心内心电定位法在神经科置入PICC导管患者中的应用与分析

目的探究心内心电定位法置入PICC导管在神经科患者中的应用效果及导管相关并发症。方法选取符合入组标准的患者100例,应用心内心电定位法置入PICC导管。心电图定位结果与胸片结果进行对照,观察导管留置期间并发症的发生情况。结果以胸片结果为金标准,心内心电图判断PICC导管头端进入上腔静脉的灵敏度为95.79%、特异度为100%。导管留置期间发生渗血11例、导管脱出3例、出口部位感染5例、可疑导管相关血流感染4例、导管堵塞2例、导管破裂2例。结论心内心电定位法判断PICC导管头端位置具有很高的灵敏度和特异度。

两种心内心电定位技术置入PICC导管的对比分析

目的探究两种心内心电定位技术置入PICC导管的准确性、敏感度。方法选取符合入组标准的患者100例，将两种心内心电定位技术置入PICC导管分为研究组和对照组各50例，应用心电图定位结果和胸片结果进行对比分析。结果以心电图特征性P波判断PICC导管头端进入上腔静脉下1，3段的灵敏度，研究组和对照组分别为100％和96％，两组比较差异无统计学意义（P=0．495）；以胸片结果为金标准，PICC导管头端进入上腔静脉下1／3段的准确度，研究组和对照组分别为100％和86％，两组比较差异有统计学意义（P=0．012）。结论研究组心内心电定位技术判断PICC导管头端位置较对照组具有更高的灵敏度和准确度。

导管定位动态取血检测肝脏吲哚青绿代谢提取率在肝病患者诊治中的应用

目的：导管定位动态取血观测肝脏吲哚青绿（ＩＣＧ）代谢提取率（ＩＣＧＥＲ），用以指导肝病的诊断与治疗。方法：①导管制作：选双腔腔静脉导管，距顶端开口６５ｍｍ处新造开口（４ｍｍ×３ｍｍ），使新造口和顶端开口二者都独立与相关管腔相通。②置管定位：导管置入腔静脉后，使双腔管充满导电液体，并分别通过金属接头与心电监护仪胸前导联相连，显示心内心电特征，并以此为依据调整导管，使导管顶端开口位于下腔静脉与右房交界处（Ｅ），新造开口位于上腔静脉内（Ａ）。③静脉注射ＩＣＧ后分别在５、１０和１５分钟时，同时从Ａ、Ｅ两点取血样检测。④肝静脉血ＩＣＧ浓度（ＩＣＧＨＶ）＝２．４Ｅ－１．４Ａ，ＩＣＧＥＲ＝（Ａ－Ｅ）／Ａ×２４０％。结果：①２５例（３１次）检测，Ａ、Ｅ两点取血９０对，有浓度差８６对（９５．６％），每组３次浓度２０分钟内呈指数函数下降且互相平行。②ＩＣＥＥＲ与ＩＣＧ１５分钟滞留率（ＩＣＧＲ１５）呈明显负相关（Ｐ＜０．００１）。③ＩＣＧＥＲ与ＩＣＧ消失率（ＩＣＧＫ）呈明显正相关（Ｐ＜０．００１）。④ＩＣＧＥＲ检测数据与肝功能状态和发展趋势基本相符。结论：依据心内心电特征定位自制静脉导管，检测ＩＣＧＥＲ具有方便、可靠、准确的特点?

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.

Comparison of plasma NSE, protein S-100b and EEG changes in traditional arrested-heart procedures and on-pump beating-heart procedures

Objective: To assess the cerebral injury in on-pump beating-heart procedures under mild hypothermia in comparison with traditional on-pump arrested-heart procedures under moderate hypothermia. Methods: Forty patients, 20 with congenital heart disease (CHD) and 20 of rheumatic heart disease (RHD) , were divided into 2 groups: Control group (group A, n =20) including 10 patients suffering from CHD as group Al and the left 10 from RHD as group A2; and experiment group (group B, n =20) which consisting of group B1 (10 with CHD) and group B2 (10 of RHD). The patients in group A underwent traditional arrested-heart procedures, and those in group B were operated on with beating-heart procedures. Arterial blood samples were collected at preoperation (time A) , 20 min after cardiopul-monary bypass (CPB) starting (time B) , 1 h after CPB (time C) and 24 h postoperation (time D) respectively. Plasma contents of neuron-specific enolase (NSE) and protein S-100b were measured with sensitive ELISA. All the patients received echoencephalography (EEG) before and 1 week after operation. Results: The plasma contents of protein S-lOOb were increased very significantly at time B, C and D in comparison with those at time A (P<0.01) , and that of patients in group Al was significantly higher than that in group B at time B (P < 0. 05 ). There was no significant difference at other time points. At time B, the plasma contents of NSE were significantly higher in group A than in group B, and in group Al and Bl than in group A2 and B2. What's more, at time B, the former fell back to their pre-operative levels, but the latter remained still higher levels than the preoperative ones ( P < 0.01). No significant difference was found in the abnormality rates of postoperative EEG between 2 groups. Conclusion: The perioperative plasma contents of NSE and protein S-100b are not significantly higher in group B than in group A. On-pump beating-heart procedures do not make more serious cerebral dysfunction than the traditional arrested-heart procedures.