埋藏式心脏起搏器术后起搏阈值的动态变化

目的:观察埋藏式心脏起搏器术后电极成熟期前后起搏阈值的变化规律。方法:对30例接受埋藏式心脏起搏治疗的患者分别于术中、术后1周、2周、1个月、2个月、3个月、6个月测定起搏阈值。结果:16例应用Medtronic CAPSURESP系列(激素洗提)心房电极的患者心房起搏阈值术后升高,本后1周达峰值,后逐渐降低,术后2个月开始趋于稳定,除术后6个月外,其余各时间点与术中比较差异均有非常显著性(P<0.01);24例应用MCSP系列心室电极的患者心室起搏阚值术后均明显高于术中(P<0.01);9例应用BIOTRONIK SYNOX SX系列(高阻抗非激素洗提)电极的患者心房、心室平均起搏阈值具有与MCSP系列起搏电极类似的术后演变趋势.其急性期起搏阈值呈明显峰化现象,且具有较高的慢性期阚值,与40条MCSP系列电极比较,两者急、慢性期起搏阈值差异均有非常显著性(P<0.01)。结论:埋藏式心脏起搏器术后6个月内,起搏阈值明显升高;激素洗提电极能明显降低急性期和慢性期阚值。     

Anesthetic management of an off-pump open-heart surgery in a dog

ObservationsA 9 year-old, 40 kg, female spayed Bouvier des Flandres was anesthetized for surgical removal of an intra-cardiac mass. Pre-anesthetic work-up included thoracic radiographs, which revealed moderate pleural effusion, and cardiac ultrasound, which identified a mass attached to the wall of the right ventricular outflow tract (RVOT). The mass caused dynamic obstruction of the RVOT during systole. The dog was pre-medicated with intravenous (IV) hydromorphone (0.05 mg kg^?1). Following pre-oxygenation, anesthesia was induced with ketamine (3.75 mg kg^?1, IV) and diazepam (0.18 mg kg^?1, IV). Anesthesia was maintained with isoflurane in oxygen, an intravenous constant rate infusion (CRI) of fentanyl (10–30 μg kg^?1 hour^?1) and a CRI of lidocaine (50–200 μg kg^?1 minute^?1). A right lateral thoracotomy was performed. The heart was stopped transiently with a cold cardioplegic solution for 7.83 minutes to allow the removal of the mass through an open-heart procedure. No cardiopulmonary bypass was used. The heart was successfully restarted after cardiopulmonary resuscitation with internal cardiac massage and internal defibrillation. The dog recovered uneventfully from anesthesia without any apparent neurological sequelae. Post-operative analgesia consisted of intercostal nerve blocks with bupivacaine, CRIs of fentanyl (2–5 μg kg^?1 hour^?1) and lidocaine (40 μg kg^?1 minute^?1) and with oral meloxicam (0.1 mg kg^?1). Five days following surgery, the dog was discharged from the hospital. Histopathology and immunohistochemistry of the mass identified an ectopic thyroid carcinoma.ConclusionsThis case showed the feasibility of whole body hypothermia and using a cold cardioplegic solution to induce cardiac arrest for a short open-heart procedure.     

Adverse events associated with pericardiocentesis in dogs: 85 cases (1999–2006)

Objective – To quantify the frequency of adverse events occurring during or post pericardiocentesis and to determine if adverse events are related to the cause of the pericardial effusion or frequency of pericardiocentesis.
Design – Retrospective study.
Setting – Referral hospital.
Animals, Intervention and Measurements – Medical records of 85 dogs that underwent 112 episodes of pericardiocentesis were reviewed. Any adverse events during pericardiocentesis and in the 48 hours post pericardiocentesis were noted. The frequency of adverse events was compared between dogs with a suspected neoplastic cause and a suspected nonneoplastic cause of their pericardial effusion and also between the first and subsequent pericardiocenteses.
Main Results – The incidence of adverse events was 10.7% within 1 hour of pericardiocentesis and 15.2% within 48 hours. There was no significant difference in the frequency of adverse events between the groups. Most adverse events identified were dysrhythmias. Forty-one percent of those dogs with adverse events were euthanized or died within 48 hours.
Conclusion – The incidence of adverse events seen within 48 hours of pericardiocentesis was 15.2%.     

Electrical velocimetry for noninvasive cardiac output and stroke volume variation measurements in dogs undergoing cardiovascular surgery

Objective

To compare electrical velocimetry (EV) noninvasive measures of cardiac output (CO) and stroke volume variation (SVV) in dogs undergoing cardiovascular surgery with those obtained with the conventional thermodilution technique using a pulmonary artery catheter.

针刺联合药物治疗心脏神经官能症的疗效观察

目的 探讨针刺联合药物治疗心脏神经官能症（cardiac neurosis,CN）的临床疗效。方法 选取本院门诊就诊的90例CN患者,随机分为单纯针刺组、单纯药物组、针刺+药物组,每组各30例。单纯针刺组取百会、神庭、内关、神门、心俞、大陵常规针刺为主,单纯药物组给予规律口服西药酒石酸美托洛尔、谷维素片、氟哌噻吨美利曲辛片,针刺+药物组为上述针刺疗法结合西药治疗,共治疗8周。于治疗前、治疗4周和8周后观察3组的汉密顿抑郁量表（HAMD）评分和汉密顿焦虑量表（HAMA）评分,比较治疗后3组患者的临床疗效。结果 治疗4周、8周后,3组患者HAMD、HAMA评分均较治疗前有所降低（P<0.05,P<0.01）;单纯针刺组和单纯药物组患者在治疗4周后和8周后的HAMD、HAMA评分均高于针刺+药物组,差异有统计学意义（P<0.05）。单纯针刺组和单纯药物组总有效率均低于针刺+药物组,差异比较有统计学意义（P<0.05,P<0.01）。结论 单纯针刺和西药治疗CN有一定的效果,两者合用后治疗效果得到较大的提高,可将药物治疗和针刺疗法有机的结合广泛应用于临床。     

IMAGING DIAGNOSIS—INTRAPERICARDIAL RIGHT AURICLE ANEURYSM IN A DOG

An 11‐year‐old, male, Pekinese was examined because of a sporadic, nonresponsive, nonproductive cough. Radiographically there was cardiomegaly and a soft tissue mass in the cranial mediastinum. Echocardiographically, chronic degenerative valvular disease was diagnosed. Furthermore, a large anechoic structure located cranial to the right atrium was detected. Computed tomography was performed to define the mediastinal mass and a right auricle aneurysm was diagnosed. The dog died suddenly 1 day after the diagnostic imaging procedures. At necropsy, a right auricular aneurysm without discontinuity of the pericardial sac was confirmed. Intrapericardial right auricular aneurysm should be included in the differential diagnoses of cranial mediastinal masses.     

The hemodynamic effects of medetomidine continuous rate infusions in the dog

ObjectiveTo characterize the hemodynamic effects of continuous rate infusions (CRI) of medetomidine administered at doses ranging from 0 to 3 μg kg^?1 hour^?1.Study designProspective, blinded, randomized experimental trial.AnimalsSix adult purpose-bred mongrel dogs.MethodsAnesthesia was induced with sevoflurane for placement of arterial and venous catheters. Dogs recovered from anesthesia after which baseline hemodynamic measurements were obtained via lithium dilution cardiac output (CO) determination, with subsequent measurements via pulse power analysis to provide continuous CO determinations. Medetomidine, 1, 2, or 3 μg kg^?1 hour^?1 or a volume equivalent placebo, was administered via CRI for 60 minutes. Systolic, mean, and diastolic arterial pressure, heart rate (HR), CO and stroke volume were measured and stroke index (SI), cardiac index (CI), total peripheral resistance (TPR), and total peripheral resistance index (TPRI) were calculated at 3, 7, 10, 20, 30, 45, 60, 90, and 120 minutes from the start of the infusion.ResultsIncrease in dose decreased SI by 25%, 19%, and 30%, HR by 33%, 57%, and 60%, CI by 50%, 65%, 70% and increased TPRI by 109%, 235%, and 222% from baseline to the 60-minute measurement for the 1, 2, and 3 μg kg^?1 hour^?1 doses, respectively. HR, TPRI, and CI all showed significant differences over the duration of the study from the placebo treatment.ConclusionsMedetomidine CRI produces clinically relevant changes in CO, TPR, and HR. The demonstrated decrease in CO is largely because of bradycardia and the degree of cardiovascular depression appears to be dose-dependent. These findings are consistent with previously described hemodynamic changes with single bolus administration of medetomidine.Clinical relevanceLow-dose medetomidine CRIs produce clinically relevant hemodynamic depression at doses as low as 1 μg kg^?1 hour^?1 and should be used cautiously in dogs.