Ensite非接触标测系统在室性心律失常患者射频消融中的应用

目的探讨Ensite系统标测室性心律失常的方法,并评价其指导射频消融的有效性和安全性。方法入选症状性室性期前收缩(室早)或室性心动过速(室速)患者98例,年龄(42±16)岁,其中男43例,女55例。经外周血管进非接触多极球囊导管至右心室或左心室三维重建心腔。心室激动时根据虚拟单极电位的等电位图,结合起搏和激动标测对起源点和突破口及优势传导通道进行消融。结果消融即时成功率95%(93/98)。起源于右心室流出道占96种,间隔部和游离壁各82、14种,起源于其他不典型部位21种,三尖瓣环8种。起源后传导突破呈快反应点爆发方式占78%(91/117),采用点消融覆盖相近的起源点和突破口;呈慢反应突破方式占22%(26/117),采用线性或片状消融策略。随访(6±3)个月,3例复发,1例经再次消融成功。结论 Ensite心内非接触式标测系统用于室性心律失常的三维标测有效安全。室速或室早自最早起源点后经优势传导通道向突破口传导有两种传导方式。     

百部生物碱的研究现状和思考

中国药典从1985版开始收载百部的来源为百部科植物直立百部Stemona sesilifolia（Miq.）Miq.、蔓生百部Stemona Japonica（BL．）Miq．或对叶百部Stemona tuberose Lour．的干燥块根。     

心房颤动控制心率还是控制节律

心房颤动(房颤)是临床中几乎每一位医生都会遇到的心律失常,可以引起心悸、血液动力学改变、心动过速性心肌病、心力衰竭、生活质量下降、血栓栓塞并发症等,是无可争议的中风独立危险因素。房颤是一种复杂的心律失常,需要多面性治疗措施,强调个体化治疗。一、房颤患者的心室率控制关于对房颤患者的治疗策略,心室率控制与节律控制,很久以来一直没有定论。近年来相继发表了关于比较复发房颤患者心室率控制与节律控制的几个重要前瞻性临床研究结果:PIAF,STAF,AFFIRM,RACE。AFFIRM研究[1]是目前认为最为重要的一个关于房颤治疗的大规…     

HPLC测定天雁减肥茶中芦荟大黄素的含量

天雁减肥茶是由番泻叶、荷叶等多味中药制成,具有清热利湿、润肠通便等功效。主要用于单纯性肥胖及习惯性便秘等症。原药品标准检验方法比较简单,含量测定为测定其总蒽醌的含量,专属性差。本文采用反相高效液相色谱法,测定了天雁减肥茶中芦荟大黄素的含量,收到满意的效果,可有效地控制该产品的质量。1仪器与试药岛津W atersModel 510高效液相色谱仪;SPD-10A检测器;C-R7A色谱处理机;Sh im-PackCLC-ODS(150 mm×4.6mm)色谱柱;芦荟大黄素(批号:0795-9301)对照品由中国药品生物制品检定所提供;天雁减肥茶由合肥迪尔医药生物工程有限公司…     

抗心律失常药物治疗进展

心律失常的种类繁多,有些可以造成猝死,严重危害患者的身体健康。处理心律失常是临床医生的一个重要任务。随着心脏起搏与心电生理专业的迅速发展,现在已经有很多非药物的治疗方法,但由于其适应证、并发症或昂贵的医疗费用等原因而只能使部分患者受益,药物治疗仍有着不可替代的作用,尤其在心律失常急诊处理及某些快速性心律失常的长期治疗中,药物治疗仍是主流。近年来心律失常的治疗取得一些进展,特别是通过大规模临床研究重新评价了原有药物,对药物的选择方面有一些新的建议;不少新药面世,对临床实践有很大的指导意义。抗心律失常药物(AA…     

分光光度法测定普乐安片中总黄酮的含量

目的　建立一个用分光光度法测定普乐安片中总黄酮含量的方法。方法　采用分光光度法。结果　通过方法学考察 ,芦丁在所试的 8.396～ 5 8.772μg· m L- 1 范围内有良好的线性关系 ,其回归方程为 :A=0 .0 12 2 0 C- 0 .0 0 342 9,r=0 .9998;平均回收率为 98.2 (n=5 ,RSD =0 .5 )。结论　试验表明 ,方法可靠 ,数据准确 ,操作简便易行     

无左心房和肺静脉三维重建的阵发性心房颤动导管消融术

Objective To investigate the differences between modeling and non-modeling left atrium in Carto XP system guided catheter ablation for paroxysmal atrial fibrillation. Methods Thirty-one cases of par-oxysmal atrial fibrillation treated by the same electrophysiologist with guidance of Carto XP during Jan to Dec in 2008 were enrolled. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients (non-modeling group) and with left atrium modeling in 14 patients (modeling group). The detailed ablation method was based on circumferential pulmonary veins isolation (CPVI). And linear ablation of tricus-pid valvular isthmus was selectively proceeded individually. The ablation endpoint was set to complete isolation of pulmonary vein potential from left atrium and no continuous fast atrial arrhythmia including atrial fibrillation, atrial flutter and atrial tachycardia could be induced. Comparisons for each step during procedure and the fol-low-up outcomes had been done. Results The male: female ratio of the 2 groups were 10:4 and 11 : 6 (P >0.05). The average age were (54.64 ± 15.58) and (59.41 ± 10.59) (P >0.05) ,the diseased courses were (5.05 ±10.4) years and (7.34±7.74)years(P >0.05),the left atrial sizes were (35.29±4.73) mm and (36.47 ±6.15)mm (P > 0.05), the total procedure time was (107.23±28.92) rain and (93.47 ±26.09) win (P>0.05). The X-ray exposure time was (21.09 ±6.49)min (modeling group) and (14.16±5.35)min (non-modeling group,P < 0.05). The CPVI time of fight pulmonary veins was (27.29±18.53) rain (model-ing group) and 18.00 ±4.51 min (non-modeling group, P < 0.05). The CPVI time of left pulmonary veins was (28.14 ±9.26) rain (modeling group) and (23.94±7.10) rain (non-modeling group, P < 0.05). The successful rates was 85.7% (modeling group) and 82.4% (non-modeling group, P > 0.05) over follow-up for 2 to 13 months. Conclusion Carto system guided catheter ablation of paroxysmal atrial fibrillation without modeling of left atrium and pulmonary veins could take less time in X-ray exposure and ablation steps, compa-ring with left atrium modeling one.     

高龄心房颤动患者的抗凝治疗

高龄心房颤动患者的危险因素评分（CHADS2）：心衰（C）、高血压（H）、年龄（A）〉75岁、糖尿病（D）、既往中风或短暂性脑缺血发作（S）每个危险因素各计1分，中风／TIA计2分。低危：0分，中危：1～2分，高危：≥3分。计分每增加1分，绝对风险增加1．5倍。     

舒张功能不全大鼠心肌线粒体结构和功能的改变

目的探讨心肌线粒体在舒张功能不全心力衰竭（DHF）大鼠心脏功能损伤中的作用。方法20只雄性SD大鼠,随机分为阴性对照组和DHF组。采用腹主动脉缩窄术建立DHF模型,4周末心脏超声检测心功能,颈动脉插管记录血流动力学,分光光度计检测心肌线粒体丙二醛（MDA）、超氧化物歧化酶（SOD）和谷胱甘肽过氧化物酶（GSHPx）水平,电镜检测心肌线粒体超微结构。结果DHF组大鼠左心室后壁（LVPW）、室间隔（IVS）、左心室心脏指数（LVM）和E／A比值增高,主动脉收缩压（SBP）、舒张压（DBP）、左心室收缩压（LVSP）和左心室舒张末期压（LVEDP）升高,左心室松弛时间常数（Tau）延长,平均左心室内压最大下降速率（LV-dp／dtmax）下降,心肌SOD和GSHPx下降,MDA增加,电镜示心肌细胞肌丝排列不整齐、线粒体肿胀及空泡化等线粒体损伤。结论心肌线粒体损伤在DHF大鼠心脏功能损害中起着重要的作用。     

无左心房和肺静脉三维重建的阵发性心房颤动导管消融术

Objective To investigate the differences between modeling and non-modeling left atrium in Carto XP system guided catheter ablation for paroxysmal atrial fibrillation. Methods Thirty-one cases of par-oxysmal atrial fibrillation treated by the same electrophysiologist with guidance of Carto XP during Jan to Dec in 2008 were enrolled. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients (non-modeling group) and with left atrium modeling in 14 patients (modeling group). The detailed ablation method was based on circumferential pulmonary veins isolation (CPVI). And linear ablation of tricus-pid valvular isthmus was selectively proceeded individually. The ablation endpoint was set to complete isolation of pulmonary vein potential from left atrium and no continuous fast atrial arrhythmia including atrial fibrillation, atrial flutter and atrial tachycardia could be induced. Comparisons for each step during procedure and the fol-low-up outcomes had been done. Results The male: female ratio of the 2 groups were 10:4 and 11 : 6 (P >0.05). The average age were (54.64 ± 15.58) and (59.41 ± 10.59) (P >0.05) ,the diseased courses were (5.05 ±10.4) years and (7.34±7.74)years(P >0.05),the left atrial sizes were (35.29±4.73) mm and (36.47 ±6.15)mm (P > 0.05), the total procedure time was (107.23±28.92) rain and (93.47 ±26.09) win (P>0.05). The X-ray exposure time was (21.09 ±6.49)min (modeling group) and (14.16±5.35)min (non-modeling group,P < 0.05). The CPVI time of fight pulmonary veins was (27.29±18.53) rain (model-ing group) and 18.00 ±4.51 min (non-modeling group, P < 0.05). The CPVI time of left pulmonary veins was (28.14 ±9.26) rain (modeling group) and (23.94±7.10) rain (non-modeling group, P < 0.05). The successful rates was 85.7% (modeling group) and 82.4% (non-modeling group, P > 0.05) over follow-up for 2 to 13 months. Conclusion Carto system guided catheter ablation of paroxysmal atrial fibrillation without modeling of left atrium and pulmonary veins could take less time in X-ray exposure and ablation steps, compa-ring with left atrium modeling one.