Despite its significant clinical implications, pressure overload-induced cardiac remodeling is poorly understood. This study aimed to investigate the role of Caveolae-Gαq interaction in the pathophysiology of pressure overload-induced cardiac remodeling. We used the abdominal aortic constriction (AAC) rat model and the angiotensin II-treated cell model to simulate pressure overload-induced cardiac remodeling. Histological changes were assessed using hematoxylin-eosin staining, immunofluorescence staining, and transmission electron microscopy. The expression, colocalization, and calcium response of the Caveolae-Gαq-PLCβ3 signaling pathway were evaluated using western blotting, quantitative real-time PCR, immunofluorescence staining, and calcium green labeling. We found AAC decreased Caveolin-3 expression but increased Gαq and PLCβ3 expressions. Similar trends in mRNA expression levels were observed. The caveolae's ultrastructure was deformed at 4 and 12 weeks after AAC surgery. AAC and angiotensin II treatments reduced Caveolin-3 and Gαq colocalization while increasing Gαq and PLCβ3 colocalization, and prolonging intracellular calcium response after Gαq activation. In conclusion, pressure overload-induced cardiac remodeling involves caveolar deformation and decreased Caveolae-Gαq interactions, which result in enhanced expression and functionality of Gαq-PLCβ3 signaling. These findings highlight the mechanistic importance of Caveolae-Gαq interactions in cardiac hypertrophy under pressure overload conditions.

Objective:To explore the effects of standard meal and treadmill exercise test on body surface gastrointestinal electrogram in healthy subjects, and to provide more evidence for the clinical application of gastrointestinal electrogram.Methods:From January to June 2021, a total of 100 healthy asymptomatic volunteers underwent gastrointestinal electrogram after fasting, standard meal and treadmill exercise test. After the subjects fasted for more than 8 hours, the gastrointestinal electrogram was performed after the subjects were lying flat, quiet, and breathing steadily, electrodes were placed on the the body surface projection positions of the gastric body, the lesser curvature, the greater curvature, the antrum, the ascending colon, the transverse colon, the descending colon, and the rectum. The fasting gastrointestinal electrogram was recorded for 6 min. Then lay for 5 to 10 min after the standard meal (100 g bread, 250 mL milk), the postprandial gastrointestinal electrogram was recorded for 6 min. And lay for 5 to 10 min after treadmill exercise test, then the postexercise gastrointestinal electrogram was recorded for 6 min. The frequency and amplitude of gastrointestinal electrogram waveforms of the three time points were compared, and the percentage of gastrointestinal electrical rhythm disorder, and slow wave frequency instability coefficient were also compared. Stratified analysis of gastric motility was performed according to age, sex and body mass index. Paired t-test, Pearson Chi-squared test, continuity correction Chi-squared test, Fisher′s exact method and Speraman correlation were used for statistical analysis. Results:The standard meal did not obviously affect the mean frequency of the gastric electrocardiogram, however the mean amplitude of gastric electrocardiogram significantly increased after standard meal compared with that of fasting, especially in the electrodes placed at lesser curvature((148.5±8.7) μV vs.(113.2±5.0)μV ), greater curvature((176.3±11.3) μV vs.(126.1±7.3) μV), and antrum((161.8±10.6) μV vs.(117.6±4.91) μV), and the differences were statistically significant( t=4.63, 4.63 and 3.99, all P< 0.001). There were no significant changs in rhythm and stability of the gastric electrocardiogram. The mean frequency of intestinal electrograms at the ascending colon, the transverse colon, the descending colon, and the rectum decreased after the standard meal compared with that of fasting ((10.8±0.2) count per minute(cpm) vs.(11.5±0.2) cpm, (10.5±0.2) cpm vs.(11.2±1.6) cpm, (10.9±0.2) cpm vs.(11.7±0.2) cpm, (11.1±0.2) cpm vs.(11.8±0.2) cpm), and the differences were statistically significant ( t=3.82, 4.55, 4.39, and 3.98, all P<0.001); the mean amplitude of the ascending colon, the transverse colon, and the rectum increased compared with that of fasting ((129.8±6.1) μV vs. (110.9±6.4) μV, (119.6±4.1) μV vs. (101.3±4.7) μV, (124.1±4.6) μV vs. (106.2±5.7) μV), and the differences were statistically significant ( t=2.62, 3.76, and 3.16; P=0.010, <0.001, =0.002); and the number of leads with enteroelectric rhythm disorder increased (398 vs. 389, the total number of leads is 400), and the difference was statistically significant( χ2=7.31, P=0.026). The mean frequency of gastric electricity after treadmill exercise in electrode placed at antrum increased compared with that after standard meal ((3.4±0.4) cpm vs.(3.3±0.3) cpm), and the differences were statistically significant( t=2.45, P=0.016), and the mean amplitude of gastric electricity in electrodes placed at gastric body, lesser curvature and antrum increased compared with those after standard meal((160.2±8.6) μV vs. (133.9±6.4) μV, (178.1±10.0) μV vs. (148.5±8.7) μV, (202.5±10.2) μV vs. (161.8±10.6) μV), and the differences were statistically significant ( t=2.30, 2.35, and 2.48; P=0.024, 0.021, and 0.015). Treadmill exercise affected the rhythm and stability of gastric electricity, and the number of electrodes with instable and abnormal coefficient frequency slow-wave significantly increased (25 vs. 1, the total number of electrodes is 400), and the difference was statistically significant( χ2=22.90, P<0.001). There was no significant change in the mean frequency of the colonic electricity after treadmill exercise compared with that after standard meal, however the mean amplitude of intestinal electrical waveform at the ascending colon, the transverse colon, the descending colon, and the rectum increased compared with those after standard meal((171.2±8.4) μV vs. (129.8±6.1) μV, (166.1±7.7) μV vs. (119.6±4.1) μV, (147.2±7.2) μV vs. (121.1±4.9) μV, (149.6±7.3) μV vs. (124.1±4.6) μV), and the differences were statistically significant( t=3.51, 5.49, 3.09, and 2.83; P=0.001, <0.001, =0.003, and=0.006), which affected the rhythm and stability of the colonic electricity, and the number of electrodes with instable and abnormal coefficient frequency slow-wave significantly increased (10 vs. 3, the total number of electrodes is 400, χ2=4.04, P=0.040). Gender was correlated with mean frequency of gastric electricity after standrdmeal and treadmill exercise test and mean amplitude of fasting and standard postprandial gastric electricity( r=0.242, -0.272, 0.286, 0.242; P=0.015, 0.006, 0.004, 0.015), and with mean amplitude of fasting and standard postprandial electricity( r=0.225, 0.460; P=0.024, <0.001). Age was only associated with mean frequency of fasting gastric electricity( r=-0.214, P=0.033). Body mass index was correlated with mean gastric electrical amplitude after fasting, standard meal and treadmill exercise( r=-0.347, -0.260, -0.211; P<0.001, =0.009, =0.036), as well as with the mean gastric electricity frequency after treadmill exercise ( r=0.242, P=0.016). Body mass index was correlated with the mean amplitude and frequency of fasting and standard postprandial intestinal electricity ( r=-0.261, -0.296, -0.400, -0.286; P=0.009, =0.003, < 0.001, =0.003). In the healthy volunteers with female gender and body mass index < 24 kg/m 2, there were statistically significant differences in the changes of gastric motility after standard meal (Fisher′s exact method, P=0.022 and 0.024). Conclusion:Both standard meal and treadmill exercise test affect gastrointestinal electrical activity, and exercise caused more changes in gastrointestinal electrical activity than standard meal.

ObjectiveAcute exposure to hypobaric hypoxia can trigger acute mountain sickness (AMS), while the exact mechanism has not been fully revealed. The role of genetic factors in the susceptibility of various high-altitude diseases has also gained much interest. Previous studies have provided evidence for the link between AMS and certain nuclear genes or mitochondrial haplogroup. The correlation between point mutations of mitochondrial DNA (mtDNA) and AMS was further explored in the present study.MethodsA total of 84 young Han males residing at low altitude were taken to an elevation of 4,000 m within 40 h. We collected data of their heart rate, blood pressure, peripheral oxygen saturation (SaO2), and obtained blood samples, at sea level and at high altitude. AMS was diagnosed using the revised version of the Lake Louise Questionnaire Score. Sequencing was utilized to identify the association between mtDNA alleles and the occurrence of AMS. We also assessed the association between the presence of AMS and physiological variables, and provided a preliminary discussion of the association between genotypic and phenotypic variation.ResultsThe percentage of neutrophils [Odds ratio (OR): 1.06, 95% confidence interval (CI): 1.01–1.12, P = 0.034) and SaO2 level (OR: 0.87, 95% CI: 0.79–0.95, P = 0.004) were independently associated with the development of AMS. A4576G was a risk factor for AMS (OR: 6.27, 95% CI: 1.2–32.7). T11613C (OR: 0.10, 95% CI: 0.01–0.83), A8923G (OR: 0.15, 95% CI: 0.03–0.76), and T5543C (OR: 0.19, 95% CI: 0.04–0.95) were protective factors for AMS. The level of SaO2 was significantly lower in the individual with A4576G mutation as compared with the individual without A4576G mutation (68.1 ± 7.9 vs. 75.8 ± 6.1, P = 0.001). The level of serum sodium was significantly higher in the individual with A8923G mutation as compared to the individual without A8923G mutation (144.6 ± 1.9 vs. 143.2 ± 1.9, P = 0.027).ConclusionsThe increase in neutrophils and the disability to preserve oxygen saturation may be associated with the high altitude intolerance in young Chinese Han males. A4576G is the risk factor for AMS. T11613C, A8923G, and T5543C are protective factors for AMS. The role of A8923G mutation may correlate with the sodium and water balance and the role of the A4576G mutation may be related to the disability to maintain blood oxygen level after quickly entering the plateau.

临床上常见的疾病有高钾血症、肺栓塞等,当两者合并存在时,病情变化急骤,诊断存在难点,心电图变化迅速且复杂,本文介绍1例少见的胰腺癌患者罹患高钾血症合并急性肺栓塞的病例.现对该病例进行报道分析.

This study introduced the current testing content and standards of ECG medical electronic instruments, combined with actual clinical needs, and discussed the comprehensive verification and evaluation protocol for ECG medical electronic instruments. The protocol mainly includes hardware performance testing, automatic diagnostic function testing and clinical application evaluation. The protocol emphasizes the clinical practicality and importance of the comprehensive verification and evaluation program, and provides a reference for the institutions involved in the program.

本文通过调研分析国内心电图机市场分布和临床应用情况,探讨目前心电图机在应用中可能存在的问题和临床需求,为后续国家分层应用标准的制定,提供考量.通过采用调查问卷方式进行线上调研心电图机使用单位,调查问卷内容填写完整视为有效.根据实践应用中,心电图机使用中的易用实用性等,设计三类调查问卷:心电图机临床应用可靠性与耐用性问卷调查(13小题)、易用实用性问卷调查(10小题)及应用场景问卷调查(5小题),且调查问卷内容通过心电领域专家组论证后实施.结果显示,共调研了国内21个省市心电图机应用的194家医疗单位,其中团以上单位(50家,占比25.8％)、团级单位(73家,占比37.6％),团以下单位(70家,占比36.1％)和特殊环境(1家,占比0.5％).心电图机68.6％应用于检查专科,其次为基层医疗单位,如干休所、门诊部等,最后,还用于急会诊心电图采集;使用超过5年以上的占50％以上.根据临床应用易用性和实用性回访结果,95分以上的占14.4％,90～95分占9.3％,80～90分占22.7％,70～80分占28.4％,70分以下占25.3％,排名前三的故障主要为:配件故障、打印功能障碍和屏幕显示故障.心电图机自动诊断功能诊断符合率方面,49％符合医生诊断,其中43家单位的心电图机无自动诊断功能,占22.2％.国产心电图机占60％左右.因此,心电图机品牌品类繁多,临床应用广泛,多数可以满足临床需求,自动诊断功能有待进一步提高.

晕厥是常见的临床综合征,其发作迅速,发病机制众多.心血管疾病相关晕厥是晕厥中预后最差的一类,如何快速识别、早期诊断、准确评估和治疗是关键.本文从临床诊疗管理的角度,简要综述了心血管疾病相关晕厥的病因、评估、诊断及治疗.

This study established a rapid ECG screening system through the application of wearable ECG equipment. The closed-loop and self-service process of ECG inspection, data collection, transmission and printing have been realized. The new rapid ECG screening system docking with HIS system in the hospital, forming a new intelligent mode of rapid ECG screening. This paper introduces the design of the intelligent mode of ECG rapid screening from the aspects of hardware, software, wearable ECG examination equipment, and briefly describes its implementation path and technical scheme. With the rapid ECG screening system, human power can be saved, the timeliness of ECG examination can be enhanced. The level of ECG diagnosis in the basic units can be improved through building a multiple medical centers which is rely on the cloud platform.

目的 探讨分析健康人群心电图参数(P波时限、电轴,QRS波群时限、电轴,PR间期,QT及QTc间期)范围值.方法 选取1539例(男623例,女916例)健康人群,并采集心电图,计算各年龄段不同性别心电参数,并与通用正常范围做比较.结果 男女性心率最低值随年龄增长而呈现下降趋势.P波时限男女随年龄均较正常范围延长,同年龄组间30岁以上男性P波时限长于女性,差异有统计学意义(P<0.01).PR间期男性在40岁以上,女性在60岁以后较正常范围延长,同年龄组间60岁以上男性PR间期长于女性,差异有统计学意义(P<0.01).QRS时限在男性健康人群中时限均延长,同年龄组间男性长于女性,差异有统计学意义(P<0.01).T波时限男性在30岁以上可较正常范围延长,同年龄组间男性T波短于女性,差异有统计学意义(P<0.01).QT及QTc间期延长可继发于T波延长,同年龄组间男性QTc间期短于女性,差异有统计学意义(P<0.01).R波电轴在50岁以后会逐渐左偏,T波电轴在30岁以上逐渐左偏,差异有统计学意义(P<0.01).结论 临床诊断中关于健康人群P波时限、QRS时限(男性)可适当延长,PR间期、T波时限(男性)、QT及QTc间期随年龄增长可适当延长,R波及T波电轴随年龄增长逐渐左偏.同年龄比较P波时限、PR间期、QRS时限男性较女性有延长趋势,T波时限、QT及QTc间期男性较女性有缩短趋势.

在上世纪六十年代初,Hoffman在狗的实验中预测了在传统心电图的P-R间期内的特殊传导系统电位分布位置及时程.然而,传统心电图扫描记录不到P-R间期内的特殊传导系统电位活动信号.近年来,有学者报道在动物体表和人类体表(在P-R间期)内扫描记录到了可视化可辨别的电生理新的小波,按照这些小波可以得到7个标测线,与Hoffman猜测一样的结果.根据这些小波的特性和是否出现可鉴别心律失常的性质.

Many sea-level residents suffer from acute mountain sickness (AMS) when first visiting altitudes above 4,000 m. Exercise tolerance also decreases as altitude increases. We observed exercise capacity at sea level and under a simulated hypobaric hypoxia condition (SHHC) to explore whether the response to exercise intensity represented by physiological variables could predict AMS development in young men. Eighty young men from a military academy underwent a standard treadmill exercise test (TET) and biochemical blood test at sea level, SHHC, and 4,000-m altitude, sequentially, between December 2015 and March 2016. Exercise-related variables and 12-lead electrocardiogram parameters were obtained. Exercise intensity and AMS development were investigated. After exposure to high altitude, the count of white blood cells, alkaline phosphatase and serum albumin were increased ( P < 0.05). There were no significant differences in exercise time and metabolic equivalents (METs) between SHHC and high-altitude exposures (7.05 ± 1.02 vs. 7.22 ± 0.96 min, P = 0.235; 9.62 ± 1.11 vs. 9.38 ± 1.12, P = 0.126, respectively). However, these variables were relatively higher at sea level (8.03 ± 0.24 min, P < 0.01; 10.05 ± 0.31, P < 0.01, respectively). Thus, subjects displayed an equivalent exercise tolerance upon acute exposure to high altitude and to SHHC. The trends of cardiovascular hemodynamics during exercise under the three different conditions were similar. However, both systolic blood pressure and the rate–pressure product at every TET stage were higher at high altitude and under the SHHC than at sea level. After acute exposure to high altitude, 19 (23.8%) subjects developed AMS. Multivariate logistic regression analysis showed that METs under the SHHC {odds ratio (OR) 0.355 per unit increment [95% confidence intervals (CI) 0.159−0.793], P = 0.011}, diastolic blood pressure (DBP) at rest under SHHC [OR 0.893 per mmHg (95%CI 0.805−0.991), P = 0.030], and recovery DBP 3 min after exercise at sea level [OR 1.179 per mmHg (95%CI 1.043−1.333), P = 0.008] were independently associated with AMS. The predictive model had an area under the receiver operating characteristic curve of 0.886 (95%CI 0.803−0.969, P < 0.001). Thus, young men have similar exercise tolerance in acute exposure to high altitude and to SHHC. Moreover, AMS can be predicted with superior accuracy using characteristics easily obtainable with TET.

目的 分析12导联实时可穿戴心电设备监测家庭和基层医院患者远程早期事件的价值.方法 在家庭和基层医院使用12导联实时可穿戴心电设备采集20271例受检者的心电图并传输至我院基层诊断会诊中心.按照危急、急和普通的等级对全部心电图数据进行分类,并及时告知患者及其家属或基层医院.对危急心电图病例在1～12 d内完成随访.结果 共纳入21253份心电图进行分析.其中,男性12007份(56.50％),比例略高于女性;有11695份(55.03％)来源于基层医院,比例略高于来源于家庭的心电图.有40.55％(8619份)的心电图来自有不适症状的受检者,以胸闷胸痛和心慌心悸为主;66.63％的心电图(14160份)出现异常,其中心肌缺血心电图占39.45％(8385份),心律失常心电图占24.64％(5237份).心律失常中室性早搏最多(5.52％).危急心电图报告占0.61％(130份),来自94例受检者,其中20.21％(19/94)发生严重的临床事件.结论 12导联实时可穿戴心电设备可以对家庭和基层医院患者的远程早期心律失常和心肌缺血进行监测,对远程心电进一步就诊进行危急、急和普通分类,可改善患者预后,最终惠及患者和基层医疗机构.

随着医学科学技术的发展,心电学技术广泛应用于医学的各个领域.为了进一步满足临床需要,我国科研人员不断在心电学的深度和广度探索,研发出18导动态心电图系统.经过临床试验,18导动态心电图在疑似心肌缺血、损伤及梗死的监测中,在临床相关疾病的诊断和治疗中发挥重要作用.18导动态心电图的基本原理、操作规范、技术指标、临床应用等内容并达成共识.

目的 探讨经皮冠状动脉介入治疗(PCI)术后患者心肺运动试验参数及其变化规律,以期建立PCI术后患者心肺运动试验正常参考值范围.方法 选取解放军总医院心血管内科2017年6月 ～2019年6月1149例行PCI的冠心病患者,采用心肺运动测试系统进行心肺运动试验,对不同年龄段的心肺运动试验各项参数进行分析比较.结果 PCI术后患者心肺运动试验各项参数中:峰值功率(Wmax)、峰值摄氧量(VO2max)、峰值公斤摄氧量(VO2max/kg)、无氧阈时公斤摄氧量(VO2AT/kg)、峰值氧脉(O2pulse)、峰值呼吸交换率(RERmax)、心率储备(HRR)、呼吸储备(BR)随着年龄的增加而减少,二氧化碳通气当量(VE/VCO2)随着年龄的增加而增加.结论 根据患者不同年龄段特点来进行适宜的运动试验,从而在获得准确数据的同时,保证运动试验的安全性.本研究首次提出PCI术后患者心肺运动试验参考值应用方程,为心肺运动试验检查的精准进行提供了可靠依据.

Background. Sudden cardiac death is a leading cause of death from coronary heart disease (CHD). The risk of sudden cardiac death (SCD) increases with age, and sudden arrhythmic death remains a major cause of mortality in elderly individuals, especially ventricular arrhythmias (VA). We developed a risk prediction model by combining ECG and other clinical noninvasive indexes including biomarkers and echocardiology for VA in elderly patients with CHD. Method. In the retrospective study, a total of 2231 consecutive elderly patients (≥60 years old) with CHD hospitalized were investigated, and finally 1983 patients were enrolled as the model group. The occurrence of VA within 12 months was mainly collected. Study parameters included clinical characteristics (age, gender, height, weight, BMI, and past medical history), ECG indexes (QTcd, Tp-e/QT, and HRV indexes), biomarker indexes (NT-proBNP, Myo, cTnT, CK-MB, CRP, K+, and Ca2+), and echocardiology indexes. In the respective study, 406 elderly patients (≥60 years old) with CHD were included as the verification group to verify the model in terms of differentiation and calibration. Results. In the multiparameter model, seven independent predictors were selected: LVEF, LAV, HLP, QTcd, sex, Tp-e/QT, and age. Increased HLP, Tp-e/QT, QTcd, age, and LAV were risk factors (RR > 1), while female and increased LVEF were protective factors (RR < 1). This model can well predict the occurrence of VA in elderly patients with CHD (for model group, AUC: 0.721, 95% CI: 0.669∼0.772; for verification group, AUC: 0.73, 95% CI: 0.648∼0.818; Hosmer–Lemeshow χ2 = 13.541, P=0.095). After adjusting the predictors, it was found that the combination of clinical indexes and ECG indexes could predict VA more efficiently than using clinical indexes alone. Conclusions. LVEF, LAV, QTcd, Tp-e/QT, gender, age, and HLP were independent predictors of VA risk in elderly patients with CHD. Among these factors, the echocardiology indexes LVEF and LAV had the greatest influence on the predictive efficiency of the model, followed by ECG indexes, QTcd and Tp-e/QT. After verification, the model had a good degree of differentiation and calibration, which can provide a certain reference for clinical prediction of the VA occurrence in elderly patients with CHD.

Purpose: We evaluated the long-term effect of a smartphone-facilitated home-based cardiac rehabilitation (HBCR) model in revascularized patients with coronary heart disease (CHD) on major adverse cardiac events (MACE), and secondary outcomes, including safety, quality of life, and physical capacity.Methods: It was a prospective observational cohort study including a total of 335 CHD patients after successful percutaneous coronary intervention (PCI) referred to the CR clinic in China between July 23, 2015 and March 1, 2018. Patients were assigned to two groups: HBCR tailored by monitoring and telecommunication via smartphone app (WeChat) (HBCR group, n = 170) or usual care (control group, n = 165), with follow-up for up to 42 months. Propensity score matching was conducted to match patients in the HBCR group with those in the control group. The patients in the HBCR group received educational materials weekly and individualized exercise prescription monthly, and the control group only received 20-min education at baseline in the CR clinic. The primary outcome was MACE, analyzed by Cox regression models. The changes in the secondary outcomes were analyzed by paired t-test among the matched cohort.Results: One hundred thirty-five HBCR patients were matched with the same number of control patients. Compared to the control group, the HBCR group had a much lower incidence of MACE (1.5 vs. 8.9%, p = 0.002), with adjusted HR = 0.21, 95% CI 0.07–0.85, and also had reduced unscheduled readmission (9.7 vs. 23.0%, p = 0.002), improved exercise capacity [maximal METs (6.2 vs. 5.1, p = 0.002)], higher Seattle Angina Questionnaire score, and better control of risk factors.Conclusions: The Chinese HBCR model using smartphone interaction is a safe and effective approach to decrease cardiovascular risks of patients with CHD and improve patients' wellness.Clinical Trial Registration:http://www.chictr.org.cn, identifier: ChiCTR1800015042.

Background: In this study, we aimed to investigate whether the traditional Chinese medicine, Compound Danshen Dripping Pill (CDDP), can prevent acute mountain sickness (AMS). We allocated CDDP and matching placebos to 160 volunteers before they ascended to a high altitude. Treadmill exercise tests, echocardiography, blood routine examinations, biochemical analysis, and blood gas analysis were performed upon arrival at high altitude. The primary outcome included incidence of AMS, exercise times, and metabolic equivalents (METs) of treadmill exercise tests. Second endpoints included the heart rates and rate-pressure product (RPP) before and after treadmill exercise tests. Results: After high-altitude exposure, the incidence of AMS in the CDDP group was lower than that in the placebo group (48.6% vs. 67.6%, p = 0.022). The exercise time of the treadmill exercise test was significantly longer (507 ± 77.9 seconds vs. 457 ± 90.8 seconds, p = 0.004), the heart rate was lower (pre-exercise: 91.8 ± 11.7 beats/min vs. 97.2 ± 12.7 beats/min, p = 0.016; postexercise: 114 ± 22.2 beats/min vs. 121 ± 22.6 beats/min, p = 0.019), the pre-exercise and postexercise RPP were lower (pre-exercise: 1.13 × 104 ± 1.68 × 103 mmHg·beats/min vs. 1.23 × 104 ± 1.84 × 103 mmHg·beats/min, p = 0.027; postexercise: 1.19 × 104 ± 1.75 × 103 mmHg·beats/min vs. 1.31 × 104 ± 2.00 × 103 mmHg·beats/min, p = 0.002), and the MET value of the treadmill exercise test was significantly higher (9.93 ± 1.18 METs vs. 9.31 ± 1.52 METs, p = 0.037) in the CDDP group. Discussion: CDDP decreases the incidence of AMS and enhances exercise tolerance greater than placebo after high-altitude exposure. CDDP decreases the heart rate and myocardial oxygen consumption, increases the levels of hemoglobin, hematocrit, and antioxidant factors, and decreases the levels of inflammatory factors, which may explain the roles of CDDP in improving the adaptation to high-altitude exposure.

目的 研究急进4000 m海拔高原的健康青年男性长时程心率变异性(HRV)的变化,为急进高原对自主神经系统活动的影响提供理论依据.方法 2014年8月至2015年12月整群抽样兰州驻军某部队服役1年以上急进海拔4000 m高原、年龄≤35岁的健康青年男性100名作为急进高原组,整群抽样敦煌海拔1700 m驻军某部队服役1年以上体检健康青年男性100名作为高原组和北京海拔43.5 m驻军某部队服役1年以上体检健康青年男性42名作为平原组.急进高原组在急进4000 m高原后驻扎高原,24 h内行动态心电图检查,对比3组心电参数.结果 研究最终入选急进高原组91名,高原组98名和平原组40名.急进高原组总心搏数、平均心率、最高心率、最低心率、窦性心搏总数、最高窦性心率、最低窦性心率和平均窦性心率均明显高于高原组和平原组(均为P<0.05).3组心律失常的发生率比较无显著性差异(均为P>0.05),而HRV指标比较差异均有统计学意义(均为P<0.01).与平原组比较,高原组代表总频率24 h全部窦性RR间期的标准差(SDNN)和代表交感神经张力的超低频指标24 h内每5 min节段窦性RR间期平均值的标准差(SDANN)明显降低[(186.3±43.8)ms比(214.2±42.0)ms,t=3.239,P<0.01;(172.5±44.6)ms比(206.0±47.5)ms,t=4.004,P<0.01];与高原组比较,急进高原组代表迷走神经张力的高频指标24 h内相邻两个正常窦性RR间期差值大于20 ms的个数所占百分比(PNN50)、24 h内全部窦性RR间期差值的均方根(RMSSD)和代表总频率的HRV三角指数均明显降低[6.45％±3.5％比12.7％±5.1％,t=6.466;(47.6±23.3)ms比(62.4±22.9)ms,t=2.853;43.9±9.9比50.9±13.5,t=2.246,均为P<0.01].所有HRV指标急进高原组均低于平原组(均为P<0.05).结论 健康青年男性急进高原后所有频率水平的HRV指数均降低,可能是自主神经逐步调节所致;高原环境习服后交感神经首先调节,在进一步急进高海拔地区后迷走神经占主导.

目的 观察合并完全性左束支传导阻滞(CLBBB)或完全性右束支传导阻滞(CRBBB)住院患者的临床结局差异,探讨CRBBB在院内全因死亡中的预测价值.方法 选择2007年1月至2017年1月于郑州市第九人民医院住院的合并CLBBB或CRBBB的1556例患者为研究对象.根据合并束支传导阻滞类型分为CLBBB组和CRBBB组,比较2组患者性别、年龄及合并疾病等临床资料.根据是否发生院内死亡分为死亡组和非死亡组,比较2组患者临床疾病、束支传导阻滞类型、性别及年龄等临床指标的差异.应用logistic回归分析院内全因死亡的预测因素.结果 CLBBB组合并冠状动脉粥样硬化性心脏病(CHD)、急性心肌梗死(AMI)、扩张型心肌病(DCM)、其他心律失常患病率显著高于CRBBB组(P<0.05);CLBBB组男性占比、合并高血压病、糖尿病(DM)患病率及病死率显著低于CRBBB组(P<0.05);2组患者年龄、合并肿瘤和高脂血症患病率比较差异均无统计学意义(P>0.05).院内死亡患者44例(2.8％),死亡组患者年龄大于非死亡组,合并AMI、CRBBB及肿瘤患病率均高于非死亡组(P<0.05);2组合并CHD、DCM、高血压病、DM、高脂血症患病率比较差异均无统计学意义(P>0.05).校正年龄、AMI和肿瘤后,CRBBB是住院患者全因死亡的独立预测因素[比值比=3.682,95％置信区间(CI):1.249～10.865,P=0.018].该模型用于预测院内全因死亡的受试者工作特征曲线下面积为0.833(95％CI:77.6％ ～88.9％,P<0.001).结论 合并CRBBB可增加住院患者的全因死亡率,CRBBB是与AMI和年龄等传统全因死亡危险因素同等重要的心电指标,CRBBB可作为院内全因死亡的独立危险因素.

长QT综合征(long QT syndrome,LQTS)又称复极延迟综合征,是指在心电图上表现为QT间期延长,临床上表现为心悸、晕厥且易产生恶性室性心律失常甚至心脏性猝死的一组综合征.LQTS根据病因可分为遗传性QT间期延长综合征和获得性QT间期延长综合征2种.12导联心电图QT间期延长(女性QTc>460 ms,男性QTc>450 ms)是LQTS的主要心电图特征,但并不是每次检查均会出现QT间期延长.因此,充分测量QT间期及多次复查心电图对LQTS诊断尤为重要.本文介绍间歇性QTc延长的LQTS 1例,并对其分型、机制及治疗进行讨论.