膈肌起搏器在慢性阻塞性肺疾病呼吸机依赖患者脱机中的应用临床疗效观察

目的:探讨慢性阻塞性肺疾病(COPD)呼吸机依赖患者膈肌起搏器的应用及疗效。方法:把2018年6月~2019年6月本院呼吸内科收治的COPD使用呼吸机并发生依赖的清醒患者60例作为研究对象,男27例,女33例;患者年龄60~75岁,平均(66.3±1.2)岁,随机分为观察组(运用常规治疗及护理并增加使用膈肌起搏器)和对照组(运用常规治疗及护理),每组30例,对两组脱机成功率和脱机时间进行比较。结果:观察组患者脱机情况明显优于对照组,观察组与对照组2周脱机成功率分别为83.3%和46.7%,脱机时间分别为(7.56±1.45),(9.42±1.28)d,差异均有统计学意义(P<0.05)。结论:COPD呼吸机依赖患者准备脱机前,给予膈肌起搏器治疗,可明显提高脱机成功率及缩短呼吸机使用时间。     

Motility Disorders after Roux-en-Y Gastrojejunostomy

About 30% of patients who have a Roux-en-Y gastrojejunostomy after gastrectomy suffer from abdominal pain, nausea, vomiting of food and bloating made worse by eating. This syndrome, called the Roux stasis syndrome, is caused, in part, by a motility disorder of the Roux limb. Transection of the jejunum during the construction of the limb separates the limb from the natural small intestinal pacemaker located in the duodenum. Ectopic pacemakers then appear in the limb and trigger retrograde contractions in its proximal portion. These contractions slow transit through the limb and result in Roux stasis. Current nonsurgical treatment of the syndrome includes the use of prokinetic agents and intestinal pacing, neither of which has demonstrated long-term benefits. A near-total gastrectomy may speed upper gastrointestinal transit somewhat, but stasis in the Roux limb often persists. Our current approach aims at preventing the syndrome by the use of an ‘uncut’ Roux limb, an operation which preserves myoneural continuity between the duodenal pacemaker and the Roux limb and so prevents the appearance of ectopic pacemakers and stasis in the limb.     

胺碘酮抑制缺血浦肯野纤维起搏离子流

目的观察正常及模拟“缺血”时胺碘酮对绵羊心室浦肯野纤维起搏离子流（Ｉｆ）的影响。方法双微电极电压钳制术,使膜电位过度极化以激活Ｉｆ。结果胺碘酮１×１０－５ｍｏｌ／Ｌ在正常台氏液中显著降低浦肯野纤维Ｉｆ幅值;模拟“缺血”也使Ｉｆ幅值降低,在此基础上,胺碘酮使Ｉｆ幅值进一步减小,加剧了“缺血”对Ｉｆ离子流的抑制作用。结论提示胺碘酮能抑制心肌缺血时心室正常自律性活动。     

双腔起搏器对缓慢性心律失常并心力衰竭病人血流动力学的影响

目的评估双腔起搏器对缓慢性心律失常并心力衰竭病人血流动力学的影响。方法对20例缓慢性心律失常心衰病人经锁骨下静脉植人DDD型起搏器,对比分析术前及术后1～2周X线胸片、放射性核素门控心室显影和超声心动图检查结果。结果所有患者临床症状及心功能明显改善,术后心胸比例、射血分数（EF）、心排血量（CO）、心脏指数（CI）均明显好转［分别为0．70±0．13vs0．61±0．12、0．29±0．09vs0．38±0．10、2．30±0．81vs3．34±0．75（L／min）、1.31±0．71vs1．98±0．49（L／min·m2）,P＜0.05或P＜0．01］。结论DDD起搏器治疗能显著改善缓慢性心律失常心力衰竭病人的血流动力学,可作为治疗缓慢性心律失常并心力衰竭的有效方法之一。     

Metabolic influences on circadian rhythmicity in Siberian and Syrian hamsters exposed to long photoperiods

Calorie restriction and other situations of reduced glucose availability in rodents alter the entraining effects of light on the circadian pacemaker located in the suprachiasmatic nuclei. Siberian and Syrian hamsters are photoperiodic species that are sexually active when exposed to long summer-like photoperiods, while both species show opposite changes in body mass when transferred from long to short or short to long days. Because metabolic cues may fine tune the photoperiodic responses via the suprachiasmatic nuclei, we tested whether timed calorie restriction can alter the photic synchronization of the light-entrainable pacemaker in these two hamster species exposed to long photoperiods. Siberian and Syrian hamsters were exposed to 16 h:8 h light:dark cycles and received daily hypocaloric (75% of daily food intake) or normocaloric diet (100% of daily food intake) 4 h after light onset. Four weeks later, hamsters were transferred to constant darkness and fed ad libitum. The onset of the nocturnal pattern of locomotor activity was phase advanced by 1.5 h in calorie-restricted Siberian hamsters, but not in Syrian hamsters. The lack of phase change in calorie-restricted Syrian hamsters was also observed in individuals exposed to 14 h:10 h dim light:dark cycles and fed with lower hypocaloric food (i.e. 60% of daily food intake) 2 h after light onset. Moreover, in hamsters housed in constant darkness and fed ad lib., light-induced phase shifts of the locomotor activity in Siberian hamsters, but not in Syrian hamsters were significantly reduced when glucose utilization was blocked by pretreatment with 500 mg/kg i.p. 2-deoxy-D-glucose. Taken together, these results show that the photic synchronization of the light-entrainable pacemaker can be modulated by metabolic cues in Siberian hamsters, but not in Syrian hamsters maintained on long days.     

Syncope after effort

A 29-year-old man developed recurrent syncope following exertion. Cardiac investigations revealed no evidence of structural heart disease, but during exercise testing, in the recovery phase, he sustained a bradycardia and then asystole for a prolonged period. Before cardiac massage could be instituted a tonic-clonic fit occurred, and this initiated a return to sinus rhythm. His symptoms were abolished following the implantation of a dual-chamber pacemaker.     

支原体耐药性与抗菌药消耗量相关性研究

目的：了解支原体耐药性与抗生素消耗量之间的相关性。方法：对112份解脲支原体阳性标本进行9种抗菌药敏感性试验，统计2002～2003年有关药物的消耗量，分析解脲支原体耐药率与相应药品消耗量之间的关系。结果：多因素逐步回归分析表明上年度相关药物成人剂型的消耗量是有显著性意义的相关因素（r=0．858，F=16.778，P〈0．01）。结论：支原体的耐药率主要与上一年度的相关药物消耗量相关。     

阵发性心房颤动时右心房f波振幅的测量

目的:测量阵发性心房颤动(atrial fibrillation,AF)患者右心房不同部位的f波振幅,探讨在AF律状态下起搏器心房电极固定位置的选择和植入的可行性。方法:13例阵发性AF患者,窦性心律和AF时,分别把6F的4极电极导管送至高位右心房、中位右心房、低位右心房、房间隔上部、房间隔中部和冠状窦口处。利用Medtronic PSA 5311分析仪测量6F电极1～2极间的电位差。结果:(1)右心房中部和房间隔上部的f波振幅均值分别为(3．93±1．84)mV和(3．96±1．35)mV。(2)右心房中部与高、低位右心房之间的f波振幅均有明显差异(P＜0．05);房间隔上部与房间隔中部的f波振幅也有明显差异(P＜0．05)。(3)AF时f波振幅均值低于A波振幅均值(P=0．002)。结论:(1)右心房中部和房间隔上部的f波振幅值较其它4个部位的振幅高。(2)AF时f波振幅波动范围明显较大。(3)阵发性AF时,右心房中部与高位、低位右心房之间的电位均有明显差异。右心房中部和房间隔上部的f波振幅较其它部位高,可选为右心房主动固定电极的植入部位。     

我院2002～2004年非甾体抗炎药使用动态分析

目的：探讨非甾体抗炎药的使用状况和发展趋势,为其新产品的开发利用和临床合理有效地选择非甾体抗炎药提供依据.方法：应用DDDs排序及金额排序对我院2002～2004年非甾体抗炎药的用量和销售金额进行统计分析.结果：用药频度最高的是阿司匹林肠溶片,对乙酰氨基酚的单方和复方制剂品种及剂型较多,在感冒和各类慢性疼痛的治疗中占据重要地位,高选择性的COX-2抑制剂如美洛昔康DDDs排序快速上升,随着新品种的不断上市,非甾体抗炎药市场的竞争将日趋激烈.结论：非甾体抗炎药正向着高效、低毒的方向发展.     

我院2003～2004年抗微生物药物使用频度分析

目的:了解我院抗微生物药物的应用情况及趋势,为临床医护人员及产、供、用单位有关人员提供参考。方法:以限定日剂量(DDD)、用药人次(DDDs)、消耗金额(元)、每日药费(元)为统计指标,对我院2003 -2004年抗微生物药物的应用情况进行初步统计、分析结果:2003年DDDs排序前20位的品种有14个进入2004年的前20位,2003年消耗金额排序前20位的品种有16个进入2004年的前20位:与2003年比较:2004年抗微生物药物的品种增加了14种、消耗金额增加了311%、人均日药费增加了19.84%,口服制剂所占的DDDs和消耗金额比率略有下降,而注射制剂的情况正好相反。结论:我院抗微生物药物应用广泛, 使用基本合理。