静脉注射胺碘酮治疗急性心肌梗死并发室性心动过速患者48例

目的:探讨胺碘酮治疗急性心肌梗死并发室性心动过速的疗效。方法:将96例急性心肌梗死并室性心动过速患者,随机分为治疗组和对照组。治疗组48例给予胺碘酮治疗;对照组48例给予利多卡因治疗。结果:胺碘酮治疗组,7～10d室性心律失常明显减少,3周后复查心电图,室性心动过速得到控制,病情稳定。结论:静脉给予胺碘酮治疗急性心肌梗死并发室性心动过速的疗效明确,不良反应少,安全可靠。

分支性室性心动过速的电生理特征及治疗探讨

目的:探讨分支型室速(FVT)的电生理特性及合理治疗。方法:就28例FVT的临床资料、心电图、食道及心内电生理特征和治疗进行探讨。结果:28例患者QRS波时限为120～140ms。16例为左后分支型室性心动过速:心电图呈右束支传导阻滞(RBBB)伴左前分支传导阻滞(LAFB)。12例为左前分支型室性心动过速:心电图呈右束支传导阻滞(RBBB)伴左后分支阻滞(LPFB),4例可见室房1∶1逆传,24例可见室房分离。18例FVT可被食道调搏诱发和终止。1例先用胺碘酮、食道调搏、电复律治疗无效后间断用胺碘酮及异搏定及口服倍他乐克后终止;16例直接用异搏定终止;5例憋气后自行终止;6例食道调搏不能终止用异搏定或胺碘酮治疗。其中24例经射频消融治疗成功,无复发。结论:分支性室性心动过速有典型的心电图特征,食道调搏可以终止大部分发作,急性发作用异搏定效果好,导管射频消融术可根治,其多为折返机制。

7例尖端扭转型室性心动过速的临床反思

目的 探讨抗心律失常治疗中尖端扭转型室性心过速 (Tdp)发生的因素。 方法 回顾性分析作者所遇到的 7例Tdp的临床资料 ,以及QT间期、心功能、血电解质水平、药物与剂量和患者性别等与Tdp的关系。 结果 7例Tdp患者 ,由氨碘酮引发的 5例 ,于服药 2～ 7d发生 ,总剂量 1.8～ 4 .6g ;索他洛尔引发的 2例 ,于服药 8d和 10d发生 ,总剂量 1.2 8g和 2 .88g。QT间期 0 .5 1～ 0 .6 2s ,3例有低血钾 ,5例有心功能不全 ,4例合用地高辛。 6例治疗后好转 ,1例死亡。 结论 胺碘酮和索他洛尔均可引起QT间期延长 ,引发Tdp。低血钾、心功能不全和合并应用地高辛等因素可能增加Tdp的发生 ,应注意预防。

应用零射线射频消融术救治1例妊娠33周伴短阵室性心动过速孕妇的护理

室性心律失常是指发生在希氏束分叉以下的束支、心肌传导纤维、心室肌的心律失常,持续性发作时可导致血流动力学状态的恶化,是最危险的心律失常之一,也是心源性猝死的常见原因,必须积极治疗。若妊娠期间发生室性心律失常,则更加严重。妊娠合并快速心律失常临床虽不多见,但因对孕妇和胎儿安全存在较大风险,应积极给予干预治疗。孕妇是高危人群,目前,几乎所有的抗心律失常药均可通过胎盘,有潜在的影响胎儿发育的风险。

青年人多形特发性室速5例分析

目的:探讨青年人多形特发性室速的分类及治疗结果。方法:回顾分析5例青年人多形特发性室速的一般资料。结果:死亡1例,治疗有效4例。结论:青年人原因不明的心慌、胸闷、晕厥除常规心电图检查外24 h动态心电图检查是十分必要的。

尖端扭转性室速的抢救与护理

尖端扭转性室速是多形性室速的一种类型,若不及时抢救与护理,可进展为室颤,危及生命.我院自1998年3月至2004年5月,收治疗6例尖端扭转性室速,经积极抢救与护理,预后良好.现体会报告如下.

Transvenous versus open chest lead placement for resynchronization therapy in patients with heart failure： comparison of ventricular electromechanical synchronicity

Background Transvenous lead placement is the standard approach for left ventricular （LV） pacing in cardiac resynchronization ther- apy （CRT）, while the open chest access epicardial lead placement is currently the most frequently used second choice. Our study aimed to compare the ventricular electromechanical synchronicity in patients with heart failure after CRT with these two different LV pacing tech- niques. Methods We enrolled 33 consecutive patients with refractory heart failure secondly to dilated cardiomyopathy who were eligible for CRT in this study. Nineteen patients received transvenous （TV group） while 14 received open chest （OP group） LV lead pacing. Intraand inter-ventricular electromechanical synchronicity was assessed by tissue Doppler imaging （TDI） before and one year after CRT procedure. Results Before CRT procedure, the mean QRS-duration, maximum time difference to systolic peak velocity among 12 left ventricle segments （LV Ts-12）, standard deviation of time difference to systolic peak velocity of 12 left ventricle segments （LV Ts-SD）, and inter-ventficular mechanical delay （IVMD） in OP and TV group were 166 ± 17 ms and 170 ± 21 ms, 391 ±42 ms and 397 ± 36 ms, 144 ± 30 ms and 148 ± 22 ms, 58 ± 25 ms and 60 ± 36 ms, respectively （all P 〉 0.05）. At one year after the CRT, the mean QRS-duration, LV Ts-12, LV Ts-SD, and IVMD in TV and OP group were 128 ± 14 ms and 141 ± 22 ms （P = 0.031）, 136 ± 37 ms and 294 ± 119 ms （P = 0.023）, 50± 22 ms and 96 ± 34 ms （P = 0.015）, 27 ± 11 ms and 27 ± 26 ms （P = 0.86）, respectively. The LV lead implantation procedure time was 53.4±16.3 rain for OP group and 136 ± 35.1 min for TV group （P = 0.016）. The mean LV pacing threshold increased significantly from 1.7 ± 0.6 V/0.5 ms to 2.3 ± 1.6 V/0.5 ms （P 〈 0.05） in TV group while it remained stable in the OP group. Conclusions Compared to conventional endovascular approach, open chest access of LV pacing for CRT leads to better improvement of the intraventricular synchronization.

Role of colonoscopy in patients with persistent acute diverticulitis

AIM： To identify patients with persistent acute diverticulitis who might benefit from an early colonoscopy during their first hospitalization. METHODS： All patients hospitalized between July 2000 and December 2006 for acute diverticulitis who underwent colonoscopy were included in the study. Patients were followed during hospitalization and after discharge. Patients were considered to have a persistent course of acute diverticulitis if symptoms continued after 1 wk of conventional treatment with 1V antibiotics, or if symptoms recurred within 2 mo after discharge. Patients were considered to benefit from an early colonoscopy if the colonoscopy was therapeutic or if it changed a patient＇s outcome. RESULTS： Three hundred and six patients were hospitalized between July 2000 and December 2006 with the diagnosis of acute diverticulitis. Two hundred and twenty four of these were included in the study group. Twenty three patients （10.3%） fulfilled the criteria for a persistent course of acute diverticulitis. Of them, four patients （17.4%） clearly benefited from an early colonoscopy; these patients＇ clinical course is described. None of the patients with a regular non-persistent course demonstrated any benefit from colonoscopy. CONCLUSION： Early colonoscopy detected other significant pathology, which accounted for the clinical presentation in 17% of patients with persistent acute diverticulitis. Therefore, we believe an early colonoscopy should be considered in all patients with a persistent clinical course.

The role of electrocardiography in the elaboration of a new paradigm in cardiac resynchronization therapy for patients with nonspecific intraventricular conduction disturbance

Cardiac resynchronization therapy （CRT） is associated with a favorable outcome only in patients with left bundle branch block （LBBB） pattern and in patients with a QRS duration 〉 150 ms, in patients with non-LBBB pattern with a QRS duration of 120-150 ms usually is not beneficial. After adjusting for QRS duration, QRS morphology was no longer a determinant of the clinical response to CRT. In contrast to the mainstream view, we hypothesized that the unfavorable CRT outcome in patients with non-LBBB and a QRS duration of 120-150 ms is not due to the QRS morphology itself, but to less dyssynchrony and unfavorable patient characteristics in this subgroup, such as more ischemic etiology and greater prevalence of male patients compared with patients with LBBB pattern. Further, the current CRT technique is devised to eliminate the dyssynchrony present in patients with LBBB pattern and inappropriate to eliminate the dyssynchrony in patients with non-LBBB pattern. We also hypothesized that electrocardiography may also provide information about the presence of interventricular and left intraventricular dyssynchrony and the approximate location of the latest activated left ventricular （LV） region. To this end, we devised new ECG criteria to estimate interventricular and LV intraventricular dyssynchrony and the approximate location of the latest activated LV region. Our preliminary data demonstrated that the latest activated LV region in patients with nonspecific intraventricular conduction disturbance （NICD） pattern might be at a remote site from that present in patients with LBBB pattern, which might necessitate the invention of a novel CRT technique for patients with NICD pattern. The application of the new interventricular and LV intraventricular dyssynchrony ECG criteria and a potential novel CRT technique might decrease the currently high nonresponder rate in patients with NICD pattern.

Establishing a predictive model for aspirin resistance in elderly Chinese patients with chronic cardiovascular disease

Background Resistance to anti-platelet therapy is detrimental to patients. Our aim was to establish a predictive model for aspirin resistance to identify high-risk patients and to propose appropriate intervention. Methods Elderly patients （n = 1130） with stable chronic coronary heart disease who were taking aspirin （75 mg） for 〉 2 months were included. Details of their basic characteristics, laboratory test results, and medications were collected. Logistic regression analysis was performed to establish a predictive model for aspirin resistance. Risk score was finally established according to coefficient B and type of variables in logistic regression. The Hosmer-Lemeshow （HL） test and receiver operating characteristic curves were performed to respectively test the calibration and discrimination of the model. Results Seven risk factors were included in our risk score. They were serum creatinine （〉 110 μmol/L, score of 1）; fasting blood glucose （〉 7.0 mmol/L, score of 1）; hyperlipidemia （score of 1）; number of coronary arteries （2 branches, score of 2; 〉 3 branches, score of 4）; body mass index （20-25 kg/m2, score of 2; 〉 25 kg/m2, score of 4）; percutaneous coronary intervention （score of 2）; and smoking （score of 3）. The HL test showed P ≥ 0.05 and area under the receiver operating characteristic curve ≥ 0.70. Conclusions We explored and quantified the risk factors for aspirin resistance. Our predictive model showed good calibration and discriminative power and therefore a good foundation for the further study of patients undergoing anti-platelet therapy.

Radiofrequency catheter ablation of ventricular tachycardia in a patient with dermatomyositis

A 51-year old male who presented at our hospital for recurrent palpitation for several months was diagnosed dermatomyositis ten years ago and had interstitial lung disease since two years ago. Recently, he was admitted for atypical hepatitis, and received maintenance treatment of oral corticosteroids.

Sonographic findings of acute appendiceal diverticulitis

Preoperative images of acute appendiceal diverticulitis are rarely reported because of the difficulty of distinguishing appendiceal diverticulitis from other iliocecal diseases like acute appendicitis or cecal diverticulitis. We report a case of preoperatively diagnosed acute appendiceal diverticulitis. A 30-year-old female with a presumptive diagnosis of acute appendicitis from history and physical examination was admitted to our hospital. Ultrasound sonography showed inflamed appendiceal diverticula and inflammatory changes of the surrounding tissue. The swollen appendix was detected but its findings were slightly different from those of typical acute appendicitis in the following points. One difference was the thickened wall of the appendix, the other difference was the presence of air in the appendix. The patient underwent appendectomy and the pathological specimen revealed inflammatory changes of diverticula within the appendix.

尖端扭转型室速10例的急救护理

目的总结尖端扭转型室速患者的急救与护理体会。方法对急诊科接诊的10例尖端扭转型室速患者的急救护理措施进行回顾性分析。结果10例患者经急诊科快速诊断、有效处理、严密观察，病情平稳后转入病区治疗。结论快速诊治和有效的急救护理有利于提高该类患者的急救成功率。