40例宽QRS波心动过速体表心电图及食管电生理诊断分析

目的　探讨体表心电图及食管电生理检查对宽 QRS波心动过速的诊断的准确性。方法　回顾分析 40例宽 QRS波心动过速患者体表心电图、食管心电生理检查特点 ,并与心内电生理检查结果比较 ,检验各传统指标的敏感性、特异性及准确性。结果　在体表心电图及食管电生理检查各项诊断指标中 ,诊断室性心动过速的敏感性、准确性较高的指标有 :胸导联无 RS型、食管心电图房室分离、心房起搏不能终止心动过速。结论　将体表心电图及食管电生理检查结合起来分析可提高对宽 QRS波心动过速诊断的准确性。     

食管心电生理检查鉴别宽QRS波心动过速

目的探讨食管电生理检查在宽QRS波心动过速的诊断应用价值。方法结合心内电生理检查结论,对42例宽QRS波群心动过速（WCT）发作时的食管心电图及体表心电图诊断进行回顾性比较分析,评价食管电生理在诊断WCT中的应用价值。结果与体表心电图诊断结果相比较,食管心电图对WCT的诊断准确度更高,而误诊率、漏诊率更低。结论应用食管电生理能显著提高对WCT的诊断和鉴别诊断水平,在心律失常的治疗上也具有实用价值。     

食管心房调搏诊断预激综合征宽QRS心动过速

用食管心房调搏结合多导同步描记术对33例预激综合征伴宽 QRS 心动过速进行电生理检查。提出了反向型房室折返性心动过速和正向型房室折返性心动过速伴束支传导障碍的食管调搏诊断标准。讨论了这些标准在诊断和鉴别诊断上的意义与局限性。     

食管心房调搏检查对窄QRS波群心动过速的诊断意义

目的 探讨食管电生理检查对窄QRS波群心动过速诊断的临床意义。方法 比较98例窄QRS波群心动过速食管和心内电生理检查的结果。结果 98例窄QRS波群心动过速97例分型诊断一致：房室折返性心动过速52例，房室结内折返性心动过速32例，心房内折返性心动过速和心房扑动各5例，房性自律性心动过速、窦房折返性心动过速和室性心动过速各1例。6例房性心动过速与54例房室折返性心动过速起源两种检查结果完全一致。结论 食管心房调搏对窄QRS波群心动过速的分型诊断和初步定位诊断具有很高的准确性，故可作为必要检查，有助筛选射频导管消融病例。     

宽QRS波群心动过速临床常见问题的重新评价

宽 QRS 波群心动过速在临床上较为常见,它可能为室上性或室性心律失常。尽管已有一系列临床与心电图(ECG)鉴别标准,但两者鉴别仍常失误。多数室上性心动过速(SVT)预后良好,而室性心动过速(VT)可能是致命的。误诊可导致误治,其后果严重。本文对150例宽 QRS 心动过速进行了前瞻性研究。经12导联 ECG 诊断的规则性宽 QRS 心动过速150例,均于入院后作电生理检查,确定心动过速机     

三种宽QRS波心动过速鉴别流程的对比研究

目的 探讨aVR单导联四步法、室速积分法、肢体导联流程(LLA)诊断宽QRS心动过速的临床价值.方法 选取41例宽QRS心动过速患者发作时的体表12导联心电图,并经心内电生理检查证实心动过速性质,由两位心电图医师分别用三种鉴别流程进行诊断,对比三种方法诊断室速(VT)的敏感度、特异度、准确性、约登指数及一致性.结果 a...     

QRS波第一峰时限诊断宽QRS波心动过速395例

宽QRS波心动过速指QRS时间≥0;12 s,频率＞100次/min的心动过速[1].室性和室上性心动过速心电图上都可表现为宽QRS波群,两者电生理机制、诊断、治疗不同,因此,对宽QRS波心动过速的鉴别诊断十分重要.依据体表12导联心电图鉴别宽QRS波心动过速是临床常用方法,已开展的有Brugada四步法、Vereckei四步法及aVR四步法.2010年国外学者又提出通过心电图Ⅱ导联测量QRS波第一峰时限(RWPT)[2](新方法)来鉴别宽QRS波心动过速.     

宽QRS心动过速39例临床分析

本文回顾总结39例经电生理检查确诊的宽QRS心动过速资料,以评价该方法的敏感性和特异性。1　对象与方法1.1　研究对象选择1988年1月～1998年1月入院的宽QRS波心动过速患者39例。心动过速发作时心电图(ECG)之QRS均≥0.12s,心率范围140～250次/min。其中男21例,女18例,平均年龄(44.9±16.6)岁。全部患者入院后依据症状、体征、ECG、超声心动图(UCG)、胸片及电生理检查确定诊断。1.2　临床资料分析收集每例病因及发作时临床症状、体征等资料进行统计分析。1.3　ECG分析宽QRS心动过速诊断标准:出现规则的宽QRS心动过速,QRS≥0.12s;…     

窄QRS心动过速体表心电图鉴别指标与心脏电生理检查结果的对比分析

本文对76例窄QRS心动过速发作时的体表心电图(ECG)鉴别指标与心脏电生理检查结果的对比分析,寻求各种预测指标对鉴别诊断的价值,以提高对窄QRS心动过速诊断的准确性,鉴别要点及治疗对策。 1 资料与方法 1.1 临床资料 选择自1989年3月以来窄QRS心动过速在我院行心内电生理检查和自1994年8月以来行RF-CA的病例,76例中男性39例,女性37例,平均年     

QRS波第一峰时限与aVR导联四步法诊断宽QRS波心动过速的分析

宽QRS波心动过速(WCT)指QRS时间≥0.12 s、频率＞100次/min的心动过速[1].室性和室上性心动过速心电图上都可表现为宽QRS波群,两者电生理机制、诊断、治疗不同,因此,对宽QRS波心动过速的鉴别诊断十分重要.依据体表12导联心电图鉴别宽QRS波心动过速是临床常用方法,已开展的有Brugada四步法、Vereckei五步法及aVR导联四步法.2010年Luis提出通过心电图Ⅱ导联测量QRS波第一峰时限(R-wave peak time,RWPT)[2](新方法)来鉴别宽QRS波心动.本研究应用新方法和aVR导联四步法对395份动态心电图记录的宽QRS波心动过速进行了回顾性分析,比较两种方法鉴别WCT的优劣,现将结果报告如下.     

心肌结核的研究进展

心肌结核是由结核分支杆菌直接或间接感染机体引起的一种心脏病,虽然罕见却是引起心脏性猝死（suddencar-diacdeath,SCD）的重要原因之一,尤其是在年轻患者中。心肌结核与SCD有着密切关系,因而对心肌结核的研究除了能够降低人类结核病负担外,还能够降低猝死的发生率,具有重要的临床意义。目前,国内对心脏结核的研究仅仅局限于结核性心肌炎,而且缺乏大样本的基础实验和临床研究。故而本综述拟对心肌结核的国内外研究做一简要总结,主要阐述其发病机制、临床表现、病理和影像学及治疗等。     

Changes in B-type Natriuretic Peptide Levels before and after Elective Major Non-cardiac Surgery in Patients With Heart Disease

Objectives To measure circulating B-type natriuretic peptide （BNP） levels in patients with heart disease undergoing elective major non-cardiac surgery and to explore the relationship between the changes in BNP level and cardiac events after surgical intervention. Methods Subjects comprised 232 patients with heart disease undergoing elective major non- cardiac surgery. Patients were classified into two groups based on BNP concentrations before surgery： those with BNP plasma levels ≤ 100 pg/mL （ Group A, n = 170） ; and those with BNP plasma levels 〉 100 pg/mL （ Group B, n = 62 ）. Preoperative BNP sampling was undertaken 24h before surgery, and postoperative 2 h after surgery. Screening for cardiac events was performed using clinical criteria, cardiac tropnin I analysis and serial electrocardiography. Results There was no significant difference in BNP concentrations between before surgery （73.5 ± 20. 6） pg/mL and after non- cardiac surgery （69.3 ± 27.5 ） pg/mL in group A （P 〉 0. 05 ）, while there was a significant difference in BNP concentrations between before surgery （ 149.3 ± 73.5 ） pg/mL and after non-cardiac surgery （ 341.5 ± 162. 4 ） pg/mL in group B （P 〈 0. 001 ）. Patients with postoperative cardiac events had significantly higher BNP levels （207.3 ± 99. 1 ） pg/mL before and （416. 9 ± 202. 8） pg/mL after non-cardiac surgery than those in patients with no cardiac events in group B. There was a significant difference in cardiac events between group A, in which no patient had cardiac events, and group B, in which 15 patients had cardiac events （ P 〈 0. 001 ）. Conclusions The changes in BNP levels after non- cardiac surgery were influenced by the preoperative levels of BNP, and relative to cardiac events.     

Upregulation of miR-29b contributes to the anti-fibrotic effect of macrophage migration inhibitory factor in diabetic myocardial fibrosis

Background Macrophage migration inhibitory factor(MIF) possesses proinflammatory function when secreted from the cells, and it also exhibits antioxidant properties based on its intrinsic oxidoreductase activity.However, the role of MIF in cardiac fibrosis is not well known. In the present study, the effect of MIF on fibrosis-associated gene expression and the underlying mechanism were examined. Methods The collagen content in mouse myocardium was detected by Masson staining. Expressions of MIF and fibrosis-associated Col1a1, Col3a1 and α-SMA in mouse myocardium or mouse cardiac fibroblasts were detected by quantitative real-time PCR and Western blot assay, respectively. Mature miR-29b expressions in mouse myocardium and cardiac fibroblasts were determined by real-time PCR. Smad3 activation in MIF-treated cardiac fibroblasts was also detected by Western blot assay. Results Compared with the db / m control mice, the collagen content was significantly increased in the myocardium of diabetic db / db mice. MIF was up-regulated, but miR-29b was down-regulated in the diabetic myocardium. Quantitative real-time PCR and Western blot assay showed that MIF could inhibit fibrosis-associated Col1a1, Col3a1 and α-SMA expressions in mouse cardiac fibroblasts.Smad3 activation was inhibited, but miR-29b was up-regulated in MIF-treated cardiac fibroblasts. Enforced expression of miR-29b significantly suppressed Col1a1, Col3a1, and α-SMA mRNA and 1protein expressions in cardiac fibroblasts. Conclusions MIF possesses the anti-fibrosis activity through inhibiting Smad3activation and through up-regulating miR-29b expression, and miR-29b can inhibit fibrosis-associated Col1a1,Col3a1 and α-SMA expressions in cardiac fibroblasts.     

心血管疾病戒烟干预中国专家共识

吸烟是心血管疾病的独立危险因素,并且也是患者唯一能够自我控制的致病因素。许多心血管医生已经认识到吸烟的危害和戒烟干预的重要性,但尚缺乏相应的戒烟知识和戒烟技巧。本共识通过全面总结吸烟的危害和戒烟的益处,     

食管调搏作为临时起搏器治疗心跳骤停53例临床分析

食管调搏（TEP）对室上速的诊断和治疗作用大家非常熟悉,也常见有人报道,但TEP作为临时起搏器抢救突发心跳骤停患者却十分罕见。本研究就此问题探讨TEP的临床应用价值。     

心房纤维化及重构与房颤发展的新视点

房颤的发生源于心脏电生理改变和心房结构重塑的共同作用。心房纤维化是一个有害的过程,会引起细胞外基质沉积与降解失衡及成纤维细胞的过度增值等。早期研究显示,心室纤维化会引起心室壁进行性硬化,进而引起心室功能不全和充血性心力衰竭。但随后的研究突出显示了心房纤维化与房颤的关系,与瓣膜病、高血压和老龄化的关系。     

Relevance of Depression/Anxiety and Health-related Quality of Life in Paced Patients

Depression/anxiety is commonly present in paced patients and is associated with increased cardiovascular morbidity and mortality. The high prevalence of depression/anxiety in paced patients supports a strategy of increased awareness and treatment for depression/anxiety in paced patients. Health-related quality of life （HRQoL） is being increasingly considered as an expected out-come of therapeutic interventions and rehabilitation programs in clinical cardi- ology including patients before and after pacemaker（PM） implantation. This multispeciahy consensus document reviews the evidence linking depression/anxiety with arrhythmia and cardiac pacing; HRQoL and cardiac pacing, at the same time, provides recommendations for healthcare providers for the treatment of depression/anxiety. （S Chin J Cardiol 2009; 10（4） ： 190 -195）     

以肠梗阻为首要表现的胆囊十二指肠瘘1例

病例：患者女,86岁,因＂间断腹痛、呕吐5 d＂于2010年12月23日就诊于我院消化内科。患者入院前5 d无明显诱因下出现上腹部疼痛,呈间断性发作,伴恶心、呕吐胃内容物,1~2次/d,约50 ml/次。患者发病期间无排便、排气,无发热、呕血,小便正常。门诊行腹部立位平片示,肠梗阻（见图1）。患者既往有胆囊结石病史20余年,曾于2010年9月28日行上腹部CT检查示,胆囊结石,胆囊壁增厚（见图2）。遂以肠梗阻、慢性胆囊炎收治入院。     

Clinical efficacy and predictor of cardiac resynchronization therapy on left bundle branch block-associated heart dysfunction

Background Left bundle branch block （LBBB） results in an altered pattern of left ventricular （LV） activation and subsequent contraction. Cardiac synchrony and cardiac function are deteriorated by LBBB. However, the effect of LBBB history on progressive heart dysfunction and clinical efficacy of cardiac resynchronization therapy （CRT） in such patients are not clear. In this study we explore the clinical efficacy and predictor of cardiac resynchronization therapy in LBBB heart dysfunction. Methods Twenty-seven LBBB patients with severe heart failure were treated with CRT. Twenty-six LBBB patients without CRT served as control. During 6 months follow-up, ECG, plasma NT-proBNP and echocardiogram indexes were measured. Results Compared with baseline, NYHA functional class of 23 patients （85.2%） was improved in CRT group. Compared with baseline and control, QRS duration （QRSd） was significantly more narrow （P = 0.023, P = 0.019）, NT-proBNP was significantly lower （P = 0.011,P = 0.009）, ventricular septal to left ventricular posterior wall delay time and left ventricular dyssynchrony index （Ts-SD） were significantly worse （P 〈 0.05）; left ventricular ejection fraction, left ventricular end-systolic volume, mitral regurgitation area were significantly improved in CRT group （P 〈 0.05）. when the LBBB history was I〉 2 years and QRSd I〉 155 ms, the sensitivity and specificity of CRT super-response were 53.4% and 85.6% respectively. Conclusions CRT can improve the synchronization and hemodynamic of LBBB patients with heart dysfunction, the LBBB history I〉 2 years and QRSd I〉 155 ms are one of the CRT super-response predictors.     

医师提供人文医学服务探究——不同医学模式的医疗服务差异性分析

近些年来,社会上呼唤人文医学或人文医生的声音很响,似乎而今的医疗服务使社会大众难于接受。对此,我们复习研究了许多相关文献,从远古时代的神灵主义医学模式发展到今天的生物一心理一社会医学模式各时段的医疗服务。这一文献复习始于朱宗涵教授于2001年在北京地区会议上讲话时提出的“人文医学”这一概念。