜0.05).结论 A系统与B系统ST-T的改变并不相同,不能以ECG的标准诊断AECG,AECG诊断心肌缺血时应慎重,以免误诊.     

12导联动态心电图对冠心病心肌缺血的临床诊断价值分析

目的 ：探讨12导联动态心电图对冠心病心肌缺血的临床诊断价值研究。方法 ：选取2019年2月～2021年12月本院疑似患有冠心病患者96例为研究对象,采用随机数字表法（n=48）,分为常规组和观察组,各48例,常规组给予常规心电图诊断;观察组给予12导联动态心电图诊断方式,对比两组阳性检出率和诊断认可度。结果：常规组阳性检出率低于观察组,两组差异有统计学意义（P<0.05）。观察组诊断认可度各项指标显著高于常规组,两组差异有统计学意义（P<0.05）。结论：12导联动态心电图对冠心病心肌缺血的诊断更为有效,能较好地反映冠状动脉病变和心肌缺血部位,值得临床推广及应用。     

推衍12导联心电图对老年骨科患者术中心肌缺血监测的临床价值分析

目的 探讨推衍12导联心电图ST段连续监测对老年骨科患者术中心肌缺血监测的临床价值.方法 对95例老年骨科患者术中连续监测推衍心电图12导联ST段.结果 被调查老年患者术中心肌缺血总的发生率为36.8%(35/95),其中全身麻醉43.5%(10/23),腰/硬麻醉40%(24/60)和神经阻滞麻醉8.3%(1/12).未发生心肌缺血者合并高血压病的比例(21/60)明显低于发生心肌缺血者(26/35),差异有统计学意义(P＜0.05).术中发生的心肌缺血事件,70%(49/70)持续时间＜5 min;72.9%(51/70)ST段压低≤0.15 mV.结论 推衍12导联心电图可用于老年骨科术中心肌缺血的检测,高血压病为术中发生心肌缺血的易患因素,术中发生的心肌缺血绝大多数持续时间短、ST段压低程度轻.     

头胸导联与常规导联心电图对显性旁路定位诊断的比较

目的 观察在对预激综合征患者显性旁路定位诊断方面,头胸导联心电图是否具有与常规导联心电图一样的价值.方法 对于按标准预先筛选的预激综合征患者,同时记录常规心电图及头胸导联心电图各1份,由两位资深的电生理医生进行分析,对旁路作出定位诊断,而后由观察者将两种导联心电图的诊断结果与心内电生理检查的结果相对照,计算出两种导联心电图对旁路定位的准确率,并作X2检验,同时对两种导联心电图△波的大小进行比较.结果 本实验包括由全国12家大医院提供的符合入选标准的预激综合征患者58例.常规导联心电图的诊断准确率是86.2%(50/58),头胸导联心电图的准确率是84.4%(49/58),两者无统计学上的差异(P>0.05);头胸导联记录的△波都比对应常规导联的更为明显.结论 在对预激综合征患者显性旁路定位诊断方面,头胸导联心电图与常规心电图一样都具有较高的准确率.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.