植入心律转复除颤器病人认知行为疗法护理

对5例植入心律转复除颠器(ICD)病人,于安装ICD术前、术后及随访时,运用认知行为疗法原理,通过端正认知、积极面对现实、互相帮助等方法进行心理护理,使病人表现为逃避症状的心理转化为能坦然地面对顺其自然地接受及治疗,有效地缓解了心理压力,防止及缓解了ICD病人的术前、术后的恐惧、焦虑及忧郁等不良心理障碍,尤其是对于经历过电击的病人效果显著。     

Swartz鞘在阵发性室上性心动过速常规射频消融失败病例中使用方法探讨

目的 对47例阵发性室上性心动过速(PSVT)用常规电生理标测和导管射频消融(RFCA)未成功者改用Swartz鞘作为支撑，探讨Swartz鞘在提高PSVT消融成功率中作用。方法右房房性心动过速(AT)和房室结折返性心动过速(AVNRT)慢径路消融用SRoSwartz鞘，左侧房室旁路(AP)并房室折返性心动过速(AVRT)穿房阿隔后用SL，鞘，右侧AP据不同部位用SR4、SR2、SR3鞘。结果47例PSVT常规方法消融未成功者其中46例改用Swartz鞘作支撑后获得成功。结论 Swartz鞘的使用明显提高PSVT患者RFCA的成功率。     

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.     

右室特发性室性心动过速的射频消融

目的 报道5例右室间隔特发性室性心动过速的电生理标测及射频消融治疗。方法 用7FEPT温控大头电极导管进行消融,心动过速时在右室后间隔标侧到明显提前的P电位处为消融靶点,以温控50～55℃、功率30～35W放电。3s心动过速终止,巩固放电40s,然后行常规心内电生理检查,不能诱发心动过速作为消融终点。术后口服Aspirin 0.1g/d 1个月。结果 放电消融5s内心动过速终止,巩固放电40s,消融前后体表心电图无明显改变。术后心室S1S2程序刺激,静脉滴注异丙肾上腺素后,重复上述刺激,均不能诱发心动过速,射频消融成功。随访4～22个月,无心动过速发作,无并发症出现。结论 (1)在右室后间隔也能形成类似于左室后间隔的特发性室性心动过速,在标测到明显提前的P电位处消融容易获得成功。(2)右室特发性室性心动过速在心动过速时也有典型的体表心电图特征。(3)此型室性心动过速应与束支折返性室性心动过速相鉴别。     

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.     

慢旁道与快旁道并存的复杂心电图分析

本文报道1例慢传导旁道（简称慢旁道）与快传导旁道（简称快旁道）并存的病例，并分析讨论了其复杂的心内电生理现象。病例资料与电生理检查结果患者女性，30岁，于1996年12月行心内电生理和射频消融术。患者心动过速发作史5年，近1年发作频繁，发作为室上性心动过速，频率170次／分左右。术中各电生理检查导管到位后，即因导管机械刺激诱发心动过速，心内电图见最早道传A波出现于冠状窦近端（参见图2），故首先考虑为左后壁隐匿性旁道参与的房室折返性心动过速。终止心动过速后，以550－250Ins多个周长起搏右心室，发现550－450Ins周长起…     

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.     

香芹酚预处理对心肌缺血再灌注时线粒体损伤的作用

目的探索香芹酚（CAR）对心肌缺血再灌注（I-R）时线粒体损伤的作用。方法 C57BL/6小鼠冠状动脉左前降支结扎45min,解除结扎2h构建心肌I-R损伤模型。将小鼠随机分为3组（每组n=12）：假手术组、Vehicle（DMSO in saline）＋I-R组、CAR（60mg/kg）＋I-R组。Vehicle或CAR于冠脉结扎前15min给药。心肌缺血45min再灌注2h后,检测心肌梗死面积,并测定平均线粒体面积、线粒体分裂百分比、线粒体基质微粒及脂滴数量以评估线粒体损伤情况。结果与假手术组相比,Vehicle组心梗面积显著增加,差异有统计学意义（P〈0.05）;与Vehicle组相比,CAR（60mg/kg）预处理可显著减少心梗面积,差异有统计学意义（P〈0.05）。与Vehicle组相比,CAR预处理可显著降低平均线粒体面积、线粒体基质微粒数、线粒体周围脂滴数和线粒体分裂百分比,差异均有统计学意义（P〈0.05）。结论 CAR可通过减轻心脏组织中线粒体损伤降低小鼠心肌I-R后心梗面积。     

群体性风湿热一级预防观察

目的探讨一种简易、经济、有效的群体性风湿热一级预防方法.方法选取394名9～12岁小学生随机分成观察组（n=201）和对照组（n=193）两组进行甲链性咽炎早期诊断,一旦确诊甲链性咽炎,观察组即给予新青霉素或红霉素治疗,对照组则密切随访.结果经过逐月观察和干预后,观察组甲链性咽炎发病率为1.28%,对照组为4.15%,两者差异非常显著（P＜0.001）.观察组甲链带菌率为11%、对照组为19%,两者差异非常显著（P＜0.001）.观察组干预后抗DNA酶B（ADNaseB）抗体平均几何均数（GMT）为146 U/ml,对照组为166 U/ml,两者差异非常显著.观察组甲链性咽炎患者的ADNaseB抗体平均GMT为184 U/ml、对照组为267 U/ml,两者差异非常显著（P＜0.001）.观察组甲链感染率为17%、对照组为30%,两者比较,差异非常显著.观察组甲链性咽炎患者感染率为39%,对照组为63%,两者比较,差异非常显著（P＜0.001）.结论研究表明,本研究采用的方法进行群体性风湿热一级预防确实有效,具有流行病学意义和实用价值.     

曲美他嗪治疗不稳定型心绞痛的临床观察

目的观察曲美他嗪与传统药物相结合治疗不稳定型心绞痛的疗效。方法将64例不稳型心绞痛的患者随机分成两组,治疗组32例,除用硝酸酯类、抗血小板药物、β受体阻滞剂等传统药物治疗外,加用曲美他嗪;对照组32例用传统药物治疗。连续观察4w,观察两组患者心绞痛发作次数、心肌缺血时间、心率、血压、动态心电图的变化及副作用。结果治疗组心绞痛发作次数减少、ST段最大下降幅度、总缺血时间的缩短更为明显(P<0.05),曲美他嗪对心率、血压无影响(P>0.05)。结论在传统治疗基础上加用曲美他嗪对改善心绞痛症状、减少缺血发作次数、ST段下降最大幅度和总缺血时间有良好的效果,对血流动力学无影响,是安全、有效的治疗方案。