心动过速性心肌病16例临床分析

慢性心动过速可导致心脏的组织学和病理学发生类似心肌病的变化,称为心动过速性心肌病（TCMP）,是一种可逆性心肌病.我院1998～2004年共收治16例TCMP患者,现报告如下.     

心动过速性心肌病的识别及治疗

过去很长时间一直认为心肌病患者发生的室上性或室性心律失常均是继发的，直到1971年Coleman等首先报道心动过速可能导致进行性心肌病变和心力衰竭，之后更多的类似病例陆续被发现。其共同临床特点是长期发作的心动过速导致左室功能不全，而在心率控制后这种功能不全能够部分甚至完全恢复正常。最近研究显示，不论心动过速发生前是否已存在心脏疾患，慢性心动过速均可导致心脏的组织和病理生理发生类似心肌病的变化，临床表现为心脏扩大、心功能下降。有学者将其称为心动过速性心肌病（Tachycardiomyopathy，TCMP），它的最大特点是具有可逆性。因此，识别和治疗这种类型的心肌病具有极大的临床价值。     

动态心电图中伪差样室性心动过速1例

动态心电图中，由于电极粘贴不牢或强烈的肌电干扰所致，心电图中可突然出现频率增快、连续的宽大畸形的“QRS波群”，心室率为140～300bpm，持续时间20s～3．25min，易被误诊为室性心动过速或心室颤动。现报道如下。     

1例同种异体原位心脏移植术后心电图分析

1临床资料1.1一般资料男性患者,41岁,阵发胸闷、心慌、喘憋8个月加重5d入院。外院诊断扩张型心肌病、心功能不全。患高血压3年。心电图检查:心肌缺血ST-T改变,异常Q波,室性早搏,夜间时有阵发室速。入院检查:X线片显示心影大,心电监测室性心动过速。经电击除颤,恢复窦性心律。诊断扩张型心肌病已发展到晚期,行同种异体原位心脏移植术。1.2术后心电图当天心电图显示各导联隐约可见较规律出现的p波,频率116/min,P-R间期约0.20s下传心室,其间可见频繁出现的舒张晚期房性早搏(多数成对出现)早搏后P-R间期约0.16s,QRS波终末端粗顿,V1呈rSr?…     

22例致心律失常性右室心肌病的心电图特征和临床观察

目的：分析研究致心律失常性右室心肌病患者的心电图特征以及临床表现观察。方法：选取2010年10月到2012年10月的22例致心律失常性右室心肌病患者资料进行回顾性分析,观察22例患者的临床表现、腔内电生理检查、心电图参数、超声心动图等临床资料。结果：22例患者中19例患者出现心悸和胸闷,8例患者同时伴随晕厥,1例患者有家族性猝死史。通过心电图显示8例患者显示Epsibn波,22例患者右胸导联QRS波大于等于110ms,在22例患者中出现T波倒置的患者有10例,12例患者出现S波升支时间大于等于55ms,13例患者出现室壁阻滞,15例患者显示持续性或者是非持续性心动过速。结论：致心律失常性右室心肌病一般多发于青年男性,属于造成晕厥、室壁运动异常以及室性心律失常的主要因素, Epsilon波、右胸导联QRS波大于等于110ms和T波倒置、室性心律失常作为具有特征性心电图变化,S波升支时间延长、室壁阻滞、患者右胸导联S波升支时间大于等于55ms对此病的诊断相对有所帮助,通过导管射频消融治疗实行心动过速的成功几率比较低。     

隐匿性慢旁路折返性心动过速的诊断

为了明确2例反复发作的室上性心动过速的诊断，我们给予心内电生理检查及心内标测和消融治疗，其结果：①心房和心室电刺激易诱发和终止心动过速；②心动过速时体表心电图QRS波窄型、逆行的P波、RP＞PR；③心动过速与右心室起搏均呈同样的偏心性心房激动顺序；④心动过速时于希氏束不应期刺激心室可提早夺获心房；⑤经劳路室房传导呈递减性，未发现旁路有前传特性；⑥射频消融阻断心动过速的逆传支，2例分别于600ms及500ms心室起搏时显示室房分离。根据以上结果诊断为隐匿性慢旁路折返性心动过速。隐匿性慢旁路折返性心动过速的诊断@王…     

急性心肌梗塞QT间期离散度变化及其临床意义

通过测量65例急性心肌梗塞患者QT间期离散度并与心绞痛患者和正常健康人对照，结果急性心肌梗塞合并室性心律失常（室性早搏、室性心动过速、室性颤动）、心源性休克或心脏摔死者QTcd：（91．6±24．6）ms，心梗合并心衰者其QTcd：心功能Ⅰ～Ⅱ故者为（80．2±15．8）ms，Ⅲ～Ⅳ级者为（84．7±22．3）ms，无并发症心梗者为（59．6±11．2）ms。有并发症心梗与无并发症者比较差异有显著性（P＜0．05）；急性心梗患者，无论有无并发症，均较心绞痛患者有显著性差异（P＜0.05），与正常健康人比较均有非常显著性差异（P＜0．01）。表明急性心肌梗塞患者QT离散度是增加的，QTCd的变化可作为反应病情严重程度和预测心脏事件：室性早搏、室性心动过速、心室纤额、心脏猝死、心源性休克等的一个重要指标。     

心室扑动伴阿斯综合征2例

患者1,男,60岁.因发现心电图异常19年,反复咳喘3年,复发伴四肢水肿4月入院.19年前体检发现心电图为三度房室传导阻滞及心脏形态改变,诊断为"充血性心肌病".本次入院前心电图示室性自身性心动过速,左前分支阻滞,(Ⅱ、Ⅲ、Ⅴ1-5)异常Q波.入院诊断:扩张性心肌病,心力衰竭,心功能Ⅳ级.次日动态心电图检查中记录到室性心动过速转为心室扑动持续10分钟.同时出现阿斯综合征及急性左心衰症状,即抢救2分钟后缓解.6天后安置永久性人工心脏起搏器,病情稳定出院.半年后死于心衰及肺部感染.     

慢性心力衰竭患者心电图变化临床观察

目的此次主要针对慢性心力衰竭病患的心电图变化特征进行观察和分析。方法随机选取2016年1月至2018年1月2年之内接受治疗的85名慢性心力衰竭病患为主要研究对象,观察85名慢性心力衰竭病患的心电图临床变化特征。结果对比不同心功能分级慢性心力衰竭患者心电图情况发现Ⅰ-Ⅱ级患者的心电图异常发生率为55.6%,明显比Ⅲ-Ⅳ级病患的心电图异常发生率81.6%低,且Ⅰ-Ⅱ级病患心室除极时间明显比Ⅲ-Ⅳ级病患短,具一定差异;对比正常心室除极时间波动和宽心室除极时间波的病患血浆BNP水平发现,85名病患中有25名病患出现宽心室除极时间波,发生率为33.0%,其中心室除极时间≥120 ms组的病患血浆BNP水平及LVEDD均大于心室除极时间120 ms组,LVEF低于心室除极时间120 ms组,具有一定差异。结论本研究中心电图异常主要表现为心房颤动等快速型心律失常、T波低平或倒置、左前分支传导阻滞、心室除极时间心力波时限增宽、高侧壁心电轴左偏、缺血性心力J心力波、前间壁胚胎性r心力波等有关。     

经食道心电监测42例临床分析

目的探讨经食道心电监测心律失常的可行性、安全性和临床意义。方法开启心电监护仪，42例患者经前鼻孔插入食道电极35～40cm，用中继线连接食道电极和心电监护仪，选择导联，以观察到P波正负双向且振幅最大、QRS波呈Qr型、T波倒置（即食道心电图）处为最佳位置，胶布固定电极，观察食道心电图P、QRS、T波关系。结果42例患者术前常规心电图诊断阵发性室上性心动过速30例，阵发性室性心动过速10例，频发室性早搏2例。食道心电监测示，原2例频发室性早搏中1例早搏的P波隐藏于其前窦性心搏的T波尖端初，该早搏为房性早搏伴差异性传导；30例阵发性室上性心动过速中11例患者的R—P’间期＞70ms，为房室折返性心动过速，7例患者的R—P’间期＜70ms，为房室结折返性心动过速，5例为心房率为360次·min^-1（2：1下传心室）的心房扑动，4例为房性心动过速，3例患者为心房颤动；10例阵发性室性心动过速中3例患者R—P’间期＞70ms，为房室旁道前传的房室折返性心动过速，2例患者的R—P’间期＜70ms，为房室结折返性心动过速伴差异性传导。结论经食道心电监测是一种无创伤性、安全可靠、操作简单、痛苦小、实用性强、无并发症的心内科诊疗新技术，可广泛推广应用。     

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.