Pitfalls in rate and rhythm control: Severe concomitant orthostatic hypotension unmasked after conversion to sinus rhythm

Rate control is an acceptable strategy in management of patients with recurrent atrial fibrillation. Typically, it is more simple approach than rhythm control. Once optimal ventricular rate control is achieved patients with long-lasting atrial fibrillation commonly remain in good clinical status and do not require subsequent readmissions and change of prescribed drugs and their doses. We report a case of effective rate control strategy failure after relatively long period due to transformation of atrial fibrillation into atypical atrial flutter. Subsequent spontaneous conversion to sinus rhythm improved patient's hemodynamic but unmasked concomitant orthostatic hypotension that was severe and had significant impact on treatment of patient.Learning objectiveTransformation to atrial flutter may cause failure of rate control strategy even in previously stable patients with long time persistent atrial fibrillation. Spontaneous conversion to sinus rhythm can unmask orthostatic hypotension. Management of comorbid orthostatic hypotension might be challenging as it could be severe and have significant impact on patients’ condition.     

稽留流产应用米非司酮联合米索前列醇流产与人工流产效果比较

目的对稽留流产应用米非司酮联合米索前列醇流产与人工流产效果进行研究及判定。方法选取2015年2月~2016年1月期间本院收治的60例稽留流产患者作为本次的研究对象,依据人工流产措施将其分为对照组与观察组,各30例,对照组于戊酸雌二醇口服后行人工流产术,观察组行米索前列醇、米非司酮联合治疗,并将两组患者经干预的流产效果进行对比。结果观察组稽留流产患者经治疗的完全流产率为66.67%,不完全流产率为23.67%,失败率为6.66%,优于对照组(P0.05),且术中出血量为(52.19±14.97)m L,手术时间为(7.19±1.53)min,术后阴道出血时间为(4.08±0.79)d,少于对照组,且子宫开始收缩时间为(27.25±8.13)min,用药后排胎时间为(9.17±5.13)h,排胎2 h内出血量为(90.17±22.16)m L,优于对照组(P0.05),且不需宫口扩张;但两组的再次清宫率及人工流产综合征率差异无统计学意义(P0.05)。结论稽留流产应用米非司酮联合米索前列醇流产与人工流产效果显著,可提高流产的成功率,改善其预后,值得临床推广。     

B型超声监测在药物流产中的临床价值

目的：探讨B型超声与药物流产临床结局的相关性及临床应用价值。方法：对门诊1920例要求药物流产的健康妇女，在用药前后进行超声检查。结果：用药前超声检查筛查出异位妊娠，葡萄胎及不符合药流条件者170例，用药前不同大小妊娠囊在绒毛排出时间无显著差异，但妊娠囊越大，出血量越多，出血持续时间越长，则有明显差异（P＜0.01)。服药后7天超声检查提示不全流产182例。流产失败3例。结论：药物流产前后超声监测，即可筛查异常确定孕龄，又可对流产后阴道出血＞7天的病例做出及时的相应处理，减少并发症的发生。     

心理干预在减轻特发性气胸胸腔闭式引流患者焦虑及疼痛中的作用

目的：讨论心理干预对减轻特发性气胸胸腔闭式引流患者焦虑及疼痛的作用。方法：将患者随机分为对照组25例和观察组24例，观察组行系统的心理干预，对照纽行常规指导和介绍。应用zung焦虑自评量表（SAS）、疼痛分级标准分析各项指标。结果：观察组焦虑程度、疼痛强度、疼痛时间均低于对照组，两组比较具有统计学意义（P〈0．05）。结论：应用心理干预对特发性气胸行胸腔闭式引流术患者进行心理护理，提供情绪支持，具有减轻焦虑及疼痛的作用，利于康复。     

经腋下小切口治疗自发性气胸180例

目的：评价腋下小切口治疗自发性气胸。方法：腋下小切口治疗自发性气胸180例。其中血气胸30例，复发性气胸35例。经胸腔穿刺胸腔闭式引流无效而行手术治疗126例，首次发病直接手术治疗38例。双侧性病变8例，其中3例同时行双侧手术。肺大泡缝扎或结扎术132例，胃肠吻合器缝合8例，剖胸止血30例。结果：术中平均输血120ml。手术时间平均56min，术后胸腔引流液平均105ml。术后置管1～11d，平均2．1d拔管，住院日为8．6d。术后出血1例，复发1例，均经再次手术治愈。术后15-30d恢复上学或工作。结论：腋下小切13手术适用于所有自发性气胸患者。     

急性心肌梗死自溶现象分析--附31例报告

目的:分析急性心肌梗死(acute myocardial infarction,AMI)梗死相关动脉(infarct related artery,IRA)的自溶现象,探讨自溶现象的影响因素和预后意义.方法:155例未予静脉溶栓的首次AMI患者,均在发病12小时内行直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI).所有患者按照有无自溶现象分为两组:自溶组(31例)和无自溶组(124例).用放射性核素测定心功能,观察两组心力衰竭、再发心肌梗死的发生率和住院病死率.结果:①自溶组梗死前心绞痛的发生率显著高于无自溶组(P＜0.01);CK-MB、心肌肌钙蛋白I峰值均低于无自溶组(P＜0.01,P＜0.01),侧支循环发生率亦低于无自溶组(P＜0.05);②自溶组心肌梗死面积小于无自溶组(P＜0.05);左心室射血分数显著高于无自溶组;③多元Logistic回归分析结果显示,梗死前心绞痛和缺乏侧支循环是发生自溶现象的独立预测因素(P＜0.01,P＜0.05).结论:梗死前心绞痛和缺乏侧支循环是发生自溶现象的独立预测因素,而自溶现象可缩小心肌梗死面积,保护心功能,改善预后.     

Excitatory transmitter release induced by high concentrations of γ-aminobutyric acid (GABA) in crayfish neuromuscular junctions

At the neuromuscular junction of very small crayfish (0.4–2 g) addition of -aminobutyric acid (GABA) to the superfusing solution at concentrations exceeding 100 mmol/l elicited high frequency release of excitatory transmitter quanta. In seven experiments single application of 500 mmol/l GABA gave rise to instantaneous release of 70,000 to 130,000 quanta. These stores of transmitter were released by GABA in a first order process with time constants, _q, of between 9 s and 20 s, the maximum rate of release,ñ ₀, reaching 10,000 quanta/s in some cases. After release had ceased in the presence of GABA, the preparation was allowed to recover for five minutes in normal solution. Subsequently, a second trial evoked about 50% of the release induced during the first application of GABA. Pretreatment of the preparation with 2 mol/l serotonin (5-HT) facilitated GABA-induced transmitter release resulting in larger rates of release and consequently in a larger output of transmitter by a factor of about 3. The largest amount of transmitter released on a single application of GABA in the presence of serotonin comprised about 220,000 quanta with a maximum rate of releaseñ ₀ 25,000 quanta/s. The release evoked by high GABA-concentrations did not depend markedly on extracellular Ca²⁺ or Mg²⁺, but required extracellular Na⁺. The effects induced by high concentrations of GABA on release of excitatory transmitter quanta were quantitatively similar to the effects of high glycine-concentrations on release of quanta from the inhibitory terminals (Finger 1983a, b).This investigation was supported by the Deutsche Forschungs-gemeinschaft, Project Fi 305/1-3     

五加生化胶囊减少药物流产阴道出血临床观察

目的:观察五加生化胶囊对药物流产后阴道出血情况的影响。方法:自愿要求药物流产的早孕妇女随机分为治疗组、对照组各79例。治疗组常规服用米非司酮+米索前列醇的同时加服五加生化胶囊3d,对照组服用米非司酮+米索前列醇。结果:2组在孕囊排出时间上无显著差异;阴道出血量及出血持续时间,治疗组优于对照组(P<0.05)。结论:五加生化胶囊可减少药物流产后阴道出血,缩短出血时间,值得临床应用。     

胸腔镜治疗自发性气胸的临床分析及护理对策

目的比较胸腔镜手术和剖胸手术在治疗自发性气胸方面的优势以及护理的特点。方法选择确诊为自发性气胸的住院病例共130例。其中胸腔镜手术65例,剖胸探查手术65例。比较其手术时间、术中出血量、住院时间、护理工作量及复发率。结果胸腔镜手术的手术时间、术中出血量明显小于剖胸探查术组,胸管拔管时间及住院天数明显短于剖胸探查术组。复发率、护理工作量明显少于剖胸探查术组。结论胸腔镜手术治疗自发性气胸具有手术时间短,出血少,术后恢复快,住院时间短和护理工作量明显减少等优势。     

经直肠超声彩色多普勒血流成像在药物流产中的应用

目的 探讨经直肠超声彩色多普勒血流成像(CDFI)在药物流产诊断治疗中的应用价值.方法 选择2005年1月-2006年2月在我院妇产科门诊行药物流产的患者65例,应用经直肠超声CDFI观测患者妊娠囊排出后当日其妊娠囊着床部位的彩色多普勒血流状态,并分为3类:Ⅰ类:妊娠囊着床部位无血流信号(16例);Ⅱ类:妊娠囊着床部位见星点状或短棒状血流信号(35例);Ⅲ类:妊娠囊着床部位见火球状血流信号(14例).于药物流产15 d后常规复查宫腔情况.结果 第15天复查发现Ⅰ、Ⅱ类血流显示者宫内未发现残留物;Ⅲ类血流显示者宫腔内均发现残留物并行清宫术,病理检查证实为底蜕膜组织,部分可见绒毛.结论Ⅰ、Ⅱ类血流显示者可动态观察,Ⅲ类血流显示者当日即可行清宫术.经直肠超声CDFI对于预测药物流产是否完全及其临床转归有很高的参考价值.