致心律失常性右室心肌病患者Epsilon波的检出率

Objective To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventrieular cardiomyopathy (ARVC). Methods The Epsilon wave was detected in 32 patients [24 men, mean age (42.3±13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordiai leads ECG (F-ECG). The Epsilon wave was defined as wiggle, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment. Results Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R-ECG and F-ECG respectively. The detection rates derived from the three recording methods were similar(P ＞ 0.05). The Epsilon wave was only detectable by S-ECG in one case, by R-ECG in three cases, and by F-ECG in five cases. The detection rate of Epsilon wave was 50.0% by combined use of S-ECG and R-ECG (SR-ECG), 56.3% by combined use of S-ECG and F-ECG (SF-ECG), and 65.6% by combined use of the three recording methods (SRF-ECG). The detection rate was significantly higher by SF-ECG (56.3%) and SRF-ECG (65.6%) than by S-ECG alone (37.5%, all P ＜0.05). Most Epsilon waves detected by the S-ECG, R-ECG and F-ECG were small spiked waves. Conclusion Combined use of S-ECG, F-ECG and R-ECG could increase the detection rate of Epsilon wave in patients with ARVC.     

致心律失常性右室心肌病患者Epsilon波的检出率

Objective To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventrieular cardiomyopathy (ARVC). Methods The Epsilon wave was detected in 32 patients [24 men, mean age (42.3±13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordiai leads ECG (F-ECG). The Epsilon wave was defined as wiggle, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment. Results Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R-ECG and F-ECG respectively. The detection rates derived from the three recording methods were similar(P ＞ 0.05). The Epsilon wave was only detectable by S-ECG in one case, by R-ECG in three cases, and by F-ECG in five cases. The detection rate of Epsilon wave was 50.0% by combined use of S-ECG and R-ECG (SR-ECG), 56.3% by combined use of S-ECG and F-ECG (SF-ECG), and 65.6% by combined use of the three recording methods (SRF-ECG). The detection rate was significantly higher by SF-ECG (56.3%) and SRF-ECG (65.6%) than by S-ECG alone (37.5%, all P ＜0.05). Most Epsilon waves detected by the S-ECG, R-ECG and F-ECG were small spiked waves. Conclusion Combined use of S-ECG, F-ECG and R-ECG could increase the detection rate of Epsilon wave in patients with ARVC.     

致心律失常性右室心肌病患者Epsilon波的检出率

Objective To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventrieular cardiomyopathy (ARVC). Methods The Epsilon wave was detected in 32 patients [24 men, mean age (42.3±13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordiai leads ECG (F-ECG). The Epsilon wave was defined as wiggle, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment. Results Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R-ECG and F-ECG respectively. The detection rates derived from the three recording methods were similar(P ＞ 0.05). The Epsilon wave was only detectable by S-ECG in one case, by R-ECG in three cases, and by F-ECG in five cases. The detection rate of Epsilon wave was 50.0% by combined use of S-ECG and R-ECG (SR-ECG), 56.3% by combined use of S-ECG and F-ECG (SF-ECG), and 65.6% by combined use of the three recording methods (SRF-ECG). The detection rate was significantly higher by SF-ECG (56.3%) and SRF-ECG (65.6%) than by S-ECG alone (37.5%, all P ＜0.05). Most Epsilon waves detected by the S-ECG, R-ECG and F-ECG were small spiked waves. Conclusion Combined use of S-ECG, F-ECG and R-ECG could increase the detection rate of Epsilon wave in patients with ARVC.     

体表心电图特征鉴别左右室流出道心律失常的临床分析

目的分析体表心电图特点对鉴别流出道室性心律失常(OTVA)起源部位的临床价值。方法对电生理检查及射频消融明确靶点的87例OTVA患者[(其中起源于右室流出道(RVOT)的64例;起源于左室流出道(LVOT)的23例]体表心电图进行分析,分别以R/S振幅指数、R波时限指数、胸导联移行区(TZ)指数、V2转换率及V2S/V3R指数来评估体表心电图特征,分析其对LVOT/RVOT室性心律失常的鉴别的准确性。结果以V1导联R/S波振幅指数≥30%判断OTVA起源于LVOT的灵敏度为60.87%,特异度92.19%,R波时限指数≥50%判断灵敏性为34.78%,特异度96.87%;TZ指数0判断灵敏度为69.57%,特异度87.5%;以V2转换率0.6的判断灵敏度为69.57%,特异度90.63%;V2S/V3R指数≤1.5的判断灵敏度为65.22%,特异度92.19%。结论V2S/V3R指数≤1.5是一种简便准确地鉴别OTVA起源于左右流出道靶点的体表心电图判断方法,具有很好的临床实用价值。     

射频消融治疗经右心房游离壁切口术后的双环折返性房性心动过速

目的 总结经右心房游离壁切口术后双环折返性房性心动过速（房速）的发生率及射频消融后长期随访的结果.方法 2007年1月至2012年12月共入选48例在南京医科大学第一附属医院心脏科行经右心房游离壁切口治疗先天性心脏病或获得性心脏病后发作房速的患者.双环折返性房速的定义为心房同时存在两个折返环,同时在折返的可能路径上进行多部位拖带均为隐匿性.结果 共观察到8例患者术中存在双环折返性房速,男4例,平均年龄（40.4±22.0）岁.第1次外科术后至房速发作时间为（79.0±65.2）个月,第1次房速发作至第1次消融的时间为（20.8±28.3）个月,所有患者房速均持续发作.所有患者的双环折返性房速均与三尖瓣峡部以及右心房游离壁切口相关.5例患者在消融三尖瓣峡部过程中,心动周期突然变化;1例患者消融三尖瓣峡部时,心动周期无变化,右心房游离壁多部位拖带为右心房游离壁折返性房速,间隔部位拖带证实此部位不在折返环内,可能提示右心房游离壁折返性房速为主导折返环,;1例患者消融过程中心动过速终止,同样行切口致下腔的线性消融;1例患者消融三尖瓣峡部时心动过速无明显变化,但冠状静脉窦的激动有细微变化,拖带标测提示三尖瓣峡部不在折返环内,右心房游离壁多部位拖带提示为围绕右心房切口瘢痕折返的心动过速,行外科切口下部至下腔静脉消融时,房速终止.平均随访（33.6±16.7）个月,3例复发患者均为风湿性心脏病换瓣术后,其中1例复发房速,另外2例复发房颤.结论 经右心房游离壁切口术后双环折返性房速主要与三尖瓣峡部以及切口相关,三尖瓣峡部以及切口至下腔静脉线性消融常能够治疗这类心律失常.     

多普勒超声和心导管测量阵发性心房颤动患者左心房压力的研究

目的探讨多普勒超声能否有效地预测阵发性心房颤动(PAF)患者的左心房压力(LAP)。方法选择PAF患者31例,导管射频消融术前1d行经胸及经食管彩色多普勒超声检查,测左心房内径、LVEF、舒张期肺静脉血流衰减时间(DTD)、收缩期肺静脉血流衰减时间(STD)等相关参数;术中通过心导管测量LAP。对多普勒超声参数与LAP进行相关性分析。结果 31例患者LAP(14.45±7.60)mm Hg(1mm Hg=0.133kPa)、DTD(176.97±56.74)ms、STD(193.97±55.17)ms。DTD和STD与LAP呈负相关(r=-0.63,r=-0.81,P=0.00)。结论DTD和STD可能是简便、可靠、无创性预测PAF患者LAP的理想指标。     

心房颤动导管消融中可调弯鞘使用的经验

目的报道心房颤动（简称房颤）导管消融过程中使用可调弯韒（Agilis NxT鞘）的经验。方法 15例房颤患者采用Agilis NxT鞘进行导管消融。阵发性房颤11例,持续性房颤4例。穿刺房间隔,双侧肺静脉造影后,在EnSite VelocityTMv.3.0指导下构建左房几何模型,先行双侧肺静脉电学隔离,持续性房颤或阵发性房颤合并典型心房扑动患者继行三尖瓣峡部线性消融,而后持续性房颤患者电复律,在窦性心律下行左房高密度标测,若有低电压区或碎裂电位,继续行基质改良。结果 15例均完成4根肺静脉电学隔离。持续性房颤中,4例完成三尖瓣峡部线性消融;复律后在窦性心律下行左房高密度标测2例后壁有低电压区,遂完成两侧消融圈后壁线消融;2例右下肺静脉前庭双电位与碎裂电位,行基质改良。阵发性房颤患者中,2例合并典型心房扑动行三尖瓣峡部线性消融,1例合并冠状窦口房性心动过速消融。右、左肺静脉隔离时间分别为（20.9±5.7）min、（19.2±7.1）min。没有1例出现严重并发症。随访（5.2±1.6）个月,1（6.7%）例3月后有房颤发作。结论在房颤导管消融过程中,使用Agilis NxT鞘,能便利消融且安全有效。     

复方蛋清糊治疗Ⅱ度急性放射性皮炎32例

我科1991年5月～1995年5月，用自制复方蛋清糊治疗I度放射性皮炎32例，并与同期接受常规治疗的25例进行对比，疗效满意。王对象和方法1．且对象在放疗中发生月度急性放射性皮炎（局部疼痛或烧灼感，皮肤起水癌，部分糜烂、渗出）的恶性肿瘤57例被随机分为两组：（l）治疗组32例，男13例，女19例；皮损部位：颈部8例，腋下12例，会阴部10例，腹股沟、破部各1例；（2）对照组25例，男10例，女15例；皮辑部位：颈部6例，腋下8例，会阻部8例，腹股沟，耳后、腕部各1例。1．2治疗方法治疗组用复方蛋清糊（现用现配；药物成分：大黄粉、云南白药…     

经腹吻合器法联合门奇断流术18例报告

1　临床资料本组 18例 ,男 14例 ,女 4例 ,年龄 2 6～ 6 8岁 (平均 4 2岁 ) ,全部为肝炎后性肝硬化。按Ｃｈｉｌｄ分级 ,Ａ级 6例 ,Ｂ级10例 ,Ｃ级 2例。本组择期手术 15例 ,急诊手术 3例 ,其中 1例为再次手术。本组病例全部得到随访。手术方法是取左肋缘下斜切口 ,或上腹部Ｌ形切口 ,经腹将近端胃及食管下段 6～ 8ｃｍ的周围血管离断 ,尽量保留前迷走神经干 ,如果切断需加幽门成形术。电刀切开胃前壁 5ｃｍ ,经此用ＧＦ型吻合器切断吻合贲门上 2～ 3ｃｍ处食管 ,ＸＦ吻合器闭合胃切口。脾切除或脾动脉干结扎 ,脾留在原位。本组 7例行脾动脉…     

单纯碎裂电位指导心房颤动消融的初步临床观察

Objective To evaluate the feasibility of mdiofrequency catheter ablation of atrial fibrilla-tion (AF) guided by complex fractionated atrial electrograms (CFAEs). Methods Twenty-two patients with drug refractory and symptomatic AF(16 paroxysmal, 6 persisten) were enrolled. Using Carto, the left atrial or biatrial replica was created during spontaneous or induced AF, and areas associated with CFAEs were identi-fied. Radiofrequency ablation at the site with CFAEs was performed and the end points were to eliminate CFAEs or convert to sinus rhythm. Results Thirteen patients(59%)were converted to sinus rhythm, (7 cases conver-ted directly to sinus rhythm, and 6 via the intermediate atrial tachycardia(AT) or atrial flutter (AFL). The re-maining nine patients required cardioversion with D. C. shock or drug. Repeat ablation was performed in 6 pa-tients (5 AT/AFL, 1 paroxysmal AF). During(10.9 ±4.8) months follow-up, 16 patients (73%) were free of arrhythmia and symptoms. CFAEs were most commonly found along the left interatrial septum, pulmonary veins, left atrial roof. CFAEs ablation prolonged AFCL[(157 ± 18) ms vs (211 ± 32) ms, P < 0.05]. Only one patient had pericardial tamponade that required pericardiocentesis. Conclusion Radiofrequeney catheter abla-tion of atrial fibrillation (AF) guided by CFAEs is safe and effective.