α-干扰素治疗小儿呼吸道合胞病毒肺炎31例临床疗效分析

我科对1988年2月至1989年6月收治的支气管肺炎患儿,经单克隆抗体荧光检测RSV阳性的65例,随机分组应用α-干扰素治疗,临床取得满意效果,现报告如下。     

更昔洛韦治疗婴儿肝炎综合征的临床研究

目的了解婴儿肝炎综合征的人巨细胞病毒 (CMV)感染情况 ;探讨更昔洛韦治疗CMV肝炎的临床效果。方法对 117例临床诊断婴儿肝炎综合征患儿进行血清HCMV IgM和CMV DNA(PCR法 )检测 ;将HCMV IgM或CMV DNA阳性的患儿随机分成两组 ,对照组给予病毒唑 [10～ 15mg/(kg·d) ,静滴 ,10～ 14天 ],治疗组给予更昔洛韦 [5～7.5mg/(kg·d) ,静滴 ,10～ 14天 ],其余对症治疗相同 ;观察患儿CMV感染转阴率及临床症状缓解情况。 结果①婴儿肝炎综合征患儿CMV感染率是 4 1.88% ;②治疗组CMV感染总转阴率 (85 .71% )明显高于对照组 (30 .4 3% ) ;③治疗组总有效率 (85 .19% )明显高于对照组 (31.82 % ) ;④治疗组血清胆红素恢复正常时间是 (13.4 8± 11.0 3)天 ,对照组是(2 4 .0 8± 7.34)天 ,丙氨酸氨基转移酶恢复正常时间是 (34.4 8± 11.0 3)天 ,对照组是 (48.6 7± 9.11)天 ,治疗组临床症状恢复正常时间明显短于对照组 ;⑤治疗组不良反应率 (33.33% )与对照组 (2 7.2 7% )比较无显著性差异。结论更昔洛韦治疗婴儿肝炎综合征安全、有效。     

三维电解剖标测指导疑难右侧游离壁旁路的导管消融

Objective To demonstrate the electroanatomic substrates of right-sided free wall (RFW)accessory pathways (APs) which were refractory to conventional catheter ablation utilizing three-dimensional (3D) mapping. Methods Seventeen patients with RFW APs that failed initial conventional catheter ablation(s)by a mean of 1～3(1.8±0.6) attempts were enrolled in the study. Electroanatomic mapping of the right atrium was performed during right ventricular pacing in 14 patients and orthodromic reciprocating tachycardia in 3patients. Radiofrequency energy was delivered via irrigation catheter to the earliest atrial activation site. Results The earliest atrial activation site, which represented the atrial insertion of the APs, was separated from the tricuspid annulus by an average of 9 ～ 20 ( 13.6 ± 3.4 ) mm, and the local activation time was 18 ～ 80(31.5±16.3) ms earlier than that of the corresponding annular point. The target electrogram demonstrated AP potential in fourteen patients and ventriculoatrial fusion in the rest three. Accessory pathway was blocked in one case during moving the catheter and RF ablation delivery on the areas. One patient exhibited an AP with wide branching on the atrial side during mapping. RF ablation with an irrigated catheter successfully interrupted AP conduction in remaining 16 patients without complications. After a mean follow-up of 3 ～ 41 (18.6±12.7) months, there were no recurrences of ventricular preexcitation or episodes of tachycardia. Conclusion RFW APs refractory to conventional catheter ablation might be due to unique anatomic AP features such as more epicardial course at the annulus level with atrial insertion distance from the tricuspid annulus. Electroanatomic mapping is helpful to accurately localize the atrial insertion sites of these APs and facilitates catheter ablation.     

碎裂QRS波在致心律失常性右心室心肌病诊断中的价值

Objective To evaluate diagnostic value of fragmented QRS complex (fQRS)in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods Forty-three patients [33 men, aged (40. 4 ± 13.9)years]meet the ISFC/ESC diagnostic criteria for ARVC were enrolled in this study. A standard twelve-lead electrocardiogram was obtained during the resting status. Characteristics of fQRS were detailedly studied by three doctors independently. A comparison of the prevalence among fQRS, epsilon wave and T wave inversion( TWI )in the right precordial leads exceeding V3 was done. Results Most fQRS could be found in the inferior leads (44. 3% ) and the right precordial leads (24. 2% ). Within the QRS complex, the prevalence of fQRS in the R wave was significantly higher than it in the S wave(58. 4% vs 32. 9% ,Z =4. 30,P ＜0. 01 ).fQRS could be found in a total of 31 of 43 cases( mean 4. 6 ± 1.7 ( range 2 to 9) per patient). The prevalence of fQRS was significantly higher than that of epsilon wave ( 73.8% vs 30. 2%, Z = 3.67, P ＜ 0. 01 ) and TWI (73.8% vs41.9% ,Z =2. 61 ,P＜0. 01 ). Conclusion fQRS was a common electrocardiographic abnormality,and most was found in the inferior and right precardial leads in patients with ARVC. It may be used as an important noninvasive preliminary screening electrocardiographic criteria.     

磁导航遥控射频导管消融治疗房室结折返性心动过速的初步体会

Objective To evaluate the safety and feasibility of remote radiofrequency catheter ablation of atrioventricular nodal reciprocating tachycardia (AVNRT) using the magnetic navigation system (MNS). Methods A total of 37 patients[female 29, mean age (44 ± 15 )years]with documented AVNRT were enrolled in this study from March 2007 to June 2009. A 4 mm tip magnetic mapping and ablation catheter ( Helios Ⅱ ,Stereotaxis, USA),which was remotely controlled by the MNS (Niobe Ⅱ , Stereotaxis, USA), was used for both mapping and ablation. Conventional slow pathway modification with focal ablation at the fight posterior septum was first performed in all patients. If it was failed, linear lesions at the base of Koch' s triangle was then done. Results After ablation, AVNRT was non-inducible in all 37 patients without any complication except one case experienced transient first degree AV block. Focal ablation was performed in 34 patients, and linear ablation strategy was used in the remaining three cases to achieve the end point. Among all the 37 patients, slow pathway ablation was achieved in 14, whereas slow pathway modification was reached in the remaining 23 cases.The mean procedural time, the RF deliveries, the duration of RF application were ( 120 ± 32) min, (2. 9 ± 1.6)times, ( 130 ± 33 )s,respectively. The total fluoroscopy time and the physician X-ray exposure time were(5.3 ±2. 7)min and(2.9 ± 1.1 ) min,respectively. There was no significant change of the AH interval,the HV interval,and the atrioventricular nodal conduction refractory period after ablation. Compared with the first 18 patients, the mean procedural time, the total fluoroscopy time and the X-ray fluoroscopy time during magnetic navigation were significantly decreased in the later 19 patients (P ＜0. 001 ). It indicated that the learning curve of remote catheter ablation using the MNS is short. Conclusion Remote catheter ablation using the MNS to cure AVNRT is safe and effective with short learning curve and decreasing X-ray exposure time for interventional physicians.     

起源于左侧希氏-浦肯野系统的特发性加速性室性自主心律

目的 介绍起源于左侧希氏-浦肯野系统的特发性加速性室性自主心律,揭示其临床特征并探讨可能的电生理机制.方法 回顾分析4例特发性加速性室性自主心律患者的心电图形态特征、临床表现、治疗方法及预后.结果 4例患者,男性2例,平均年龄48(40～54)岁,均无器质性心脏病.室性自主心律均呈右束支阻滞型,其QRS时限0.11～0.13 s,符合左侧希氏-浦肯野系统起源,其中3例电轴右偏,1例电轴左偏.自主心律RR间期不规则,平均频率为87(55～110)次/min,与窦性心律交替出现.所有患者临床均表现为发作性心悸.1例患者室性自主心律在短期服用普罗帕酮后消失,另1例短期服用维拉帕米后消失,余2例未予以特殊处理后自然消退.平均随访4.5(2～8)年,临床无心律失常发作,亦无其他心血管事件发生.结论 起源于左侧希氏-浦肯野系统的加速性室性自主心律是左侧希氏-浦肯野系统特发性室性心律失常的一种表现形式,多数为自限性,临床呈良性经过.     

红霉素在喂养不耐受新生儿中应用

新生儿常存在喂养不耐受现象 ,促胃肠动力的药物可改善喂养。近年国外研究发现红霉素对胃肠有促动力作用 ,但国内对此报道少见。本研究就口服红霉素对新生儿喂养不耐受的临床治疗效果进行初步评价 ,以期为新生儿喂养不耐受的治疗提供临床资料。资料与方法一、临床资料１．对象 :为１９９８年１１月～２０００年１２月住院新生儿 ,符合标准６１例。随机分２组 ,治疗组３１例 ,男１９例 ,女１２例 ;对照组３０例 ,男１５例 ,女１５例。基础疾病包括 :窒息２９例 ,早产儿１８例 ,足月小样儿７例 ,胎粪吸入综合征４例 ,败血症３例。２．诊断标准…     

儿童脑性瘫痪综合治疗方法的探讨

目的 :探讨综合治疗小儿脑性瘫痪的疗效 ,旨在减轻脑瘫患儿的伤残程度。方法 :采用药物治疗、穴位注射、经络导平、功能锻炼、高压氧治疗。结果 :经综合治疗 ,患儿基本治愈率 2 7.9% ,显效率 5 1.5 % ,有效率 14 .7% ,无效率5 .9% ,总有效率 94.1%。结论 :早期诊断及多方面综合治疗 ,可明显减轻小儿脑性瘫痪的伤残程度 ,促进患儿正常发育。     

三维电解剖标测指导器质性心脏病室性心动过速导管射频消融的初步经验

器质性心脏病室性心动过速（室速）是一临床顽疾，也是导管射频消融治疗的难题。在上世纪九十年代，心肌梗死后室速和致心律失常性右室心肌病（ARVC）室速的成功标测与消融充分揭示了此类室速的电生理机制。目前认为，绝大多数器质性心脏病室速是瘢痕相关性的折返性心动过速，其缓慢传导区常位于瘢痕内部，入口和出口位于瘢痕边缘。     

心房颤动消融术后二尖瓣峡部房性心动过速的发生机制及消融治疗

目的探讨心房颤动(简称房颤)患者环肺静脉左房线性消融术后二尖瓣峡部房性心动过速(简称房速)的发生机制及其消融策略。方法122例房颤患者采用EnSite-NavX和环状电极行环肺静脉左房线性消融,术后32例复发房颤或房速,8例经EnSite-NavX激动标测及拖带标测证实存在二尖瓣峡部房速,在三维导航下于左下肺静脉口部下缘至二尖瓣环之间行线性消融,对不能成功阻断二尖瓣峡部传导者予以冠状静脉窦内消融。术中同时探查双侧肺静脉电位,如传导恢复予以再次隔离。结果8例中2例呈无休止性发作,6例为阵发性,可被程序刺激诱发。房速的周长217.5±20.6ms,其中顺钟向折返5例,逆钟向折返3例。二尖瓣峡部线性消融至完全性双向传导阻滞5例,3例心内膜途径失败者经冠状静脉窦内消融,其中1例获得成功。术后随访5.5±4.3个月,6例无房颤及房速发作,1例仍有阵发性房速发作。另1例术后房速呈无休止发作,予以胺碘酮及美托洛尔控制心室率治疗。结论环肺静脉线性消融术后发生的二尖瓣峡部房速与左房线性消融治疗房颤的致心律失常作用有关,其主要的机制是消融线相关的大折返性心动过速,阻断峡部传导可以治疗此类房速。