目的:探讨怀疑冠心病患者行活动平板运动试验的社会支持现状.方法:对109名门诊或住院患者进行活动平板运动试验测试,并进行量表填写,分析活动平板运动试验特点以及社会支持情况.结果:平板实验患者的社会支持状况的客观支持、主观支持、支持利用度及社会支持总分四项指标均低于国内常模,且与常模相比,差异具有统计学意义(P＜0.01).结论:与常模比较,活动平板运动试验患者社会支持度不高,我们应该有针对性地进行健康教育,采用措施以获得有效支持.

Objective To investigate the clinical significance of heart rate recovery (HRR) by treadmill exercise test ( TET) in diagnosis of coronary heart disease ( CHD) .Methods One hundred and ten patients who were suspected coronary heart disease were selected to receive TET examination , and underwent coronary artery angiography ( CAG) 2 week after the TET examination, according to whether implanted stent or not , they were divided into stent implantation group (group A) with 66 cases and non-stent implantation group ( group B) with 44 cases, the TET parameters included section ST , maximum ST/HR slope (ST/HR), HRR, the ratio of systolic blood pressure (rSBP) etc were compared between the two groups .Results In group A, the index of ST segment , ST/RR and rSBP were higher than in group B , the difference was statistically significant ( P <0.05, P <0.01), while HRR was lower than that in group B , the difference was statistically significant ( P <0.01). To compare the diagnostic value of various indexes of TET , ST segment’s highest sensitivity was 93.9%, the sensitivity of rSBP was 90.9%, the maximum ST/HR slope’s sensitivity was 89.4%, the sensitivity of HRR was 87.9%;HRR’s speci-ficity was 90.9%, the correct index was 78.0%.HRR index combined with ST index , maximal ST/HR slope and rSBP, the sensitivity was 90.1%, 86.2%and 85.4%respectively, the specificity was 72.3%, 77.4%and 87.0%respectively.Con-clusion The specificity of HRR is high , combined with other indicators , it can be used for the diagnosis of coronary heart disease.

本院近15年行直立倾斜试验5020例,其中50例发生严重缓慢性心律失常,混合型占88%(44/50),心脏抑制型占12%(6/50)。50例中25例发生心脏停搏,最长停搏20.6 s,12例次需进行徒手心肺复苏,其它患者放平倾斜床或注射阿托品后,心率、血压自行恢复,结论:倾斜试验是一项比较安全,值得进一步推广的临床检查。

Objective To investigate the relationships between uric acid(UA) and results of coronary artery angiography in patients with positive treadmill exercise test(TET).Methods 238 hospitalized patients with positive TEP undergoing coronary artery angiography were selected during February 2006 and December 2008.All patients received biochemical measurement.According to the results of coronary artery angiography,the patients were divided into positive coronary artery angiography group and negative coronary artery angiography group.UA and blood lipids levels(cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein) in both the groups were compared.Results 187 patients were in positive coronary angiography group,and 51 were in negative coronary artery angiography group.There were no significant differences in gender,age,complication,smoking history,and drinking history between the two groups(P0.05),with comparability.However,the UA level in positive coronary artery angiography group was higher than that in negative coronary artery angiography group,and the difference was significant(P0.05).There was no significant difference in blood lipids between two groups(P0.05).Conclusion There is a close relationship between UA level and results of coronary artery angiography in patients with positive TET.

OBJECTIVE:To investigate the value of QT hysteresis index during treadmill exercise test (TET) in diagnosing coronary heart disease (CHD).METHODS:One hundred consecutive patients suspected for CHD were referred for TET and selective coronary angiography (CAG). Patients were divided into positive [n = 55, age (56.0 ± 7.9) years] and negative [n = 45, age (53.2 ± 6.7) years] group based on their CAG results. For each TET recording, 50 points were selected for the RR, QTp, and QTe interval measurements. QTp and QTe interval was plotted against corresponding RR interval. QT/RR curve was constructed by connect all point, QT hysteresis index was calculated for each patient.RESULTS:The QTp [(22.4 ± 10.3) ms vs. (6.7 ± 4.6) ms, P < 0.001] and QTe [(27.1 ± 11.1) ms vs. (7.6 ± 4.6) ms, P < 0.001] hysteresis index of patients in positive group were significantly higher than those in negative group. The sensitivity of QTp and QTe hysteresis index for diagnosing CHD was 89.1% (49/55) and 94.5% (52/55), respectively, and the specificity was 82.2% (37/45) and 80.0% (36/45), respectively. If the patient fulfilled both the classical TET and QT hysteresis criteria, the sensitivity for diagnosing CHD increased to 94.3% (33/35, QTp) and 94.6% (35/37, QTe), and the specificity were both 100% (26/26, 26/26). Moreover, QTp (r = -0.399, P < 0.001) and QTe (r = -0.547, P < 0.001) hysteresis index highly correlated to Duke treadmill score.CONCLUSION:QT hysteresis index is useful parameter for CHD diagnosis and which could improve the diagnostic value of TET for CHD in combination with the classical TET criteria for diagnosis of CHD.

目的:探讨硝酸甘油激发倾斜试验的循证护理要点。方法:对672例病人试验前做好病人的心理护理,备好各项急救物品和药品;试验中严密监测病人的心率、血压、意识等,出现心脏停搏立即胸外心脏按压及放平倾斜床,并实施相关药物治疗;试验后病情稳定才离开检查室。结果:所有病人无一人发生严重并发症,顺利完成检查。结论:将循证护理运用于硝酸甘油激发倾斜试验中,可避免并发症的发生,是病人安全的重要保障。

Objective To explore the social support status and related factors of the patients with vasovagal syncope(VVS).Methods Six hundred patients with VVS were investigated with social support rating scale(SSRS) as well as 520 subject for normal control.Results Scores of SSRS of the patients were lower than that of the normal people(P<0.05).There were significant differences in social support status among the patients with different age and sex(P>0.05).The patients who were younger than 45 years old or male had lower social support.Conclusions Doctors should assess the patient′s social support system correctly,and take way to help them adapt the disease course,set up harmonious family relationship and enlarge social communication,and improve their quality of life.

Objective To investigate the relationship between QT interval rate dependence and ventricular arrhythmias in patients with chronic heart failure.Methods Thirty-one patients with chronic heart failure were enrolled in this study and investigation included history collection,clinical examination,echocardiography,electrocardiogram and 24h ambulatory electrocardiogram.Following indexes were determined,left ventricular end diastolic dimension(LVEDD),left ventricular ejection fraction(LVEF),QT dispersion(QTd),SDNN.the slope of QT/RR plots of the linear regression,ventricular premature beats(VPB)and non-sustained ventricular tachycardia(NSVT).All above indexes were compared between patients with and without NSVT,The correlation factor between QT/RR slope and NSVT was calculated.Results In 31 patients with chronic heart failure.there were 17 patients with NSVT in their 24 h holter recording.The frequency of VPB(5631.2±7218.0 vs 285.9±371.7,P<0.05),QTe/RR slope(0.210±0.049 vs 0.161±0.058,P<0.05)and QTp/RR slope(0.195±0.046 vs 0.151±0.041,P<0.05)were significantly higher in patients with NSVT than those without.In all patients,QTd(r=0.414,P<0.05),VPB(r=0.768,P<0.05),QTe/RR slope(r=0.380.P<0.05)and QTp/RR slope(r=0.433,P<0.05)highly correlated to the frequency of NSVT.Conclusion QT interval rate dependence represents the dynamic QT variance over time.QT/RR slope correlates to the ventricular arrhythmia tightly,and is valuable fbr the risk stratification of sudden cardiac death in chronic hean failure.

目的 观察冠心病患者平板运动负荷试验中QT间期的动态变化规律并探讨其机制.方法 收集经冠状动脉造影确诊的冠心病患者21例和对照组20例,分析两组受试者冠状动脉造影前的平板运动负荷试验心电图,每位受试者测量50个点的RR间期、QTp间期和QTe间期,计算QTpc间期、QTec间期和Tp-Te 间期.以RR间期为横坐标,QTp间期、QTe间期、QTpc间期、QTec间期或Tp-Te间期为纵坐标,作直线相关分析,求相关直线斜率.结果 平板运动负荷试验全程,冠心病组QTe/RR斜率高于对照组(P＜0.05),而两组间QTp/RR、QTpc/RR、QTec/RR和Tp-Te/RR斜率比较差异无统计学意义(P＞0.05)；运动期,冠心病组QTe/RR和QTec/RR斜率高于对照组(P＜0.05)；恢复期,冠心病组QTpc/RR斜率高于对照组(P＜0.05),Tp-Te/RR斜率低于对照组(P＜0.05).冠心病组运动期QTe/RR、QTec/RR和Tp-Te/RR斜率高于恢复期(P＜0.05),运动期QTpc/RR斜率低于恢复期(P＜0.05).对照组运动期和恢复期QTe/RR、QTp/RR、QTec/RR、QTpc/RR和Tp-Te/RR斜率比较差异均无统计学意义(P＞0.05).结论 冠心病患者运动负荷试验中的QT滞后现象与交感神经张力异常增高和T波终末部的异常动态改变有关.

Objective To observe the QT interval hysteresis phenomenon in treadmill exercise testing in patients with coronary heart disease (CHD).Methods Twenty-one patients with CHD,which were diagnosed based on their coronary artery angiography,were enrolled as CHD group.Twenty healthy people were enrolled as control group (con).All subjects underwent treadmill exercise test according to Bruce protocol For each recording,50 points were selected for the RR,QTp(from the onset of QRS to the peak of T wave),and QTe(from the onset of QRS to the end of T wave)interval measurement.Rate corrected QTp(QTpc) and QTe (QTec) were calculated using Bazett formula[ QTc =QT/( RR ) 1/2 ].QTp,QTe,QTpc and QTec interval were plotted against corresponding RR interval,respectively.The difference in QTp,QTe,QTpc and QTec were compared between exercise and recovery period,under RR interval of 600 ms,550 ms,500 ms,450 ms,and 400ms.Results In control group,the QT/RR curve of recovery period nearly overlapped with exercise period.In CHD group,the QT/RR curve of recovery period separated downward from exercise period at the region of RR interval from 500 ms to 600 ms.In control group,there were no significant difference in QTp,QTe,QTpc and QTec between exercise and recovery period under any same RR interval ( P＞0.05 ).In CHD group,QTp and QTpc of exercise period was significant higher than that in recovery period under RR interval of 550 ms,500 ms,and 450 ms( P＜0.05 ),QTe and QTec of exercise period was significant higher than that in recovery period under RR interval of 550 ms,and 500 ms(P＜0.05).Conclusion In treadmill exercise testing,patients with CHD showed overt QT interval hysteresis phenomenon.The QT hysteresis might serve as a useful non-invasive tool in the early detection of patients with CHD.

随着人民生活水平的不断提高,冠心病已成为危害人类健康的主要疾病,死亡率居全球之首[1].目前冠状动脉造影是冠心病诊断的"金标准",但操作复杂且为有创性检查,也受技术和设备的限制.平板运动试验因其无创、价格较低、重复性强,是筛查和诊断冠心病很有价值的无创性检查试验.但是运动可诱发心绞痛、心肌梗死、严重的心律失常[2,3]、晕厥[4]甚至死亡.

Aim To discuss the first aid and nursing care on ventricular tarchycardia during the process of transesophageal atrial pacing.Methods Nursing care were was taken before,during and after transesophageal atrial pacing.Results All patients were turned to be sinus rhythem,1 by synchronous difibrillation,8 by transesophageal atrial pacing,23 by transesophageal atrial pacing and injection of amiodarone.No patients had serious complications.Conclusion Instant and accurate judgement,first aid with doctors,close observation and physiological nursing care are critical for patients' safety.

目的探讨食管心房调搏术(transesophageal atrial pacing,TEAP)转复Ⅰ型心房扑动的有效性。方法采用超速抑制法和短阵快速刺激法(Burst法)转复Ⅰ型房扑。结果 43例Ⅰ型心房扑动转复39例,4例失败,有效率90.7%,无并发症发生。结论食管心房调搏术转复Ⅰ型房扑急诊患者不良反应小,费用低,操作简单,有显著疗效,临床非常实用。

Objective To design a kind of apparatus for training the waist and helping the waist recovery,which can increase Lumbar muscles' force without adding the burden of the spine.Methods The electric motor and the initiative eccentric wheel hinged on the output axis of the transmission were used to drive the driven eccentric wheel and the connecting rod of type ⊥,and then the semicircular movement support was forced to move in multi direction.Results The semicircular movement support could realize omnidirectional training of the lumbar muscle.Conclusion The healing instrument,with simple structure,easy operation and excellent performance,is particularly applicable to the recovery of the lumbar muscle.

腰椎间盘突出症是临床中常见腰腿痛病症,笔者在2007年-2009年间运用中医理论对我院90例腰椎间盘突出症伴硬膜囊轻度受压患者进行治疗,45例运用刺络拔罐为主要方法,结合推拿治疗取得较好疗效,现报告如下.

Objective To design a diastolic pressure reducer with circuit simulators according to the popular way of reducing diastolic pressure by striking the plantar reflex zones with a bamboo chip.Methods The bamboo chip that stuck to a magnet springy chip was caused to vibrate by the regular magnetic field generated from software-controlled circuit.Results The testing results on 6 volunteers showed that the bamboo chip could effectively reduce the diastolic pressure.It could vibrate according to the preset frequency with strong hitting power given for high frequency and weak hitting power for low frequency.Conclusion Being cost-effective and reliable,the reducer is an useful equipment for reducing diastolic pressure.

目的探讨平板运动试验联合冠心病高危因素对诊断冠心病的价值。方法收集我院行平板运动试验和冠状动脉(冠脉)造影者316例,计算单纯平板运动试验、平板运动试验联合血脂指标及联合男性性别诊断冠心病的灵敏性、特异性、阳性预测值和阴性预测值。结果单纯平板运动试验诊断冠心病阳性预测值、阴性预测值分别为91.87%、51.43%,平板运动试验联合血脂指标诊断冠心病预测值分别为97.32%、92.86%,平板运动试验联合男性性别诊断冠心病预测值分别为97.12%、25.00%,单纯平板运动试验与后两者比较差异有统计学意义(P<0.01,P<0.05)。结论平板运动试验联合血脂指标对冠心病的诊断价值较单纯平板运动试验具有更高的阳性预测值和阴性预测值,而联合男性性别诊断时虽然阳性预测值高,但阴性预测值降低。

Objective To investigate whether QT restitution property of middle-aged women is affected by the exercise capacity.Methods Treadmill exercise tests were performed in 80 middle aged women.69 cases were divided into the low exercise capacity group(LEC group) and the high exercise capacity group(HEC group) by the median exercise capacities.Sequential QT intervals and their preceding TQ intervals were measured and the QT restitution curve(QTRC) was constructed.2 exponential equations were used to match the data and calculate the slope of QTRC,respectively.Results With the exercise level elevating,the women in the LEC group had a higher change rate of QT intervals(41±10 ms/Met vs.29±3 ms/Met,P=0.001) and TQ intervals(46±12 ms/Met vs.41±7 ms/Met,P=0.046),and the ratio of QT interval alterations to QT interval alterations increased(0.41±0.09 vs.0.36±0.07,P=0.003).Compared with HEC group.The Smax of the QTRC in the LEC group were bigger than that in the HEC group(1.43±0.44 vs.1.13±0.34,P=0.002).There was an inverse relationship between Smax and exercise capacity(r=-0.43,P=0.001).Conclusion QT restitution properties in middle-aged women is related to their exercise capacity.

目的探讨倾斜试验中发生心脏停搏的抢救及护理经验。方法对24例患者试验前做好心理护理,备好各项急救物品和药品;试验中严密监测患者的心率、血压、意识等,出现心脏停搏立即胸外心脏按压及放平倾斜床,并实施相关药物治疗;试验后病情稳定才离开检查室。结果 24例患者无一人发生严重并发症,顺利完成检查。结论护理人员做好心理护理,密切观察病情,及时配合医生进行抢救,是患者安全的重要保障。

输液是医院常用的一种医疗手段,医护人员须根据药液种类和输液对象的不同调节输液的滴速,而常用的调节滴速的方法通常是使用普通手表数输液的滴数,既浪费时间又不是很准确.