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慢性完全闭塞冠状动脉血管的治疗
慢性完全闭塞冠状动脉的定义为闭塞冠状动脉远端无前向造影剂通过(TIMI 0级)或仅有少量造影剂通过(TIMI 1级)。患者通常无症状,但在活动或其他引起心肌耗氧增加的情况下出现心绞痛,少数则以心功能不全为主要表现。关于这些患者的临床处理目前尚有争议。 1 慢性完全闭塞血管及病理特点 在行冠状动脉造影(CAG)检查的患者中,约5%~15%的患者可发现冠状动脉血管闭塞[1,2]。我院2500例CAG中共发现132例慢性完全闭塞血管,占4.5%。一般认为血管闭塞时间超过3个月以上称为慢性完全闭塞。这些闭塞血管病理基础不同于急性或亚急性闭塞,急性或亚急性闭塞多为斑块纤维帽破裂,急性血栓形成所致;而慢性闭塞则由于血栓渐渐机化,纤维化及钙化斑块形成所致。 2 慢性完全闭塞血管患者临床特点 慢性完全闭塞冠状动脉血管的临床表现受闭塞血管的大小、部位、闭塞血管区域有无存活心肌以及侧枝循环多少等因素的影响。慢性完全闭塞冠状动脉血管常常存在侧枝循环,尽管如此,侧枝循环血流仅为前向血流的10%左右。多数患者在静息状态下可依靠侧枝循环的血流来维持心肌的供氧,但在活动或其他引起心肌耗氧量增多的情况则不能增加心肌供氧,因而出现心绞痛。少数患者以心功能不全为主要表现。
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绝对不应期电刺激对正常兔在体心脏心功能的影响
20世纪60年代的成对兴奋性起搏对心力衰竭的治疗,因较大的心律失常风险性而被弃用.多部位心室起搏对心力衰竭的治疗仅限于宽QRS波的病人群体,且多部位心室起搏不增加收缩力.一种全新的心脏收缩调节(cardiac con-tractility modulation,CCM)方法,即在心肌兴奋的绝对不应期发放电刺激来增强心肌收缩功能的方法近来颇受关注.然而,新近开始的这项研究处于起始阶段,许多问题尚不明了.本实验的目的就是观察绝对不应期电刺激对健康兔在体心脏心功能的影响以及这种方法的短期安全性.
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干细胞移植改善心功能的旁分泌机制及治疗策略
急性心肌梗死(acute myocardial infarction,AMI)是当前威胁人类健康的头号杀手,现有的治疗措施(药物、冠状动脉介入、冠状动脉旁路移植术)在一定程度上可恢复心肌灌注,改善心功能,但对于已坏死的心肌却无能为力.随之而来的心肌细胞凋亡及心室重构使心功能进行性恶化,预后极差.
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超声心动图心功能检测与血浆脑钠素浓度测定的关系
心脏功能的测定包括左右心收缩和舒张功能的测定.超声心动图可实时显示心脏的形态结构、室壁运动和心脏血流动力学,且具有简便、准确、安全和价廉的优点,因而已成为测量心脏功能常用的无创性检查技术.
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卧位排便对心功能、心率和血压的影响
排便对患者的循环系统影响较大,尤其是卧位排便,由于病人不习惯这种体位,故常需多次屏气才能使大便排出,为观察卧位排便对人体心率、血压和心功能的影响,我们做了以下实验,现将结果报告如下.
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右心衰对血浆中脑钠肽浓度影响的分析
脑钠肽(BNP)是一种心脏神经激素,主要由心室肌合成和分泌,可反映心室的功能。近年来,BNP作为一个新的实验室检测指标在慢性心力衰竭的临床诊断中被广泛关注。然而,近年来对BNP的研究的病例来源多局限于左心衰及全心衰的患者,右心衰的患者并不多。目的本文旨在研究单独的右心衰对血浆中脑钠肽(BNP)的影响及分析左右心衰和全心衰患者血浆中BNP浓度的不同。方法选择确诊的慢性心功能衰竭(CHF)患者120例,分为4组,对各组患者的血浆中BNP浓度进行回顾性调查。结果120个患者的平均血浆中BNP的浓度为239±44pg/ml,明显高于正常对照组(168±65pg/ml)。右心衰和左心衰患者平均血浆中的BNP的浓度分别为332±70pg/ml和373±80pg/ml,两组无明显差别,全心衰的患者平均血浆中BNP的平均浓度高,为413±95pg/ml。结论右心衰患者的血浆中BNP浓度水平也升高,BNP也能较好地反映心室功能状态,并且全心衰血浆中BNP的浓度要明显高于单独左心衰或右心衰的患者,对心力衰竭诊断和程度判断有重要意义。
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持续泵入硝普钠﹑多巴胺治疗顽固性心力衰竭19例疗效观察
目的:观察微量泵持续泵入硝普钠、多巴胺在顽固性心衰治疗中的效果。方法选取我院2012年5月至2013年11月于我院住院治疗的19例顽固性心衰患者,在常规予以吸氧、洋地黄、利尿剂、卡托普利、倍他乐克及去除诱因、纠正电解质紊乱等治疗基础上,予以微量泵持续泵入硝普钠及多巴胺。结果微量泵持续泵入硝普钠及多巴胺治疗顽固性心衰总有效率94.7%,心率、呼吸均明显改善(P<0.05)。结论微量泵持续泵入硝普钠及多巴胺治疗顽固性心衰疗效满意,值得推广应用。
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骨髓间充质干细胞移植联合冠心Ⅱ号对大鼠急性心肌梗死心功能和血管新生的影响
背景:虽然大量的实验和临床研究均证实骨髓间充质干细胞应用于心脏修复的安全性和有效性,但心肌梗死后缺血缺氧的环境及早期炎症反应均不利于移植细胞的存活,致使其治疗效果受到限制.目的:观察冠心Ⅱ号联合骨髓间充质干细胞移植对急性心肌梗死模犁鼠心功能及血管新生的影响,探讨两者是否具有协同治疗作用.设计,时间及地点:随机对照动物实验,于2006-08/2008-01在广西医科大学科学实验中心和中国中医科学院西苑医院基础医学研究中心完成.材料:清洁级雄性SD大鼠78只,由广西医科大学动物实验中心提供.冠心Ⅱ号汤剂由中国中医科学院中药研究所仝燕老师制备完成并提供.方法:取4只大鼠双侧股骨骨髓,应用全骨髓法+差速贴壁法体外分离培养大鼠骨髓间充质干细胞,传至第3代行CM-DiI标记.取10只大鼠作为正常对照组,余64只建立急性心肌梗死模型,造模后随机均分为4组,模型组、冠心Ⅱ号组在心肌梗死区及边缘区分5点注射L-DMEM培养基,前组用生理盐水灌胃,后组以冠心Ⅱ号汤剂灌胃,1次/d,共7 d:细胞移植组、联合组在心肌梗死区及边缘区分5点注射2×106个CM-DiI标记的骨髓间充质干细胞,前组用生理盐水灌胃,后组以冠心Ⅱ号汤剂灌胃,1次/d,共7d.主要观察指标:通过多普勒超声心动图分析心功能变化,心肌组织冰冻切片荧光显微镜下观察移植细胞;免疫组织化学染色检测心肌梗死边缘区微血管密度和血管内皮生长因子的表达,荧光定量RT-PCR检测血管内皮生长因子 mRNA的表达水平.结果:与模型组比较,冠心Ⅱ号组、细胞移植组和联合组左室舒张末内径及左室收缩术内径均显著减小(p<0.01),短轴缩短率及射血分数均显著升高(P<0.01),其中联合组变化幅度优于冠心Ⅱ号组、细胞移植组(P<0.01或0.05).荧光显微镜下细胞移植组、联合组左心审心肌组织冰冻切片可见发出红色荧光的CM-DiI标记移植细胞,其余各组未见阳性细胞.与模型组比较,冠心Ⅱ号组、细胞移植组和联合组心肌梗死边缘区微Ⅱ血管密度、血管内皮生长因子表达、血管内皮生长因子mRNA表达均显著提高(p<0.01),其中联合组变化幅度优于冠心Ⅱ号组、细胞移植组(P<0.01).结论:单纯冠心Ⅱ号汤剂治疗或骨髓间充质干细胞移植以及两者联合均可改善心肌梗死大鼠心功能,减少心室扩张程度,但两者联合情况下效果佳,对心肌梗死具有协同治疗作用.冠心Ⅱ号可促进骨髓间充质干细胞移植后的血管新生,增加移植细胞区域的血供,可能与其促进血管内皮生长因子分泌和上调血管内皮生长因子基因的表达有关.
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原发性高血压患者心功能特征100例分析
背景:高血压患者心功能常有不同程度损害,不同分期高血压患者心功能损害程度有何差异?目的:观察高血压不同分期患者的心功能,并与健康者相应指标进行对照.设计:病例-对照,对比观察.单位:解放军沈阳军区总医院特诊科.对象:选择2002-10/2003-05解放军沈阳军区总医院内科住院原发性高血压患者100例.其中高血压Ⅰ期30例,高血压Ⅱ期40例,高血压Ⅲ期30例.选择同期本院健康体检者30人为对照.纳入对象均知情同意.方法:纳入对象心功能测定采用XJS-Ⅰ型心功能检测仪.患者取仰卧位,按四电极法放置电极.于呼气末屏气,同步描记Ⅰ导联心电图、心音图、心导纳微分图、颈动脉搏动图.通过微机处理显示各种指标.检测指标为:心率,排血前时间,左室排血时间,排血前时间/左室排血时间,电机械延迟时间,等容收缩时间,等容收缩时间/左室排血时间,脉搏波传递时间,每搏量,心排血量,心脏指数,心肌收缩强度指数,总外周阻力,血管顺应性.主要观察指标:不同分期高血压患者与健康者心功能状况比较.结果:原发性高血压患者100例和健康者30人均进入结果分析.[1]排血前时间、等容收缩时间、总外周阻力、排血前时间/左室排血时间和等容收缩时间/左室排血时间:高血压患者明显大于或长于健康者(P<0.01),Ⅱ,Ⅲ期高血压患者明显高于或长于Ⅰ期高血压患者(P<0.01).[2]每搏量、心排血量、心肌收缩强度指数、血管顺应性、脉搏波传递时间、心脏指数:高血压患者明显低于或短于健康者(P<0.01),Ⅱ,Ⅲ期高血压患者明显低于或短于Ⅰ期高血压患者(P<0.01).在上述指标中,Ⅲ期高血压患者血管总外周阻力明显高于Ⅱ期高血压患者(P<0.05),血管顺应性明显低于Ⅱ期高血压患者(P<0.05).结论:高血压患者心功能较健康者明显下降,随着高血压病情发展,心功能进一步下降.
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彩色室壁运动显像评价冠心病患者康复训练后心功能的研究
Background: Ultrasound cardiogram plays an important role in evaluating cardiac function of patients with coronary heart disease before and after rehabilitation.Wall motion,function of contraction,and cardiac function could be evaluated using ultrasound cardiogram.Sensitivity of visual method in evaluating wall motion is not high.Color kinesis(CK) is a kind of new technology.Objective: To study sensitivity and accuracy of CK and visual method in evaluating wall motion.Design: In order to test sensitivity of CK,we compared CK and visual method.Unit: General Hospital of Shenyang Military Region Subjects:120 patients suffered from coronary heart disease during 1998~ 2000,78 male,42 female,aged from 36~ 72 years(mean:54 years).All patients had history of precardial pain,and ST-T changes were found in ECGs.Intervention: Coronary arteriography was done on all patients.To observe wall motion using visual method and CK.Color Doppler inspector HP2500 with a probe(2.5MHz/2.0MHz).Patients lied in horizional position.Then CK examination was done after defining endocardium.Simularly,electrographic signals were recorded.Endocardial motion were numbered colorfully.
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健康复教育在冠心病疗养员二级预防中的作用
Background:Secondary prevention of coronary heart disease is to prevent patients with proofs(for example: painlessmyocardial ischemia,angina pectoris,heart failure and arrhythmia) of coronary heart disease actively from myocardialnecrosis,cardiac death,to improve cardiac function and patients' living quality.Objective: To change the health idea,decrease the possibility of myocardial necrosis,cardiovascular death,and improvecardiac function through reasonable health education.Design:To evaluate the risk factors(for example: hyperlipemia,diabetes,smoking,much drinking,hyperadiposis,lackingsports,long-term nervousness,family history etc.)of in atients,make respective education plans according to the differentconditions,carry on the health education,and evaluate cardiac function before and after the treatment.Unit:Cadre Curative Department of Navy Guangzhou Sanitarium.Subject:40 cases of coronary heart disease,male 29 cases,female 11 cases,average age(56.12± 3.53)years.
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真彩色图像体视学分析系统对心脏功能受损的评估
Background:Some studies showed the significance of troponin-T in the diagnosis of acute myocardial ischemia.A number of studies evaluated level of troponin-T in blood,no expression of troponin-T has been reported. Objective:To investigate significance of troponin-T in abnormal cardiac function. Design:Descending anterior branch of left coronary artery in pigs was ligated to establish ischemic acute cardiac infarction model.Myocardial necrosis and expression of troponin-T in cardiac tissue were showed by histochemical techniques and immunohistochemical techniques respectively.Quantitative analysis of expression of troponin-T was performed with true color image and sterostatic analysis system.
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综合治疗脑卒中后肩手综合征的疗效
Background:The patients after hemodialysis may be caused malnutrition for decreased nutrition intake, nutrition loss during the hemodialysis, consumption caused by the disease, metabolic disorder and endocrine disorder etc. Malnutrition may caused lowered immunological function, long terms of anemia and hypoproteinemia may cause malnutrition of the cardiac muscle, lower cardiac function and risk heart failure. Malnutrition may also harm appetite and cause the malnutrition worse. Malnutrition caused insufficient vigor in the patients and affect their daily living abilities directly. So to regulate the nutrition level scientifically is important for ameliorating nutrition condition of the patients and to increase their daily living abilities.
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A Novel Method to Predict Left Ventricular Ejection Fraction after Revascularization Using Mechanical Modeling and Echocardiography
An important goal of cardiac revascularization is to improve the left ventricular ejection fraction ( LVEF), which is an important long - term prognostic clinical indicator for patients with coronary artery disease. Prediction of cardiac function improvement after revascularization would be very helpful for patients with severe left ventricular dysfunction who are at high surgical risk. Our objective is to develop a quantitative method to estimate post -revascularization LVEF prior to revascularization.
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甲状腺激素水平与心功能的关系观察
目的:观察甲状腺激素在各级心功能期的变化和预后的关系.方法:160例心脏病患者按纽约心脏协会分级方法分成4组,测定空腹血清甲状腺激素,观察统计各级心功能组T3、T4、FT3、FT4、rT3、TSH值的变化规律及NTIS在各级心功能组的发生率和死亡比例的关系.结果:血清T3、T4、FT3随心功能减退而逐降低,rT3反之升高,各级心功能组间差别显著(P<0.05),而FT4、TSH各组间无明显改变(P>0.05),而FT4、TSH各组间无明显改变(P<0.05).心功能Ⅰ级、Ⅱ级两组中无1例发生NTIS,而Ⅲ级、Ⅳ级组发生率分别占67%和88%,Ⅰ级、Ⅱ级组与Ⅲ级、Ⅳ级组NITS发生率比较差别显著(P<0.05).NTIS组78例死亡20例,占25.6%,非NTIS组82例死亡7例.占8.5%,两组病死例数比较有显著意义(P<0.01).结论:血清甲状腺激素中T3、T4、FT3可随心功能减退而降低,rT3反之升高.甲状腺激素水平能反映心功能状况,NTIS是心功能不全患者预后不良
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高气压暴露对心脏功能影响的研究进展
随着高压氧治疗的广泛应用、娱乐潜水的逐渐普及,以及水下沉箱作业、饱和潜水技术的深入发展,人类在高气压环境中从事的活动越来越多,高气压暴露时,高静水压、高分压氧、高密度的呼吸气体都会对人类心脏功能有一定的影响.本文结合国内外相关研究结果,从心脏电生理、心脏血流动力学、心脏内分泌等方面,分析高气压暴露对心脏功能的实际影响及其可能机制.
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冠心病患者室性早搏后心率震荡与左室功能和配对间期的关系
近年来心内电生理研究室性早搏后心率震荡(HRT)与心功能及配对间期的文章逐年增多,但有两种不同观点,一种观点认为凡无器质性心脏病患者或心功能正常病人,其TO和TS与室性早搏配对间期有较好相关性[1,2].而另一种观点认为TO和TS与室性早搏配对间期无相关性[3].为了解冠心病病人自然状态下室性早搏后HRT参数与左室功能和配对间期的关系,我们对两组患者临床资料进行回顾性分析.
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Objective The autonomic nervous system plays a key role in regulating cardiac function by modifying heart rate, contractility and impulse. The parasympathetic neurotransmitter acetyl-choline and muscarinic agonist carbachol (Cch) inhibit excitation-contraction coupling in cardiac ventricular myocytes. Muscarinic agonists suppress adenylyl cyclase (AC) acitivity and,by reducing activation of the cAMP/protein kinase A (PKA)cascade, inhibit the L-type Ca2+ current (ICa(L) ). They also increase the content of cGMP by stimulating guanylyl cyclase (GC) activity. The role of nitric oxide (NO)/cGMP in muscarinic inhibition has undergone considerable scrutiny. The role of the NO/cGMP pathway in the inhibition of ICa(L) by Cch was examined in guinea-pig ventricular myocytes.
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法舒地尔对不稳定型心绞痛患者心功能及IL-6、IL-8和TNF-α表达的影响
[目的]观察法舒地尔对不稳定型心绞痛患者心功能和血清炎症因子的影响.[方法]112例患者随机分为两组,均予常规治疗,治疗组在常规抗心绞痛治疗的基础上加用生理盐法舒地尔30 mg静滴,2次/d,10 d为一疗程,观察给药前后心功能、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)的改变.[结果]治疗后两组间比较发现:法舒地尔组心功能改善,血清IL-6、IL-8和TNF-α值降低幅度高于对照组(P<0.05).[结论]法舒地尔可以显著改善不稳定心绞痛患者心功能,降低患者血浆中IL-6、IL-8、TNF-α水平.
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Cerebral microcirculatory changes in hypovolemic hypotension we re investigat ed in rats with a cardio-pulmonary bypass (CPB) during pulsatile and non-pulsati le flow. The hypovolemic hypotension was induced by reducing the CPB flow-rate. In the non-pulsatile flow, the cardiac beat was stopped using a fibrilator, whi le in the pulsatile flow the cardiac function was retained. The pial microcircul ation was observed and recorded during CPB, using fluorescence videomicroscopy. The arteriolar diameter and red cell velocity were measured based on the recorde d videoimages. The flow-rate was calculated from the measured diameter and veloc ity data. The present results showed that the flow-rate remained almost constant up to 60 mmHg arterial pressure during pulsatile flow. On the other hand, in n on-pulsatile flow, the flow-rate decreased with a decrease in arterial pressure, indicating the impairment of microvascular autoregulation. It was suggested th at pulsatile flow has an advantage over non-pulsatile flow in a view-point of ce rebral microcirculatory changes in hypovolemic hypotension. Collaborating researchers: Drs. T. Yamakawa, S. Yamaguchi, Y. Ohnishi (National Cardiovascular Center, Osaka,Japan)