对"肢体加压法治疗阵发性室上性心动过速24例"的验证

读了贵刊２０００年第１１期“肢体加压法治疗阵发性室上性心动过速２４例”一文后，启发很大。一年半来笔者用此法治疗阵发性室上性心动过速（室上速）２１例，收到满意效果，现报告如下。２１例阵发性室上速患者中，男１４例，女７例，年龄２０～６５岁。１１例为病毒性心肌炎所致，７例为预激综合征所致，３例病因未明。初次发作５例，反复发作１６例。治疗方法见该文犤１犦。治疗效果：２１例治疗后１３例急性发作终止，有效率为６２％（１３／２１），其中４例为初次发作，９例为反复发作；８例为病毒性心肌炎所致，４例为预激综合征所…     

甲氧胺治疗阵发性室上性心动过速24例

甲氧胺治疗阵发性室上性心动过速２４例程元桥．中国危重病急救医学，１９９４，６（６）：３４２作者选用甲氧胺治疗阵发性室上性心动过速２４例，男９例，女１５例，年龄１３～７５岁，病程１～３５年。均无高血压病，３例肺心病，１例甲亢。诱因：多为劳累、精神紧张。...     

甲氧胺治疗阵发性室上性心动过速24例

甲氧胺治疗阵发性室上性心动过速２４例武汉石化医院内科（４３００８２）程元桥我院１９９０年１月～１９９３年１２月选用甲氧胺治疗阵发性室上性心动过速２４例，获良好效果，报告如下。１临床资料１．１一般资料：年龄１８～７５岁，男９例，女１５例，病程１～３５年...     

阵发性室上性心动过速的治疗

阵发性室上性心动过速是一类常见的心律失常 ,发病率约 0 .2 5 %。主要类型包括房室结折返性心动过速和房室折返性心动过速 ,房性心动过速相对较少。1　发生机制房室结折返性心动过速的折返环由房室结内双径路构成 ,其常见类型为慢—快型折返 (顺向型折返 ) ,少见的有快—慢型折返 (逆向型折返 )和慢—慢型折返。房室折返性心动过速的折返环由房室结和旁道(隐匿性或显性 )构成 ,其中多数是房室结顺传和旁道逆传的顺向型折返 ,而经旁道顺传和房室结逆传的逆向型折返较为少见 ,由一条旁道顺传和另一旁道逆传的折返更为罕见。房性心动过速的发…     

阵发性室上性心动过速的治疗

阵发性室上性心动过速的治疗南京军区总医院（２１０００２）林修功病因及电生理机制阵发性室上性心动过速（阵发性室上速，ＰＳＶＴ）是异位节律起源于希氐束分支以上的一种快速心律失常；临床几乎所有的心脏病皆可引起，而常见的主要有风心病、心肌炎、心肌病、甲亢、冠...     

阵发性室上性心动过速一例

临床资料患者男 ,62岁 ,退休干部 ,因冠心病、陈旧性前壁心肌梗死 2 2个月 ,于 1 998年 1 0月 1 3日入院。 1 997年 1月因患急性前壁心肌梗死住院治疗 ,1 997年 8月及 98年 2月曾两次发生心前区不适、胸闷 ,含服硝酸甘油缓解。现病情稳定 ,来我院疗养。入院查体 :体温36 3℃ ,脉搏 75次 /分 ,血压 1 3/9ｋＰａ ,体重 71ｋｇ ,心肺( -) ,腹软 ,肝脾肋下未触及 ,莫菲氏征阴性 ,未触及包块 ,肠鸣音 5次 /分。查血、尿、便常规及血脂三项均正常。心电图示 :窦性心律 ,陈旧性前壁梗死。诊断为冠心病 ,陈旧性前壁心肌梗死。自服硝酸异山梨酯 5ｍｇ…     

阵发性室上性心动过速80例

目的分析80例阵发性室上性心动过速的急诊治疗效果。方法选取符合研究条件的阵发性室上性心动过速患者80例且根据其具体情况给予相应的抗心律失常药物进行治疗,同时对所得数据进行统计学处理,然后分析其结果。结果本次研究心律平和异搏定的治疗总有效率明显优于西地兰且复律时间也明显优于西地兰治疗者（P〈0.05）。结论选取适合患者的抗心律失常药进行相应治疗,同时严格掌握抗心律失常药物的适应证与禁忌证对提高临床疗效、改善患者生活质量具有十分重要的临床价值。     

腺苷治疗阵发性室上性心动过速

病人在危重情况下发生阵发性室上性心动过速,ICU 的护士应学会使用腺苷(Adenosine)。作者报道一例病人63岁,男性,因消化道出血收入ICU 救治。病人有高血压、慢性阻塞性肺病和慢性肾功能不全病史.经内窥镜检查为十二指肠溃疡出血,剖腹探查实施了十二指肠后壁溃疡缝合、迷走神经切断和幽门成形术。术后第3天出现原因不明的心动过速(心率110～120次/分)。术后第5天,突然阵发性室上性心动过速(心率150～170次/分),经颈动脉按压,静注异搏定10mg 无效。即快速静注腺苷6mg,转复为窦性心律。术后第8天,又有一类似发作,经颈动脉按压、静注异     

1,6-二磷酸果糖在阵发性室上速转复后治疗的临床意义

阵发性室上速（PSVT）是我国最常见的心律失常,该病具有较高的发病率,患病率约为2.25/1000。PSVT转复后1-2d,由于心肌耗氧量增加,患者时常自感周身乏力,活动后气短,精神倦怠,我们使用1,6-二磷酸果糖（FDP）辅助治疗。进行了总结,现报道如下。     

扩张型心肌病室速和室颤的抢救治疗及随访

目的　探讨应用胺碘酮 (AM)对扩张型心肌病 (DCM)伴室性心动过速 (VT)和 (或 )心室颤动 (VF)的治疗及预防疗效。方法　本组 19例 DCM伴 VT和 (或 ) VF,左室射血分数 (L VEF) (2 3± 8.2 ) % ,静脉注射 AM首剂 3～ 5 mg/kg,稀释后 10～ 2 0分钟注入 ,继以 0 .75～ 1mg/min维持静脉注射 ,如心律失常控制不满意 ,可每隔 30分钟追加 75～ 15 0 mg的 AM。在静脉用药的同时口服 AM6 0 0～ 80 0 mg/d。结果　 11/19患者 2 4小时心律失常获控制占 5 8% ,AM静脉用量平均为 (12 41± 12 5 .5 ) mg(115 6～ 2 14 2 mg) ,72小时完全控制心律失常。结论　静脉注射 AM治疗 DCM并 VT和 (或 ) VF安全有效 ,预防心律失常发作需长期口服 AM。     

循序加压肢体综合治疗糖尿病性末梢神经炎疗效观察

目的　观察循序加压肢体综合治疗Ⅱ型糖尿病的治疗效果。方法　采用 30 0 4型顺序循环治疗仪 ,该仪器具有 4个相互重叠的、对病肢由远端向近端进行间断的系列性挤压的气舱 (压力4.0～ 13.5kPa) ,治疗每日 1次 ,30min ,连续 30次为 1疗程。通过这种对上下肢末梢至躯干的反复压迫和松弛 ,能显著促进血液 (静脉 )和淋巴液回流 ,改善肢体组织和末梢神经供血供氧 ,从而改善临床症状。结果　治疗组 5 9例显效率及总有效率 (6 8% ,95 % )优于对照组 (16 % ,5 4% ) ,P <0 .0 1。治疗后运动神经传导速度明显改善 (P <0 .0 5 ) ;由于全身血液循环好转 ,促进了尿糖、血脂等代谢的改善 (P <0 .0 5 )。结论　应用循环加压肢体综合治疗对糖尿病性末梢神经炎的康复有明显的促进作用     

Treatment of monitored out-of-hospital ventricular fibrillation and pulseless ventricular tachycardia utilising the precordial thump

Background

Few studies have described the value of the precordial thump (PT) as first-line treatment of monitored out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation and pulseless ventricular tachycardia (VF/VT).

Methods

Patient data was extracted from the Victorian Ambulance Cardiac Arrest Registry (VACAR) for all OHCA witnessed by paramedics between 2003 and 2011. Adult patients who suffered a monitored VF/VT of presumed cardiac aetiology were included. Cases were excluded if the arrest occurred after arrival at hospital, or a ‘do not resuscitate’ directive was documented. Patients were assigned into two groups according to the use of the PT or defibrillation as first-line treatment. The study outcomes were: impact of first shock/thump on return of spontaneous circulation (ROSC), overall ROSC, and survival to hospital discharge.

Results

A total of 434 cases met the eligibility criteria, of which first-line treatment involved a PT in 103 (23.7%) and immediate defibrillation in 325 (74.8%) cases. Patient characteristics did not differ significantly between groups. Seventeen patients (16.5%) observed a PT-induced rhythm change, including five cases of ROSC and 10 rhythm deteriorations. Immediate defibrillation resulted in significantly higher levels of immediate ROSC (57.8% vs. 4.9%, p < 0.0001), without excess rhythm deteriorations (12.3% vs. 9.7%, p = 0.48). Of the five successful PT attempts, three required defibrillation following re-arrest. Overall ROSC and survival to hospital discharge did not differ significantly between groups.

Conclusion

The PT used as first-line treatment of monitored VF/VT rarely results in ROSC, and is more often associated with rhythm deterioration.     

Bidirectional ventricular tachycardia induced by caffeine poisoning

Bidirectional ventricular tachycardia (BVT) is a tachyarrhythmia characterized by 180-degree beat-to-beat alteration in the QRS axis. BVT is traditionally known as an electrocardiography (ECG) finding pathognomonic of digitalis poisoning and a hallmark of catecholamine-induced ventricular tachycardia. Apart from digitalis poisoning, aconitine poisoning is the only reported cause of poisoning-related BVT, and no report of caffeine-poisoning-related BVT is as yet available. A-27-year-old woman was transported to hospital with cardiac arrest from ventricular fibrillation after taking a massive dose of a caffeine-containing supplement (corresponding to 6 g of caffeine) 6 h before presentation. Return of spontaneous circulation (ROSC) was achieved by defibrillation. She developed BVT after ROSC. Hemodialysis was performed to remove the causative drug from the blood, with subsequent resolution of BVT and hemodynamic stabilization. At presentation, she had a blood caffeine concentration of 232 μg/mL. A suggested mechanism of development of BVT is that increased intracellular calcium concentration causes delayed afterdepolarization, which induces alternate occurrence of triggered activities within different His-Purkinje fibers, and thereby produces characteristic ECG findings. Caffeine acts on the ryanodine receptor to promote calcium release from the sarcoplasmic reticulum, and thus can induce BVT via the same mechanism. Caffeine poisoning can be treated by dialysis. In cases of BVT induced by caffeine poisoning, hemodynamic stabilization can be achieved by emergency dialysis.     

短阵室性心动过速76例临床分析

目的 探讨动态心电图（DCG）检出短阵室性心动过速的临床意义。方法 回顾性分析76例短阵室性心动过速患者的DCG检查结果。结果 76例中,67例窦性心律,9例心房纤颤;持续性室速4阵,非持续性室速747阵;单源性室速735阵,多源性室速16阵;室速发作呈左束支传导阻滞波形11例,ST段改变38例（其中缺血性改变28例）,大部分患者同时合并有其他心律失常。结论 室速多发生于器质性心脏病,应全面结合患者的临床资料,充分认识高危因素,客观评价其预后;对植物神经功能紊乱和睡眠呼吸暂停综合征（OSAS）所致的室速,应引起重视。     

持续型特发性室速二例误诊为室上速

１　病例资料【例１】　女,２３岁。因突发心悸１小时就诊。查体：一般情况好,心率１５８／ｍｉｎ,血压１３．３／９．３３ｋＰａ。既往有反复短暂心悸发作史,但未曾描记心电图,临床拟诊室上速,静脉注射普罗帕酮５０ｍｇ转为窦性心律。用药前心电图１２导联显示：Ｐ波不清楚,Ｒ－Ｒ规则,０．３８Ｓ,相当于１５８／ｍｉｎ,ＱＲＳ时限０．１１～０．１２Ｓ,ＱＲＳ呈右束支阻滞型加电轴左偏,ＱＲＳⅢ呈ｒＳ型,Ｓ波终末部挫折酷似逆行Ｐ波,ＳＴ－Ｔ无特殊。心电图诊断为阵发性室上性心动过速伴室内差异传导。３天后行食管电生理检…     

室性心动过速和心室颤动治疗进展

室性心动过速（室速）和心室颤动（室颤）是心源性猝死最常见的原因。本文就器质性、特发性和离子通道病性室速/室颤的药物、器械、导管消融术及其他治疗等的最新进展进行了总结,以期能够达到规范临床诊疗的作用。     

An unusual cause of ventricular tachycardia

Inflammatory pseudotumour (IP) of the heart is an extremely uncommon and potentially fatal lesion which presents a challenging diagnosis even for the experienced pathologist, cardiologist and cardiac surgeon. This spindle cell tumour is known to be present in virtually every anatomical region but, in adults, has only previously been found in the heart at postmortem. We report the case of a 27-year-old man who presented with ventricular tachyarrhythmias and a right ventricular mass which was subsequently shown to be an IP.