稳心颗粒联合胺碘酮治疗心力衰竭并发室性心律失常有效性及安全性的Meta分析

目的:系统评价稳心颗粒结合胺碘酮治疗心力衰竭并发室性心律失常的疗效与安全性。方法:计算机检索中国知网(CNKI)、维普网(VIP)、万方、中国生物医学文献数据库(CBM)、PubMed、Web of Science和the Cochrane Library等数据库,检索有关稳心颗粒联合胺碘酮治疗心力衰竭并发室性心律失常的随机对照试验(RCT)。由2名研究者分别对文献进行筛选、提取数据和评价纳入研究的偏倚风险后,采取RevMan 5.3及R语言统计软件进行Meta分析。结果:共纳入18项研究,涉及1 527例病人。Meta分析结果显示,稳心颗粒联合胺碘酮治疗心力衰竭并发室性心律失常,在提高临床总有效率[RR=1.19,95%CI(1.14,1.25),P<0.000 1]、减少室性期前收缩次数[SMD=-2.42,95%CI(-4.66,-0.18),P=0.03]、稳定心率[SMD=-1.66,95%CI(-1.94,-1.37),P<0.000 1]、增加左室射血分数[SMD=1.57,95%CI(0.54,2.61),P=0.003]均优于单独使用胺碘酮,且不良反应发生率低于单独使用胺碘酮[RR=0.59,95%CI(0.43,0.80),P=0.000 8]。结论:现有证据表明,稳心颗粒联合胺碘酮在治疗心力衰竭并发室性心律失常,能够明显提高临床疗效、LVEF,且不良反应更少,安全性较好。

埋藏式心脏复律除颤器的随访及参数调整

报道 2例埋藏式心脏复律除颤器 (ICD)治疗恶性室性心律失常的临床应用经验。采用锁骨下静脉穿刺置入ICD ,并进行随访观察 ,从心电储存器中了解恶性室性心律失常的治疗情况。结果 :1例发生快速室性心动过速、心室颤动 ,由于ICD放电过迟 ,导致患者心源性晕厥。另 1例发生室上性心动过速 ,导致ICD误感知。 2例均经过重新调试 ,设置ICD工作参数 ,并联合足量抗心律失常药物治疗 ,随访至今未再有类似情况发生。结论 :术后严密随访 ,合理设置工作参数 。

Effects of Dingjifumai Decoction on Electrocardiogram and sodium potassium pump of rats with ventricular arrhythmia

Objective:To investigate the effect of Dingjifumai Decoction(DJFM)on Electrocardiogram(ECG)and sodium potassium pump in rats with ventricular arrhythmia.Methods:Forty healthy male SD rats(200±20g)were randomly divided into blank group,model group,Metoprolol group and DJFM group.Ten rats in each group were fed with normal diet and free drinking water.Each group was given gavage,and the amount of gavage in each group was calculated according to body weight.In the model group,0.001%Aconitine was injected into the tail vein at 30ug/kg.In the Metoprolol group,Metoprolol suspension was given according to the standard of 5.2mg/kg per day.In the DJFM group,DJFM was given at 17.6g/kg per day.After 2 weeks of administration,the biologic experiment system BL-420F was used to monitor the II lead ECG curve,and the ECG changes were observed and recorded.Then,the left ventricle of the rat was taken,and part of the heart tissue sodium potassium pump was detected.Results:(1)The effect of DJFM on ECG of rats with ventricular arrhythmia:After intravenous injection of aconitine,the incidence of Ventricular Premature beat(VP),Ventricular Tachycardia(VT),Ventricular Fibrillation(VF)in the model group was 100%,suggesting that the model building of rats with ventricular arrhythmia was successful.(2)VP,VT,and VF time:Compared with model group,DJFM group and Metoprolol group can significantly delay the VP,VT and VF,the difference was statistically significant(P<0.05).The effect of DJFM group and Metoprolol group on delaying the appearance of VP,VT and VF was the same,there was no significant difference(P>0.05).(3)The effect of DJFM on sodium potassium pump in rat ventricular arrhythmia heart tissues:Compared with the blank group,the sodium potassium pump value in the model group was significantly decreased,and the difference was statistically significant(P<0.05).Compared with the model group,the sodium potassium pump value of the tissues in the Metoprolol group and the DJFM group increased,and the difference was statistically significant(P<0.05).There was no significant difference in sodium potassium pump between the Metoprolol group and the DJFM group(P>0.05).Conclusion:1.The rat model of ventricular arrhythmia can be successfully prepared by intravenous injection of Aconitine.2.DJFM can prolong the occurrence time of cardiac arrhythmias caused by aconitine in rats,such as VP,VT,VF,et al.The mechanism may be related to fast Na^+channel,and it may prevent and control arrhythmias by inhibiting Na^+influx and reducing the fast response cellular self-discipline.3.DJFM can protect the myocardial tissue sodium potassium pump,which can protect the myocardial cells and improve the myocardial metabolism.

Clinical and familial study of arrhythmogenic right ventricular cardiomyopathy

Objective To explore the characteristics of arrhythmogenic right ventricular cardiomyopathy (ARVC) Methods Seven patients with arrhythmogenic right ventricular cardiomyopathy and 34 members of three families were studied All patients and family members underwent history collection, clinical examination, electrocardiogram (ECG), two dimensional echocardiography (2 DE) and a signal averaging electrocardiogram Programmed ventricular stimulation was performed in five patients Results All patients and family members had normal morphologic characteristics and normal function of the left ventricular by 2 DE Fourteen persons had abnormal findings indicating ARVC Five had enlargement of the right ventricular with diffused hypocontractility, eight had thin and systolic bulging in the focal anterior wall with hypokinesia and one had bulging of the inferior wall Twenty five persons (seven patients and 18 family members) had abnormal findings in ECG Positive ventricular late potential was recorded in 13 persons (six patients) Two to three monomorphic ventricular tachycardia (VT) with left bundle branch block (LBBB) configurations were induced in five patients Ventricular fibrillation was induced in two patients during the electrophysiologic study (EPS) Five patients had very high pacing threshold and/or ineffective pacing in one or many regions of the right ventricle Two members of one family died suddenly One member was a dwarf with ARVC Spontaneous VT with a left bundle branch block (LBBB) configuration was recorded in five patients, polymorphic VT with extremely short coupling interval in one, and premature ventricular complexes with LBBB configuration in 12 (six patients) Conclusion Our familial study strongly suggests that ARVC may be a hereditary disease and it is helpful in the diagnosis and detection of ARVC The most common manifestations were abnormal structure and function of the right ventricle and abnormal ECG of repolarization and ventricular arrhythmia which originates from the right ventricle