Successful Therapeutic Hypothermia in Patients with Congenital Long QT Syndrome

Therapeutic hypothermia has been shown to improve neurological outcomes in patients who remain comatose following resuscitation from cardiac arrest. While there are numerous reports of patients who have had a successful course after induction of therapeutic hypothermia, such therapeutic intervention has not been described in patients with congenital long QT syndrome (LQTS). We report outcomes in two patients with LQTS who had therapeutic hypothermia following a ventricular fibrillation arrest. Careful and routine monitoring of the QT interval in this patient population is necessary due to the potential for worsening electrical instability during induced hypothermia. Ann Noninvasive Electrocardiol 2011;16(1):100–103     

葛根素注射液联合巴曲酶治疗突发性耳聋的临床疗效观察

目的 研究葛根素注射液联合巴曲酶治疗突发性耳聋的临床效果。方法 选择2016年2月—2016年12月在榆林市星元医院进行诊治的突发性耳聋患者78例，随机分为两组，每组各39例。对照组给予巴曲酶注射液，每次10 BU，加入500 mL生理盐水中稀释后进行静脉滴注，每两天1次。观察组在对照组基础上联合静脉滴注葛根素注射液治疗，将0.4 g葛根素注射液加入250 mL生理盐水中进行静脉滴注，每天1次。两组均治疗10 d。比较两组的临床治疗效果，以及治疗前后的活化部分凝血活酶时间、凝血酶时间、凝血酶原时间和血浆纤维蛋白原，全血黏度低切、血细胞比容、全血黏度高切、血浆黏度和纯音听阈值。结果 观察组的有效率为89.74%，明显高于对照组的71.79%，差异有统计学意义（P<0.05）。两组治疗后的凝血酶时间、活化部分凝血活酶时间以及凝血酶原时间均明显升高，血浆纤维蛋白原明显降低，同组治疗前后比较差异有统计学意义（P<0.05）；且两组间相比差异有统计学意义（P<0.05）。两组治疗后的全血黏度低切、血细胞比容、全血黏度高切及血浆黏度均明显降低，同组治疗前后比较差异有统计学意义（P<0.05）；且观察组明显低于对照组，差异有统计学意义（P<0.05）。两组治疗后的纯音听阈值均明显改善，同组治疗前后比较差异有统计学意义（P<0.05）；且观察组明显优于对照组，差异有统计学意义（P<0.05）。结论 葛根素注射液联合巴曲酶治疗突发性耳聋的临床效果明显优于单独使用巴曲酶，不仅可以有效改善患者的临床症状还可以改善血液流变学状态以及血液高凝状态。     

糖皮质激素治疗突发性耳聋的临床效果观察

目的：研究分析糖皮质激素治疗突发性耳聋的临床效果。方法：选取在我院治疗的突发性耳聋患者80例（2014年5月～2015年5月）。将其动态随机化分2组，研究组和对照组各40例。对照组患者给予非激素常规治疗，研究组患者在常规治疗的基础上给予糖皮质激素进行治疗，对比两组患者突发性耳聋的临床疗效。结果：研究组患者治愈率为27．50％，总有效率为87．50％，与对照组患者对比存在明显差异（P＜0．05）。结论：采用糖皮质激素对突发性耳聋患者进行治疗的效果显著，能有效改善患者听力情况，在临床上可以广泛应用。     

The usual suspects in sudden cardiac death of the young: a focus on inherited arrhythmogenic diseases

Up to 14,500 young individuals die suddenly every year in Europe of cardiac pathologies. The majority of these tragic events are related to a group of genetic defects that predispose the development of malignant arrhythmias (inherited arrhythmogenic diseases [IADs]). IADs include both cardiomyopathies (hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, dilated cardiomyopathy) and channelopathies (long QT syndrome, short QT syndrome, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia). Every time an IAD is identified in a patient, other individuals in his/her family may be at risk of cardiac events. However; if a timely diagnosis is made, simple preventative measures may be applied. Genetic studies play a pivotal role in the diagnosis of IADs and may help in the management of patients and their relatives.     

Pilot Study to Determine the Feasibility of Training Army National Guard Medics to Perform Focused Cardiac Ultrasonography

Abstract

Objective. To assess the ability of Army National Guard combat medics to perform a limited bedside echocardiography (BE) to determine cardiac activity after a brief training module. Methods. Twelve Army National Guard health care specialists trained to the level of emergency medical technician–basic (EMT-B) underwent an educational session consisting of a 5-minute lecture on BE followed by hands-on practical training. After the training session, each medic performed BEs, in either the subxiphoid (SX) or parasternal (PS) location at his or her discretion, on four healthy volunteers. The time required to complete the BE and the anatomic location of the examination (SX vs. PS) was documented. A 3-second video clip representing the best image was recorded for each BE. These clips were subsequently reviewed independently by two of the investigators with experience performing and interpreting BE; each BE was graded on a six-point scale designed for the study, the Cardiac Ultrasound Structural Assessment Scale (CUSAS). A score of 3 or greater was considered to be adequate to assess for the presence of cardiac activity. Where there was disagreement on the CUSAS score, the reviewers viewed the clip together and agreed on a consensus CUSAS score. We calculated the median time to completion and interquartile range (IQR) for each BE, the median CUSAS scores and IQR for examinations performed in the SX and PS locations, and kappa for agreement between the two reviewers on the CUSAS. Results. A total of 48 BEs were recorded and reviewed. Thirty-seven of 48 (77%) were obtained in the SX location, and 11 of 48 (23%) were obtained in the PS location. Forty-four of 48 (92%) were scored as a 3 or higher on the CUSAS. Median time to completion of a BE was 5.5 seconds (IQR: 3.7–10.9 seconds). The median CUSAS score in the SX location was 4 (IQR: 4–5), and the median CUSAS score in the PS location was 4 (IQR: 4–4). Weighted kappa for the CUSAS was 0.6. Conclusion. With minimal training, the vast majority of the medics in our study were able to rapidly perform a focused BE on live models that was adequate to assess for the presence of cardiac activity.     

126例急性心肌梗死患者院外救治分析

目的分析比较接受院前救治的急性心肌梗死(AMI)患者不同结局的影响因素及其原因。方法回顾性分析126例2008年10月—2011年10月我站收治的AMI患者的临床特征及治疗效果,将126例患者分为治疗无效组(包括死亡、病情恶化)和治疗有效组(包括病情稳定、症状缓解)进行分析,比较各组中性别组成、年龄结构、基础疾病(3个以上)、有无并发症、发病致救治时间。结果治疗有效组97例(其中病情稳定82例,病情缓解15例),治疗无效组29例(其中死亡5例、病情恶化24例),两组男女比例分别为74/23和22/7(P=0.84),中青年和老年人比例分别为治疗有效组为26/71,治疗无效组为2/27(P=0.04),合并有基础疾病者和无基础疾病者比例分别为25/72和23/6(P<0.01),存在并发症者和无并发症者分别为17/80和24/5(P<0.01),发病致救治的时间分别为(82.3±8.1)min和(172.5±32.6)min(P<0.01)。我站AMI抢救成功率为76.98%。结论高龄、存在基础疾病、早期出现并发症及就诊时间长短是AMI院外急救的成功危险因素,如能控制以上各因素,可提高AMI患者的抢救成功率。