经皮腔内室间隔心肌消融术对心电指标的影响

目的研究肥厚梗阻型心肌病患者经皮腔内室间隔心肌消融术对心电指标的影响。方法对50例肥厚梗阻型心肌病患者行经皮腔内室间隔心肌消融术,记录术前、术中和术后出现的心律失常类型,配对分析术前、术后心电指标的变化。结果术后与术前相比,QRS时限[(122.0±24.0)ms对(97.3±15.5)ms,P=0.000]明显延长,QTc[(469.3±32.2)ms对(434.3±41.5)ms,P=0.004]、PR间期[(169±26)ms对(162±24)ms,P=0.044]稍延长。术中心律失常发生率分别为:右束支传导阻滞70%(35/50),左束支传导阻滞8%(4/50),一过性AVB38%(19/50),频发室性早搏24%(12/50),短阵室性心动过速24%(12/50);未发生持续性室性心动过速和室颤。术后心律失常发生率分别为:右束支传导阻滞56%(28/50),左束支传导阻滞8%(4/50),交界区性心动过速4%(2/50),频发室性早搏16%(8/50),短阵室性心动过速8%(4/50)。无永久性起搏器植入及死亡病例。结论经皮腔内室间隔心肌消融术致心律失常的发生率高,右束支传导阻滞最为常见。严格选择适应证后谨慎地行PTSMA术是安全、可行的。     

爱维心口服液药理作用的实验观察

爱维心口服液在临床上治疗冠心病、心律失常、神经衰弱等疾病有较好疗效。为了阐明其药理作用，针对其在临床上的主要疗效，采用了数种动物模型的实验方法，通过肾上腺素诱发家兔室性心律失常实验、肾上腺素引起大鼠心肌缺血实验、小鼠常压耐缺氧实验、小鼠游泳实验和小鼠自主活动实验，进行了爱维心口服液的药理观察。结果表明：爱维心口服液可对抗肾上腺素引起的室性早搏；减轻异丙肾上腺素引起的大鼠心电图ＳＴ段位移程度；延长小鼠常压耐氧存活时间；延长小鼠游泳时间；减少小鼠自主活动。以上药理作用的阐明，为临床合理用药提供了理论依据。     

炙甘草汤配合胺碘酮治疗心律失常的疗效观察

目的:观察炙甘草汤配合治疗心律失常的临床疗效.方法:将60例心律失常患者随机分为两组,治疗组30例,加用益气滋阴、补血复脉的炙甘草汤,7天为一个疗程,观察两个疗程.结果:治疗组和对照组临床症状显效率分别为96.7%和73.3%;两组心电图显效率分别为93.3%和56.7%,组间比较有显著差异,P＜0.05或＜0.01.结论:以益气滋阴、补血复脉为法,炙甘草汤配合治疗心律失常,疗效显著.     

胺碘酮治疗急性心肌梗死室性心律失常的临床应用

目的：评价胺碘酮治疗急性心肌梗死（AMI）室性心律失常的疗效和安全性。方法：观察180例AMI患者采用胺碘酮治疗室性心律失常的疗效和安全性，随访1年。结果：反复发作的持续性室速、室颤患者，首剂3～5mg/kg胺碘酮，10min内静脉注射；再以1.0～1.5mg/min维持，室速均被有效终止。以200mg/d胺碘酮作为长期维持量能有效地控制室性早搏。结论：采用胺碘酮治疗AMI患者室性心律失常效果满意，安全可靠。     

Decreasing the toxic potential of intravenous regional anaesthesia

In an attempt to reduce the dose of local anaesthetic agent during intravenous regional anaesthesia (IVRA) of the upper limb, we have used a forearm tourniquet in 12 adult volunteers. The volume of the forearm venous system was predetermined angiographically. We performed IVRA with three solutions of lidocaine (0.25, 0.375, 0.5 per cent) administered in a volume equal to the forearm venous system. Angiographic results indicate that: a forearm tourniquet provides adequate vascular isolation; the volume of the forearm venous system can be correlated with body weight; the progression of the fluid in the venous system follows a pattern that is similar for all patients with the small veins of the distal forearm and proximal hand being filled last. With this technique, lidocaine 0.5 per cent resulted in a dose of 1.5 mg.kg-1 and provided excellent analgesia. Lower concentrations were unsatisfactory. We conclude that the use of a forearm tourniquet allows reduction of the local anaesthetic dose to a non-toxic level and thus increases the safety of IVRA.     

Plasma magnesium should be monitored perioperatively in patients undergoing colorectal resection

Objective Hypomagnesemia has been shown to have several clinically important sequelae. The aims of this study were: to assess the impact of bowel preparation, with sodium picosulphate (Picolax®), on plasma electrolytes, with particular regard to plasma magnesium, in patients undergoing bowel preparation for colonoscopy and colorectal resection and to evaluate the influence of perioperative magnesium levels on postoperative cardiac dysrhythmias. Method Sixty‐one patients receiving sodium picosulphate (Picolax®) bowel preparation were studied in two groups: Colonoscopy (31 patients) and Colorectal resection (30 patients). Plasma sodium, potassium, magnesium, calcium, urea, creatinine and blood haematocrit were measured in all patients prior to commencement of bowel preparation, at the time of colonoscopy or colorectal resection and 24 h postoperatively (surgery group only). Mean electrolyte and haematocrit levels were then compared. Postoperative cardiac dysrhythmias were recorded and analysed. Results No significant changes following bowel preparation were observed in plasma sodium, potassium, calcium or creatinine. Plasma urea fell following bowel preparation (colonoscopy P < 0.001, resection P = 0.004) and rose following resection (P = 0.002). Magnesium levels increased following bowel preparation in both groups (colonoscopy P < 0.001, resection P = 0.007) and fell following resection (P < 0.001). Thirty‐four per cent (21/60 patients) were hypermagnesemic following bowel preparation and 20% (6/30 patients) became hypomagnesemic following surgery. Postoperative cardiac dysrhythmias were associated with lower magnesium levels at induction and postoperatively (P = 0.022 and P = 0.033). Conclusion Bowel preparation with Picolax® does not appear to cause significant electrolyte disturbance, except in elevating plasma magnesium. Postcolorectal resection plasma magnesium dropped significantly suggesting perioperative monitoring and replacement should be routine following colorectal surgery.     

培哚普利对老年人心脏保护性作用与神经肽Y的关系

目的探讨神经肽Ｙ（ＮＰＹ）在老年人高血压心律失常中的作用及培哚普利对心律失常的影响。方法放免分析法测定８０例老年人高血压患者培哚普利干预前后血中ＮＰＹ的含量，并用动态心电图、超声心动图了解治疗前后心律失常、心肌缺血和心肌肥厚程度的状况。结果左室肥厚组、心肌缺血组患者血ＮＰＹ浓度明显高于相应的对照组，并且血中ＮＰＹ浓度与左室肥厚程度、心肌缺血时间正相关。培哚普利在降低血ＮＰＹ浓度、减少心律失常发生的同时，伴有心肌肥厚程度和心肌缺血时间缩短，相关分析亦发现ＮＰＹ下降程度与心肌肥厚减轻和缺血时间缩短正相关。结论ＮＰＹ含量减少在血管紧张素化酶抑制剂作用过程中起到一定的作用     

酸枣仁抗大鼠实验性心律失常和心肌缺血作用的研究

酸枣仁醇提物的水溶液静脉注射能明显对抗BaCl_2和改善鸟头碱诱发的大鼠心律失常的EKG变化。此制剂也能明显改善脑垂体后叶素引起大鼠心肌缺血的EKG变化。     

氟哌啶醇对豚鼠心室肌细胞IK的影响

目的 观察氟哌啶醇对豚鼠单个心室肌细胞延迟整流钾电流(IK)通道的作用,探讨氟哌啶醇致心律失常的离子基础.方法 应用全细胞膜片钳技术记录氟哌啶醇对豚鼠单个心室肌细胞IK的影响.结果 在获得单个细胞后,分别给予0.3、1.0 、3.0 μmol/L的氟哌啶醇.延迟整流钾电流在试验电压+70 mV时,从给药前的(16.660 4±1.571 7)分别减少至(5.025 5±1.937 2)、(9.857 2±3.900 2)、(7.179 4±1.816 0)pA/pF (n=7,P＜0.01).结论 氟哌啶醇可抑制IK,使动作电位时程延长而引发心律失常,其致心律失常作用可能与其对钾通道的作用有关.     

VLCAD deficiency in a patient who recovered from ventricular fibrillation,but died suddenly of a respiratory syncytial virus infection

VLCAD deficiency is an autosomal recessive disorder caused by a defect of fatty acid oxidation. The phenotype is classified into three clinical forms on the basis of the onset of symptoms: a severe form with neonatal onset; a milder form with childhood onset; and a late‐onset form. The neonatal form is the most common, and has a higher mortality rate than the others. We report the case of a newborn infant with VLCAD deficiency who developed ventricular fibrillation, which was successfully treated by intensive care, but who suddenly died after a respiratory syncytial virus infection. Early institution of i.v. glucose treatment and active immunization with vaccine, such as palivizumab (anti‐RSV mAb), may be important to reduce the frequency and severity of life‐threatening episodes.