老年患者心脏病室性早搏的心电图分析

目的：探讨老年人器质性心脏病室性早搏的特点。方法：对照分析了132例老年器质性心脏病组引起的室性早搏（心脏病组）及94例老年非心脏病组（对照组）室性早搏的心电图特点。结果：老年心脏病组室性早搏起源于左室98例,起源于右室34例;对照组起源于左室20例,起源于右室74例。老年心脏病组室性早搏QRS波振幅〈20mV者占67．4％,时限〉0．12s者占77．3％,有切迹或呈错折波占87．1％。与对照组比较差异有统计学意义（P〈0．05）。结论：老年心脏病室性早搏多起源于左心室,QRS波振幅〈20mV,时限〉0．12S,形态有切迹或错折波。     

射频消融治疗流出道室早与非持续性室性心动过速的研究

目的　评价频发室性流出道早搏和非持续性室性心动过速 (室速 )患者的射频消融有效性和安全性。方法　 60例患者非持续性室速和频发性室性早搏进行了导管射频消融。男 38例 ,女 2 2例 ,年龄 ( 4 6 2± 7 1 )岁 ,采用起搏标测和激动顺序标测 ,确定室速和室性早搏的起源部位 ,前者以起搏时与室早QRS波形态完全相同点为消融靶点 ,后者以早搏时最早心室激动点为消融靶点。结果　 60例室早室速与多数起源于心室流出道 ,右室流出道室早室速QRS呈左束支阻滞形态 ;左室流出道室早室速QRS波均呈右束支阻滞形态。消融即刻成功率 96 6 % ( 5 8/60 ) ,2 4小时动态心电图记录消融前室早数为( 2 0 4 1 6± 1 891 )次 ,室速 ( 31 4± 73)阵次 ,消融后室早数 ( 1 2 2± 1 40 )次 (P <0 0 0 1 ) ,无室速再发。所有病人无任何并发症。随访 ( 1 9± 6)月未服用任何抗心律失常药物的 ,复发率为 3 4% ( 2 /5 8) ,随访期间亦无不良反应和并发症发生。结论　经导管射频消融可有效而安全地消除正常心脏单形室早和非持续性室性心动过速     

难治性右室流出道室性早搏的导管射频消融治疗

目的　探讨导管射频消融治疗右室流出道室性早搏的适应证、方法和疗效。方法　选择 5 5例难治性右室流出道室性早搏患者进行射频消融治疗 ,男 15例 ,女 40例 ,年龄 (41.1± 2 .2 )岁 ,病史 (8.5± 3.6 )年 ;均有明显症状 ,多种抗心律失常药物治疗无效 ,均无器质性心脏病的证据 ,心电图显示室性早搏均呈左束支阻滞图形 ,Ⅱ、Ⅲ、aVF导联为高大的R波 ,采用起搏标测和 (或 )激动标测。结果　程序刺激不能使室性早搏有明显的变化 ,而静脉滴注异丙肾上腺素可使 6 6 .7%(10 /15例 )的患者室性早搏明显增多 ;所有病例均采用起搏标测 ,部分结合激动顺序标测 ,即刻成功率为 90 .9%(5 0 /5 5例 ) ,X线曝光时间为 (18.7± 2 .5 )min。术中及术后无并发症发生 ,2 4h动态心电图检查消融前后室性早搏为 (1815 7± 2 36 0 )次 /2 4h和 (6 5 6± 5 10 )次 /2 4h ,两者间差异有显著性 (P <0 .0 0 1)。随访 1～ 87个月 ,复发率为 8.0 %(4/5 0例 )。结论　对于病程较长、症状明显且药物治疗无效的右室流出道室性早搏 ,选择导管射频消融进行根治性治疗是安全有效的。     

室性早搏临床意义的探索

本文搜集有室性早搏的心电图189份,结合临床分析体会到:1.左室源早搏多发生于器质性心脏病,但室性早搏QRS源发位置不能作为该侧心室负荷增加的显示。2.室性早搏QRS时限和室性早搏R波高度在器质性心脏病和无器质性心脏病例中差异不大。3.早搏后心动周期中R波振幅改变的意义比T波振幅改变为大,4.室性早搏的病例测量(QTc)和室性早搏易损期指数是有一定临床意义。     

室性早搏治疗前后QT离散度的变化

目的　研究应用胺碘酮治疗室性早搏的疗效及治疗前后 QT离散度的变化。 方法　观察 2 2例室性早搏经胺碘酮治疗前后的心电图及动态心电图结果 ,分析其疗效及 QT、QTc、QT离散度 (QTd、QTcd)的变化。 结果　胺碘酮对室性早搏抑制 75 %以上的有效率为 6 3.6 %。治疗后 QT和 QTc分别由396 .4± 2 4.7ms和 42 2 .7± 2 9.6ms延长为 42 7.8± 2 9.6ms和 44 8.5± 31.3ms(P <0 .0 5 ) ,QTd和QTcd由6 6 .4± 16 .2ms和 6 8.9± 2 9.6ms下降为 37.8± 9.8ms和 39.2± 16 .5ms(P <0 .0 1)。结论　胺碘酮治疗室性早搏疗效好 ,室性早搏治疗后QT间期延长 ,QTd和QTcd减小 ,因而致心律失常发生率较低     

顽固性室性早搏的射频消融治疗

目的 :通过对 2 3例顽固性室性早搏 (简称室早 )的射频消融分析 ,探讨室早的心电图特点、消融方法及效果 .方法 :男性 16例 ,女性 7例 ,均为频发、药物难治、症状明显的顽固性单形性室早患者 ,年龄(4 4 4± 9 6 )岁 .采用起搏标测和激动顺序标测 ,前者以起搏时与室早QRS波形态完全相同点为消融靶点 ,后者以早搏时最早心室激动点为消融靶点 .2 3例中 17例室早起源于右室 ,4例起源于左室 .消融即刻成功率86 9% ,累积放电 (930 4± 72 5 )s,成功者行动态心电图检查记录消融前后室早数为 (5 6 71± 2 4 36 )次 / 2 4h和 (39± 5 2 )次 / 2 4h (P <0 0 1) .随访 (2 3 2± 12 3)月 ,未服任何抗心律失常药 ,无 1例复发及并发症发生 .结论 :射频消融可有效而安全地消除单形性室早 ,采用粗标激动顺序、精标起搏图形 ,多点、长时间、高功率放电可提高成功率 ,降低复发率 ,可作为症状严重、药物无效或不能耐受患者的治疗选择     

室性早搏QRS波群宽度的临床意义

室性早搏 (VPB) ,是临床上最常见的心律失常之一 ,它可以是器质性心脏病的一种表现 ,也可见于正常人 ,但是正确鉴别对于其诊断和治疗的意义不同。本文对VPB病人的心电图进行分析 ,旨在阐述VPB的QRS波群宽度的临床意义。资料与方法　　 1 .一般资料　收集 1 2 4例VPB ,均来自门诊或住院病人。其中男 64例 ,女 60例 ,年龄 1 8～ 82岁 ,平均 54± 2 0岁。根据心电图QRS波群宽度分成两组 ,A组为室性早搏QRS波群宽度≥ 1 4 0ms,共 48例 ;B组为QRS波群宽度 <1 4 0ms ,共 76例。2 .测量方法　以上病人均是采用日本光电 91 30K型十二导联…     

单形性室性早搏的射频消融治疗

目的　评价单形性室性早搏 (简称室早 )经导管射频消融治疗的有效性和安全性。方法　对 1 9例正常心脏的室早进行了导管射频消融。采用起搏标测与激动顺序标测 ,前者以起搏时与室早QRS波形态完全相同点为消融靶点 ,后者以早搏时最早心室激动点为消融靶点。结果　 1 9例室早全部起源于右室流出道 ,均呈左束支阻滞形态。消融即刻成功率 89.5 %(1 7 1 9) ,2 4h动态心电图记录消融前后室早数为 1 5 892± 2 6 5 4次 2 4h和 891± 783次 2 4h(n =1 7,P <0 .0 0 1。所有病人无任何并发症。随访期间也无不良反应和并发症发生。结论　经导管射频消融可有效而安全地消除正常心脏单形室早 ,可作为症状严重、药物治疗无效或不能耐受患者的治疗选择。     

189例室性早搏临床意义的探索

本文搜集有室性早搏的心电图189份,结合临床分析,体会到①左室源早搏多发生于器质性心脏病,但室性早搏源发位置不能作为该侧心室负荷增加的显示。②室性早搏QRS时限和室性早搏R波高度在器质性心脏病和无器质性心脏病例中差异不大。③早搏后心动周期中R波振幅改变的意义比T波振幅改变为大。④室性早搏的病例测量QTC和室性早搏易损期指数有一定临床意义。     

经皮腔内冠状动脉成形术与冠状动脉内支架术的临床应用

目的 :评价经皮腔内冠状动脉成形术 ( PTCA)和支架置入术的临床疗效。方法 :总结 1 996年 1 1月至 2 0 0 1年 3月行 PTCA和支架置入术的冠心病患者 1 0 3例。结果 :1 0 3例冠心病患者 1 5 0支冠状动脉血管PTCA并支架置入 1 35枚 ,置入成功率 1 0 0 % ,无明显并发症发生。其中不稳定心绞痛者占 5 2 .4 3% ,既往有心肌梗死史者占 4 7.5 7%。单支病变者占 5 5 .34 % ,双支病变者占 32 .0 4 % ,3支病变者占 1 2 .6 3% ;A型病变者占 33.98% ,B型病变者占 2 6 .2 1 % ,C型病变者占 39.81 %。 PTCA所用的球囊直径平均为 ( 2 .4 8± 0 .4 3)mm,平均长度 ( 2 0 .4 0± 2 .84 ) mm,球囊所加压力平均为 ( 6 .2 3± 1 .81 ) atm。共置入支架 1 35枚 ,其直径平均为 ( 30 .96± 0 .38) mm,平均长度为 ( 2 1 .2 9± 6 .30 ) mm,释放支架时球囊所加压力平均为 ( 9.6 5± 3.0 8) atm。所用支架主要是 BX 4 5枚 ,占 33.33% ,NIR 30枚 ,占 2 2 .2 2 % ,AVE 2 7枚 ,占 2 0 .0 0 % ,MAC 1 6枚 ,占1 1 .85 % ,Jomed和其他共 1 7枚 ,占 1 2 .5 9%。支架置入 LAD内 71枚 ,占 5 2 .5 9% ,RCA内 4 8枚 ,占35 .5 5 % ,LCX和对角支 1 6枚 ,占 1 1 .85 %。结论 :PTCA和支架置入术是一种安全、有效的介入性治疗技术 ,其成功率高 ,并发     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.