三度房室传导阻滞21例分析

三度房室传导阻滞是一种严重缓慢性心律失常,临床较少见,常导致阿斯综合征,严重威胁患者的生命,现对我院近年来收治的三度房室传导阻滞患者进行总结分析,报道如下。     

不同浓度的罗哌卡因对糖尿病大鼠坐骨神经电生理的影响

Objective To observe the effects of clinical routine dasages 0.375% and 0.5% ropivacaine on electrophysiologic of changes of the sciatic nerve in diabetic rats. Methods Twelve healthy rsts and 12 rats with streptozotocin (STZ) induced diabetic peripheral,neuropathy were:used and further divided to 2 groups.Both sciatic nerves were exposed under general anesthesia.0.5 ml of either 0.375% or 0.5% ropivacaine was iniected in close proximity to the right seiatic nerve which was the experimental side.0.5 ml of 0.9% sodium chloride was iniected in close proximity to the left sciatic nerve which served as control.Motor nerve conduction velocity(MNCV),amplitude (AMP) and latency (LAT) of compound muscle action potential were recorded before injection,at the moment of injection,at one minute intervals for to 15 minutes and 48 hours after the injection. Results MNCV,AMP and LAT didn't change at all the observed time points of the 0.9% sodium chloride iniected control side in either healthy rats or diabetic rats.MNCV and AMP in normal rats injected with 0.375% ropivaeaine began to decrease at average 4 minutes and became zero at 10 minutes,while they began to decrease at average 3 minutes and dropled to zero at average 9 minutes while injected with 0.5% ropivacaine.These parameters returned to baseline levels after 48 hours.MNCV and AMP in diabetic rats injected with 0.375% ropivacaine began to decrease at average one minute and became zero at 7 minutes,while they began to decrease at average one minute and dropped to zero at 6 minutes with 0.5% ropivacaine injection.The time course had statistically significant difference between diabetic and normal rats.LAT had the same change pattern as MNCV and AMP.After 48 hours.MNCV in 0.375% ropivacaine diabetic group was not different from baseline value(P＜0.05),but AMP and LAT Were still significantly different from baseline levels.MNCV, AMP and LAT in 0.5% ropivacaine diabetic group had significant difference comparing to baseline levels and levels of 0.375% ropivaeaine diabetic group(P＜0.05). Conclusion Either 0.375% or 0.5% ropivacaine may deteriorate the diabetic peripheral nerve injury,the latter more remarkable.     

动脉僵硬度与脑梗死患者神经功能缺损程度的关系研究

目的探讨脑梗死患者动脉僵硬度与其神经功能缺损程度的关系。方法130例脑梗死患者（脑梗死组）根据美国国立卫生研究院卒中量表（NIHSS）评分．分为轻、中、重度三组,另选择105例健康体检者作为健康对照组。采用脉搏波传导速度（PWV）自动测定系统对上述人群测定颈动脉．股动脉PWV（cfPWV）。结果健康对照组、轻度组、中度组、重度组患者的cfPWV分别为（8．62±0．82）、（9．97±1．26）、（12．82±1．84）和（16．56±1．64）m／s,在校正了年龄、性别、血压、血糖和血脂参数后,神经功能缺损程度与ctPWV呈显著正相关（P〈0．01）。结论动脉僵硬度增加与脑梗死患者神经功能缺损程度相关,改善动脉僵硬度可能对改善神经功能缺损程度有益。     

基于超高速成像技术的脉搏波传导速度检测颈动脉弹性的一致性和重复性研究

目的评价不同超声医师应用基于超高速成像技术的脉搏波传导速度检测颈动脉弹性的一致性,以及同一医师多次检测同一受检者的重复性。方法随机选取13名健康志愿者作为受检者。两名超声医师应用此技术检测志愿者的颈动脉弹性,获得收缩期起始时和结束时的脉搏波传导速度,即BS和ES。每名志愿者每侧颈动脉各检测5次,按左右标记为LBS、LES、RBS和RES。应用Bland-Altman检测两名医师测量数据的一致性,组内相关系数ICC检测同一名医师测量同一志愿者数据的重复性。结果 Bland-Altman图显示LBS和RBS的点都落在95%一致性界限内,LES和RES各仅有1个点落在95%一致性界限外,参数显示LBS、LES、RBS、RES在95%一致性界限较窄,且在界限范围内最大差值的绝对值均较小,在临床上是可以接受的。每名超声医师检测同一名志愿者的LBS、LES、RBS、RES各5次,ICC均大于0.75。结论基于超高速成像技术的脉搏波传导速度检测颈动脉弹性有着较好的一致性和重复性,是一项反映颈动脉弹性的可信指标。     

通心络胶囊治疗原因不明Ⅱ°Ⅱ型房室传导阻滞观察

几年来,我们采用石家庄以岭药业有限公司生产的通心络胶囊治疗不明原因的Ⅱ°Ⅱ型房室传导阻滞,并与常规单纯西药治疗进行对照,现报告如下.     

房性早搏合并室内差异传导1例

房性早搏伴束支阻滞型室内差异传导较少见,健康查体中检出更为罕见。临床上常将房性早搏（简称房早）伴有室内差异传导而误读为室性期前收缩（简称室早）,有必要充分认识和熟悉掌握房早伴室内差异传导的心电图特征与鉴别,对临床医疗有重要意义。     

人房室交界区形态结构观察及其临床意义

目的 探讨人房事交界区的形态结构,为导管消融提供可靠的依据.方法 成人心脏做房室交界区的水平面连续切片,在HE染色下观察其形态学特征.结果 房室结位于房室隔内中心纤维体的右侧,主要由P细胞和T细胞组成.其向后形成的延伸部同射频消融慢径的部位吻合.结论 房室交界区不同层面和部位细胞形态有较大差异;房室交界区的概念应当扩大,分布范围从房室隔内中心纤维体的右侧一直向后接近冠状窦口.     

临床路径护理在单纯房室缺修补术患者中的应用

目的观察临床路径护理对单纯房室缺修补术患者的效果。方法对80例行择期手术的单纯房室缺修补术患者随机分为对照组与观察组各40例,对照组行常规护理,观察组行临床路径护理,并对两组结果进行统计分析。结果对照组的平均住院时间为19．32d,观察组为14．11d;对照组的平均医疗费用为22176．88元,观察组为17782．69元;对照组的健康教育知识得分为88．37分,观察组为95．26分;对照组的患者满意度为82．77分,观察组为94．29分。两组比较平均住院时间、平均医疗费用、健康教育知识得分、患者满意度均有显著性差异（P〈0．05）。结论临床路径护理有利于优化护理程序,降低医疗成本,提升服务品质,可在临床推广应用。