心率失常心电图总结(新大纲新增)

心率失常心电图总结(新大纲新增) 心 电 图 第一节 临床心电学的基本知识 1.心电图产生原理 • 静息状态 外正内负 • 除极(depolarization)状态 外负内正 电源前 电穴后 电极对向电源--向上 波形 • 复极(repolarization) 电源后 电穴前 电极对向电源--向下波形 • 复极方向与除极方向相反 心外膜向心内膜 • 心电向量(vector) 具有强度和方向性的电位幅度 – 与心肌细胞数量呈正比 – 与探查电极位置和心肌细胞距离呈反比 – 与探查电极的方位和心肌除极的方向夹角呈反比 • 心电综合向量原则 2.心电图各波段的组成和命名 • P波:心房的除极过程 • P-R段(P-Q段):心房复极过程及房室结、希氏束、束支的电活动 • P-R间期:自心房开始除极至心室开始除极 • QRS波群及命名:心室除极 ST段和T波:心室缓慢和快速复极 • • Q-T间期:心室开始除极至心室复极完毕 3.心电图导联体系 • 肢体导联(limb lead) – Einthoven三角 – 标准导联--双极肢体导联 I II III – 加压单极肢体导联 aVL aVR aVF – 额面六轴系统 • 胸导联(Chest lead) – 单极导联V1-V6 – 肢体导联三个电极各串一5kW电阻，将三者连接起来，构成无干电极，为负 极 第二节 心电图的测量和正常数据 1.心电图测量 • 走纸速度25mm/s时，纵线1mm=0.04s 标准电压1mV=10mm时，横线1mm=0.1mV • 心率的测量:60/R-R或P-P间期的秒数 • 各波段振幅的测量:QRS波起始前的水平线上缘到波顶，下缘到波底 • 各波段时间的测量 – 12导同步心电图 • P波、QRS波、Q-T间期从最早起点至最晚终点 • P-R间期从最早P起点至最早QRS起点 – 单导心电图 • P波、QRS波:最宽的P波、QRS波 • P-R间期:最宽大P波且有Q波 • Q-T间期最长 – 测量各波时间应自波形起点的内缘测至波形终点的内缘 • 平均心电轴: – 概念:平均QRS电轴，是心室除极过程中全部瞬间向量的综合，说明心室在 除极过程的总时间内的平均电势方向和强度，是额面电轴 – 测定 方法 快递客服问题件处理详细方法山木方法pdf计算方法pdf华与华方法下载八字理论方法下载 :I、III;目测;代数和 – 临床意义 • - 30? ~ +90? 正常范围 • +90? ~+180? 右偏 右心室肥大 左后分支阻滞 • - 30? ~ - 90? 左偏 左心室肥大 左前分支阻滞 • - 90? ~- 180? 极度右偏 • 心脏循长轴转位 – 心尖?心底 – 顺钟向转位 右心室肥大 – 逆钟向转位 左心室肥大 2.正常心电图波形特点和正常值 • P波 心房除极的电位变化 – 形态:圆形 偶有切迹 • 综合向量:左、前、下 • I、II、AVF、V4-V6向上;AVR向下 – 时间:< 0.12S – 振幅:肢导 < 0.25mV;胸导 < 0.2mV • P-R间期 心房开始除极至心室开始除极的时间 – 正常范围:0.12~0.20s – 心动过速时缩短，心动过缓时延长 ? 0.22s • QRS波群 心室肌除极的电位变化 – 时间:0.06 ~0.11s – 波形和振幅 • V3 R/S=1 • V1< 1mV • V5、V6 < 2.5mV • AVR < 0.5mV • AVL < 1.2mV • AVF < 2.0mV • I、II、III主波向上 • 肢体导联<0.5mV或胸前导联<0.8mV为低电压 • Q波:振幅<同导联1/4R，时间<0.04S • J点:自QRS波群的终末与ST段起始之交点 • ST段:自QRS波群终点与T波起点间的线段代 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf 心室缓慢复极过程 – 下移<0.05mV;抬高 V1、V2 <0.3mV;V3 <0.5mV • T波:代表心室快速复极时的电位变化 – 方向:与主波一致 ;振幅:> 同导联R波的1/10 • Q-T间期:从QRS波的起点至T波终点，代表心室肌除极和复极全过程所需的时间 – 正常范围:0.32-0.44s – 校正Q-Tc= Q-T/ R-R • U波:T波后0.02~0.04s的振幅很小的波，代表心室后继电位 第三节 心房、心室肥大 1.心房肥大 • 右房肥大(right atrial enlargement) – P波高尖，振幅?0.25mV，II、III、AVF显著又称“肺性P波” • 左房肥大(left atrial enlargement) – P波增宽?0.12s，I、II、R、L; – 呈双峰，两峰间距?0.04s，又称“二尖瓣型P波” – P波终末电势(Ptf):V1负向P波时间乘以负向波振幅?0.04mm.s • 双心房肥大波增宽?0.12s,振幅?0.25mV 2.心室肥大 • 左室肥大(left ventricular hypertrophy) – Rv5/v6 >2.5mV – Rv5+Sv1>4.0mV(男) >3.5mV(女) – RI >1.5mV, RaVL >1.2mV, RaVF >2.0mV RI+SIII>2.5mV – – 额面电轴左偏 – QRS时间0.10~0.11s – 左室肥大劳损RS波群增高伴ST-T改变 • 右室肥大(right ventricular) – V1 R/S ?1,V5 R/S?1, 重度肥厚V1呈qR型 – Rv1+Sv5>1.05mV – 电轴右偏 – ST-T改变 • 双侧心室肥大(biventricular hypertrophy) – 正常或一侧肥大表现 第四节 心肌缺血与ST-T改变 1.心肌缺血的心电图类型 • 缺血型心电图改变 – 由心外膜?心内膜 – 心内膜下心肌缺血 T波高尖 – 心外膜下心肌缺血 T波倒置 • 损伤型心电图改变 – ST-T:从正常心肌?损伤心肌 – 心内膜下ST段压低 – 心外膜下ST段抬高 – 机制: 轻度缺血:钾离子进入细胞?过度极化?损伤电流?缺血导联ST压低 严重缺血:钾离子溢出细胞?极化不足?损伤电流?缺血导联ST抬高图6-5 • 临床意义 – ST压低/T波倒置:典型心绞痛/慢性冠不全 – ST抬高/T波高尖:变异型心绞痛/心肌梗死 – 其它:心肌病 心包炎 药物 继发改变 第五节 心肌梗死 (myocardial infarction) 1.基本图形及机制 • 缺血型改变 (T波) – 心肌复极时间延长 3位相延长 – – QT延长 • 升支与降支对称 • 顶端呈尖耸的箭头状 • 由直立变倒置 损伤电流学说 Prinzmetal 测得损伤区细胞膜4时相极化程度低 • • 正常心肌电流流向损伤心肌--舒张期损伤电流 • 向量方向与损伤电流方向相反 • 背离探查电极 • 心内膜下ST段压低 • 心外膜下ST段抬高 除极波受阻学说 • 正常心肌除极后呈负电位 • 损伤心肌不除极呈正电位 • 产生电位差 • ST向量由正常心肌指向损伤心肌 • 面向损伤区的导联出现ST段抬高 • 损伤型改变(ST段) – 超急性ST段抬高 – 损伤期单向曲线 – 机制 损伤电流学说 除极受阻学说 • 坏死型改变 – 异常Q波 宽度0.04，深度1/4R – Q波镜面相 – 正常q波消失 – QRS波正常顺序的改变 – 机制 坏死组织不产生心电向量，正常组织照常除极，产生与梗塞部位相反的 综合向量 2.心肌梗死的图形演变及分期 • 早期(超急性期) 数小时 – 急性损伤性传导阻滞:QRS高/宽 – ST斜型抬高(下壁)，T波高耸 • 急性期 数小时--数周 – QS/QR波 – ST段单向曲线，T波倒置加深 • 亚急性期 数周--数月 – ST段恢复至基线，T波变浅 • 陈旧期(愈合期) 3-6月后 – QS ST-T恒定，可出现r/R 3.心肌梗死的定位诊断 • 前间壁: V1、V2 • 前 壁: V3、V4 • 前侧壁: V5、V6、aVL • 广泛前壁:V1--V6 • 高侧壁: I、aVL • 下 壁: II、III、aVL • 正后壁: V7、V8、V9 右 室: V3R、V4R、V5R • 4.心肌梗死的不典型图形改变 • 非Q波心肌梗死 – 心内膜下心肌梗死 – 局灶心肌梗死 5.鉴别诊断 • ST段抬高:早期复极综合征、急性心包炎、变异型心绞痛、Brugada综合征 • V1、V2:心脏转位、左室肥厚、LBBB、高度肺气肿，qRs/qrS波多为陈旧前间 壁心肌梗死 • I、aVL、V5、V6:心肌病、正常心电图 • II、III、aVF:心脏横位、预激综合征 第六节 心律失常(arrhythmia) 1.概述 窦性心律失常 起源异常 被动性:逸搏与逸搏心律(房性、室性、房室交界) 异位心律 期前收缩 (房性、室性、房室交界) 主动性 心动过速(房性、室性、房室交界) 扑动与颤动(心房、心室) 生理性传导障碍:干扰与脱节(包括心脏的各个部分) 心律失常 窦房阻滞 房内阻滞 传导异常 病理性传导阻滞 房室传导阻滞 室内阻滞 意外传导 传导途径异常:预激综合征 2.心律失常心肌电生理 • 自律性:心肌在不受外界刺激的影响下能自动地、规律地产生兴奋及发放冲动的特性。 – 静息状态下，4位相自动缓慢除 – 心房肌、心室肌无起搏功能 – 窦房结、冠状窦区、心房传导组织、房室交界区、希氏束、束支、蒲肯野纤维 – 窦房结60--100次/分 – 房室交界区40--60次/分 – 希氏束以下25--40次/分 • 兴奋性:心肌细胞对受到的刺激作出应答性反应的能力 – 绝对不应期(absolute refractory period): 200ms; 任何刺激不能引起反应。 其后10ms强刺激科引起局部兴奋产生新的不应期，但不能扩布称有效不应期(effective refractory period) – 相对不应期:50~100ms动作电位-60~-80mV，除极速度振幅低，传导慢，不应期短 – 总不应期:250~400ms;有效不应期+相对不应期 – 易损期:心电图T波顶峰前约30ms处;R on T 90mV，低于阈值的刺激也激发动作电位的产生 – 超常期:动作电位-80~- • 传导性:心肌激动能自动向周围扩布;蒲肯野纤维及束支传导速度400mm/s;房室结20~200mm/s – 影响因素:动作电位幅度和0相除极速度 收缩性 • 第六节心律失常 (Cardiac arrhythmias) 1.心律失常概述 – 冲动形成异常 • )有正常自律性:窦结、结间束、冠状窦口附近、房室结远端、希)氏束-蒲肯野系统?植)物神经系统兴奋性改变或内在病变。 • )无自律性心肌细胞:心房和心室肌细胞由于缺血、药物等?异常自律性。 – 心脏传导系统的解剖 – .窦房结(Sinus node):位于右心房与上腔静脉交接处，.主要由P细胞(起搏细胞)、过渡细胞、心房肌细胞组成。 – .结间束: – (1)前结间束:发自窦房结前方分为两束，一束到左心房，一束进入房间隔。 – (2)中结间束:起自窦房结后部到房间隔后上部。 – (3)后结间束:起自窦房结后部到房室结 – (James?fiber-预激综合征) – .房室结 2(心律失常的发生机制 (1)冲动形成异常 • )有正常自律性:窦结、结间束、冠状窦口附近、房室结远端、希)氏束-蒲 肯野系统?植)物神经系统兴奋性改变或内在病变。 • )无自律性心肌细胞:心房和心室肌细胞由于缺血、 药物等?异常自律性。 (2).触发活动:指局部出现儿茶酚胺浓度增高、低血钾、高血钙与洋地黄中毒时，心房、心室与希氏束-蒲肯野组织在动作电位后产生除极活动，被称为后除极。若后除极的振幅增高并抵达阈电位便可引发触发活动。 (3)冲动传导异常 传导速度延缓—与细胞的膜反应性有关。 动作电位[0]相的振幅。 dv/dt值(除极速度) 递减传导—膜电位有关 膜的静止电位在-90mv传导最快 膜的静止电位在-55mv传导阻滞 膜的静止电位在-65mv —-70mv可传但速度慢动作电位[0]相的振幅及dv/dt逐渐减少?发生传导阻滞?递减传导。 单向阻滞:心肌细胞正常都是双向的。 超常期传导:在心动周期的某个时候，若心脏某部分的传导得到暂时的意外改善称为超常期传导。最常见的部位在房室连接区，其次是室内传导，其表现是一个激动到达这些部位时本应受阻，但意外下传或传导时间本来延长，而这时缩短。 4.折返现象(图2-11P19) 当一激动从心脏某处发生后，经过向下传导又回到原处再次引起激动，这种现象叫折返现象。三个条件(1)有一个环行通道使激动可以循环运行。(2)环行通道的一部分出现单向传导阻滞。(3)传导速度减慢。 二、心律失常的诊断 – .病史: )心律失常的存在及类型 ? ? )心律失常的诱发因素 ? )心律失常发作的频率与起止方式 ? )心律失常对病人造成的影响及后果 – .体检心率、心律 – .心电图: ? )心房与心室节律是否规则，)频率如何, ? )PR间期是否恒定, ? )P波与QRS波群形态是否正常, ? )P波与QRS波群相互关系 – .动态心电图 – .运动试验 – .食道心电图 – .信号平均技术:微伏级的心电信号，.监测心室晚电位预测心梗猝死。 – .临床心电生理检查:适应症 ? )病态窦房结综合征 ? )房室与室内传导阻滞 ? )心动过速 ? )不)明原因晕厥 第二节 窦房节性心律失常 ? 、窦性心动过速(Sinus tachycardia) ? .心电图特点 ? )频率100-200次/分 ? )P波在I、II、avF导联直立，)avR倒置 ? )PR间期0.12-0.20秒 ? (图一窦性心动过速) ? .临床意义 ? )健康人、活动、情绪 ? )病理状态 ? )药物肾上腺素、阿托品 ? .治疗:针对原发病，.去除病因 ? 、窦性心动过缓(Sinus bradycardia) ? .心电图 ? )频率<60次/分 ? )可同)时发生心律不)齐 ? (图二窦性心动过缓) ? .临床意义 ? )健康人、运动员、睡眠 ? )病理状态:颅内疾患、严重缺氧、低温、甲减、病窦、急性心肌梗塞 ? )药物:拟副交感药物、β-阻滞剂、钙拮抗剂 ? .治疗:无症状无需治疗 有症状:心排血量不足，伴有快速心律失常应用药物或心脏起搏。 ? 、窦性停搏或窦性静止(Sinus pause or sinus arrest) ? .心电图 ? )PP间期显著延长 ? )长的PP间期与基本的窦性PP间期无倍)数关系。 ? )长时间的窦停后出现单个逸搏或逸搏性心律。(图窦停) ? .临床意义 ? )迷走神经张力增高或颈动脉窦过敏。 ? )病理状态:AMI、窦房结病变、纤维化、脑血管意外。 ? )药物:洋地黄、奎尼丁、钾盐、乙酰胆碱。 治疗:同心动过缓 ? 、窦房阻滞(Sinoatrial block) ? .心电图分三度 ? )一度—窦房结电位不)显示故无法诊断。 ? )二度—I型PP间期进行性缩短直至出现一个长PP间期，)该长PP间期短于 基本PP间期的两倍)。 ? )二度—II型长PP间期为基本PP间期的两倍)，)可出现逸搏。 ? )三度与窦停鉴别。 ? (见图) ? .临床意义同.窦停 ? .治疗同.病窦 ? 、病态窦房结综合征(sick sinus syndrome) ? 由于窦房节病变导致功能减退，产生多种心律失常的综合表现。 ? .病因 ? )各种病变淀粉样变性、甲减、感染、纤维化、硬化与退行性变。 ? )迷走神经张力过高。 ? )抗心律失常药抑制窦房结功能。 ? .临床表现:心脑脏器供血不.足 ? .心电图 ? )非药物所致持续而)显著的心动过缓。 ? )窦停与窦房阻滞 ? )窦房阻滞与房室传导阻滞并存。 ? )心动过速—心动过缓综合征 ? .心电生理检查 ? )固有心率低于正常人118.1-(0.57*年龄)。 ? )窦房结恢复)时间不)超过2毫秒，)窦房传导时间不)超过147毫秒。 ? .治疗:无症状-不.治疗，.有症状-起博器 第三节 心房性心律失常 ? 、房性早搏(atrial premature beats) ? .心电图 ? )P波提前出现，)与窦性P形态各异。 ? )房早未下传或缓慢传导(下传的PR延长)。 ? )QRS波群正常。 ? )代偿间歇完全或不)完全。 ? (图房早) ? .治疗: ? )通常无需治疗。 ? )去除诱因。 ? )药物治疗:镇静、β-阻滞剂、抗心律失常药物。 ? 、房性心动过速(atrial tachycardia) ? 分为自律性房性心动过速 ? 折返性房性心动过速 ? 混乱性房性心动过速 ? )自律性房性心动过速发生于 ? .临床特点 ? )发生于严重器质性心脏病病人。 ? )洋地黄中毒。 ? )发作短暂或持续数月。 ? .心电图 ? )房律150-200次/分，)P波形态与窦性不)同)。 ? )洋地黄中毒继续使用房律增快，)PR延长，)出现二度房室传导阻滞。 ? )P波等电位线存在。 ? )刺激迷走神经不)能终止心动过速，)仅加重房室阻滞。 ? )发作开始心率逐渐加速。 ? .电生理 ? )心房程序刺激不)能诱发心动过速。 ? )心动过速的第一个P波与随后的P波相同)。 ? )心房超速起搏能抑制心动过速，)但不)能终止其发作。 ? .治疗 ? )房速合并阻滞时，)心室率不)快可不)予处理。 ? )洋地黄中毒时 ? 停洋地黄 ? 血钾不高补钾(口服半小时5g) ? 高血钾给予普鲁洛尔、苯妥英、普鲁卡因胺与奎尼丁 ? )非洋地黄引起 ? 给予洋地黄 ? 奎尼丁、普鲁卡因胺普罗帕酮或胺碘酮 ? )折返性房性心动过速 ? 特点:1.器质性心脏病的患者。 ? 2. P波形态与窦性不同，PR延长。 ? 3. 心房程序刺激能诱发和终止。 ? 4.刺激迷走神经不能终止发作，但可产生房 ? 室阻滞。 治疗同室上性心动过速。 ? )混乱性房性心动过速 ? 特点: 1.发生于慢阻肺和心衰老人、洋地黄中毒、低血钾。 2.心电图3种以上形态各异的P波，PR间期各不相同。 ? .心房率100-300次/分。 ? .大多数P波能下传，.部分受阻，.心室率不.规则。 ? .治疗原发病，.维拉帕米、胺碘酮可能有效。 ? 、心房扑动(atrial flutter) – .病因: ? )阵发房扑可发生于无器质病变的心脏病者。 ? )持续房扑见于风心病、冠心病、高心病、心肌病、慢性充血性心衰、甲亢、 酒精中毒、心肌炎。 – .临床表现 ? )不)稳定—房颤或窦律，)偶有持续数月或数年。 ? )按摩颈动脉能减慢房波心室率。 ? )心室率不)快者无症状。 – .心电图 ? )规律的锯齿状扑动波，)等电位线消失，)II、III、avF、V1明显，)房率250-300 次/分。 ? )心室率规则或不)规则，)取决于房室传导比率是否恒定。 ? )QRS波群形态正常，)有差传或束枝阻滞时可增宽。 – .治疗 ? )药物治疗。 – .洋地黄: ? 通过迷走神经的作用?心房不应期缩短?房率增快?房扑变房颤?窦性心律。 ? 加重房室传导阻滞?心室率变慢。 ? 成功率40-60%。 – .奎尼丁、普鲁卡因酰胺延长心房不.应期，.转复.窦率，.成功率30-60%。 – .其它:β受体阻断剂减慢房室结传导，.胺碘酮延长心房有效不.应期转复.房颤。 ? )直流电复)律<50J。 ? )食道调搏超速抑制转复)。 ? )消融手术。 ? 、心房颤动(atrial fibrillation) ? )病因 – .阵发房颤可见于正常人、情绪激动、手术后、运动、酒精中毒。 .持续房颤可见于风心病、–冠心病、高心病、甲亢、缩窄性心包炎、感染性心内膜炎、心衰及慢性肺原性心脏病。 – .孤立性房颤见于无已知心脏疾患者。 临床表现 .症状轻重与心室率快慢有关，.–房颤时心排血量减少25%以上。 – .有较高体循环栓塞的危险，.中风的发病率明显增高。 – .体征:心音强弱不.等，.心律绝对不.齐，.脉搏短绌，.原发病的心脏体征。 – .房颤病人的心室率变规则应考虑: ? )恢复)窦性心律。 ? )房性心动过速。 ? )房扑伴固定的房室传导比率。 ? )发生房室交接性心动过速或室速。 ? )完全性房室传导阻滞。 (3)(4)(5)最常见于洋地黄中毒。 心电图 – .P波消失，.代之以大小不.等的f波，.频率350-600次/分。 – .心室率极不.规则在100-160次/分。 – .QRS波通常正常，.但可有室内差异性传导。 治疗 – .转复.:转复.前常规抗凝药物治疗3周。包括药物转复.、直流电复.律、射频消融术。 ? )药物 ? Ia类奎尼丁使用前应用β受体阻断剂减慢房室结传导。 Ib类普罗帕酮、氟卡尼 III类胺碘酮 – .减慢心室率 – 洋地黄、普萘洛尔、维拉帕米 ? 节房室交界区性心律失常 ? 房室交界性过早搏动 – .冲动起源于房室交界区。 – .提前产生QRS波群与逆行P波。 3.P波可位于QRS波群前、中、后。 – .QRS波群形态可正常。 ? 、房室交界性逸搏和心律 – .窦房结发放冲动减慢，.低于交界区。 – .传导障碍—窦房结冲动不.能下传。 – .心电图—较为正常的PP间期长的间歇后出现一个正常QRS波群，.P波在其前或后。 – .房室交界性心律指.房室交界性逸搏连续发生形成的节律，.频率35-60次/分，.室律超过房律，.房室分离。 – .生理性保护机制。 – .治疗—提高窦房结冲动发放频率，.改善传导。 ? 、非阵发性房室交界性心动过速 – .发生机制与交界区组织自律性增高或触发活动有关。 .病因—洋地黄中毒、下壁心肌梗塞、心肌炎、手术，.–偶见正常人。 – .心电图—心率逐渐变化70-150次/分，.QRS波群正常。 – .治疗基本病因，.无需特殊处理。 ? 、阵发性室上性心动过速 ? )房室结折返性心动过速 – .病因:无器质性心脏病患者。 – .临床表现 ? )突发突止，)心悸，)焦虑，)眩晕，)晕厥，)严重者心衰与休克。 ? )体检第一心音强度恒定，)心律匀齐。 3.心电图 (1)心率150—200次/分，节律规则。 (2)QRS波群正常，但可有差传，或原有束枝阻滞图形。 ? )逆行P波，)II、III、avF倒置，)常在QRS波群内或终末部。 起始突然，房早触发，PR间期显著延长，引起心动过速。 4.心电生理检查 ? )快径路传导速度快，)不)应期长。 ? )慢径路传导速度慢，)不)应期短。 ? )房早时，)快径受阻，)经慢径前传，)快径逆传。 – .治疗原则 刺激迷走神经无效?腺苷6-12mg或维拉帕米5-10mg、地尔硫卓0.25-0.35mg/kg，普萘洛尔0.25-0.5mg无效?直流电复律或食道调搏?射频消融术 ? )房室折返性心动过速 – .房室旁道，.经房室结前传，.旁路通道逆传，.QRS波群正常，.逆行P波落在ST或T波起始部。 – .心房或心室程控可诱发和终止心动过速。(图) ? 、预激综合征(preexcitation syndrome) ? 心房激动提前激动心室的一部分或全体。解剖基础房室间Kent束。 ? )临床特点 – .发病率1.5‰，.男性多，.可见于正常人、先心病、二尖瓣脱垂、心肌病。 – .心动过速(房室折返性心动过速、房颤、房扑)发生率1.8%，.预激本身无症状，.合并心动过速时可导致充血性心衰、低血压甚至死亡。 ? )心电图 – .PR<0.12秒。 – .QRS波群>0.12s，.其前有Δ波。 – .ST-T继发改变。 – .A型QRS波群均向上，.预激发生在左室或右室后底部。B型QRS波群V1向下，.预激发生在右室前侧壁。 – .正向房室结折返性心动过速最常见。 – .5%逆向房室结折返性心动过速，.QRS增宽，.与室速类似。(图预激心动过速伴房颤) ? )治疗:从无心动过速或偶有发作症状轻微无需治疗伴心动过速者治疗。 1药物 ? )正向房室结折返性心动过速处理同)房室结折返性心动过速，)刺激迷走神经?无效?腺苷、维拉帕米、普奈洛尔。机理:房室结传导减慢、不)应期延长，)对旁路传导无影响。 ? )洋地黄缩短旁道不)应期，)不)能单独用于曾有房颤或房扑患者。 ? )预激合并房颤或房扑发生晕厥低血压应立即电复)律，)或选择延长旁道与房室结不)应期的药物如普鲁卡因胺与普洛乃尔或普洛帕酮与胺碘酮。静注利多卡因与维拉帕米，)加重预激合并房颤心室率，)应禁用。 2射频消融术适应症: ? )心动过速发作频繁、药物不)能控制。 ? )房颤房扑经旁道快速传导，)心室率极快。 ? )药物治疗无法减慢心动过速心室率。 ? )心电生理检查房颤时旁道前向传导不)应期短于250ms。 第五节心室性心律失常 ? 、室性早搏(premature ventricular beats) ? )病因 正常人各种心脏疾患、缺血、缺氧、麻醉、手术、左室假腱索、药物中毒、电解质紊乱、烟酒、咖啡。 ? )临床表现:1心悸、重者晕厥，引发心绞痛、低血压。2听诊室早后长间歇，室早第二心音减弱。 ? )心电图:提前发生的QRS波群超过0.12秒，)宽大畸形，)T波与主波方向相反，)配对间期恒定，)代偿间期完全。间位性室早、二联律、三联律、单形性室早、多源性室早。室性并行心律:心室异位起搏点独立的规律发放冲动，)并能防止窦房节冲动侵入。心电图表现为配对间期不)恒定，)长RR间期是短RR间期的整倍)数，)可有室性融合波。 ? )治疗 1.无器质性心脏病，无名显症状，不频繁，单一室早不需药物治疗—镇静，调整生活方式，去除诱因。 – .有器质性心脏病，.室早>5次/分，.多源室早，.成对或连续室早，.“R on T”，.药物治疗。首选利多卡因，.其次普鲁卡因胺其次、安搏律定、胺碘酮。 二、室性心动过速(ventricular tachycardia) ? )病因: 1冠心病(AMI)。 2扩张型与肥厚型心肌病 3二尖瓣脱垂、心瓣膜病 4药物中毒 5长QT综合征 6无器质心脏病患者 ? )临床表现 1心悸、气短、血压降低、昏厥、阿-斯综合征 2查体:心率120-200次/分，轻度不规则，第一心音强弱不等，颈静脉规律巨大a波 心电图 1三个以上室早连续出现 2QRS波群宽大畸形>0.12s，ST-T与主波方向相反 3心率100-250次/分，规则 4房室分离 5心室夺获与心室融合波 ? )鉴别诊断:室性心动过速与室上性心动过速伴差传(图) ? )电生理检查:鉴别室性/室上性，)激动折返/自律性增强 1室上性心动过速V前都有H波，HV>30ms。 2心房调搏法:心房超速抑制，夺获心室的QRS波窄<0.10秒证明为室性心动过速 3程序刺激能诱发和终止心动过速为折返机制。 ? )治疗 原则:无器质性心脏病发生非持续性室速无症状无需治疗。有器质性心脏病发生 非持续性室速及持续性室速均应治疗。 – .终止发作 )有血流动力学障碍者同)步直流电复)律100-200J开始，)重复)可达360J。? 洋地黄中毒不)宜复)律。 ? )无血流动力学障碍者首选利多卡因、普罗帕酮、胺碘酮。 ? )射频消融术 – .预防复.发 ? )治疗原发病，)去除诱因。 ? )选择疗效好、毒副作用小药物，)β阻滞剂、慢心律、普罗帕酮、胺碘酮。 ? )特殊类型的室速 1加速性室性自主心律(缓慢性室速) ? )心室率60-110次/分 ? )与窦性起搏点交替控制心律出现融合波 ? )见于AMI再灌注、心脏手术、心肌病、风湿热、洋地黄中毒 ? )无需治疗，)阿托品提高窦性频率消除加速性室性自主节律 2尖端扭转室速 ? )长QT综合征，)药物，)电解质紊乱，)颅内病变，)心动过缓 ? )QRS波群围绕等电位线扭转 ? )频率150-250次/分，)QT间期>0.5S，)U波明显 ? )进展为室颤、猝死 ? )肾上腺素依赖性长QT综合征，)β阻滞剂治疗 ? )治疗IB类和镁盐，)停用IAIC、III类药，)必要时起搏或颈胸交感神经切) 断术 ? 、心室扑动与心室颤动(ventricular flutter and ventricular fibrillation) 1临床表现:意识丧失、抽搐、呼吸暂停，心音消失，Bp0 2心电图: ? )室扑呈正弦波图形，)频率150-350次/分 ? )室颤大小不)等颤波，)频率250-500次/分 ? )治疗:心肺复)苏，)人工呼吸，)除颤复)律 第六节心脏传导阻滞 ? 、房室传导阻滞(atrioventricular block) ? 房室交界区脱离了生理不应期后，心房冲动传导延迟或不能传导到心室。可发 生于房室结、希斯束，束支。分三度。 1病因:正常人、运动员-文氏。其他 2临床表现:无症状-疲倦、乏力、心悸-晕厥阿-斯综合征 听诊第一心音减弱，变化，大炮音 3心电图 I度AVB PR间期超过0.20秒，QRS正常，延缓大部分在房室结。 II度AVB –I型(文氏阻滞)，PR，RR间期 II度AVB –II型 III度AVB房室分离，房率快于室率，频率 4治疗 二室内传导阻滞 希斯束以下阻滞 心电图1右束支传导阻滞 (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.