心脏起搏器适应证变迁

ThThis pattern of depolarization results in efficientmechanical contraction - which is lhe purpose - 1o pump blood.     

可调式动物心脏起搏器的设计

提出了一种可调式动物心脏起搏器的设计方法,并通过动物实验,初步验证了起搏效果的有效性.该心脏起搏器可以在体外调节起搏脉冲的宽度和频率,实现心功能损害程度不同的心衰模型的复制.     

床旁安装人工临时心脏起搏器在急诊科的应用

目的根据我院自2002年至今在急诊科床旁所做的2例人工临时心脏起搏器安置术资料,对其经验进行总结.方法采用股静脉穿刺的方法将心脏电极导线送至右心室心尖部,记录起搏器参数后,然后将心脏电极导线与心脏临时起搏器脉冲发生器连接,进行起搏.结果 2例人工临时心脏起搏器患者中均为男性,年龄24-65岁,均为VVI型.结论人工临时心脏起搏器安置术安全、有效.     

心脏起搏器安置术的临床护理体会

目的 探讨心脏起搏器安置手术的护理配合.方法 对46例需安置心脏起搏器的患者实施安置临时或永久性起搏器手术,并进行系统化护理.结果 46例患者起搏器安置手术均顺利完成,无并发症发生.结论 做好起搏器安置术前的心理护理、术前准备、术中配合、术后护理及出院指导的全程护理,提高了医疗护理质量和患者生活质量.     

37例永久性心脏起搏器置入术的护理体会

目的：探讨提高安置永久性心脏起搏器置入术的护理质量的方法,保障病人生活质量。方法：对37例心脏起搏和传导功能障碍患者置入永久性起搏器,实施术前、术中、术后的护理和健康指导。结果：实施正确的护理措施和健康指导,使病人消除思想负担,增强战胜疾病的信心,提高了生活质量。结论：对安置永久性心脏起搏器的患者提供统一而规范的护理,...     

自制起搏电极在心脏电生理实验中的应用研究

本文探索了自制起搏电极在心脏电生理研究中的应用,通过选择适当的材料,分为三部分制作电极:极片部分、起搏器接口部分、焊封与绝缘.最后,将电极缝合于犬的心脏进行起搏.结论是自制起搏电极应用于动物实验进行心脏电生理的研究是可行的.     

气囊漂浮电极床旁紧急心脏起搏的临床应用

目的：观察气囊漂浮电极床旁紧急心脏起搏抢救心室停搏和严重缓慢型心律失常的疗效。方法：采用气囊漂浮电极床旁紧急心脏起搏治疗心室停搏2例、严重窦缓6例，Ⅲ度以上房室传导阻滞7例。结果：15例均起搏成功，平均历时15min。结论：气囊漂浮电极床旁紧急心脏起搏，与普通电极起搏相比，具有操作简便，成功率高，无需X线定位，可争取抢救时间等优点。     

心脏起搏器自动阈值夺获功能的对比与适应性分析

在心脏起搏器自动化进程中,除了安全性,节电及便利性也是起搏器应用中备受关注的焦点.自动阈值夺获功能可自动测试心室起搏阈值.不同种类的起搏器,其自动夺获功能的原理不尽相同,且各有特点.本文对比了国内主要使用的三大品牌起搏器,即美国Pacesetter、德国Biotronik和美国Medtronic的自动阈值夺获功能,在安全性、智能性、程控便利性及电极兼容性等方面进行对比分析,具有较强的临床指导意义.     

Effects of Different Right Ventricular Pacing Sites on QRS Duration in Patients Receiving Permanent Dual Chamber Pacemakers

Objective:To investigate the influence of different right ventricular (RV) pacing sites on QRS width, and to provide a potential reference site for permanent right ventricular pacing in patients implanted with permanent pacemakers. Pacing at the site with the shortest QRS duration may reduce the deleterious effects of RV pacing on LV function, and thus having beneficial effects on patient's outcome. Methods: All consecutive patients who were planned to have permanent pacemaker implantation for a ClassI or IIaindication atour departmentfromOctober 2010 toJuly2012 werescreened for the participation in this prospective, single center, non-randomized study. The baseline surface ECG was analyzed for QRS width and morphology, respectively. During the implantation procedure patients were transiently paced at different RV locations(right ventricular apex, right ventricular inflow tract [RVIT], mid septum, high septum and right ventricular outflow tract [RVOT]) before the lead was placed at its final position. During pacing at the different positions the surface 12-leads ECG was recorded. Based on the surface of ECG QRS duration and morphology of the different right ventricular pacing sites were analyzed and compared with baseline and to each other. Results: A total of 216 patients(39% female, mean age 69±13 years, higher degreeAV block 30.5%)wasenrolled in thestudy. Paced QRS duration wassignificantly different between all right ventricular pacing sites compared with the baseline ECG(baseline: 106 ms±21 ms; mean paced: 158 ms±16 ms; p0.001). RVA pacing showed the widest QRS(168 ms±16 ms). QRS duration with RVIT pacing was 166 ms±15 ms,and that with RVOT pacing was 165 ms±15 ms, respectively. QRS duration was not significantly different between these three positions. Mid-septal pacing showed the narrowest QRS(139 ms±19 ms) compared to all other pacing sites(p0.001). Pacing at the high-septum showed a broader QRS (153 ms±14 ms) than that pacing at the mid-septum. Compared to other right ventricular pacing sites, QRS morphology at the mid-septum was close to normal, and electrical axis was unchanged as compared to baseline. Conclusion: Pacing at different right ventricular sites showed the significant widening of QRS compared to baseline. The shortest QRS duration was seen with mid-septal pacing. Therefore, mid-septal pacing may have less deleterious effect on LV function compared to other RV pacing locations, which may be the optimal right ventricular pacingsite in permanent pacemaker recipients.     

Changes in Cardiac Refractory Period During Signalled Shock Avoidance in Dogs

The effect of training during an aversive conditioning schedule on the ventricular effective refractory period (ERP) and the occurrence of repetitive extrasystoles (RE) was investigated in 11 dogs. The ERP was decreased significantly at avoidance onset during the first 5 days of the experiment. but remained unaltered during the second 5 days of testing. The changes in ERP were most pronounced on the first day. REs were observed most during avoidance in the animal with the greatest decrease in ERP but inconsistently in other animals. The potential use of aversive Training procedures to study the role of neural factors in cardiac arrhythmias is discussed.     

不同起搏部位对左心室重构及左心收缩功能的影响

目的 研究右室间隔起搏及传统右室心尖部起搏对左心室重构及左心收缩功能的影响。方法 收集2013年1月~2015年5月曾于亳州市人民医院心内科行双腔起搏器植入术且随访资料完整的患者共63例,其中右室间隔起搏组共32例,右室心尖部起搏组共31例,观察两组术前与术后1年左室舒张末容积、左室射血分数、及血清NT-proBNP水平变化。结果 两组起搏器植入术前血清NT-proBNP水平及左室舒张末期内径和左室射血分数比较,差异无统计学意义（P＞0.05）,术后1年随访检测血清NT-proBNP水平,右室心尖部起搏组较右心室间隔部组升高（P＜0.05）;右心室间隔部起搏组术后左室舒张末期内径和左室射血分数与术前比较,差异无统计学意义（P＞0.05）;右室心尖部起搏组术后1年左室舒张末期内径较术前增大,左室射血分数减小（P＜0.05）。结论 相较于传统的右室心尖部起搏,右室间隔部起搏更能保证心室正常的电活动顺序,且对左室收缩功能的影响较小。     

连续性护理干预对老年糖尿病合并心律失常患者置入心脏起搏器后的影响研究

目的探究连续性护理干预对老年糖尿病合并心律失常患者行心脏起搏器置入术后的临床疗效,观察患者术后负性情 绪及生活质量遥方法选择我院82 例择期行心脏起搏器置入术的老年糖尿病合并心律失常患者,按照随机数字表法分组,各41 例遥对照组实施常规护理,观察组采取连续性护理干预,比较两组干预前后护理效果遥结果观察组干预后HAMD尧HAMA评分 均较对照组降低（约0.05）曰经随访,观察组干预后4 y SF-36 评分较对照组提高（约0.05）曰观察组并发症发生率17.07%低于对 照组36.59%（约0.05）遥结论对行心脏起搏器置入术的老年糖尿病合并心律失常患者采用连续性护理干预效果显著,可明显缓 解患者负性情绪,减少并发症发生情况,提升患者生活质量遥     

起搏器频率自适应功能综述

起搏器的频率自适应功能可以弥补心脏变时性功能不全的问题.其实现原理是通过传感器感知与人体代谢水平相关的生理或非生理参数,并根据一定的算法计算出传感器指示频率,以此提供与代谢水平相适应的起搏频率进而调整心输出量.频率自适应功能显著改善了患者的运动耐量,提高了他们的生活质量,已经成为众多起搏器必不可少的基本功能.     

Heart Rhythm and Cardiac Pacing: An Integrated Dual-Chamber Heart and Pacer Model

Modern cardiac pacemaker can sense electrical activity in both atrium and ventricle, and deliver precisely timed stimulations to one or both chambers on demand. However, little is known about how the external cardiac pacing interacts with the heart’s intrinsic activity. In this study, we present an integrated dual-chamber heart and pacer (IDHP) model to simulate atrial and ventricular rhythms in the presence of dual chamber cardiac pacing and sensing. The IDHP model is an extension and improvement of a previously developed open source model for simulating ventricular rhythms in atrial fibrillation and ventricular pacing. The new model takes into account more realistic properties of atrial and ventricular rhythm generators, as well as bi-directional conductions in atrium, ventricle, and the atrio-ventricular junction. Moreover, an industry-standard dual-chamber pacemaker timing control logic is incorporated in the model. We present examples to show that the new model can generate realistic cardiac rhythms in both physiologic and pathologic conditions, and simulate various interactions between intrinsic heart activity and extrinsic cardiac pacing. Among many applications, the IDHP model provides a new simulation platform where it is possible to bench test advanced pacemaker algorithms in the presence of different types of cardiac rhythms.     

Bioz.com用于心脏手术围术期监测的临床价值研究

目的 评价无创血流动力学监测系统（Bioz.com）用于心脏手术患者围手术期心功能评估的准确性及可靠性。方法 选取在2017年12月~2018年6月于承德医学院附属医院行择期心脏手术患者35例,包含瓣膜性疾病23例,冠心病12例。选取“肺动脉漂浮导管”及“超声心动图”作为比较指标,严格按照Bioz.com系统操作规范进行操作,对心排出量（CO）、每搏输出量（SV）、心指数（CI）进行监测,分别记录手术前后患者血流动力学变化情况,并进行相关统计学分析。结果 心脏手术前后,采用 Bioz.com系统及超声心动图两种方法对患者血流动力学参数CO、SV、CI进行监测并比较,差异均无统计学意义（P＞0.05）。心脏手术中,采用Bioz.com系统及漂浮导管两种方法对患者血流动力学参数CO、SV、CI进行监测并比较,差异均无统计学意义（P＞0.05）。结论 在心脏手术中Bioz.com系统与肺动脉漂浮导管,Bioz.com系统与超声心动图监测的精确度与准确度具有一致性,是一种较为可行的心功能监测方法。     

心瓣膜置换术80例临床分析

目的：总结心瓣膜置换术手术方法、围术期处理经验,以提高手术成功率并减少术后并发症。方法：回顾性分析我院2000年2月～2008年11月总计80例心瓣膜置换术的手术技术、心肌保护、术后处理以及死亡原因等。80例中单纯行二尖瓣置换术（MVR）50例,主动脉瓣置换术（AVR）12例,双瓣联合置换术（DVR）18例（1例为再次双瓣置换术）;同期行三尖瓣Devega成形术48例。结果：本组76例痊愈,4例死亡,死亡率5％。术后二次开胸止血6例,占7．5％（6／80）,无其他严重并发症。结论：提高手术技巧、改进心肌保护方法、加强围术期管理等,可显著降低心瓣膜置换术的死亡率和并发症发生率。     

阈下条件电刺激心室抑制作用空间限制性的实验研究

临床上,已利用阈下条件刺激心室抑制作用的空间限制性对室性心律失常异位激动起源点进行定位。为了解这种方法定位的精确性,本工作采用各种观察阈下条件刺激的心室抑制作用及其空间限制性的方法,并首次设计了阈下条件刺激心室起搏节律抑制模型,进行了详细研究。结果表明,阈下条件刺激的心室抑制作用具有很强的空间限制性,这一特性可用来对室性心律失常异位激动起源点进行精确定位。     

Anti-Myosin Humoral Immune Response Following Cardiac Injury

A sensitive and highly specific ELISA assay was developed to determine the anti-myosin humoral immune response (AMA) in various heart diseases: acute viral myocarditis, infective endocarditis, acute myocardial infarction, and valve and coronary bypass surgery. The mean study entry AMA titer of each patient group was already significantly increased compared with age matched controls. During further follow-up (90 d) all the groups except for endocarditis showed a significant increase of AMA titer compared with their entry titer. Anti-myosin antibody titer were higher after cardiac surgery than after myocardial infarction or inflammatory heart disease. These results suggest that anti-myosin immune response is not limited to infectious processes in which the pathogen induces antibodies which cross-react with heart constituents but is merely caused by direct cardiac injury. Myosin as a major compound of heart cellular proteins turned out to be a good candidate to trigger immune response after cardiac injury.