参松养心胶囊与慢心律比较治疗室性早搏随机对照试验的系统评价

目的 评价参松养心胶囊与慢心律(美西律、脉克定)治疗室性早搏的疗效差异及安全性.方法 两名作者独立收集资料和评价纳入文献质量,运用Meta分析对资料进行定量综合,评价不良反应.结果 (1)对7项研究的临床疗效有效率合并效应量的检验:OR合并=3.07,0R合并95%的置信区间为[1.30,7.21],Meta分析结果有统计学意义(P=0.01);(2)对4项研究的心电图疗效有效率合并效应量的检验:OR合并=2.45,95%CI:[1.60,3.76](P＜0.01);(3)共有4篇论文报道发现参松养心胶囊有副作用,3篇报道胃肠不适、失眠等不良反应例数:参松养心胶囊组24例,发生率为5.71%;对照组28例,发生率为7.91%.(4)在治疗前后对参松养心胶囊组患者血、尿、粪常规、肝肾功能、心肌酶和电解质的检验,均未发现异常变化.结论 现有证据提示参松养心胶囊临床疗效和心电图疗效优于慢心律,且不良反应少.受纳入文献的质量限制,其疗效有待高质量的随机对照试验来评价.     

30例窦性心动过缓患者心率震荡分析

目的应用窦性心率震荡（heart rate turbulence,HRT）这一新的预测心脏性猝死方法,探讨窦性心动过缓患者的临床预后。方法30例窦性心动过缓患者接受动态心电图检查,窦性心率〈50次／分为入组条件。采集单发室性早搏的前2个窦性RR间期及后20个窦性RR间期,根据公式分别计算震荡初始（turbulence onset,TO）和震荡斜率（turbulence splope,TS）。结果30例窦性心动过缓患者的HRT均值TO：（1．03±0．97）％;TS：（3．87±1．93）ms／RR间期。提示本文30例窦性心动过缓患者室性早搏后初始窦性心率加速现象消失。结论窦性心率〈50次／分的心动过缓患者可能也是发生心脏性猝死的高危人群。     

Clinical Assessment of the Right Ventricle Anterior Papillary Muscle Extrasystoles with Holter Recordings

To assess the short-term behavior of the right ventricle anterior papillary muscle extrasystoles (APME) based on Holter recording and exercise data, 20 subjects (age 31.5 +/- 13.7 years) with otherwise normal electrocardiogram were studied. APME was diagnosed when it resembled LBBB morphology, with downward oriented AQRS in the frontal plane, slurred r wave in lead V1, and an R/S ratio less than 1 in this same lead. Except for palpitations in ten patients, there were no other symptoms related to the arrhythmia. Two Holter recordings, 30 to 330 days apart, were performed and their results compared. In the first Holter recording, the average rate of VPB/minute was 9.9 +/- 2.5 (xg +/- SD). Half of the patients had couplets and five had ventricular tachycardia. In the second Holter recording, the average rate of VPB/minute was 8.7 +/- 3. In eight cases, couplets were recorded, in half of which one or more episodes of ventricular tachycardia were also noted. Six patients showed another VPB morphology distinct from APME. Stress test suppressed VPB in 10/13 patients, couplets in 2/3 and ventricular tachycardia in the only one with this arrhythmia at the start of the test. Repetitive forms vs APME frequency and vs heart rate exhibited an inverse relationship. We conclude that APME is a clinical condition with both high and stable VPB levels, which can be found in subjects with otherwise normal hearts and in the short-term has a spontaneous uncomplicated outcome.     

Heart Rate Turbulence

Heart rate turbulence (HRT) is a baroreflex-mediated biphasic reaction of heart rate in response to premature ventricular beats. Heart rate turbulence is quantified by: turbulence onset (TO) reflecting the initial acceleration of heart rate following premature beat and turbulence slope (TS) describing subsequent deceleration of heart rate. Abnormal HRT identifies patients with autonomic dysfunction or impaired baroreflex sensitivity due to variety of disorders, but also may reflect changes in autonomic nervous system induced by different therapeutic modalities such as drugs, revascularization, or cardiac resynchronization therapy. More importantly, impaired HRT has been shown to identify patients at high risk of all-cause mortality and sudden death, particularly in postinfarction and congestive heart failure patients. It should be emphasized that abnormal HRT has a well-established role in stratification of postinfarction and heart failure patients with relatively preserved left ventricular ejection fraction. The ongoing clinical trials will document whether HRT can be used to guide implantation of cardioverter-defibrillators in this subset of patients, not covered yet by ICD guidelines. This review focuses on the current state-of-the-art knowledge regarding clinical significance of HRT in detection of autonomic dysfunction and regarding the prognostic significance of this parameter in predicting all-cause mortality and sudden death.     

应用超声心动图探讨早搏与心功能的关系

目的　观察和评价早搏对心功能的影响。方法　用彩色多普勒超声心动图检查 80例室性早搏、房性早搏和交界性早搏患者早搏时和早搏前、后各一个心动周期的心功能指数变化。结果　早搏时心搏出量、排血分值、左室短轴缩短率均明显低于正常心动周期(P <0 .0 1 ,交界性早搏P <0 .0 5) ;在配对间期和代偿间期两个心动周期中 ,一次室早、房早和交界性早搏分别使心脏减少作功 9.0 %、3 .0 %、3 .3 %。结论　无论何种类型的早搏 ,均可不同程度地影响心功能。     

应用超声心动图观察和评价早搏对左心功能的影响

本文应用彩色多普勒超声心动图检查、观察和测定了65例室性早搏（室早）、房性早搏（房早）和交界性早搏患者早搏时和早搏前、后各一个心动周期的心功能指数变化。结果显示：早搏时心搏出量、排血分值、左室短轴缩短率均明显低于正常心动周期，两者比较有显著性差异（P＜0．01，交界性早搏P＜0．05）；在配对间期和代偿问期两个心动周期中，一次室早、房早和交界性早搏分别使心脏减少作功9．0％、3．0％、3．3％。表明无论何种类型的早搏，均可不同程度地影响心功能。     

现存慢型克山病室性早搏的心电图分析

目的分析慢型克山病人室性早搏在心电图上的有关项目的表现,为克山病的防治研究提供有价值的资料。方法应用心电图记录现存慢型克山病人的室性早搏,分析室性早搏在心电图上的有关项目。结果慢型克山病室性早搏发生的次数最少的1次/分,最多44次/分,平均8.6次/分。单纯偶发或多发的占84%,多源多发占16%。测量室性早搏QRS波时间均值为0.15ms～0.16ms,R波电压均值为0.87mv～1.62mv,T波(正或负)的电压均值0.44mv～0.55mv,T波时间的均值为0.17ms～0.19ms,R/T的均值为2.4～3.9。目测可以看到一个比正常图形提前出现的QRS、T波群,T波与本身的QRS主波方向相反,QRS的主波与正常图形的QRS主波方向相反或一致,不论R波的大或小QRS波的时间比正常图形明显延长,T波的高度或深度较大。QRS波多数有不同程度的顿挫或切迹。结论慢型克山病室性早搏多见偶发或多发,少见多源多发,每分钟发生的频率多数在5次以上。测量的QRS波时间比正常图形(<0.11ms)明显延长,R的平均电压除V1导联大于正常图形外其余导联均在正常范围内。相反方向的R/T值较小,T的(正或负)电压和时间较大和较长。目测室性早搏在心电图上的QRS、T波群和正常图形有明显不同。