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窦性心跳过慢是什么原因导致的

2017-11-13 50页 doc 149KB 20阅读

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窦性心跳过慢是什么原因导致的窦性心跳过慢是什么原因导致的 窦性心跳过慢是什么原因导致的, 引起窦性心跳过慢的原因很多,根据窦性心跳过慢发生的原因可将其 主要分为生理性窦性心跳过慢和病理性窦性心跳过慢。 一、生理性窦性心跳过慢:它属于正常现象。这种心跳过慢多见于长期从事体力工作的人、运动员或经常参加体育活动的年轻人,也可见 于睡眠中的正常人。 二、病理性窦性心跳过慢:这种心跳过慢大致是由心外因素和心内因素两种原因导致的。心外因素包括:?患有脑血管疾病、脑瘤等疾病的人,可因颅内压增高而出现心跳过慢;?患有胃扩张、肠梗阻、胆石症、颈部或纵隔肿瘤等疾病的人,...
窦性心跳过慢是什么原因导致的
窦性心跳过慢是什么原因导致的 窦性心跳过慢是什么原因导致的, 引起窦性心跳过慢的原因很多,根据窦性心跳过慢发生的原因可将其 主要分为生理性窦性心跳过慢和病理性窦性心跳过慢。 一、生理性窦性心跳过慢:它属于正常现象。这种心跳过慢多见于长期从事体力工作的人、运动员或经常参加体育活动的年轻人,也可见 于睡眠中的正常人。 二、病理性窦性心跳过慢:这种心跳过慢大致是由心外因素和心内因素两种原因导致的。心外因素包括:?患有脑血管疾病、脑瘤等疾病的人,可因颅内压增高而出现心跳过慢;?患有胃扩张、肠梗阻、胆石症、颈部或纵隔肿瘤等疾病的人,可反射性地导致迷走神经的张力增高而出现心跳过慢;?使用某些降压药、抗心律失常药、β受体阻滞剂、镇静剂等药物的人可出现心跳过慢。心内因素包括:患有心肌炎、病态窦房结综合征或处于下壁心肌梗死急性期的人可出现窦性心 跳过慢。 窦性心跳过慢注意事项 窦性心跳过慢是什么原因导致的,窦性心跳过慢的注意事项包括:1)合理饮食调摄:饮食宜高热量、高维生素而易消化的食物,避免食用过硬不消化及带刺激的食物。吸烟饮酒是引起心律失常的重要诱发因素,应戒烟忌酒。平时可服用益气养心的药膳,如人参粥、大枣粥、莲子粥等。2)大便干燥对心律失常患者来说非常不利。它使病人临厕努挣,烦躁不安,可以使腹压增高,大量血液回流心脏,造成心脏负担过重,而加重心律失常,诱发心力衰竭。对于有冠心病的病人,还可诱发心绞痛,甚至急性心肌梗塞、心脏破裂,导致死亡。 因此,保持大便通畅,对心律失常病人非常重要。 窦性心律过缓怎么办, 心脏的跳动,主要是靠窦房结来调控的。凡是由窦房结冲动引发心脏跳动而形成的心律,统称为窦性心律。正常窦性心律的频率为60,100次,分。窦性心律跳动的快慢因每个人的代谢情况而有所不同。通常,在安静状态下人的心率若低于60次,分即可被诊断为窦性心律过缓。而病态窦房结综合征(简称病窦综合征),则是指由窦房结病变导致功能减退而产生的多种心律失常的综合现。其主要特 征是患者会有持续而显著的窦性心律过缓表现。 窦性心律过缓的注意事项 窦性心律过缓怎么办,窦性心律过缓的注意事项包括:1)合理饮食调摄:饮食宜高热量、高维生素而易消化的食物,避免食用过硬不消化及带刺激的食物。吸烟饮酒是引起心律失常的重要诱发因素,应戒烟忌酒。平时可服用益气养心的药膳,如人参粥、大枣粥、莲子粥等。2)大便干燥对心律失常患者来说非常不利。它使病人临厕努挣,烦躁不安,可以使腹压增高,大量血液回流心脏,造成心脏负担过重,而加重心律失常,诱发心力衰竭。对于有冠心病的病人,还可诱发心绞痛,甚至急性心肌梗塞、心脏破裂,导致死亡。因此,保持大便通 畅,对心律失常病人非常重要。 窦性心率失常的种类 窦性心律过缓怎么办,窦性心率失常是指激动仍然起源于窦房结,但其速率及节律有所变异的一类心律失常。有如下几种: (1)窦性心动过速:窦房结自律除极的频率增加,超过正常窦性心律的上限,即成人超过100次/分,儿童则高于相应年龄的正常范围,即称为窦性心动过速。 (2)窦性心动过缓:当窦性心律频率低于60次/分时,称为窦性心动过缓。窦性心动过缓常伴有窦性心律不齐。(3)窦房结暂停:窦房结在一个或多个心动周期中不能产生冲动,以致未能激动心房或整个心脏时,称为窦房结暂停。 (4)窦性心律不齐:指窦房 结不规则地发出激动所引起的心房及心室的节律改变,称之为窦性心律不齐。(5)窦房传导阻滞:窦房结发出的激动,不能通过窦房结与心 房肌组织的连接区,便称为窦房传导阻滞。 心跳过快、过慢或不整齐 不一定是病 ?记者 刘坤 做心电图时,很多人查出了“毛病”——窦性心动过速、窦性心动过缓或是窦性心律不齐。这些人平常没有明显的心脏不适症状,但拿到检查单后,心里就直打鼓:不会真有心脏病吧,记者就这些医学名词请教了河南省胸科医院心内科周晗主任医师。 心跳的正式称呼叫做“窦性心律” 窦性心动过速、窦性心动过缓和窦性心律不齐,这三个名词都带有“窦性”,很多人一看“窦性”就蒙了,以为得了啥病。周晗说,解释“窦性”,要从窦房结说起。窦房结是心脏跳动的最高司令部,它是位于心脏右心房上的一个特殊小结节。它可以自动地、有节律地产生生物电,这种生物电传送到心脏的各个部位,从而引起心肌细胞的收缩和舒张,心脏的跳动就是这样产生的。由于是窦房结“发电”引起的心脏有节律的跳动,因此我们的心跳就叫做“窦性心律”。既然每个人都是窦性心律,这自然不是一种病,而是心跳的一种正式称呼。 窦房结发一次电,心脏就跳动一次,窦房结的发电频率是每分钟60,100次,因此医学教科书上就把正常的心率规定为每分钟60,100次。每分钟心跳次数少于60次,称为窦性心动过缓;每分钟心跳次数超过100次,称为窦性心动过速;心跳不规律,有快有慢,就叫窦性心律不齐。 心动过缓 可能是“运动员心脏” 一般来说,只要心跳每分钟低于60次,做心电图的医生就会写成“窦性心动过缓”。周晗说,心动过缓不一定是病,有时反而是身体好的表现,比如运动员在休息状态下心跳会低于60次/分钟,另外很多健康的成人、老年人,心率也会低于60次/分钟。普通人睡眠时心率也会降到30~40次/分钟,这都是正常的,因为这时身体不需要心脏使劲工作。 运动员、经常运动的成年人,虽然心跳得慢,但心脏跳动有力,所输出的氧气和养分已经足够全身使用。有统计认为,有25%的青年人心率为50,60次/分钟。而老年人心跳得慢,则是因为他们的窦房结和全身的器官一样,退化了,身体代谢减慢,虽然心跳慢,但输出的氧气和养分也够用了。 有人说,心跳越慢越好,并举例说,乌龟能活150年,老鼠寿命还不足两年,是因为乌龟的心跳每分钟不足10次,老鼠的心跳每分钟高达900次。但是,对于人类来说,心跳不是越慢越好。周晗说,国际上有专家曾经提出,把正常的心率改成55~90次/分钟,因为医学上认为心率在55次/分钟以上都是正常的,只有在55次/分钟以下才算是病态。不过有一个例外,如果是运动员的话,心率在55次/分钟以下也算是正常。所以,对于喜欢体育运动的年轻人来说,心动过缓意味着你有一颗“运动员心脏”。 如果心率经常在55次/分钟以下,则需要进一步检查,看是不是心脏出了问题。首先,窦房结这个发电站出了问题,会导致心跳过慢,其次,冠心病或心肌炎会引起心动过缓。其他少见原因如甲状腺功能减退、高钾血症对此也有影响。出现心动过缓,轻者表现为头晕、乏力、胸闷等,在活动时加重;重者可出现眼前发黑、晕倒甚至突然死亡。目前治疗心跳过慢的长期有效方法是在患者体内安装一台起搏器。心脏起搏器就是一个人工的“备用电池”,它能替代窦房结发电,使心脏有节律地跳动起来。 周晗说,有一个简单的方法可以鉴别心动过缓是不是病态,那就是运动,剧烈运动比如跑步、打球之后,心跳能达到每分钟90次以上,心脏就没问题,如果运动后心跳依然上不去,就说明患心脏病了。 心动过速 交感神经太兴奋 心跳每分钟超过100次,就是“窦性心动过速”,它与交感神经兴奋有关。 人体内脏都受植物神经支配,植物神经又称自主神经,不受人的意志控制。心脏就受植物神经支配,所以人的意识无法控制心跳快慢。植物神经分为交感神经和副交感神经,对于心脏来说,交感神经具有兴奋作用,副交感神经具有抑制作用,二者相互制约平衡。 常常心动过速的人,多是交感神经比较兴奋的人。心动过速在很多情况下是正常的,比如体力活动、情绪激动、饱餐、饮浓茶、喝咖啡、吸烟、饮酒等,可使交感神经兴奋,心跳加快。另外,人站立时交感神经兴奋,心率也加快,躺下时副交感神经兴奋,心率则减慢。生理因素导致的窦性心动过速常为一过性,持续时间较短。 另外,儿童的交感神经比较兴奋,因此儿童常常出现窦性心动过速。6岁以前的儿童心率可超出100次/分钟,初生婴儿则可达100,150次/分钟,心率随着年龄的增长而逐渐下降。 一些疾病会引起心动过速。比如甲状腺功能亢进,研究发现,大多数甲亢患者都有心动过速。感冒发烧、心肌炎也能引起心动过速,体温每升高1?,心率每分钟可增加10,15次。此外,一些药物如肾上腺素、麻黄素等会引起交感神经兴奋,导致心动过速。 周晗说,窦性心动过速通常是生理性的,不需治疗,但需排除作为某些疾病的伴随症状,如甲状腺功能亢进、心肌炎等。 儿童几乎个个都是心律不齐 许多人,特别是年轻人,在做心电图时,常常会得到“窦性心律不齐”的诊断。多数人都知道心跳应该是规律整齐的,所以一听说“心 律不齐”,不少人便认为这是不正常的现象。周晗说,“窦性心律不齐”以儿童、青少年最常见,成年人也不少见,其实它并不意味着心脏有疾病。 年轻人常见的窦性心律不齐大多数属于“呼吸性窦性心律不齐”,它的特点是随呼吸的变化而变换,吸气时交感神经张力增高,心率增快,呼气时副交感神经兴奋,心率变慢。心率快慢变化的周期恰等于一个呼吸周期,屏气时心律转为规整。这种心率失常一般多发于儿童、青年和老人,属于一种正常的生理现象,通常不必治疗,活动后心率增快则消失。 有细心的家长发现孩子有“窦性心律不齐”,非常担心。周晗告诉记者:“儿童几乎个个都是窦性心律不齐。”这是因为儿童的交感神经和副交感神经发育尚不健全,对心脏的调节不稳定。有心脏专家指出:“孩子有窦性心律不齐,不仅不用担心,而且这对孩子来说是好事。”研究发现,窦性心律不齐说明孩子没有器质性的心脏病,而且这种正常的现象还有利于增强孩子的心脏储备能力。心脏储备指的是心脏工作水平上升的可能性的大小,比如能否挨过重病,能否耐受酷暑或发高烧,能否应付高强度的活动。可以通过心率变化情况来判断心脏储备的大小,心率变化越大,心脏储备就越强。 老年人单纯出现窦性心律不齐一般没有大碍,如果同时出现心律不齐和心动过缓,需到医院进一步检查诊治。 [心律失常] 【专题讲座】窦性停搏 窦性停搏(sinus arrest)又称窦性静止(sinus standstill)、窦性间歇、窦性暂停等。窦性停搏指窦房结在一定时间内停止发放激动。 疾病名称 窦性停搏 疾病别名 窦性静止、窦性间歇、窦性暂停[1] 疾病概述 窦性停搏是指窦房结在一个或多个心动周期中不产生冲动,以致不能激动心房或整个心脏,或又称为窦性静止。青年人多由于强烈的迷走神经反射所致,常见于咽部受刺激、气管插管、按压颈动脉窦或眼球、应用洋地黄、硫酸奎尼丁等药物。有时炎症、缺血、损伤、退行性变等各种因素,损伤了窦房结的自律细胞,造成窦性停搏,其时间长短不一,病人会感觉到心脏有一段时间不跳动,长时间的停顿后又可恢复窦性搏动。多数在停顿之后出现异位搏动,常为交界性逸搏或室性逸搏,有时为房性逸搏。如果停顿后什么激动也没有,那就是心脏停搏,病人可发生抽搐,昏厥,甚至死亡。频发的窦性停搏是一种严重的心律失常,是窦房结功能衰竭的表现,必须查清病因给予治疗,常需及时安装人工心脏起搏器。 疾病病因 窦性停搏CT扫描 1.原发性窦性停搏较多见,主要是窦房结本身的损害,多由器质性心脏病所致。例如冠心病、急性心肌炎、心肌病、病窦综合征、频死性停搏即为各种疾病晚期的临终前表现。 2.继发性窦性停搏 (1)继发于各种快速性心律失常之后的短暂性窦性停搏(2,4s):最常见于室上性心动过速,经刺激迷走神经以及药物治疗或食管调搏术超速抑制后,室上性心动过速被突然纠正后而发生的窦性停搏,多为短暂发生。 (2)抗心律失常药物过量或中毒可致窦性停搏:如洋地黄、奎尼丁、利舍平、胺碘酮等。普罗帕酮(心律平)、莫雷西嗪、氟卡尼、安他唑啉、三磷腺苷(ATP)。 (3)迷走神经张力增高对窦房结功能抑制作用致窦性停搏:例如压迫眼球、按摩颈动脉窦、刺激咽部、气管插管等。正常人有时也可发生。 (4)心脏外伤或心脏外科手术时损伤窦房结:可于手术中或手术后出现窦性停搏。冠状动脉造影等也可导致窦性停搏。 (5)高血钾、低血钾亦可引起窦性停搏。 疾病分类 心血管内科 疾病病因 迷走神经张力增高或颈动脉窦过敏均可发生窦性停搏。此外,急性心肌梗死、窦房结变性与纤维化、 窦性停搏CT扫描 脑血管意外等病变、应用洋地黄类药物、奎尼丁、钾盐、乙酰胆碱等药物亦可引起窦性停搏。 临床症状 过长时间的窦性停搏可令病人出现晕眩、视朦或短暂意识障碍,严重者甚至发生抽搐。心电图表现为在较正常PP间期显著长的间期内无P波发生,或P波与QRS波群均不出现,长的PP间期与基本的窦性PP间期无倍数关系。 症状体征 多数窦性心动过缓,尤其是神经性因素(迷走神经张力增高)所致者心率在40,60次/min,由于血流动力学 窦性停搏心肌 改变不大,所以可无症状(也无重要的临床意义。如果不是显著的窦性心动过缓,则心动过缓另一方面的意义是可减少心肌耗氧量,增加心肌休息时间,心室充盈良好,因此心脏每搏输出量增加,可代偿心率减少,故每分钟的心排血量并无减少。但当心率持续而显著减慢,心脏的每搏输出量又不能增大时,每分钟的心排血量即减少,冠状动脉、脑动脉及肾动脉的血流量减少,可表现气短、疲劳、头晕、胸闷等症状,严重时可出现晕厥,冠心病患者可出现心绞痛。这多见于器 质性心脏病。心率持续而显著减慢还使室性异位节律易于产生,器质性心脏病患者,尤其是急性心肌梗死患者容易发生。因为急性心肌梗死时细胞外液的钾离子浓度增高,细胞膜电位负值减少,心室异位起搏点易于发生自动舒张期除极,易于发生室性期前收缩或室性心动过速。由于心动过缓心肌细胞复极的时间不一致,相邻细胞间电位不等而易产生电位差,这也可引发异位心律。 辅助检查 心电图检查:心电图表现为在较正常PP间期显著长的间期内无P波发生或P波与QRS波群均不出现长的PP间期与基本的窦性PP间期无倍数关系。 诊断检查 诊断: 1.在正常窦性心律中,突然出现显著的长间歇。 2.长间歇中无P-QRS-T波群出现。 3.长间歇的P-P间歇与正常的窦性P-P间期不成倍数。 4.在长的P-P间歇后,可出现逸搏或逸搏心律,以房室交接区性逸搏或逸搏心律较常见,室性或房性逸搏较少见。 5.凡遇逸搏心律这一单一心律时,应考虑持久性原发性窦性停搏的可能。 其他辅助检查: 心电图检查可明确诊断,有以下特点: 1.短暂性或持久性窦性停搏窦房结一次或多次没有发生冲动,因此在心电图上出现一个长短不等的较长间歇,在此长间歇内。不出现P-QRS-T波,长的P-P间期不是基本窦性心律周期的整倍数。在同一心电图上,可出现一次或多次长的P-P间歇,但彼此出现的长P-P间歇的长度可互不一致。短暂性窦性停搏多不出现逸搏,有时也可出现,多为房室交接区性逸搏。较久性窦性停搏常伴有一过性逸搏心律。多为房室交接区性逸搏心律。 2.持久性或永久性窦性停搏在心电图上均见不到窦性P波,可见到继发的逸搏心律或过缓的逸搏心律,常伴有房室交接区性逸搏心律。室性逸搏心律、房性逸搏心律少见。持久性或永久性窦性停搏甚至可致心脏停搏死亡。 3.阵发性室上性心动过速、心房扑动、心房颤动等致窦性停搏由于这些快速心率可导致超速抑制,故可引起窦性停搏,但其窦房结功能仅轻度降低,所以预后好,长P-P间歇常大于2s,快-慢综合征的转变过程中,也可见到不同程度的窦性停搏。 鉴别诊断 1.短暂性窦性停搏与重度而显著的窦性心律不齐的鉴别有时两者不易鉴别。重度而显著的窦性心律不齐较少见,其慢相P-P间期可显著延长,少数情况下,可大于两个短P-P间期之和,类似窦性停搏。然而窦 窦性停搏图 性心律不齐时P-P间期的变化是逐渐的。P-P间期呈逐渐缩短又逐渐延长的周期变化,并且慢相的P-P间期不是快相P-P间期的整倍数,表现为P-P间期长短不一。 2.短暂窦性停搏与未下传的房性期前收缩和未下传的房室交接区性期前收缩的鉴别 (1)未下传的房性期前收缩的特点有: ?未下传的房性期前收缩的P′波常重叠在前一心搏的T波上,使T波形态变化。应仔细找出,这是诊断的关键,可用加大电压或走纸速度增快的方法使P′波显露。 ?未下传房性期前收缩的代偿间歇是不完全的:一般小于2个窦性心律P-P间期之和。 ?多个未下传房性期前收缩产生的长P-P间期相等或大致相等。 (2)未下传的房室交接区性期前收缩的特点有: ?逆行P′波常重叠于前一心搏之T波上,可使T波形态发生变化,故应仔细查找。 ?未下传房室交接区性期前收缩所引起的长P-P间期在心电图上互相之间应相等或大致相等。 3.短暂性或较久性窦性停搏与窦房传导阻滞的鉴别 (1)二度?型窦房传导阻滞的特点是在长P-P间期之后的P-P间期逐渐缩短,又突然出现长P-P间期,呈“渐短突长”的特点,上述现象周而复始地出现。 (2)二度?型甚至高度窦房传导阻滞的特点是无窦性P波的长间期是基本窦性心律P-P间期的整倍数,易于鉴别,但如合并窦性心律不齐,则诊断有一定困难。 4.持久性或永久性窦性停搏与三度(完全性)窦房传导阻滞的鉴别 (1)持久性或永久性窦性停搏很少出现房性逸搏或房性逸搏心律,而三度窦房阻滞可伴有房性逸搏或房性逸搏性心律。其原因是抑制窦房结的病理因素也同时抑制心房起搏。 (2)在持久或永久性窦性停搏前连续描记的心电图或24h动态心电图的永久性或持久性窦性停搏前,有暂时性窦性停搏的,则持久性或永久性窦性停搏的可能性大;如有二度窦房传导阻滞出现,则三度窦房传导阻滞可能性大。 (3)静脉注射阿托品后,窦房传导功能无改善为窦性停搏;有改善为三度窦房阻滞。若两者无法区别时,不妨诊断为窦性停搏。 5.持久性或永久性窦性停搏与房室交接区性逸搏心律和室性逸搏心律的鉴别 (1)伴有室房传导的房室交接区性逸搏和室性逸搏心律者,实际上并无窦性停搏,而是房室交接区激动的室房传导引起一系列的窦性节律的顺延而已。 (2)伴有室房逆传阻滞后,仍未见窦性P波出现,则很可能是窦性停搏。 6.持久性或永久性窦性停搏与窦室传导的鉴别窦室传导即弥漫性完全性心房肌阻滞,窦性激动沿房间束下传至房室交接区和心室肌,产生QRS波,但不能通过丧失了传导性的心房肌传导,故见不到任何P波。有助于这一诊断的要点是:?血钾过高。?有临床上导致血钾过高的病因。?QRS波宽大畸形。?T波尖耸如帐篷样。 7.持久性或永久性窦性停搏与显著的窦性心动过缓的鉴别明显的窦性心动过缓其频率如低于同例房性逸搏心律或伴有室房传导的房室交接区或室性逸搏心律时,则窦性P波如期出现,与房室交接区性逸搏心律形成干扰性房室脱节。如同一次或其他几次心电图上曾见到窦性心动过缓的频率稍超过逸搏心律的频率,而呈现为单纯窦性心动过缓或窦性心动过缓与逸搏心律形成干扰性脱节时,则有助于窦性心动过缓的诊断。然而,由窦性心动过缓转为窦性停搏的可能性也是存在的。 治疗 治疗时也可按下面方法尝试进行: 1、对症治疗:停搏时间较短时可无症状;时间较长时可发生昏厥“心脑综合症”应及时抢救。 窦性停搏护理 2、积极治疗:引起窦性停搏的原发病同时输注提高心率的药物,对昏厥反复发作者可安装人工心脏起搏器。 3、静注钙剂,钙离子有助于恢复细胞膜的兴奋性,尤其是对心电图P波消失QRS波增宽者效果显著。 4、应用异丙肾上腺素作用于心脏B1受体,提高窦房结的自律性,对抗高钾血症对窦房结的抑制作用。 并发症 本病如果治疗不及时病人可发生抽搐昏厥甚至死亡这也是本病唯一且最严重的并发症。 保健贴士 1、治疗骨质疏松的钙盐及维生素D2可对抗维拉帕米的抗心律失常作用。 窦性停搏膳食 2、不良反应防治 (1)窦房结功能不全或房室传导阻滞患者,用药后可发生窦性心动过缓、窦性停搏、心脏阻滞、低血压、休克,甚至心脏停搏。 (2)请勿用于异常通路传导伴QRS增宽的快速性心律失常。 (3)用于肥厚性心肌病时可发生严重传导紊乱。肺高压症患者用药可发生心脏停搏及猝死。 (4)心衰患者应用宜小心。 临床资料 女,62岁,因“反复胸闷、气短、心悸半年,加重20天”主诉入院。体格检查:BP21/14kPa,端坐呼吸,颈静脉充盈,双肺底闻及湿罗音,心率146次/分,律绝对不齐,A2,P2,心界向左下扩大,双下肢浮肿(+)。辅助检查:心电图示房颤,左室肥厚劳损,ST-T异常,胸片示心胸比例0.58,心脏彩超示全心大, 窦性停搏治疗 LVEF41%。血钾钠氯正常,肝肾功能正常,心肌酶谱及甲状腺功能均正常。入院后予抗炎、利尿、扩血管治疗后心功能由?级改善到?级,并开始用胺碘酮0.2,1天3次口服进行药物复律,4天后恢复为窦律,心率58,64次1分,伴有成对室早,心电图示P-R间期0.18S,Q-T间期0.38S,窦性心律,完全性右束支传导阻滞,将胺碘酮减量至0.2,2次/日口服。第二天,突然出现意识丧失、四肢抽搐,心电监护示室颤,静推利多卡因50mg及电除颤后恢复窦律,50次/分,P-R间期0.20s, QT间期0.47S,同时静滴胺碘酮共150mg,随后的7小时内又有3次室颤发作,均予电复律,又静推了胺碘酮共300mg,心电图示窦性心动过缓伴交界区逸搏,随后心电监护示长达5s的窦性停搏并转成室扑、室颤,仍经除颤而恢复为交界区心律46次/分,静推阿托品2mg无效,患者意识模糊,遂紧急安装临时心脏起搏器,将起搏频率调至95次/分时,室速、室颤均消失。为防止水肿,予脱水治疗,48h后意识恢复。停用胺碘酮后1周,恢复窦性心律,P-R间期0.20s,Q-T间期0.47s。两周后行冠脉造影术及心腔内电生理检查均未见明显异常。服扩血管药及利尿药出院。 讨论:胺碘酮作为?类抗心律失常药物,兼有轻度阻滞钠,L型钙通道和非竞争性岷外受体作用,对于器质性心脏病合并的心律失常,其作用明显优于其他抗心律失常药,有心功能不全则为首选。可延长心房肌,心室肌及传导系统的动作电位和有效不应期,抑制房室结,窦房结的功能,体表心电图表现上PR及QT间期的延长,使房颤转为窦性心律。 由于胺碘酮在体内分布容积大,吸收慢,生物利用度低而不稳定,因此在剂量掌握上差别甚大,通常认为必须给负荷量,负荷量越大起效越快,但不良反应发生率也增多。就是在复律后已经出现窦律时,又增加了胺碘酮的剂量,最终导致窦性停搏的发生。而例2则在复律后未及时减量,继续使用负荷量而引起窦性停搏。应该严格按照中华医学会心血管病学分会抗心律失常药物治疗的建议进行用药,强调个体化治疗原则,保证疗效的前提下,剂量越小越好,并注意监测心率,节律和血压。同时密切监测心电图,尤其是P-R及QT间期,上例存有明显延长,应引起重视。 (英文版 ) Two regulations promulgated for implementation is in the party in power for a long time and the rule of law conditions, the implementation of comprehensive strictly strategic plan, implementation in accordance with the rules and discipline to manage the party, strengthen inner-party supervision of major initiatives. The two regulations supporting each other, the < code > adhere to a positive advocate, focusing on morality is of Party members and Party leading cadres can see, enough to get a high standard; < rule > around the party discipline, disciplinary ruler requirements, listed as "negative list, focusing on vertical gauge, draw the party organizations and Party members do not touch the" bottom line ". Here, the main from four square face two party rules of interpretation: the first part introduces two party Revised regulations the necessity and the revision process; the second part is the interpretation of the two fundamental principles of the revision of laws and regulations in the party; the third part introduces two party regulations modified the main changes and needs to grasp several key problems; the fourth part on how to grasp the implementation of the two regulations of the party. < code > and < Regulations > revised the necessity and revised history of the CPC Central Committee the amendment to the Chinese Communist Party members and leading cadres honest politics several guidelines > and < Chinese Communist Party discipline and Punishment Regulations > column 1 by 2015 to strengthen party laws and regulations focus. Two party regulations revision work lasted a Years, pooling the wisdom of the whole party, ideological consensus, draw historical experience, respect for the wisdom of our predecessors, which reflects the unity of inheritance and innovation; follow the correct direction, grasp the limited goals, adhere to the party's leadership, to solve the masses of the people reflect a focus on the problem. The new revision of the < code > and < rule >, reflects the party's 18 and the eighth session of the third, the spirit of the fourth plenary session, reflecting the experience of studying and implementing the General Secretary Xi Jinping series of important speech, reflects the party's eighteen years comprehensive strictly practice. (a) revised two regulations of the party need of < the ICAC guidelines > in < in 1997 Leaders as members of the Communist Party of China clean politics certain criteria (Trial) > based on revised, the promulgation and implementation of January 2010, to strengthen the construction of the contingent of leading cadres play an important role. But with the party to manage the party strictly administering the deepening, has not been able to fully meet the actual needs. Content is too complicated, "eight prohibition, 52 are not allowed to" hard to remember, and also difficult to put into practice; the second is concisely positive advocated by the lack of prohibited provisions excessive, no autonomy requirements; the third is banned terms and discipline law, both with the party discipline, disciplinary regulations repeat and Criminal law and other laws and regulations repeat; the fourth is to "clean" the theme is not prominent, not for the existing problems, and is narrow, only needle of county-level leading cadres above. < rule > is in 1997 < Chinese Communist Party disciplinary cases (Trial) > based on revision, in December 2003 the promulgation and implementation, to strengthen the construction of the party play very important role. Along with the development of the situation, which many provisions have been unable to fully meet the comprehensive strictly administering the practice needs. One is Ji law, more than half of the provisions and criminal law and other countries laws and regulations Repetition; two is the political discipline regulations is not prominent, not specific, for violation of the party constitution, damage the authority of Party Constitution of misconduct lack necessary and serious responsibility to pursue; third is the main discipline for the leading cadres, does not cover all Party members. Based on the above situation, need to < the criterion of a clean and honest administration > and < rule > the two is likely to be more relevant regulations first amendment. By revising, really put the authority of Party discipline, the seriousness in the party tree and call up the majority of Party members and cadres of the party constitution of party compasses party consciousness. (II) two party regulations revision process the Central Committee of the Communist Party of China attaches great importance to two regulations revision . Xi Jinping, general books recorded in the Fifth Plenary Session of the eighth session of the Central Commission for Discipline Inspection, on the revised regulations < > made clear instructions. According to the central deployment, the Central Commission for Discipline Inspection from 2014 under six months begin study two regulations revision. The Standing Committee of the Central Commission for Discipline Inspection 4 review revised. Comrade Wang Qishan 14 times held a special meeting to study two regulations revision, amendment clarifies the direction, major issues of principle, path and target, respectively held a forum will listen to part of the province (area) secretary of the Party committee, Secretary of the Discipline Inspection Commission, part of the central ministries and state organs Department The first party committee is mainly responsible for people, views of experts and scholars and grassroots party organizations and Party members. Approved by the Central Committee of the Communist Party of China, on 7 September 2015, the general office of the Central Committee of the Party issued a notice to solicit the provinces (autonomous regions, municipalities) Party, the central ministries and commissions, state ministries and commissions of the Party (party), the General Political Department of the military, every 3 people organization of Party of two regulations revision opinion. Central Commission for Discipline Inspection of extensive solicitation of opinions, careful study, attracting, formed a revised sent reviewers. In October 8 and October 12, Central Committee Political Bureau Standing Committee and the Political Bureau of the Central Committee After consideration of the two regulations revised draft. On October 18, the Central Committee of the Communist Party of China formally issued two regulations. Can say, two laws amendment concentrated the wisdom of the whole party, embodies the party. Second, < code > and < Regulations > revision of the basic principles of two party regulations revision work and implement the party's eighteen, ten eight plenary, the spirit of the Fourth Plenary Session of the Eleventh Central Committee and General Secretary Xi Jinping important instructions on the revised < low political criterion > and < Regulations >, highlighting the ruling party characteristics, serious discipline, the discipline quite in front of the law, based on the current, a long-term, advance as a whole, with Bu Xiuding independent < rule > and < rule >. Main principle is: first, adhere to the party constitution to follow. The constitution about discipline and self-discipline required specific, awaken the party constitution of party compasses party consciousness, maintaining the authority of the constitution. General Secretary Xi Jinping pointed out that "no rules, no side round. Party constitution is the fundamental law, the party must follow the general rules. In early 2015 held the eighth session of the Central Commission for Discipline Inspection Fifth Plenary Session of the 16th Central Committee, Xi Jinping again pointed out that constitution is the party must follow the general rules, but also the general rules." the revision of the < code > and < rule > is Method in adhere to the regulations established for the purpose of combining rule of virtue is to adhere to the party constitution as a fundamental to follow, the constitution authority set up, wake up the party constitution and party rules the sense of discipline, the party constitution about discipline and self-discipline specific requirements. 4 second is to adhere to in accordance with the regulations governing the party and the party. The Party of rule of virtue "de", mainly refers to the party's ideals and beliefs, excellent traditional style. The revised the < code > closely linked to the "self-discipline", insisting on the positive initiative, for all members, highlight the "vital few", emphasized self-discipline, focusing on the morality, and the majority of Party members and the ideological and moral standards. The revised < > Ji method separately, Ji, Ji Yan to Method, as a "negative list", emphasizing the heteronomy, focusing on vertical gauge. Is this one high and one low, a positive reaction, the strict party discipline and practice results transformation for the integration of the whole party to observe moral and discipline requirements, for the majority of Party members and cadres provides benchmarking and ruler. Third, insist on to. In view of the problems existing in the party at the present stage, the main problems of Party members and cadres in the aspect of self-discipline and abide by the discipline to make clearly defined, especially the party's eighteen years strict political discipline and political rules, organization and discipline and to implement the central eight provisions of the spirit against the four winds and other requirements into Disciplinary provisions. Not one pace reachs the designated position, focusing on in line with reality, pragmatic and effective. After the revision of major changes, major changes in the < code > and < rule > modified and needs to grasp several key problems (a) < code > < code > adhere to according to regulations governing the party and party with morals in combination, for at the present stage, the leadership of the party members and cadres and Party members in existing main problems of self-discipline, put forward principles, requirements and specifications, showing Communists noble moral pursuit, reflected at all times and in all over the world ethics from high from low 5 common requirements. One is closely linked to the "self-discipline", removal and no direct relation to the provisions of . the second is adhere to a positive advocate, "eight prohibition" 52 are not allowed to "about the content of the" negative list moved into synchronization amendment < cases >. Three is for all the party members, will apply object from the leadership of the party members and cadres to expand to all Party members, fully embodies the comprehensive strictly required. The fourth is prominent key minority, seize the leadership of the party members and cadres is the key, and put forward higher requirements than the ordinary Party members. Five is to simplify, and strive to achieve concise, easy to understand, easy to remember. The revised < code > is the ruling Party since the first insists on a positive advocate forAll Party members and the self-discipline norms, moral declaration issued to all members of the party and the National People's solemn commitment. > < criterion of a clean and honest administration consists of 4 parts, 18, more than 3600 words. After the revision of the < code >, a total of eight, 281 words, including lead, specification and Party member cadre clean fingered self-discipline norms, etc. Part 3 members low-cost clean and self-discipline, the main contents can be summarized as "four must" "eight code". Lead part, reiterated on ideal and faith, fundamental purpose, the fine traditions and work style, noble sentiments, such as "four must" the principle of requirements, strong tone of self-discipline, The higher request for 6 and supervised tenet, the foothold in permanent Bao the party's advanced nature and purity, to reflect the revised standards requirements. Members of self-discipline norms around the party members how to correctly treat and deal with the "public and private", "cheap and rot" thrifty and extravagance "bitter music", put forward the "four norms". Party leader cadre clean fingered self-discipline norms for the leadership of the party members and cadres of the "vital few", around the "clean politics", from civil servant of the color, the exercise of power, moral integrity, a good family tradition and other aspects of the leadership of the party members and cadres of the "four norms" < > < norm norm. "The Party member's self-discipline norms" and "party members and leading cadre clean fingered self-discipline norms," a total of eight, collectively referred to as the "eight". "Four must" and "eight" of the content from the party constitution and Party's several generation of leaders, especially Xi Jinping, general secretary of the important discussion, refer to the "three discipline and eight points for attention" statements, and reference some embody the Chinese nation excellent traditional culture essence of epigrams. (2) the revised regulations, the main changes in the revised Regulations > to fully adapt to the strictly requirements, reflects the according to the regulations governing the law of recognition of deepening, the realization of the discipline construction and Jin Ju. < rule > is party a ruler, members of the basic line and follow. And the majority of Party members and cadres of Party organizations at all levels should adhere to the bottom line of thinking, fear discipline, hold the bottom line, as a preventive measure, to keep the party's advanced nature and purity. 1, respect for the constitution, refinement and discipline. Revised < rule > from comprehensive comb physical constitution began, the party constitution and other regulations of the Party of Party organizations and Party discipline requirements refinement, clearly defined in violation of the party constitution will be in accordance with regulations to give the corresponding disciplinary action. The original 10 categories of misconduct, integration specification for political discipline, discipline, honesty and discipline masses Ji Law and discipline and discipline and other six categories, the content of < rule > real return to Party discipline, for the majority of Party members and listed a "negative list. 7 2, highlighting the political discipline and political rules. > < Regulations according to the stage of the discipline of outstanding performance, emphasizing political discipline and political rules, organization and discipline, in opposition to the party's leadership and the party's basic theory, basic line, basic program and basic experience, the basic requirement of behavior made prescribed punishment, increase the cliques, against the organization such as violation of the provisions, to ensure that the central government decrees and the Party of centralized and unified. 3, adhere to strict discipline in the law and discipline In front, Ji separated. Revised < Regulations > adhere to the problem oriented, do Ji separated. Any national law existing content, will not repeat the provisions, the total removal of 79 and criminal law, repeat the content of the public security management punishment law, and other laws and regulations. In the general reiterated that party organizations and Party members must conscientiously accept the party's discipline, die van comply with national laws and regulations; at the same time, to investigate violations of Party members and even criminal behavior of Party discipline and responsibility, > < Regulations distinguish five different conditions, with special provisions were made provisions, so as to realize the connection of Party discipline and state law. 4, reflect Wind building and anti-corruption struggle of the latest achievements. < rule > the party's eighteen years implement the spirit of the central provisions of the eight, against the requirements of the "four winds" and transformation for disciplinary provisions, reflecting the style construction is always on the road, not a gust of wind. In the fight against corruption out of new problems, increase the trading rights, the use of authority relatives profit and other disciplinary terms. Prominent discipline of the masses, the new against the interests of the masses and ignore the demands of the masses and other disciplinary terms and make provisions of the disposition and the destruction of the party's close ties with the masses. Discipline to protect the party's purpose. 8 of these regulations, a total of three series, Chapter 15, 178, more than 24000 words, after the revision of the regulations a total of 3 series, Chapter 11, 133, 17000 words, divided into "general" and "special provisions" and "Supplementary Provisions" Part 3. Among them, add, delete, modify the provisions of the proportion of up to nearly 90%. 1, the general general is divided into five chapters. The first chapter to the regulations of the guiding ideology, principles and scope of application of the provisions, highlight the strengthening of the party constitution consciousness, maintenance the authority of Party Constitution, increase the party organizations and Party members must abide by the party constitution, Yan Centralized centralized, would examine at all levels of the amended provisions implementing and maintaining Party discipline, and consciously accept the party discipline, exemplary compliance with national laws and regulations. The second chapter of discipline concept, disciplinary action types and effects of the regulations, will be a serious warning from the original a year for a year and a half; increase the Party Congress representative, by leaving the party above (including leave probation) punishment, the party organization should be terminated its representative qualification provisions. The third chapter of the disciplinary rules of use prescribed in the discipline rectifying process, non convergence, not close hand classified as severely or heavier punishment. "Discipline straighten "At least eighteen years of five years, these five years is to pay close attention to the provisions of the central eight implementation and anti -" four winds ". The fourth chapter on suspicion of illegal party disciplinary distinguish five different conditions, with special provisions were made provisions, to achieve effective convergence of Party and country 9 method. < rule > the provisions of Article 27, Party organizations in the disciplinary review found that party members have committed embezzlement, bribery, dereliction of duty dereliction of duty and other criminal law act is suspected of committing a crime shall give cancel party posts, probation or expelled from the party. The second is < Regulations > Article 28 the provisions of Party organizations in the disciplinary review But found that party members are stipulated in the criminal law, although not involved in a crime shall be investigated for Party discipline and responsibility should be depending on the specific circumstances shall be given a warning until expelled punishment. This situation and a difference is that the former regulation behavior has been suspected of a crime, the feeling is quite strict, and the latter for the behavior not involving crime, only the objective performance of the provisions of the criminal code of behavior, but the plot is a crime to slightly. < Regulations > the 29 provisions, Party organizations in the discipline review found that party members and other illegal behavior, affect the party's image, the damage to the party, the state and the people's interests, we should depend on the situation Seriousness given disciplinary action. The loss of Party members, seriously damaging the party's image of behavior, should be given expelled from the party. At this article is party member is in violation of the criminal law outside the other illegal acts, such as violates the public security administration punishment law, customs law, financial laws and regulations behavior. The fourth is < cases > Article 32 stipulates, minor party members and the circumstances of the crime, the people's Procuratorate shall make a decision not to initiate a prosecution, or the people's court shall make a conviction and exempted from criminal punishment shall be given within the party is removed from his post, probation or expelled from the party. Party members and crime, sheets were fined in accordance with For acts; the principal Ordinance amended the provisions of the preceding paragraph. This is the new content, in order to achieve Ji method effective convergence. Five is < > the thirty third article 10 of the provisions, the Party member due to an intentional crime is sentenced to criminal law (including probation) sheets or additional deprivation of political rights; due to negligence crime and was sentenced to three years or more (excluding three years) a penalty, shall give expelled punishment. Due to negligence crime is convicted and sentenced to three years (including three years) in prison or be sentenced to public surveillance, detention, shall in general be expelled from the party. For the individual may not be expelled from the party, should control Approval. This is followed and retained the original > < Regulations the provisions of punishment party authorization rules and report to a level party organizations. For is "party members with criminal acts, and by the criminal punishment, generally should be expelled from the party". The fifth chapter of probationary Party member of the discipline and discipline after missing members of the treatment and punishment decisions, such as the implementation of the provisions, clear the related party discipline and punishment decision made after, for duties, wages and other relevant alteration formalities for the longest time. 2, sub sub section will the original regulations of 10 categories of acts of violation of discipline integration revised into 6 categories, respectively, in violation of the punishments for acts of political discipline "in violation of discipline behavior of punishment" in violation of integrity of disciplinary action points "of violation punishments for acts of mass discipline" "the violation of work discipline, punishment" in violation of discipline of life behavior punishment "6 chapters. 3, annex" Supplementary Provisions "clear authority making supplementary provisions of, cases of interpretative organ, as well as regulations implementation time and retroactivity etc.. 11 (3) learning understanding > < regulations needs to grasp several key problems The first problem -- about the violation of political discipline behavior > < new ordinance chapter 6 the political discipline column for the six disciplines, that is the main opposition to Party leadership and the opposition of the basic theory, basic line, basic program and basic experience, basic requirements of misconduct made provisions of the disposition, especially the eighteen since the CPC Central Committee put forward the Yan Mingzheng treatment of discipline and political rules requirements and practical achievements transformation for Discipline article, increase the false debate central policies, cliques, against the organization review, make no discipline of the principle of harmony terms. These are the party's eighteen years in comprehensive strictly Process combined with the practice of rich content. (1) false debate the central policies and undermine the Party of centralized and unified the problem is made in accordance with the provisions of the party constitution. Constitution in general programme requirements adhere to democratic centralism is one of the requirements of the construction of the party must adhere to the four cardinal. Application of this principle is not only the party the basic organization principle and is also the mass line in party life, it requires that we must fully develop inner-party democracy, respect for the dominant position of Party members, safeguarding the Party member democratic rights, give full play to the enthusiasm and creativity of the party organizations at all levels and Party members, at the same time, also must implement the right concentration, ensure the party's mission < the chaos in unity and concerted action to ensure that the party's decision to get quickly and effectively implementing. The Party Central Committee formulated the major principles and policies, through different channels and ways, fully listen to the party organizations and Party members of the opinions and suggestions, but 12 is some people face to face not to say back blather "" will not say, after the meeting said, "" Taiwan does not say, and nonsense ", in fact, not only disrupt the people thought, some causing serious consequences, the damage to the Party of the centralized and unified, hinder the central policy implementation, but also a serious violation of the democratic system of principles. There is no doubt that shall, in accordance with the Regulations > 4 Specified in Article 6 to give the appropriate punishment. For did not cause serious consequences, to give criticism and education or the corresponding tissue processing. (2) about the destruction of the party's unity < New Regulations > the forty eighth to fifty second article, to damage Party's unity unified and violation of political discipline, punishment situation made explicit provisions. Article 52 of the new "in the party get round group, gangs seek private gain, cliques, cultivate private forces or through the exchange of interests, for their own to create momentum and other activities to gain political capital, given a serious warning or withdraw from their party posts disposition; if the circumstances are serious, to give Leave a party to observation or expelled from the party. (3) on against the organization review of the provisions of the constitution, party loyalty honesty is party members must comply with the obligations. Members must obey the organization decision, shall not violate the organization decided encounters by asking questions to find organization, rely on the organization, shall not deceive the organization, against the organization. For example, after the investigation does not take the initiative to explain the situation, but to engage in offensive and defensive alliance, hiding the stolen money is against survey organization, is a violation of the behavior of political discipline. Article 24 of the original > < Regulations, although the provisions of the interference, hinder group review the behavior of the fabric can be severely or 13 Aggravated punishment, but did not put this kind of behavior alone as a discipline for qualitative amount of discipline. > < new regulations increase the Article 57, "anti organization review, one of the following acts, given a warning or serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, give expelled from the party: (a) on supply or forged, destroyed, transfer, conceal evidence; (II) to prevent others expose, providing evidence Material; (III) harboring co personnel; (4) to the organization to provide false information, to hide the fact; (5) the him against the acts of the organization review. "< rule > add this clause to the Constitution requires more specific, the previous no punishment in accordance with the definite list and put forward clear punishment in accordance with. (4) about organizing or participating in superstitious activities as < Regulations > about engage in activities of feudal superstition obstruction of social management order" violations of Article 164 the provisions, but according to the original < rule > only in disrupting production, work, social life order The case to be disciplinary treatment, in other words, alone make the feudal superstition, organize or participate in the activities of feudal superstition of, does not constitute a violation. Which is not consistent with the requirements of our party's political party. > < new regulations in this change is, superstitious activities on the political discipline, increase the Article 58, is the organization of Party members, in superstitious activities included in violation of the negative list of political discipline deserves punishment, which and Party members should adhere to the correct political principle, political standpoint and viewpoint is consistent. 14 the second question about organization and discipline violation behavior of democratic centralism is our The party's fundamental organizational system. < New Regulations > Chapter 7 "in violation of the behavior of organizational discipline punishment" mainly for violation of democratic centralism, contrary to the "four obey the discipline behavior for source classification rules. Increased not in accordance with the relevant provisions or requirements to the organization for instructions to report on major issues; do not report truthfully report about personal matters; falsify personal archives; hide before joining the party serious mistakes; leading cadres in violation of the relevant provisions of the organization, will participate in the spontaneous formation of the old Xiang, Alumni Association, comrades in arms; to obtain illegal country residence abroad or foreign nationality, illegal for private frontier Documents such as discipline terms. (1) on the report truthfully report personal matters in 2010 the Central Committee of the Communist Party of China office, office of the State Council introduced < provisions on issues related to the leading cadres to report personal >, is clear about the request, deputy division level and above leading cadres should truthfully report changes in my marriage and spouse, children, moved to the country (territory), practitioners, income, real estate, investment and other matters, for failing to report, do not report, concealed and unreported, according to the seriousness of the case, giving criticism and education, and to make a correction within a time limit, shall be ordered to make a check, the commandment Jiemian conversation, informed criticism or jobs, free Post processing, constitute violations, in accordance with the relevant provisions shall be given a disciplinary sanction. But since the original < Regulations > and there is no corresponding specific terms, the violation of the regulations, do not report, as a false report about personal matters, there is no corresponding disciplinary action terms, in practice it is difficult to operate. In this regard, in order to solve is not reported, as a false report about personal matters 15 asked censure, the new < Regulations > add the Article 67 of violation of personal matters related to reporting requirements, report truthfully report the clear punishment basis, making this kind of violation behavior is no longer free drilling for Exhibition on matters of personal checks to verify and supervision of cadres, discipline review provides a powerful discipline guarantee. (2) about the illegal organization, to fellow, alumni, friends of the war will < regulations stipulated in Article 68 of >, leading cadres of the party in violation of relevant provisions of the organization, will participate in the spontaneous formation of fellow, Alumni Association, comrade in arms to give the punishment according to the seriousness of the case. Here special needs note is three points: this provision for only the leading cadres ", reflecting the high requirements of leading cadres; second violation in 2002, the Central Commission for Discipline Inspection, the central Organization Department and the The relevant provisions of the General Political Department jointly issued the < off in leading cadres not to participate in the initiative to set up "the villagers would be" alumni "" comrades in arms organization notice >. That is to say, to the spontaneous formation of fellow, Alumni Association, comrades in arms will constitute the premise of discipline is a violation of the provisions of this. The notification specified, leading cadres are not allowed to participate in the spontaneous incorporation of fellow, alumni, between comrades association would like the organization and shall not bear the sorority Human and the organizer shall not hold the corresponding position in the sorority; shall not borrow machine woven "network" and engage in kiss sparsely, round and round the gangs, but not "align" "Jieyi Gold Orchid" behavior. The third is to emphasize here that shall be organized to participate in the initiative to set up the villager, Alumni Association, comrades in arms. The so-called 16 spontaneous was established mainly means without registration. Therefore, Party members include leading cadres in the normal range of fellow, alumni, comrades in the party is not a violation of the rules of Party discipline. The three problem about integrity violations discipline Lian Jie discipline has been eighteen years clean government and anti The focus of the work of corruption. This Ordinance to amend, honesty and discipline this biggest adjustment, the new content, most of which prescribed by the original < criterion of a clean and honest administration > 8 ban and 52 are not allowed into the basic this part. (1) the central eight provisions of the spirit and requirements into < New > in the regulations of the party's eighteen years, central resolutely implement the provisions of the eight and pay close attention to the node and intensive briefing, on public funds, private bus, public funds tourism, gifts of public funds, the big parade and lavish weddings and festive, illegal payment allowances and subsidies, illegal construction of buildings such as the original masses reflects the relatively strong, "four winds" problem of the Resolute rectification. But original < Regulations > to eat and drink, super standard reception and no clear and specific expression, new < rule > will implement eight Central provisions of the spirit of the problem increased to "clean cheap self-discipline" chapter, clear to exceed the standard, beyond the scope of the reception or borrow machine eating and drinking etc. some in violation of the provisions of the spirit of the eight central relevant persons responsible for punishment, once the violation will be according to the < rule > severely punished, binding, enhanced significantly. One is to add Article 87, about to obtain illegal, hold, and the actual use of the sports card, golf ball cards and other consumer card. Illegal access to private clubs made the punishment provisions. The second is increase the Article 97, has made provisions of the disposition of illegal self pay or 17 spamming allowances, subsidies and bonuses. The third is added to the Article 99, on violation of super standard, beyond the scope of the reception or borrow machine eat and drink to make the provisions of punishment. The fourth is to increase the Article 101, on the management of conference activities in violation of the provisions made sanctions regulations. The fifth is the increased Article 102, for violation of office space management provisions made the punishment provisions. Six is to split the original < rule > Article 78, formed article 98, Article 100 of public Models of tourism, violate the provisions on the administration of the use of discipline of the bus through the list of made a more detailed provisions, apply more operational. Seven is increased the article 96, in violation of the relevant provisions of the, to participate in public funds to pay for dinner, high consumption of entertainment, fitness activities and public funds to buy gift, send gifts to make the provisions of the disposition. On the violation of the central provisions of the spirit of the eight, in addition to > < new regulations into "violation of honesty and self-discipline" misconduct outside, is different with the original < Regulations >, revised < rule > clearly defined not only to disposition of the directly responsible persons, but also dispose of collar Guide responsibilities. (2) increased trading rights, use of authority or position influence as relatives and close to profit violation of the terms of the < New Regulations > absorption < clean politics several guidelines > the relevant provisions spirit, increase the "negative list, including trading rights, the functions and powers or duties of influence as relatives and staff around profit. Increase Article 81" mutual use of office or authority ring for each other and their spouses, children and their spouses and other relatives, around 18 personnel and other specific relationship between the people to seek benefits engage in trading rights, given a warning or serious warning Sanctions; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, shall be expelled from the party. Increase Article 82 "connivance, acquiescence to the spouse, children and spouse etc. relatives and staff around the effect of Party members and cadres personal authority or position for personal gain, if the circumstances are relatively minor, given a warning or a serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, the given Expelled from the party. Party members and cadres of the spouses, children and their spouses does the actual work and get salary or although the actual work but to receive significantly beyond the same rank salary standard, Party members and cadres informed fails to correct, in accordance with the provisions of the preceding paragraph. "(3) about the gifts, gifts misconduct from handling practices in recent years, engaged in official cadres received gifts, gifts problems more prominent. This has seriously affected the image of Party members and cadres, damaged the relations between the party and the masses, and is a hotbed of corruption, is really necessary for this kind of behavior to be disciplined. < rule > no on accepting gifts, gifts, Card consumption behavior to engage in simple "one size fits all", but the difference between the different separately. One is in accordance with the provisions of Article 83, accepting may affect the impartial enforcement of the official gifts, gifts, consumer cards to depending on the seriousness of the case shall be given disciplinary sanctions. That is to say, for may affect the fair execution of business gifts, gifts, consumer cards are not allowed to accept. 19 is in accordance with the provisions of Article 83, accepting was significantly higher than normal ceremony is still exchanges of gifts, gifts, consumer card to disciplinary action. This is new regulations that daily life is purely reciprocity, accepting the same thing, boys , fellow friends gifts, gifts, shopping cards, although and fair execution of business has nothing to do, also want to as the case shall be dealt with, the situation is obviously beyond normal reciprocity ". The so-called" reciprocity ", one is emphasizes the reciprocal in protocol. In other words is you to me how, I to you how, not only does not go. The second is to significantly exceeded the normal local economy level, customs and habits, economic capacity of individual gifts, gift value. Specific sanctions to according to the processing of a variety of factors to consider, as appropriate. The third is the root according to the provisions of Article 84," to Engaged in public service personnel and their spouses and children, children's spouses and other relatives and other specific relationship presented Ming Xianchao normal reciprocity of gifts, gifts, consumer card, if the circumstances are relatively serious, given a warning until probation. "In accordance with the above provisions, gift giving significantly beyond the normal reciprocity, giver constitute the discipline. (4) on illegal trading of stocks or of other regulations of securities investment < > Article 88 is engaged in punishment regulation of camp and activity in violation of the relevant provisions on. Among them, 3 will" buying and selling stocks or in other securities investment "column as one of disciplinary cases Out. First need to be clear, > < regulations did not change the provisions of the Ordinance. The ordinance of the provisions of the second paragraph of Article 77 provisions "who, in violation of the provisions of the sale of stocks" is one of the violation, and at the beginning of the first paragraph of this article "violation of 20 against the relevant provisions of the" textual representation of the repeat revision. In, just from the legislative technique removed the "personal" in violation of the provisions, content and not to change the original provisions. Need to clear is, "buy or sell a stock or of other securities investment" refers to violation of the relevant provisions refers to in April 2001, the Party Central Committee, the State Council promulgated the On the work of the party and government organs staff's personal investment in securities if dry provisions >. According to the provisions of Article 3, use of work time, office facilities, the sale of stocks and securities investment fund belongs to illegal behavior. The fourth question, about the violation of the masses of the disciplinary actions < new regulations > would violate public discipline behavior of a single set of a class of restored "three rules of discipline and eight note" in the discipline of the masses of excellent traditional. < New Regulations > Chapter 9 "to violate the masses of disciplinary action", mainly the destruction of the party's close ties with the masses of misconduct made provisions on disciplinary; enrich and perfect the super standard, beyond the scope of Xiang Qun < All to raise fund and labor, in for involving the public affairs deliberately, chinakayao, in social security, policy support, disaster relief funds and materials and other matters assigned any kind and affectionate friends, obviously unfair acts against the interests of the masses of the disciplinary terms; increase the terms not in accordance with the provisions of the public party provided, government, factory and village (neighborhood) provided etc. violation of the people's right to know the behavior of the discipline. The fifth issue, on the violation of work discipline violation of work discipline added "negative list, including Party organizations carry out strictly Main responsibility for poor discipline terms. (1) the new party organization comprehensive strictly the main responsibility of the party does not fulfill the 21 or perform poor disciplinary terms < New Regulations > has a lead people to pay attention to the new terms, that is, in chapter ten "on the violation of work discipline behavior punishment" increase in the one hundred and fourteenth "party fail to perform comprehensive strictly the main responsibility of the party or to perform comprehensive strictly the main responsibility for administering the ineffective, resulting in serious damage or serious adverse effects, to the person directly responsible and the responsibility of leadership and give a warning or serious warning. The situation is serious, giving removed from their party posts or on probation Punishment. "Here the changes. For the first time, the main responsibility write < rule >. (2) new shall report does not report or false reporting discipline shall increase the 117 bar" in the higher level units to check to inspect the work or report to the parent unit, work report of shall report the matters do not report or do not report, cause serious damage or serious adverse effects of, to the person directly responsible and the responsibility of leadership, to give warning or a serious warning; if the circumstances are serious, giving removed from their party posts or placed on probation. "For example, during the tour visits to the region, the unit Members the obligation to the inspection teams to reflect the true situation, to conceal not reported or intentionally to the inspection teams to provide false information, causing serious damage or serious adverse effects of, the person directly responsible and the responsibility of leadership should be in accordance with the provisions of < rule > Article 117 to give the appropriate punishment. (3) the new not granted in accordance with the provisions of punishment, not according to the provisions of the implementation of disciplinary measures 22 violation of the provisions of Article 115 "Party organizations have one of the following circumstances, the direct leadership responsibility. Probation: members were sentenced punished, in accordance with the provisions give disciplinary action or in violation of state law Rules of behavior should be given disciplinary punishment and dispose of; disciplinary punishment by decision or complaint review the decision made, not in accordance with the provisions of the implementation decisions on punishment of the party, position, rank, and the treatment of the matters; Party members subject to disciplinary action, not in accordance with the cadre management authority and organizational relationships of by dispose of Party members to carry out education and supervision of daily management. "What needs to be pointed out is," cliff "demoted with cars, housing, secretary problem, implementation is not a discipline and party posts and ranks treatment by the organization department is responsible for the implementation, with cars, housing by the logistics department is responsible for the implementation of, Ji Commission responsible oversight responsibilities. The six questions, about the acts violating the discipline of life "in violation of discipline of life behavior punishment", mainly to "four winds" problems and a serious violation of social morality, family virtue acts of misconduct made provisions on disciplinary, an increase of extravagant life, contrary to the social public order and good customs disciplinary terms. Worth mentioning is, > < Regulations in Article 150 about "adultery" "mistress (Cardiff) formulation in the new < rule > is removed, to expand the scope of Article 127 provisions" and others hair improper sexual relations, let face disciplinary action Wider more strict. Four, and earnestly do a good job in the < code > and < rule > implement system of life lies in execution. < code > and < Regulations > is 23 Party organizations at all levels of a strong constraint and all Party members follow. Learning and implementing the < code > and < rule > is party committees (party), commission for discipline, discipline inspection group), the majority of Party members and cadres of the common responsibility, must party caught together, the party one execution. () Party committees (party) and play and implement comprehensive strictly the main responsibility, pays special attention to the two party regulations learning cross penetration. One is to Adhere to the party constitution is fundamental to follow, and resolutely safeguard the authority of the Party Chapter. The second is to adhere to the problem oriented, to strictly political discipline and political rule moments in the first place. The third is to adhere to the discipline and rules quite in front must not allow the bottom line to break the discipline. The fourth is to seriously organize the study of propaganda and education, in the city party members to create a disciplined, about the rules of the strong atmosphere. (II) Commission for Discipline Inspection at all levels (Discipline Inspection Group) to an important basis for the revised two party regulations as, adhere to easily blame, strengthen supervision and enforcement And early method in combining Ji, increase accountability efforts. One is to two regulations within the party important basis, adhere to the party constitution duties, with strict discipline to maintain the constitution authority. The second is to adhere to high standards and keep the bottom line, adhere to Ji Yan in law and discipline, the discipline and rules quite in front, grasping grasping small, easily blame, comprehensive use of supervision and discipline of "four kinds of form" in the discipline embodies the strict requirements and care for the discipline, tighten up, Yan. According to discipline in accordance with regulations to carry out disciplinary review. Increase the violations punishment, clues can initiate an investigation on the trial of cases According to the discipline on the provisions of the proportion of processing and control manager maintains discipline. To focus on investigating non convergence, don't accept hand serious disciplinary violations at the same time, pay more attention to the general review of discipline 24 behavior, and gradually increase the lighter punishment. Four is to illuminate two party regulations, combined with the local district of the Department of party conduct Lianzheng to relevant laws and regulations system clean, timely research proposes to establish, change, waste release opinion, avoid conflict, and the fasten system of cage, and gradually formed not rot, not rot, not want to rot system and working mechanism. (3) the leadership of the party members and cadres should play an exemplary role. The rate of higher consciousness of the front of the Ordinance to lead practice self-discipline norms, leading to maintain discipline of seriousness and authority. One is the above rate, demonstration and guidance, take the lead in learning and mastering the < code > and < > the requirements and regulations, do the deep understanding, learning to use. The second is to play an exemplary role in abiding by discipline rate, take the lead in practicing self-discipline norms, firmly establish before the discipline are equal, the system has no privilege, discipline is no exception, and consciously do standards, require more strict measures more practical. Third is to consciously accept supervision, conscientiously participate in the democratic life and debriefing honesty responsibility, such as Real to the party organization to report personal matters, and to accept the supervision of the work and life of the normal, habits under the supervision of the exercise of power, to carry out the work. The fourth is to set an example for the strict enforcement of discipline. Leading cadres should take the lead in the maintenance of discipline of seriousness and authority, to dare to seriously, dare to struggle, dare to offend people, for misconduct not laissez faire, but do not indulge, not tolerate to ensure the party constitution of party compasses party put in place. (4) the majority of Party members and cadres to set high standards and hold the bottom line, consciously abide by the < code > and < rule >. One is to control the < standard > and < 25 cases >, tight Close connection with their own thoughts, practical work and life, efforts to solve the problems, to enhance the study and implement of the effectiveness and pertinence. The second is to establish a high standard and hold the bottom line, consciously in the self-discipline pursuit of high standards, strictly in the party away from the red line discipline, discipline, about the rules and know fear, distrust, the formation of the honor system, comply with the system, safeguard system of good habits. Regulations and discipline regulations of < < New Revision of the Communist Party of China clean fingered self-discipline criterion > and < Chinese Communist Party Disciplinary Regulations > is the Party Central Committee in the new situation to promote the comprehensive strictly root of the lift, the regulations of the party construction of keeping pace with the times. We should study and implement the Standards > and < > as the primary political task, adhere to the party constitution duties, adhere to the discipline of, Ji Yan in law, the full implementation of supervision and discipline accountability responsibilities for coordination and promotion "four overall" strategic layout in XX District vivid practice to provide a strong guarantee. - Si Jian Wu, and effectively enhance the implementation of the implementation of the < code > < > The consciousness of General Secretary Xi pointed out that the party is in charge of the party, to manage the party; strictly, it can cure good party. Criterion > and < rule > keep pace with the times is our party to form a new potential strictly rules, to deepen understanding of the ruling law, is a comprehensive strictly, and strengthen the supervision within the party important grasper. Criterion > closely linked to the theme of self-discipline, self-discipline intensity-modulated, focusing on morality, for the majority of Party members and cadres set to see, feel the high standard, show the Communists noble moral sentiment; District Ordinance < < rule > the constitution of discipline integration into a political discipline, organization and discipline, honesty and discipline, discipline of the masses, work discipline, discipline, emphasize discipline, focusing on established rules, to draw the party organizations and Party members do not touch the bottom line. Party committees (party) to effectively strengthen the study and publicize the implementation of the < code > and < rule > the organization and leadership of criterion > and < > a full range, multi angle, deep publicity, the formation of study and publicize and implement the boom, in order to consolidate the development of good political environment to create a positive environment and atmosphere. The majority of Party members and cadres to strict requirements, the < rule > and < Ordinance cases > as a guide to action and behavior criterion, adhere to the moral standards and discipline of the bottom line, to maintain the discipline of worship and awe, learning, compliance, and maintain party discipline and rules of the model. The discipline inspection and supervision organs and cadres to the < code > and < > as the deepening of the "three", and strengthen supervision and discipline of accountability is important to follow correctly grasp the use of supervision and discipline of "four types", promote the comprehensive strictly in new roots. Strict discipline, adhere to the discipline and rules quite in front of the enterprise in the implementation of expensive to implement to execute. The discipline inspection and supervision organs to implement the < code > and < Efforts to investigate cases > as an opportunity, adhere to the party should manage the party strictly, serious performance of their duties to promote two regulations implementation. Change discipline concept. From the simple "investigation of illegal" to a comprehensive "stare at violate discipline"; from the business case to prosecute the big cases and timely solve the signs of tilt to. From the orientation to the normal supervision; from the tube "minority" to resist the "most". Guide Party members and cadres to seriously implement the < code > and < rule >, consciously abide by the political, organizational, honest people, work, life six discipline. Urge the leadership cadres sent to play an exemplary role, take the lead in strictly enforced. Relaxation and rest Strong wind is Su Ji, closely linked to the "four winds" prone to multiple, the masses reflect the strong important nodes and, glued to the four winds "new form, new trends, seriously investigate and deal with violations of the central eight provisions of the spirit, to increase the bulletin exposure intensity, the formation of Chajiu" four winds "loudly, continue to release and discipline must be strict signal. At the same time, extended supervision tentacles, through the development of the rural and fishery party conduct Lianzheng construction inspection, issued in a timely manner, Chajiu occurred in grassroots side of corruption and unhealthy, and earnestly safeguard the interests of the masses and social stability. The creativity and discipline. Grasp and make good use of the supervision and discipline of" four types ", to ensure the Promoting clues to lots of discipline and the law of the vacuum tube, strict together. Not only to the "less" and "very few" thorough investigation severely punished, but also the "most" to maintain zero tolerance trend through layers of conductive pressure, let the discipline about the rules for each party members and cadres consciously follow. At present, it is necessary to implement the "list" management, strictly follow the clues to the disposal of five standards, make the classification of disposal, dynamic cleanup. Zadok Party committees at all levels to implement the main responsibility, comprehensive use of disciplinary action and tissue processing and other means to effectively curb the commonplace, used to see do not blame the "small problem", not because of "practice" and "exception". Prominent Discipline characteristics, the problems of violation of discipline and rules into the focus of supervision and discipline and disciplinary review. At the same time, increase case double check the intensity, the serious problems of discipline violations or "four winds" ban but not absolutely, not only to be held directly responsible, but also held leadership responsibility; not only to pursue studies the main responsibility of the Party committee, and to pursue Commission for Discipline Inspection and supervision responsibilities and promote accountability to become the new norm. The implementation of supervisory responsibility. Maintain < code > and < rule > the seriousness and authority of the discipline and rules and truly become the party's ruler. Discipline as supervision within the party the specialized agency, we must strengthen the responsibility to act, adhere to the Impartial discipline accountability, earnestly will be strict discipline, discipline must be punished, and severely punish the acts in violation of rules and regulations.
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