乳腺癌患者术后心电图QT间期及P波电轴等指标的变化研究

目的探讨乳腺癌患者手术前后心电图QT间期及P波电轴等指标的差异性。方法选取接受治疗的乳腺癌患者200例,比较术前术后患者心电图各项指标的变化。结果将200例患者在手术前和手术后的心电图检测指标进行自身对比,心电轴钟向转位变化、RV5+SV1的电压(P=0.201)、SV1的电压(P=0.921)、RV5的电压(P=0.031)、P电轴(P=0.031)、T电轴(P=0.901)、QT间期(P=0.040)、PR间期(P=0.902)、QRS时限(P=0.79)和QRS电轴(P=0.81)。经统计分析患者在手术前后有统计学意义的指标是:V5导联的R波电压、QT间期和P波电轴,其他指标未见明显差异。结论乳腺癌患者在手术后心电图QT的间期、P波电轴和V5导联的R波较手术前有明显差异。     

模拟深埋条件下持续性挤压伤复合低氧缺水缺食大鼠脾脏的病理损伤

目的研究模拟深埋条件下挤压伤复合3缺大鼠在持续挤压条件下脾脏病理损伤规律和特点。方法雄性Wistar大鼠144只,随机分为对照组、单纯挤压组（单挤组）、低氧缺水缺食组（3缺组）、挤压伤复合低氧缺水缺食组（复合组）,采用钳夹双后肢近端方法建立挤压伤模型（压力为4.5±0.3 kg）。各时间点每组6只,于挤压后1、3、5、7、9、11 d检测静脉血中淋巴细胞百分比,取脾脏,常规制片,进行光镜和电镜观察。结果 （1）复合伤组大鼠于4.2～6.8 d、3缺组于6.5～10.8d全部死亡,其他组活存。（2）复合组淋巴细胞百分比从1 d开始即急剧下降（P〈0.01）,直至动物全部死亡。（3）复合伤组脾脏于伤后1 d即出现细胞凋亡和坏死,累及淋巴细胞、浆细胞、单核巨噬细胞、窦内皮细胞,并随持续时间延长加重和增多,至5 d后尤为显著,并伴有细胞溶解坏死,脾索排列紊乱,单挤组和3缺组依次减轻。结论挤压伤复合3缺大鼠脾脏在挤压后1 d即出现免疫功能和结构损伤,随持续时间延长加重,直至死亡,病变具有高发性、速发性、进行性、不同细胞敏感程度差异性特点     

复合性挤压伤大鼠心肌酶谱及心肌组织结构变化研究

目的探讨模拟深埋条件下挤压伤复合低氧缺水缺食（复合挤压伤）大鼠心肌酶谱及心肌组织学和超微结构的变化规律与特点。方法 Wistar大鼠125只,随机分为对照组、单纯挤压伤组、低氧缺水缺食（3缺）组和复合挤压伤组。经钳夹法作用于双后肢,置入常压低氧舱内,舱内氧浓度为10±0.1%,并禁食水,各组分别于1、3、5、7、9、11 d处死大鼠取材,检测血清肌酸激酶（CK）、乳酸脱氢酶（LDH）、谷草转氨酶（AST）水平,通过光镜和电镜观察大鼠心肌组织结构的变化,TUNEL法观察心肌细胞凋亡情况。结果单纯挤压伤组和复合性挤压伤组大鼠心肌酶谱早期均明显增高（P〈0.01）,以1 d时间点最为显著,此后呈逐渐下降趋势,两组相比较,复合挤压伤组增高更为明显;3缺组AST仅于7 d时一过性增高。复合挤压伤组光镜下,1 d可见心肌纤维肿胀变性、排列紊乱,3～7d加重;电镜可见心肌细胞线粒体肿胀,嵴排列紊乱、断裂,心肌细胞核染色质浓缩边移,核形不规则,部分细胞凋亡;复合挤压伤组心肌细胞凋亡率明显高于其他组。结论复合性挤压伤大鼠心肌酶谱和心肌组织结构均发生明显改变,具有全心性、速发性、进行性和不同部位损伤程度差异性特点。     

恶性肿瘤患者化疗后心电图异常632例

目的对恶性肿瘤患者不同方案化疗后的心电图异常表现进行临床分析。方法回顾性分析恶性肿瘤患者采用不同方案化疗后出现心电图异常的632例临床资料。结果ST—T改变352例（55．70％）,心律失常197例（31．2％）,QRS低电压91例（14．4％）,心肌梗死2例（0．32％）。结论不同化疗方案患者均可发生心电图异常,尤其在方案含有蒽环类药物时更常出现。注意化疗药物的潜在心脏毒性,常规心电图定期检查十分重要。     

心脏淋巴瘤一例

患者男,63岁.2009年10月16日,以"反复胸闷10年,加剧伴气促、水肿10 d"主诉入院.体格检查:心脏相对浊音界略向左下扩大,心率为97次/min,律齐,各瓣膜听诊区无明显病理性杂音,颜面部轻度凹陷性水肿,双下肢中度凹陷性水肿,全身浅表淋巴结无肿大.心电图示:多导联ST段下移,T波低平或倒置.脑钠肽(BNP)3694 pg/ml,乳酸脱氢酶(LDH)2322 IU/L,α-羟丁酸脱氢酶(α-HBDH)1608 IU/L.心脏彩色多普勒超声示:(1)右心房内异常团块回声,大小5.21 cm×1.84 cm,性质待定;(2)三尖瓣口血流速度增快.心脏MRI示:右心房、右心室前壁为中心的恶性肿瘤,大小9.8 cm×8.1 cm ×9.5 cm,并纵隔内多发淋巴结肿大(图1).考虑心脏淋巴瘤可能,但患者病情危重,无法耐受心脏病理活检.     

微波辐射对大鼠心脏窦房结功能的影响

目的观察微波辐射后大鼠心率、心电图(ECG)的动态变化特点,以反映微波辐射对心肌和窦房结功能的影响。方法采用0、5、10和50 mW/cm2的微波源辐射20只二级Wistar雄性大鼠,辐射时间为6 min,分别于辐射前、辐射后即刻、3 d、7 d、14 d、28 d、3 m、6 m采用多道生理记录仪检测大鼠心率和ECG变化。结果 5 mW/cm2组大鼠于辐射后6 m内心率和ECG未见明显异常;10和50 mW/cm2组大鼠心率呈辐射后即刻加快,3 m后减慢的双相改变趋势,且ECG于辐射后即刻出现窦性心律不齐及窦房结内游走性心律;50 mW/cm2组大鼠心电图P波振幅降低。结论 10～50 mW/cm2微波辐射可影响大鼠窦房结功能,且此影响与微波辐射剂量呈正相关。     

极低频电磁场暴露对大鼠脑电图及脑组织结构的影响

目的探讨极低频电磁场对大鼠脑电图及脑组织结构的影响。方法选用二级雄性Wistar大鼠48只,随机分为对照组和磁场暴露组,每组24只,磁场暴露组大鼠置于ELF-EMFS(50 Hz,400μT,<1V/M)中连续暴露60 d。终止暴露后6 h、7 d、15 d和30 d,采用MP150生理监测仪监测脑电图近似熵和功率谱分布;采用光镜观察大脑皮层组织结构。结果 (1)磁场组大鼠脑电图(EEG)于暴露后6 h和7 d,近似熵降低;(2)磁场组大鼠EEG信号于6 h出现δ频段相对功率值呈升高改变,而β频段相对功率值降低;对照组和入场前磁场组大鼠EEG基本节律为30μV左右的β波及少量不典型α波,偶见低幅θ波和δ波,磁场组大鼠θ波和δ波增多以及波幅增加,以β波为主要节律。(3)磁场组大鼠大脑皮层神经元呈缺血性改变。结论极低频电磁场暴露会导致大鼠EEG近似熵降低、功率谱分布异常及脑组织结构损伤,且此改变主要发生于终止暴露后早期。     

主动脉夹层动脉瘤误诊为心肌梗死1例

1病例报告　患者,男,48岁,既往体健.主因突然胸前区憋痛、气促1 d入院.胸前区憋痛时伴左肩部放射痛,大汗淋漓.入院时查血压16/11kPa（120/80mm Hg）急性痛苦面容,唇稍绀,双肺呼吸音粗,未闻及干湿啰音,心律齐,率100次/min,主动脉瓣区可闻二级舒张期杂音,不传导,双下肢不浮肿.心电图示：Ⅱ,Ⅲ,avF,V2～V6导联ST段明显下移.心肌酶谱LDH-L 2 100U/L,ASL 331 U/L,CK-NAC 271 U/L,肌钙蛋白（-）.     

静磁场暴露致大鼠血液流变学异常及多器官血液循环障碍

目的研究静磁场暴露对大鼠血液流变学以及重要器官形态结构的影响。方法雄性Wistar大鼠80只,随机分为对照组、低剂量组（200mT）、中剂量组（400mT）和高剂量组（600mT）。采用中科院电工所研制的超导磁体系统,将大鼠进行全身暴露,3h／d,连续14d。于暴露后1d、7d、14d、28d,3In,检测大鼠血流动力学改变,取脑、心、肺、肝、脾、肾、胸腺、肾上腺、小肠、胰腺,常规病理制片,行光镜和电镜观察。结果（1）磁场暴露后早期,中、低剂量组大鼠全血粘度升高;暴露后中晚期,高剂量组大鼠全血粘度降低。（2）磁场暴露后,大鼠脑、心、肺、脾、肾均见毛细血管充血或间质出血,并见实质细胞不同程度变性、凋亡和坏死。（3）上述病变均于暴露后1-14d呈加重趋势,28d减轻,3m未恢复,且以高、中剂量组较为明显。结论200mT、400mT及600mT中等强度静磁场暴露均导致大鼠血液流变学异常,脑、心、肺、脾、肾多器官血液循环障碍及实质细胞不同程度变性、凋亡和坏死,且与暴露剂量密切相关。     

恶性肿瘤患者化疗前后心电图变化分析

目的探讨恶性肿瘤患者化疗前后体表心电图的改变。方法选取2014年6月至2017年2月间汉阳医院和同济医院收治的700例恶性肿瘤患者,对恶性肿瘤患者采用不同化疗方案(蒽环类和非蒽环类)治疗前后12导联心电图的变化情况进行分析。结果蒽环类化疗方案患者心电图异常发生率为62.0%,明显高于不含蒽环类化疗方案患者的8.2%,差异有统计学意义(P<0.05)。两组患者化疗后Q-Tc间期比化疗前均明显延长,且含蒽环方案患者延长更明显,差异均有统计学意义(均P<0.05)。两组患者化疗后的全部窦性心搏RR间期(SDNN)、24h每5min窦性心搏R-R间期平均值标准差(SDANN)、全部相邻窦性R-R间期差值均方根(RMSSD)、相邻窦性R-R间期差值>50ms心搏数占窦性R-R间期总搏数百分比(p NN50)均比化疗前降低,且含蒽环方案患者降低更明显,差异均有统计学意义(均P<0.05)。结论各种化疗方案均可能产生心脏毒性,含蒽环类化疗方案尤为明显。     

Electrocardiographic and transmembrane potential effects of 5-iminodaunorubicin in the rat

5-Iminodaunorubicin (5-ID) is a quinone-modified anthracycline that retains antitumor activity but lacks the usual redox-cycling effects of quinoid agents. As a test for decreased cardiotoxicity, we have compared the dose- and time-dependent effects of multiple doses of 5-ID and doxorubicin (DXR) on the rat electrocardiogram (ECG) using a signal-averaging process and have related the ECG changes induced by 5-ID to transmembrane potential alterations in myocardial preparations isolated from treated rats. 5-ID was studied at dose levels of 16, 4, and 1 mg/kg, while DXR was given at 4, 2, and 1 mg/kg. At the high- and medium-dose levels, both agents produced widening of the QRS complex, increased R- and S-wave voltage, and prolonged the Q alpha T interval. The QRS widening reversed in all surviving rats, whereas Q alpha T prolongation was reversible with 5-ID but irreversible with DXR. At the lowest dose, 5-ID had no effect on the ECG until the end of treatment. Microelectrode studies on single cells showed that QRS widening occurring with 5-ID treatment was related to a decrease in the maximum rate of depolarization (Vmax) and that Q alpha T prolongation resulted from an increase in the duration of the action potential. Electron microscopic examination showed that although these toxic changes could not be related to specific morphological alterations, in general, the more severe the electrophysiological change, the greater the ultrastructural change. The most consistent ECG change was Q alpha T prolongation. Using this parameter as a marker for cardiotoxicity, 5-ID was about 4 to 5 times less cardiotoxic than was DXR at high- and medium-dose levels and was noncardiotoxic (i.e., below a threshold for cardiotoxicity) compared with DXR at 1 mg/kg over 20 (DXR) to 35 (5-ID) treatments. The decrease in cardiotoxicity relative to DXR is consistent with previous findings that quinone redox cycling is suppressed in 5-ID. However, the ECG and transmembrane potential effects that we identified at elevated doses of 5-ID can be associated with toxic changes in cardiac cell membranes. Therefore, membrane changes other than those due to quinone redox cycling and, presumably, lipid peroxidation must underlie the electrophysiological changes and structural modifications observed with 5-ID in this study. We believe that 5-ID is a useful mechanistic probe in anthracycline cardiotoxicity studies as well as being of obvious interest for clinical trials.     

右丙亚胺对表柔比星诱导大鼠心肌损伤干预机制研究

目的：比较不同剂量右丙亚胺对表柔比星诱导大鼠心肌损伤的干预作用及可能机制。方法：35只SD大鼠随机分5组,每组7只。对照组：于大鼠双侧腹腔分别注射生理盐水5mL/kg,间隔时间为30min,隔日1次,共4次（7d）;模型组（表柔比星＋生理盐水）：大鼠腹腔内注射表柔比星4.5mg/kg,隔日1次,共4次（7d）,注射表柔比星前30min于另一区域腹腔内注射生理盐水5mL/kg;表柔比星＋低、中、高剂量右丙亚胺组：大鼠腹腔内注射表柔比星4.5mg/kg,隔日1次,共4次（7d）,注射表柔比星前30min于另一区域腹腔内注射右丙亚胺45、67.5和90mg/kg,隔日1次,共4次（7d）。处死大鼠后检测各组大鼠心肌组织微量丙二醛（MDA）含量、总超氧化物歧化酶（T-SOD）活性、血浆乳酸脱氢酶（LDH）及肌钙蛋白I（cTnI）水平,观察心肌组织病理形态学改变及心肌细胞凋亡情况。结果：模型组较对照组SOD活性降低,分别为（75.10±5.14）和（101.81±13.21）U/mL,F=5.7,P=0.00;MDA含量升高,分别为（13.60±2.88）和（5.28±3.14）nmol/mg,F=7.31,P=0.00;血浆LDH升高,分别为（5.27±0.58）×103和（2.23±0.47）×103 U/L,F=23.7,P=0.00;cTnI升高,分别为（483.38±52.07）和（264.16±52.07）ρg/mL,F=20.13,P=0.00;心肌细胞病理评分升高,分别为2.70±0.20和0,F=8.65,P=0.00;凋亡指数明显升高,分别为（66.54±3.46）%和（1.55±0.74）%,F=126.86,P=0.00。而加用右丙亚胺各组均较模型组提高SOD活性,降低MDA、血浆LDH及cTnI含量,减少心肌病理评分及心肌细胞凋亡指数,P〈0.01或P〈0.05。结论：右丙亚胺对表柔比星诱导的大鼠心肌损伤有保护作用,其机制可能与减少氧自由基的产生、降低脂质过氧化物含量以及调节心肌细胞凋亡机制有关。     

Relationship between doxorubicin-induced ECG changes and myocardial alterations in rats

The aim of the present study was to evaluate the dose- and time-dependence of the effect displayed by doxorubicin (DXR) on the electrocardiogram (ECG) and to establish the relationship between structural alterations of the myocardium and ECG changes in rats administered DXR, at a dose of 1.5 or 3.0 mg/kg, every 3 days for a total of three administrations. The most interesting findings consisted of a dose-dependent, but reversible prolongation of the QRS complex, and in a dose-dependent and progressive irreversible increase in QaT and, in particular, in SaT duration. Furthermore, animals treated with the higher DXR dose showed a slight increase in serum K+ concentration and a significant decrease in serum Ca2+ levels. A good correlation was found between the morphologic score indicating the degree of observed tissue damage and SaT prolongation. These results therefore support the usefulness of measuring this ECG parameter for monitoring the development of DXR-induced cardiotoxicity in rats.     

A study of electrocardiographic changes in congenital deaf school children

Background

There is evidence of cardiac abnormalities in congenital deaf school children, together called as Jervel Lange Nielsen syndrome or Long QT syndrome.

Aim

The main aim was to study the electrocardiographic changes in congenital deaf children.

Materials and Methods

Fifty congenital deaf children aged 6–18 years were selected. ECG was taken in lead II, at rest and after exercise, as some are known to exhibit the abnormality after exercise. The child was made to run on the Tread mill till exhaustion. Corrected QT interval (QTc) was Calculated by Bazett’s formula QTc = QT/ √R-R. ECG was also analyzed for other abnormalities like Twave changes, ST depression, rhythm abnormalities etc.

Results

Out of 50, 2 children showed resting QTc of 0.45 sec which is diagnostically high. Mean value of QTc in deaf children(Cases) before exercise was 0.4111 ± 0.0271 sec and in controls 0.379 ± 0.020 sec. Mean value of QTc after exercise in deaf(cases) was 0.403 ± 0.028 sec and in controls 0.376 ± 0.021 sec. Eight deaf children showed ST depression and 2 biphasic T and 2 notched T waves. Thirty-three deaf children’s parents had consanguineous marriage.

Conclusion

The results were explained on the basis of ion channellopathy in heart and inner ear which predisposes to sensorineural hearing loss and cardiac abnormality.     

肿瘤康复乐园对肿瘤放化疗患者焦虑抑郁情绪的影响

目的观察在医院组织肿瘤康复乐园对肿瘤放化疗患者焦虑情绪的影响。方法选择2013年6月至2013年12月间收治的160例肿瘤患者作为研究对象,均行放化疗治疗,按照数字随机法分为两组,每组80例,对照组采取常规护理模式,观察组在对照组基础上定期举办肿瘤康复乐园活动,比较两组患者疗效差异及情绪变化。结果观察组入院后Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)评分分别为(39.1±4.1)分、(42.1±5.1)分,均低于对照组(51.2±4.3)分、(57.9±4.9)分,差异有统计学意义(P<0.05);两组入院后SAS评分、SDS评分与入院时比较均有明显统计学差异(P<0.05);经比较,观察组日常生活质量相关指标睡眠状况、精神状况、饮食情况、心理状况评分,分别为(4.67±0.66)分、(4.26±0.72)分、(4.43±0.87)分、(4.42±0.77)分,均优于对照组(P<0.05);观察组满意度评分为(9.34±0.45)分,明显高于对照组(7.31±0.49)分(P<0.05)。结论肿瘤康复乐园可缓解肿瘤放化疗患者焦虑情绪,对其心理状态好转具有重要价值。     

OLETF大鼠肺泡上皮细胞基板的超微结构改变与定量检测

目的观察自发性2型糖尿病OLETF（Otsuka Long—Evans Tokushima Fatty）大鼠肺泡上皮细胞基板的超微结构改变。方法用透射电镜观察、图像分析仪及形态计量学方法计算OLETF及对照的LETO（Long—EvansTokushimaOtsuka）大鼠肺泡上皮细胞基板的超微结构及厚度。结果与LETO组大鼠相比,OLETF组大鼠肺泡毛细血管内皮细胞基板与I型肺泡上皮细胞基板融合部及Ⅱ型肺泡上皮细胞基板均增厚（分别为110．6±14．14US．57．3±11．08和116．4±10．22vs．71．89±7．68,P〈0．01）。结论OLETF大鼠肺泡上皮细胞基板增厚,提示可能与糖尿病高血糖环境引起毛细血管基板成分发生改变有关。     

Drug-induced QT interval prolongation in cancer patients

Cancer patients are at an increased risk for QT interval prolongation and subsequent potentially fatal Torsade de pointes tachycardia due to the multiple drugs used for treatment of malignancies and the associated symptoms and complications. Based on a systematic review of the literature, this article analyzes the risk for prolongation of the QT interval with antineoplastic agents and commonly used concomitant drugs. This includes anthracyclines, fluorouracil, alkylating agents, and new molecularly targeted therapeutics, such as vascular disruption agents. Medications used in the supportive care can also prolong QT intervals, such as methadone, 5-HT₃-antagonists and antihistamines, some antibiotics, antifungals, and antivirals. We describe the presumed mechanism of QT interval prolongation, drug-specific considerations, as well as important clinical interactions. Multiple risk factors and drug–drug interactions increase this risk for dangerous arrhythmias. We propose a systematic approach to evaluate cancer patients for the risk of QT interval prolongation and how to prevent adverse effects.     

经皮球囊扩张椎体后凸成形手术治疗骨质疏松性椎体压缩性骨折及椎体肿瘤

目的探讨经皮球囊扩张椎体后凸成形手术治疗骨质疏松性椎体压缩性骨折和椎体肿瘤的临床疗效。方法回顾性分析2010年1月至2011年12月间45例经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折和椎体肿瘤患者的临床资料。结果治疗前视觉模拟评分法(VAS)、活动能力评分、前缘椎体高度、后缘椎体高度、Cobb's角度分别为(8.5±11.4)分、(3.2±0.7)分、(17.7±1.6)mm、(19.8±1.2)mm、(30.8±3.1)度。治疗后VAS评分、活动能力评分、前缘椎体高度、后缘椎体高度、Cobb's角度分别为(2.3±0.6)分、(1.4±0.3)分、(22.5±0.9)mm、(23.7±1.1)mm、(6.7±0.7)度。治疗前后与治疗后VAS评分、活动能力评分、前缘椎体高度、后缘椎体高度、Cobb's角度的数据比较,差异有统计学意义(P<0.05)。治疗过程中所有患者均得到较好的康复,并且无神经功能症状和感染以及血管栓塞等并发症发生。结论临床中采取经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩性骨折和椎体肿瘤效果显著,有效的提高患者临床治疗有效率,并且创伤也比较小,术后恢复也比较快,并发症也较少,有效的改善椎体高度,值得临床中应用与推广。