老年与中青年急性心肌梗死患者临床特点对比分析

目的探讨老年人急性心肌梗死的临床特点。方法回顾性分析92例60岁以上老年急性心肌梗死（老年组）患者及70例非老年急性心肌梗死（中青年组）患者的临床资料,分析起病诱因、首发临床表现、梗死部位、伴发症、并发症以及死亡率。结果老年组多数患者于发病前无明显诱因及典型的临床症状,梗死部位较广泛,非ST段抬高型心肌梗死的发生率、并发症、伴发症、病死率均较中青年组高,差异有统计学意义（ P＜0.05）。结论老年人急性心肌梗死发生率高,且以临床表现不典型者多见。     

Complete heart block—an underappreciated serious complication of central venous catheter placement

Central venous catheter (CVC) placement is a common bedside procedure that is frequently performed in critically ill patients. More than 5 million CVCs are inserted annually across the United States alone. Procedure-related complications may vary from minor bleeding to life-threatening complications such as arterial perforation and pneumothorax. Cardiac arrhythmias can often occur during the guidewire placement, and bundle-branch blocks have also been reported. We herewith report a case of complete heart block during CVC placement, which is a rare but serious complication of this procedure. Because the patient had a preexisting left bundle-branch block, complete heart block likely resulted from a probable trauma to the right bundle branch during the guidewire insertion.     

西南部分地区远程心电检测与动态心电图的对比分析

目的分析中心数据库远程动态心电(TTECG)检测资料与普通动态心电图(Holter)检测资料进行对比观察。方法选择本院心脏远程监护中心进行TTECG检查与Holter检查的病人,从2007年7月至2010年11月各26 625例患者。结果 TTECG正常3 678(13.83%),心律失常者22 914(86.17%),其中3例患者死亡,分别是室性心动过速(1例)、房室传导阻滞(1例)、交界性逸搏(1例)。Holter正常3 736例(14.06%),心律失常22 834例(85.94%),其中15例患者死亡,分别是室性心动过速(4例)、病窦综合征(7例)、房室传导阻滞(4例)。结论TTECG检测的优势为及时发现致命性心律失常,及时预警治疗,减少死亡。     

微电极阵列技术研究肌质网钙ATP酶过表达对大鼠衰竭心肌电活动的改善作用

目的 探索重组腺病毒(rAd)介导的肌质网Ca2+-ATP酶(SERCA2a)过表达对大鼠心肌梗死后心力衰竭心肌电活动节律和传导的改善作用,并探讨可能的电活动机制.方法 将26只成年雄性SD大鼠随机分为3组:假手术组(n=l0),空病毒对照组(rAd.β-gal组,n=8)和肌质网Ca2+-ATP酶(SERCA2a)转染组(rAd.SERCA2a组,n=8).假手术组仅开胸不结扎动脉,rAd.β-gal组和rAd.SERCA2a组分别进行左冠状动脉前降支结扎建立大鼠心肌梗死后心力衰竭动物模型,同时分别将携带β-gal和SERCA2a基因的重组腺病毒(rAd)导入衰竭心脏,术后2周超声心电图检测心脏舒张功能和收缩功能,心电图监测体表心电活动以及微电极阵列(MEA)技术监测离体心脏组织电活动情况.结果 rAd携带SERCA2a与β-gal基因均成功转入大鼠衰竭心脏.rAd.SERCA2a组可改善心功能,与假手术组相比心室舒张末期容积与心室收缩末期容积轻微增加[(0.41±0.13)cm2对(0.39±0.02)cm2,(0.08±0.02)cm2对(0.06±0.01)cm2,P＞0.05],左心室射血分数[(0.82±0.05)对(0.86±0.01),P＞0.05]和短轴缩短率[(46.6±2.32)％对(49.58±1.71)％,P＞0.05]无明显改变.与假手术组相比,rAd.β-gal组体表心电图QT间期延长[(111.02±7.42) ms对(94.7±1.55) ms,n=6,P＜0.05],室性早搏发生率达71.5％ (5/7),而rAd.SERCA2a组QT间期缩短[(81.45±4.97)ms对(94.7±1.55)ms,n=6,P＜0.05],室性早搏发生率达14.3％(1/7).MEA记录可发现rAd.SERCA2a组心率与假手术组相比差异无统计学意义[(435±31)次/min对(442 ±22)次/min,n=6,P＞0.05],与rAd.β-gal组相比,rAd.SERCA2a组最大场电位[(0.82±0.39)mV对(0.64±0.13) mV,n=6,P＜0.05]、最小场电位[(1.88±0.57) mV对(1.35±0.12) mV n=6,P＜0.05]、场电位时限[(124.17±21.08)ms对(113.23±12.02) ms n=6,P＜0.05]均延长;rAd.β-gal组梗死区与梗死对侧区心肌组织场电位时限差异有统计学意义[(60.36±2.08)ms对(103.24±7.35) ms,n=5,P＜0.05],并且60通道记录梗死区心肌组织场电位时限离散度大于rAd.SERCA2a组[(38.5ms±4.62)ms对(26.88±5.09) ms,n=5];rAd.SERCA2a组传导基本一致,使心肌梗死面心室肌组织电活动呈均一性传导.结论 SERCA2a转基因治疗可以显著改善心力衰竭大鼠的左心室收缩功能、舒张功能,同时可以降低心肌梗死后心力衰竭伴发心律失常的发生,改善心脏电活动的均一传导.MEA技术是一项检测心血管疾病动物模型心脏组织电生理节律和频率以及传导活动的理想技术.     

Digoxin intoxication: An old enemy in modern era

Objectives Although development of new treatment modalities limited digoxin usage, digoxin intoxication is still an important issue which could be easily overlooked. In this report we analyzed a case series definitively diagnosed as digoxin intoxication in the modern era. Methods We analyzed 71 patients hospitalized with digoxin intoxication confirmed by history, complaints, clinical and electrocardiograph (ECG) findings, and serum digoxin levels > 2.0 ng/mL, during a five year period. The demographic and clinical data, indications for digoxin use, digoxin dosage, concurrent medications, laboratory data, hospital monitoring, and ECG findings were obtained from all patients. Results Thirty-eight of 71 patients (53.5%) had symptoms of heart failure during admission or later. Sixty-four percent of patients were older than 75 years. The percentage of females was 67%. Atrial fibrillation, hypertension and gastrointestinal complaints were more frequent in the females (64% in females, 30% in males, P = 0.007; 81% in female, 52% in males, P = 0.01; 50% in female, 17.3% in males, P = 0.008, respectively). The mortality rate during the hospital course was 7%. Conclusion This report demonstrated the reduced mortality rates in patients with digoxin intoxication over the study period. Gastrointestinal complaints are the most common symptoms in this population.     

直立倾斜试验过程中的心律失常特点及安全性评价

目的探讨直立倾斜试验（HuTT）过程中的心律失常特点及安全性。方法对165例不明原因晕厥或接近晕厥患者首先进行基础直立倾斜试验（BHUT）,阴性患者再随机进行多阶段异丙肾上腺素倾斜试验（MIHUT）或舌下含化硝酸甘油倾斜试验（SNHUT）,分析HuTT过程中心律失常发生情况。结果快速性心律失常发生率50．91％（84／165）,92．68％窦性心动过速患者出现最快心率5min内发生阳性反应。缓慢性心律失常发生率30．91％（51／165）,最常见缓慢性心律失常依次为窦性心动过缓、交界性逸搏心律和窦性停搏,其中窦性停搏10例,停搏时间MIHUT组明显高于BHUT组和SNHUT组（P均〈O．01）。结论HUTT过程中心律失常发生率较高,心率突然明显增快时应警惕阳性反应发生。试验过程中存在长时间窦性停搏等多种安全风险,SNHUT在安全性等方面优于MIHUT。     

国内生物碱类中草药抗心律失常的临床应用与基础研究

阐述了国内２０种生物碱类中草药抗心律失常的临床应用与基础研究近况，为进一步研究及开发应用这些药物，发展新一类天然植物来源的生物碱类抗心律失常药物提供了理论依据。     

新生儿非良性快速型心律失常临床特点与疗效观察

目的：探讨新生儿非良性快速型心律失常的临床特点与疗效观察。方法回顾性分析2007年至2014年我院NICU住院的非良性快速型心律失常患儿的临床资料。观察比较新生儿非良性快速型心律失常的发生特点,药物及直流电复律等方法的治疗效果、并发症等。结果非良性快速型心律失常新生儿共13例,其中男10例,女3例;足月儿8例,早产儿4例,过期产儿1例;室性心动过速8例,室上性心动过速5例;原发疾病：重度窒息、败血症、肺炎、上呼吸道感染、心肌炎、呼吸窘迫综合征及先天性心脏病等。其中9例(69.2％)由其他心律失常用药后转化而来。所有病例均使用了抗心律失常药物,10例(76.9％)联合使用了直流电复律治疗。13例中12例治疗有效(92.3％)。复律后短期复发或并发其他严重心律失常8例(61.5％),均使用了乙胺碘伏酮,其中4例治愈。室性心动过速患儿均有严重原发病及诱因,病死率50％(4/8);室上性心动过速患儿无一例死亡。结论非良性快速型心律失常可发生在新生儿各年龄段及各胎龄,其中室上性心动过速预后较好,室性心动过速预后差;运用直流电复律加抗心律失常药是治疗新生儿快速型心律失常的有效方法,抗心律失常药乙胺碘伏酮可能是较好的一种药物选择。