DDD起搏治疗缓慢型心律失常的临床分析

目的 探讨DDD起搏在缓慢型心律失常中的临床疗效与安全性。方法 4年中28例缓慢型心律失常的住院患者,均安装DDD型心脏永久性起搏器。结果 28例患者均手术成功,术中测得心室起搏阈值(0.45±0.19)V,阻抗(714±168)ohm,R波振幅(13.5±4.0)mV,右心房起搏阈值为(0.71±0.25)V,阻抗(687±192)ohm,P波振幅(4.5±1.7)mV。A-V间期程控在120～200 ms之间,下限频率程控为60～70 bpm,上限频率程控于100～130 bpm之间。随访3～46个月,所有患者的生活质量明显改善(P<0.05),无起搏器并发症发生。结论 生理性起搏(包括DDD起搏)可获得接近于正常的的血液动力学效应,改善心功能。对有适应症的起搏器患者应首先推荐使用生理性起搏器,如DDD型。     

运动疗法联用二甲双胍对135例肥胖糖耐量减低及代谢干预作用

目的：评价运动疗法联用二甲双胍对肥胖糖耐量减低干预作用。方法：将肥胖糖耐量减低人群随机分成治疗组135人，给予有氧代谢运动——步行；每天快步走3000m，30min以上，每周运动5次，口服二甲双胍（745±26）mg／d。对照组125人，口服月见革油胶丸（2800±120）mg／d，po。随访1～1．5年，观察2组治疗前后空腹血糖、口服葡萄糖耐量试验（OGTT）、糖脂代谢和胰岛素敏感性差异。结果：治疗组糖耐量减低明显提高，2组间明显差异[空腹血糖（5．4±0．8）mmol／Lvs5（6．2±0．5）mmol／L，P〈0．05；OGTT（6．3±1．6）mmol／L v（9．2±-1．3）mmol／L，P〈0．05，治疗组体重指数、腰围、游离脂肪酸低于对照组[（26．2±1．8）kg／m^2 vs（28．3±1．5）kg／m^2,P〈0．05；（92±7）cm vs（95±6）cm，P〈0．05；（547±183）μmol／L vs（619±197）μmol／L，P〈0．05]，胰岛素敏感性明显改善（51±12 vs 46±3,P〈0．05）。结论：运动疗法减轻肥胖，使血中游离脂肪酸减少，增加胰岛素敏感性，提高糖耐量；二甲基双胍改善胰岛索敏感性通过降低甘油酯、游离脂肪酸发挥作用。二者均减重效应，增加胰岛素敏感性，达到协同作用。建议扩大在社区中预防肥胖糖耐量异常的人群．以防发展成2型糖尿病。     

放射性核素显像无创伤性测定门静脉压力

目的：应用核素显像测定肝硬化病人心、肝放射比值（H／L），建立无创伤性测量门静脉压力（PVP）的方程。方法：21例非肝病患者做为对照及81例肝硬化门静脉高压症患者经直肠注入99mTc－MIBI后或行心肝显像，计算其H／L及分流率（SI）。21例非肝病患者及51例门静脉高压症患者经历手术，术中直接测定门静脉压力，并与术前H／L做相关分析。结果：非肝病患者H／L为0．29±0.12，门静脉高压症患者H/L为0．88±0．12（P＜0．01）．SI值分别为0．22±0．07，及0．47±0．O4（P＜0．01），两组患者H／L与术中实测PVP有高度相关性（r=0.89，P＜0．01），根据H／L建立推算PVP的回归方程为Y（kPa）=（0．951＋2．882）H／L，由此推算该51例门静脉高压症患者PVP为（3．45±O．37）kPa，而术中实测值为（3．61±0．44）kPa，两者非常接近，结论：应用核素显像测定H/L引可以用于诊断门静脉高压症，应用本法建立的方程可用于肝硬化病人门静脉压力的无创性测定。     

大鼠微血栓形成对内皮细胞功能的影响

静脉注射高分子右旋糖酐复制大鼠微循环障碍动物模型。观察肠系膜微循环，计数循环内皮细胞（CEC），测定血浆内皮素（ET），内皮源性舒血管内子（EDRF）水平，对心内膜，主动脉，肠系膜微血管进行病理学检查，发现肠系膜微血管内血流缓慢，血细胞聚集成团，有微血栓形成，微血栓K值（22．95±3．3）明显低于对照组（3．04±0．81）；心，血管内膜缺损；CEC计数，血浆ET，EDRP水平分别为13．70±7．82（个／0．9μl),160．42±10．70（ng/L)和3．48±0．34（μmol/L)，与对照组5．33±2．34（P＜0．01），123．10±11．74（P＜0．0001）和4．08±0．44（P＜0．05）比较有显著性差异。提示；微血栓形成不仅导致微循环障碍，还导致内皮细胞损伤，功能障碍，促进血小板粘附，聚集和血栓形成，可能是伴有微血栓形成的冠心病病人心肌梗塞发生率高的重要因素。     

不同起搏方式及右室起搏比例不同对缓慢型心律失常患者心功能及新发房颤影响的随访分析

目的：探讨不同起搏方式及右室起搏比例不同对缓慢型心律失常患者新发房颤（atrial fibrillation,AF）及心功能的影响。方法我院心内科过去5年间植入永久起搏器的患者,按照起搏模式不同分为VVI、DDD组,根据右室起搏比例（Cum％VP）不同分为：DDD1组（Cum％VP≥50％）和DDD2组（Cum％VP＜50％）两个亚组。随访内容包括起搏器植入术前、术后3年心电图和动态心电图,AF发生情况,超声心动图参数。结果符合入选标准且完成随访的患者共计147例,新发AF病例VVI组14例（24．14％）,DDD1组5例（11．11％）,DDD2组3例（6．82％）。DDD2组与VVI组比较,差异有统计学意义（P＝0．03＜0．05）。术后3年超声参数比较,DDD2组与VVI组、DDD1组相比,LAD、LVED明显缩小,LVEF则明显升高,差异有统计学意义（P＜0．05）。结论DDD起搏模式加低右室起搏比例与VVI模式相比,可明显改善患者的心功能,且减少AF的发生,DDD起搏模式加最优右室起搏管理应用于临床可能给患者带来更多的收益。     

缺血预适应与缺血后适应现象对急性心肌梗死急症介入治疗后的影响

目的研究梗死前心绞痛（缺血预适应）与缺血后适应对急性心肌梗死患者介入治疗后冠状动脉血流速度及预后的影响。方法选取12h内接受急症冠状动脉介入治疗的心肌梗死患者96例,分为3组,有梗死前心绞痛症状者为预适应组（35例）,接受缺血后适应干预者为后适应组（32例）、单纯再灌注组29例,测定校正心肌梗死溶栓帧数（CTFC）、血肌酸磷酸激酶（CK）、肌酸磷酸激酶同工酶（CK—MB）、丙二醛,术后8周测定室壁运动记分。结果缺血预适应组与后适应组的CTFC（27±6,27±6）明显快于单纯再灌注组（31±7,均P〈0．05）,CK峰值与CK—MB峰值明显低于单纯再灌注组（1242U／L±801U／L,1237U／L±813U／LV81697U／L±966U／L,均P〈0．05）;122U／L±78U／L,117U／L±76U／LV8172U／L±93U／L,P〈0．05）;各组患者入院时丙二醛均高于对照组,术后各时点缺血预适应组与后适应组均低于单纯再灌注组。术后8周缺血预适应组与后适应组室壁运动恢复优于单纯再灌注组（1．2±0．2,1．2±0．2V81．4±0．3,P〈0．05）。结论缺血后适应与预适应一样可以改善介入治疗后冠状动脉血流速度,减少自由基的生成,改善心功能。     

老年心房颤动病人行房室结消融联合永久起搏器治疗的长期疗效观察

目的: 探讨对老年快速性心房颤动病人进行房室结消融联合人工心脏永久起搏器治疗，观察术后生
活质量、心功能的改变。方法: 对12 例老年心房颤动伴快速心室率病人阻断房室结致III 度房室传导阻滞后植
入心脏永久起搏器。随访观察病人的生活质量、心室重塑、心功能改善情况。结果: 随访1 a，病人的临床症状、
心功能明显改善，左室射血分数提高( 0． 53±0． 03 vs 0． 33±0． 06，P＜0． 01) ; 左室舒张末期内径减少不明显( 61． 6
±3． 7mm vs 65． 3±4． 1mm，P＞0． 05) ; 6min 步行距离和SF－36 量表较治疗前均有明显改善( P＜0． 05) 。结论: 对老
年快速性心房颤动病人进行房室结消融联合人工心脏永久起搏器治疗能改善病人的心功能、生活质量。     

孟鲁司特对反复呼吸道感染患者炎症相关指标水平的影响

目的观察孟鲁司特对反复呼吸道感染患者鼻咽抽吸物及血清炎症指标的影响。方法选择2012年7月至2015年6月周口市中心医院收治的82例反复呼吸道感染患者,按照随机数字表法分为观察组与对照组,各41例。两组患者均给予常规基础治疗,观察组加用孟鲁司特治疗,监测治疗前后两组患者免疫球蛋白指标IgA、IgE、IgG,炎症因子IL－2、IL－4、IL－5、肿瘤坏死因子－α（ TNF－α）、干扰素－γ（ IFN－γ）及中性粒细胞、淋巴细胞、单核巨噬细胞、嗜酸性粒细胞、白三烯D4（ LTD4）水平,比较两组免疫功能的改善及炎症水平的变化。结果①治疗后,观察组中性粒细胞、嗜酸性粒细胞、LTD4低于对照组[（3.78±0.16）×109／L、（0.52±0.71）×109／L、（190.32±92.14）pg／mL vs （4.14±1.13）×109／L、（0.83±0.66）×109／L、（234.62±88.43）pg／mL],单核巨噬细胞高于对照组[（2.25±0.93）×109／L vs （1.86±0.79）×109／L],差异均有统计学意义（P＜0.05）;②治疗后,观察组IgA、IgG高于对照组[（0.76±0.10） g／L、（0.39±0.06） g／L vs （0.69±0.11） g／L、（0.31±0.04） g／L],IgE低于对照组[（0.17±0.03） g／L vs （0.21±0.03）g／L],差异均有统计学意义（P＜0.05）;③治疗后,观察组IL－2、IFN－γ高于对照组[（260.71±18.62）pg／mL、（22.06±2.33）pg／mL vs （220.55±20.41）pg／mL、（15.38±5.98）pg／mL],IL－4、IL－5、TNF－α低于对照组[（11.06±8.06）pg／mL、（13.42±7.55）pg／mL、（7.55±1.02）pg／mL vs （20.04±12.22）pg／mL、（24.52±11.23）pg／mL、（14.33±2.18）pg／mL],差异均有统计学意义（ P＜0.05）;④观察组治疗总有效率为78.05％,高于对照组的56.10％（ P＜0.05）。结论采用孟鲁司特治疗反复呼吸道感染患者,治疗有效率高,患者血清炎症因子改善显著。     

吸入NO治疗急性缺氧性肺动脉高压的实验研究

了解NO吸入治疗急性缺氧性肺动脉高压的效果以及不同模式吸入NO对血流动力学的影响。给10条杂种犬吸入12％氧和88％氮混合气建立缺氧性肺动脉高压的动物模型，采用自身对照法，观察吸入（25—30）×10－6NO前后血流动力学的变化以及换用不同通气模式对以上各指标的影响。吸入12％氧和88％氮混合气30min后平均肺动脉压上升至基础值的206.13％，吸入NO1～2min内平均肺动脉压开始下降，5min后处于稳定状态，从（2.02±0.99）kPa降至（1．23±0．35）kPa（P＜0．02），基本恢复至缺氧前的基础值。在此过程中心输出量从（1．35±0．62）L／min至（1．34±0．62）L／min（P＞0.05）、体循环阻力从（1075.02±565．08）（kPa·S）/L至（1072.85±525．30）（kPa·s）／L（P＞005）均无明显改变。此外，在不同通气模式中（间歇正压通气-IPPV、双水平气道正压通气-BiPAP、压力释放通气-APRV、反比通气-IRV）配合吸入NO均可观察到以上现象，各模式之间相互比较对血流动力学的影响基本无差别。吸入NO可以选择性降低急性缺氧性肺动脉高压而不影响心输出量、系统循环阻力，不同通气模式并不影响NO的上述作用。     

肝硬化门静脉血流方向与血浆胰岛素水平的关系

通过直、间接门静脉造影确定28例肝硬化门静脉高压患者。向肝性血流组5例，双向性血流组8例和远肝性血流组15例，其血浆胰岛素值分别为22．4±6．2％μm／ml，24．3±8．3μm／ml和26．4±10．3μm／ml。其中远肝性血流组中10例患者血浆胰岛素值超过28．5μm／ml，平均为31．2±5．2μm／ml，它与向肝性血流组有显著差异（P＜0．05），所以证明血浆胰岛素增高与门静脉血流方向（分流多少）呈正向关性。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.