新型血管缝合器Starclose在老年冠状动脉介入术中的应用

目的评价Starclose血管缝合器在老年冠状动脉介入诊疗术中使用的安全性和疗效。方法204例老年冠脉介入诊疗术后患者,110例应用Starclose缝合器止血(缝合组),94例应用手工压迫止血方法止血(对照组),分别记录止血时间、下肢制动时间和手术相关并发症。结果缝合组与对照组的止血成功率无统计学差异(P>0.05);缝合组的止血时间及下肢制动时间明显较对照组缩短(P<0.01);对照组手术相关并发症发生率明显高于缝合组(P<0.05)。结论Starclose血管缝合器在老年冠状动脉介入诊疗中具有良好的临床效果和安全性。     

BiPAP无创通气治疗慢性肺心病合并Ⅱ型呼吸衰竭的临床观察

目的探讨BiPAP无创呼吸通气治疗慢性肺心病合并Ⅱ型呼吸衰竭的临床疗效。方法将68例慢性肺心病合并Ⅱ型呼吸衰竭的住院患者随机分为两组,对照组(n=34)予以常规综合治疗,治疗组(n=34)在常规综合治疗的基础上加用BiPAP无创呼吸通气治疗,3d后对两组患者的血气分析、心率、呼吸频率及临床症状等进行比较,并统计患者住院天数及病死率。结果无创通气干预3d后,治疗组血SaO2、pH值、PaO2、PaCO2分别为94.3%、7.36、82.1mmHg、49.6mmHg,其改善程度明显优于对照组(89.0%、7.31、72.8mmHg、58.9mmHg),P<0.05。治疗组住院天数(13d)及病死率(2.9%)明显短于或低于对照组(分别为21d和11.8%),P<0.01。结论无创通气治疗,能有效改善患者血气分析指标及临床症状,提高救治成功率,缩短住院时间。     

早期经鼻气管插管对高血压脑出血患者微创治疗后肺部感染的影响

目的研究早期经鼻气管插管对高血压脑出血患者微创治疗术后肺部感染发生率、ICU治疗时间的影响。方法选取58例2007年9月-2009年5月间于我院急诊科就诊并拟行微创治疗的高血压幕上型脑出血患者。根据GCS评分分层后进行随机分组,处理组于就诊时予以早期经鼻气管插管经人工鼻吸氧,对照组予以鼻导管或面罩吸氧,观察术后72h肺炎并发症发生率及ICU治疗时间,研究数据选取Fisher确切概率法及成组t检验方法进行统计分析。结果不管在GCS评分13～15分或6～12分的高血压脑出血患者中,早期插管组与对照组在术后肺炎发生率方面的差异无统计学意义(GCS13～15:21.4%vs35.7%,P=0.6776;GCS6～12:60%vs80%,P=0.2678),但在ICU治疗时间方面早期插管组较对照组明显缩短,两者间差异具有显著统计学意义(GCS13～15:4.9dvs6.9d;GCS6～12:8.2dvs10.3d,P<0.01)。结论对于高血压脑出血拟行微创治疗的患者行早期经鼻气管插管可明显减轻术后肺部并发症,减少ICU治疗时间,减轻患者经济负担,促进康复。     

半导体激光联合电针及康复干预治疗周围性面神经炎的疗效观察

目的:观察半导体低强度激光联合电针及康复干预治疗周围性面神经炎的临床疗效。方法:将急性周围性面神经炎患者76例,随机分成对照组和观察组各38例。对照组给予电针加早期康复干预;观察组在此基础上加用半导体激光仪照射治疗。评价治疗前后两组患者面神经功能及治疗后其临床疗效。结果:干预3周后,两组患者面神经功能评分均比治疗前明显提高(P<0.05);且观察组更高于对照组(P<0.05);干预后,两组疗效有显著差异(P相似文献   

老年骨折患者便秘的预防及护理

目的:探讨老年骨折患者便秘的预防措施,减少便秘的发生.方法:将45例老年骨折患者随机分为对照组23例和实验组22例.对照组实施骨科常规护理,实验组除实施骨科常规护理外,加强健康教育、心理护理、饮食护理、指导患者适当的运动及适当的辅助用药.结果:实验组便秘的发生率远远低于对照组(P<0.05).结论:恰当的健康教育、心理...     

癫痫发作对颅内肿瘤患者心理的影响

目的了解癫痫发作对颅内肿瘤患者心理状态的影响。方法采用90种症状自评量表(Symptom Checklist 90,SCL-90)对130例颅内肿瘤患者进行心理状态调查,其中观察组(伴癫痫发作者)60例,对照组(不伴癫痫发作者)70例,进行量化分析与评价。结果观察组心理状态7项因子(人际关系敏感、敌对除外)的评分均高于对照组(P<0.05);其中尤以焦虑、抑郁两项差异最为显著(P<0.01)。结论颅内肿瘤患者伴癫痫发作者的心理状态评分明显低于不伴癫痫发作者。     

老年男性心室流出道室性早搏的临床特点及与冠心病的关系

目的探讨老年男性频发流出道室性早搏心电图特征及与冠心病的关系。方法回顾性分析111例检出频发室性早搏患者的24h动态心电图,分析起源于心室流出道室性早搏的QRS波群特征及所占比例。结果111例频发室性早搏中45例起源于心室流出道,41例为非流出道起源,25例为频发多源室性早搏,流出道室性早搏患者冠心病发生率明显低于其他两组(P<0.05)。结论部分老年男性室性早搏起源于心室流出道,其电生理特性与普通心肌细胞不同,具有明显的自律性和电生理各向异性,起源于心室流出道的室性早搏与心肌缺血无相关性。     

红外/红光治疗仪联合护理干预对治疗糖尿病下肢血管病变疗效的影响

目的:探讨红外/红光治疗仪联合前列地尔及护理干预治疗糖尿病下肢血管病变的临床疗效。方法:将60例糖尿病下肢血管病变患者随机分为对照组和治疗组两组,每组各30例。对照组给予前列地尔治疗,治疗组在对照组的基础上联合红外/红光治疗仪及护理干预治疗,均以14d为1个疗程,比较两组治疗前后临床症状、足背动脉血流量、踝肱指数(ABI)的变化。结果:治疗组的总有效率显著高于对照组(P<0.01);治疗组足背动脉血流量、踝肱指数(ABI)均明显优于对照组(P<0.01)。结论:红外/红光治疗仪联合前列地尔及护理干预治疗糖尿病下肢血管病变疗效确切,值得推广。     

XE-5000检测网织血小板在血液疾病诊断中的应用

目的探讨XE-5000全自动血液分析仪检测网织血小板在血液疾病中的应用。方法随机选择特发性血小板减少性紫癜(ITP)35例,再生障碍性贫血(AA)28例,急性白血病(AL)40例,慢性粒细胞白血病(CGL)24例,应用XE-5000全自动血液分析仪测定网织血小板百分比RP%,网织血小板绝对值IPF(×109/L)和平均血小板体积MPV。结果ITP初诊组,CGL组IPF%、MPV明显高于正常对照组(P<0.05),AA组,AL组患者IPF%高于正常对照组但无显著性差异(P>0.05)。ITP缓解组IPF%低于初诊组(P<0.05),与正常对照组比较无显著性差异(P>0.05)。结论外周血网织血小板数量可反映骨髓巨核系统生成血小板的情况,从而用于疾病的诊断和鉴别诊断。XE-5000全自动血液分析仪是一种实用和有效的IPF检测仪器。     

Bax基因在人颈动脉粥样硬化斑块中的表达

目的研究Bax基因在稳定和不稳定粥样斑块中的表达及临床意义。方法颈动脉内膜剥脱术标本25例,由病理学分成稳定性(14例)和不稳定性(11例)两组,对照组正常动脉取自肝移植供者的腹主动脉及其分支(6例);进行免疫组化,原位杂交和原位凋亡DNA缺口末端标记法(TUNEL)测定Bax凋亡基因表达。结果稳定性斑块Bax阳性表达免疫组化5例,原位杂交5例,TUNEL阳性4例;不稳定性斑块Bax阳性表达免疫组化10例,原位杂交11例,TUNEL阳性表达9例,表达显著高于稳定性斑块(P<0.01);免疫组化和原位杂交阳性细胞半定量计数在稳定性斑块中分别为8.63±2.62和10.32±3.12,在不稳定性斑块分别为122±21.64和152±23.35,高于稳定性斑块(P<0.01);对照组无表达。结论Bax高表达是影响粥样斑块稳定性的分子病理学基础和脑卒中发生率的因素之一,在不同时期控制其表达可为基因治疗颈动脉粥样硬化提供靶点。     

载脂蛋白B基因3′VNTP的多态性与冠心病关系的研究

目的：探讨重庆地区人群载脂蛋白B基因（apolipoprotein B,ApoB）3’端可变数目串联重复序列（variable numble of tandem repeats,3’VNTR）的多态性与冠心病（coronary heart disease,CHD）的关系。方法：采用病例-对照相关研究策略,随机选取重庆地区120例健康人和70例CHD患者,采用多聚酶链式反应（PCR）结合聚丙烯酰胺凝胶电泳技术,对所有研究对象ApoB基因3′VNTP多态性进行分析。结果：在所有受检者中共分离出16个3′VNTR等位基因,两组人群中等位基因分布频率均呈双峰型,冠心病组中以HVE32、HVE34、HVE38为主,性别无明显差异。结论：ApoB基因3’VNTR多态性与重庆地区冠心病患者的易感性相关,与性别无关。     

冠心病患者血清瘦素水平分析

目的研究冠心病患者血清瘦素（Leptin）水平的变化,探讨其与冠心病发生发展过程的关系。方法收集我院确诊的300例冠心病患者及30名正常对照者血清。检测血清中Leptin、C反应蛋白（CRP）及20项代表不同脏器及代谢功能的生化指标水平,分析Leptin与冠心病的关系。结果与正常对照组比较,冠心病患者血清Leptin、CRP水平显著升高,但两者无显著相关性;患者代谢功能生化指标有不同程度的显著改变;Leptin与其中一些指标存在一定的相关性。结论Leptin及CRP在冠心病发病过程中具有较强的独立应答,并且Leptin与患者其他生化功能指标存在一定的相关性,其可能促进了冠心病的发生发展。     

间接免疫荧光法检测冠心病患者外周血单个核细胞PP65抗原

目的：了解冠心病患者外周血单个核细胞巨细胞病毒活动感染情况，并探讨动脉粥样硬化与HCMV感染的关系。方法：运用间接免疫荧光的方法，对29例冠心病患者、39例其他心血管病患者以及42例正常对照组外周血单个核细胞巨细胞病毒PP65抗原进行检测，并运用免疫散射比浊法对各组CRP进行测定。结果：29例冠心病患者中巨细胞病毒pp65抗原阳性者7例，占24．1％；与其他心血管患者中巨细胞病毒pp65抗原阳性率（5．1％）以及正常对照组巨细胞病毒pp65抗原阳性率（2．4%）相比明显升高，29例冠心病患者CRP水平（5．06±1．79mg/L）也明显高于其它两组（P〈0.05）。结论：冠心病患者外周血单个核细胞巨细胞病毒活动感染可能在动脉粥样硬化的发展过程中有重要作用。     

Heart instantaneous frequency (HIF): an alternative approach to extract heart rate variability

Our study focuses on a new method of estimating the heart rate variability (HRV) which does not require the use of electrocardiogram (ECG) R-wave detection. Contrary to the R-wave detection method which requires a sampling frequency higher than 100 Hz, the one proposed here can be used to calculate the HRV from an ECG signal sampled at a frequency of approximately 5 Hz with a relative mean error of 0.03. This new method is based on extracting the instantaneous fundamental frequency from the ECG. The method could be efficiently used to extract the HRV from an ECG measured for healthy subjects performing an exercise in which the HRV increases linearly with time, and for subjects with respiratory and cardiac problems. The overall error decreased as we low-pass filtered the HRV with lower cut-off frequencies. Moreover, it was shown that the method could be efficiently used to calculate the HRV from blood pressure measurements and to be robust to noise.     

Analysis of heart rate variability in the presence of ectopic beats using the heart timing signal

The time-domain signals representing the heart rate variability (HRV) in the presence of an ectopic beat exhibit a sharp transient at the position of the ectopic beat, which corrupts the signal, particularly the power spectral density (PSD) of the HRV. Consequently, there is a need for correction of this type of beat prior to any HRV analysis. This paper deals with the PSD estimation of the HRV by means of the heart timing (HT) signal when ectopic beats are present. These beat occurrence times are modeled from a generalized, continuous time integral pulse frequency modulation model and, from this point of view, a specific method for minimizing the effect of the presence of ectopic beats is presented to work together with the HT signal. By using both, a white noise driven autoregressive model of the HRV signal with artificially introduced ectopic beats and actual heart rate series including ectopic beats, the more usual methods of HRV spectral estimation are compared. Results of the PSD estimation error function of the number of ectopic beats are presented. These results demonstrate that the proposed method has one order of magnitude lower error than usual ectopic beats removal strategies in preserving PSD, thus, this strategy better recovers the original clinical indexes of interest.     

Comparison of detrended fluctuation analysis and spectral analysis for heart rate variability in sleep and sleep apnea

Sleep has been regarded as a testing situation for the autonomic nervous system, because its activity is modulated by sleep stages. Sleep-related breathing disorders also influence the autonomic nervous system and can cause heart rate changes known as cyclical variation. We investigated the effect of sleep stages and sleep apnea on autonomic activity by analyzing heart rate variability (HRV). Since spectral analysis is suited for the identification of cyclical variations and detrended fluctuation analysis can analyze the scaling behavior and detect long-range correlations, we compared the results of both complementary techniques in 14 healthy subjects, 33 patients with moderate, and 31 patients with severe sleep apnea. The spectral parameters VLF, LF, HF, and LF/HF confirmed increasing parasympathetic activity from wakefulness and REM over light sleep to deep sleep, which is reduced in patients with sleep apnea. Discriminance analysis was used on a person and sleep stage basis to determine the best method for the separation of sleep stages and sleep apnea severity. Using spectral parameters 69.7% of the apnea severity assignments and 54.6% of the sleep stage assignments were correct, while using scaling analysis these numbers increased to 74.4% and 85.0%, respectively. We conclude that changes in HRV are better quantified by scaling analysis than by spectral analysis.     

A new heart rate variability analysis method by means of quantifying the variation of nonlinear dynamic patterns

A new heart rate variability (HRV) analysis method, quantifying the variation of nonlinear dynamic pattern (VNDP) in heart rate series, is proposed and validated against the age stratified Fantasia database. The method is based on three processes: (1) a recurrence quantification analysis (RQA) to quantify the dynamic patterns, (2) the use of mutual information (MI) and the entropy (EN) to characterize the VNDP, and 3) linear discriminant analysis to exploit the associations within MI and EN measures. Practically, the VNDP method overcomes the nonstationarity problem and exploits the nonstationary properties in HRV analyses. Physiologically, the VNDP reflects the properties of the fundamental short-term HRV dynamic system and the external associations of the system within the autonomous nervous system (ANS). The characteristic probability density peaks portrayed by VNDP plots indicate the quantum-like heart dynamics, which may provide valuable insights into the control of the ANS. The discrimination results of the reduced pattern dynamic range due to aging, from a new perspective, display the reduction in HRV. The significantly improved discriminatory power, compared to conventional RQA analyses, shows that the VNDP analysis can practically quantify the nonstationary nonlinear dynamics for ANS assessments.     

基于多尺度熵的心电图ST段研究

首次用多尺度熵的理论研究了心电图的ST段，并将心电图ST段多尺度熵分析结果和ECG多尺度分析结果进行比较。我们发现：健康人和冠心病人心电图的样本熵值接近，它们都要高于心梗病人的样本熵值；而健康人心电图ST段的样本熵值最小，冠心病人的最高，心梗病人的样本熵值在两者之间，并给出了合理的解释。心电曲线复杂度变化的这些特点对于早期临床诊断具有重要的意义。     

用动态激光散射技术对冠心病危重病人血红蛋白结构的研究

目的:研究冠心病危重病人血红蛋白结构大小,为临床的诊断和治疗提供新信息。方法利用动态激光散射技术,分别对分散于pH=7.4、8.0缓冲液中的6例冠心病危重病人血红蛋白的粒径分布进行检测。结果:(1)在pH=7.4时冠心病危重病人的血红蛋白粒径保持为四聚体结构(5.62nm左右),与健康人相同。(2)pH=8.0时以粒径3.16nm左右为主,为单聚体结构,粒径4.22nm左右其次,为二聚体结构,粒径5.62nm左右非常少,为四聚体结构,与健康人在碱性环境下的粒径一致。结论:冠心病人危重病人血红蛋白的结构大小与健康人在相同条件下一致,没有发生病变。     

Real-time heart rate variability extraction using the Kaiser window

A new method for real-time heart rate variability (HRV) detection from the R-wave signal, based on the integral pulse frequency modulation (IPFM) model and its similarity to pulse position modulation, is presented. The proposed method exerts lowpass filtering with a Kaiser window. It can also be used for off-line HRV analysis in both the time and frequency domains. Real-time bandpass filtering as a new HRV investigation method and as a by-product of the proposed algorithm is also introduced. Furthermore, the discrete time domain version of the French-Holden algorithm is developed, and it is thoroughly proved that lowpass filtering is an ideal method for detection of HRV