介入治疗对急性心梗患者血浆脑钠肽水平的影响

目的 观察经皮冠脉介入治疗（PCI）对急性心梗（AMI）患者血浆脑钠肽（BNP）水平的影响。方法 选择AMI患者86例,根据行PCI情况分PCI组、非PCI组,所有入选患者分别于入院即刻、入院第24小时、入院第48小时、入院第5天、入院第14天、入院第28天采集静脉全血测定血浆BNP-32浓度,分析两组患者血浆BNP水平的动态变化。结果 两组间比较,入院即刻血浆BNP水平无显著差异;入院第24小时、入院第48小时、入院第5天、入院第14天、入院第28天PCI组血浆BNP水平显著低于非PCI组,非PCI组分别于入院24小时和入院第5天血浆BNP水平出现两次高峰。结论 研究证明再灌注治疗可明显降低AMI患者血浆BNP水平。     

血清高迁移率族蛋白B1与脓毒症小鼠心肌细胞凋亡的相关性研究

 目的 探讨血清高迁移率族蛋白B1(high mobility group box -1,HMGB1)水平与心肌细胞凋亡率及血清脑钠肽( brain natriupeptide,BNP)的相关性;评价正丁酸钠(sodium butyrate,SB)对脓毒症小鼠心肌凋亡的影响及心功能不全的保护效应.方法 采用小鼠盲肠结扎穿孔(cecal ligation and puncture,CLP)建立脓毒症模型.120只小鼠随机分为假手术组(Sham 组)、CLP组及SB组,每组40只.用ELISA法检测各组0、12、24、48、72 h血清HMGBl与BNP浓度,用流式细胞仪测定各组0、12、24、48、72 h心肌细胞凋亡率,分别对HMGB1与心肌细胞凋亡率、HMGB1与BNP进行相关性分析.另外,研究正丁酸钠对脓毒症小鼠心肌细胞凋亡率、血清BNP以及120 h生存率的影响.结果 血清HMGB1浓度在CLP术后12h开始升高,并与心肌细胞凋亡率及血清BNP浓度在12、24、48、72h各时间点均呈显著相关性(P＜0.05);正丁酸钠能明显降低心肌细胞凋亡率及血清BNP浓度,并显著改善脓毒症小鼠生存率(P＜0.05).结论 HMGB1可能参与脓毒症小鼠心肌凋亡的过程,并导致心功能不全;应用正丁酸钠干预能减轻心肌凋亡,改善心功能.     

水化加碘克沙醇对轻度肾功能不全患者肾功能的影响

目的 评价轻度慢性肾功能不全患者行冠状动脉造影时,使用碘克沙醇作为对比剂是否对肾功能造成影响.方法 对36例慢性肾功能不全患者行冠状动脉造影时,选择碘克沙醇作为对比剂,并在术前12 h及术后12 h对患者进行水化,对其术后48 h及术后96 h肾功能进行复查,与术前肾功能相对比,了解其对肾动能是否造成影响.结果 术前患者肌酐( 174.20 ±35.99) μmol/L,内生肌酐清除率(44.75 ±10.89) ml/(min·1.75 m2);术后48 h肌酐(169.53±36.74) μmol/L,内生肌酐清除率(44.54±10.57) ml/(min·1.75 m2);术后96 h肌酐(169.9±38.10) μmol/L,内生肌酐清除率(44.42±11.73) ml/(min·1.75 m2),两者与治疗前比较差异均无统计学意义(P＞0.05).结论 在对轻度慢性肾功能不全患者进行冠状动脉造影时,选择碘克沙醇作为对比剂,其安全性高,不会对该类患者肾功能造成明显影响.     

合并慢性肾功能不全患者经皮冠脉介入治疗116例

目的　回顾分析冠心病合并慢性肾功能不全患者经皮冠脉介入治疗的临床资料 ,旨在揭示其临床特点 ,对其治疗及造影剂肾病的预防进行初步探讨。方法　① 1997年 1月～ 2 0 0 1年 12月同台完成冠脉造影及PCI治疗的 116例血清肌酐 (SCr)≥ 14 1μmol/L患者作为病例组 (慢性肾功能不全组 ) ,同期进行相同介入治疗的 35 2例年龄、性别和一般情况相匹配 ,SCr <14 1μmol/L的患者作为对照组 ,记录各组临床资料 ,SCr采用苦味酸法测定 ,正常值 4 3～ 133μmol/L。②慢性肾功能不全患者在介入治疗前 3～ 7d开始施与水化疗法 :静滴葡萄糖氯化钠 5 0 0～ 10 0 0ml/d ,静注速尿 2 0～ 6 0mg/d ,同时应用血管扩张剂 :静滴多巴胺 ,2 .5～ 3.0 μg·kg- 1·min- 1,2 0～ 4 0mg/d。PCI治疗后两组患者均鼓励多饮水 ,慢性肾功能不全患者继续水化治疗 5～ 7d。③术前 2d开始每日口服阿司匹林和噻氯匹啶 ,用Judkins法行冠脉造影 ,按标准技术行PCI ,成功标准为靶病变惭余狭窄 <30 % ,且术中无严重合并症 (包括恶性心律失常、急性血栓形成、严重冠脉夹层、输血或心原性休克 )。使用非离子性造影剂 (优维显 370或安射力 35 0 )。④合并慢性肾功能不全患者PCI术后当天至出院前复查SCr ,所有患者记录术后心脏事件 ,出院后 3～ 6个月     

冠心病患者左心功能不全对冠状动脉介入术预后影响

目的探讨左心功能不全的冠心病患者临床特点,评价左心功能不全对冠心病患者行经皮冠状动脉介入术(PCI)预后的预测作用。方法回顾性分析沈阳军区总医院心血管内科自2011年1月至2014年7月经冠脉造影明确诊断并行PCI的24 627例冠心病患者,按左心室射血分数(LVEF)值分为左心功能不全组(LVEF<50%)2 182例和左心功能正常组(LVEF≥50%)22 445例,比较两组间的基线资料和PCI术后30 d及12个月主要不良心脑血管事件(MACCE)发生率。应用Logistic多因素回归分析法评估冠心病左心功能不全患者对PCI术后30 d及12个月的MACCE事件发生率的预测价值。结果术后30 d,左心功能不全组患者PCI的MACCE事件发生率显著高于左心功能正常组(2.4%比0.5%,P<0.01);术后12个月,左心功能不全组也高于左心功能正常组(6.6%比2.6%,P<0.01)。Logistic回归分析显示,LVEF值<50%为MACCE的独立预测因素。结论左心功能不全是PCI术后30 d及12个月发生MACCE的预测因素。     

碘克沙醇对单支及多支血管病变患者冠状动脉 介入治疗临床预后研究

目的探讨碘克沙醇对单支及多支血管病变患者行经皮冠状动脉介入治疗(PCI)的主要不良心脑血管事件(MACCE)及对比剂诱发的急性肾功能损伤(CI-AKI)差异。方法选取自2013年10月至2015年10月中国30个中心入选的3 042例行冠状动脉支架植入术患者为研究对象。根据病变血管支数不同将患者分为单支病变(SV)组(n=2 618)与多支病变(MV)组(n=424)。主要研究终点为PCI术后72 h MACCE[包括靶病变再次血运重建(TLR)、卒中、支架内血栓、心源性死亡、非致死性心肌梗死(MI)]及CI-AKI,次要终点为PCI后72 h至30 d的MACCE发生情况。记录并比较两组患者终点事件发生率。结果 SV组患者PCI手术时间、水化总体积、碘克沙醇用药时间、碘克沙醇体积低于MV组,术后水化比例、术前及术后均水化比例高于MV组,两组比较比较,差异均有统计意义(P<0.05)。两组患者病变血管、病变分级、术前心肌梗塞溶栓血流比较,差异有统计学意义(P<0.05)。两组患者主要终点事件比较:SV组MACCE、MI发生率低于MV组,两组比较,差异有统计学意义(P<0.05)。两组患者次要终点比较:SV组TLR发生率、支架内血栓发生率低于MV组,两组比较,差异有统计学意义(P<0.05)。结论应用碘克沙醇行PCI治疗后,MV患者住院期间的MACCE及MI发生率较SV患者增加,CI-AKI发生率无差异;术后72 h至30 d MV患者TLR及支架内血栓风险增加。     

血浆脑利钠肽在快速鉴别诊断心源性和肺源性呼吸困难中的价值

目的 评价血浆脑利钠肽(BNP)水平在心源性和肺源性呼吸困难时鉴别诊断的价值.方法 采用美国拜尔公司生产的化学发光检测仪及其BNP试剂,检测248例因呼吸困难住院的肺疾病患者血浆BNP水平,对单纯肺疾病患者、肺疾病并发左心功能不全患者、肺疾病未并发左心功能不伞患者、肺疾病并发右心衰患者各组间BNP水平进行比较.结果 肺疾病并发左心功能不全的呼吸困难患者的BNP水平明显高于未并发左心功能不全的呼吸困难患者(x2=25.597,P<0.001);肺疾病并发右心衰患者BNP水平高于单纯肺疾病患者,但差异没有统计学意义(t=1.614,P0.05);肺疾病并发左心功能不全患者的BNP水平明显高于肺疾病并发右心衰患者(t=2.531,P<0.05);肺疾病并发左心功能不全患者的心功能越差,BNP水平就越高,心功能Ⅱ、Ⅲ、Ⅳ级三组间BNP水平的差别有统计学意义(x2=29.463,P<0.001).结论 血浆BNP是快速鉴别诊断心源性和肺源性呼吸困难的重要实验窜检测指标,同时可判断肺疾病并发左心功能不全患者心衰的严重程度.     

早期口服补液对35%TBSA烧伤犬血流动力学和后期脏器功能的影响

目的研究35% TBSA烧伤休克早期口服补液对血流动力学、脏器功能和伤后5d预后的影响。方法成年雄性Beagle犬18只,体重11.0±0.5kg,先期无菌手术行动静脉置管术监测血流动力学和肠黏膜血流量(IMBF),24h后用速效药丙泊酚作10min短时麻醉,凝固汽油燃烧造成35%TBSAⅢ度烧伤,随机分为不补液组、口服补液组和静脉补液组,每组6只。伤后第1个24h不补液组无治疗,口服补液组和静脉补液组于伤后30min分别胃内输注葡萄糖-电解质溶液和静脉滴注乳酸林格液,补液量为4ml/(kg.1% TBSA),前8h补一半,后16h补另一半。伤后24h起各组动物均实施静脉补液,伤后第4天起实施静脉营养支持。分别于伤前和伤后第2、4、8、24、48、72、120h测定动物清醒状态下的平均动脉压(MAP)、心输出量(CO)、IMBF以及血中丙氨酸转氨酶(ALT)、肌酐(Cr)和磷酸肌酸激酶同工酶(CK-MB)水平,并统计三组动物的5d死亡率。结果各组动物伤后MAP、CO和IMBF均下降,但MAP在伤后4h已恢复至伤前水平,之后各组间MAP均无统计学差异(P>0.05);伤后24h内口服补液组CO和IMBF均高于不补液组(P<0.05),但低于静脉补液组(P<0.05),24h后各组间血流动力学无统计学差异(P>0.05),各组IMBF恢复均较CO滞后。伤后各组血浆ALT、Cr和CK-MB水平均不同程度升高,伤后72h内口服补液组ALT和CK-MB低于不补液组(P<0.05),但高于静脉补液组(P<0.05);口服补液组Cr在4、8、24h时点低于不补液组但高于静脉补液组(P<0.05)。不补液组伤后5d内死亡率为33.3%(2/6),口服补液组和静脉补液组死亡率均为0。结论35%TBSA烧伤后早期口服葡萄糖-电解质溶液复苏效果虽略差于静脉补液,但相比不治疗组仍能显著改善血流动力学和保护脏器功能,减少早期死亡率,有望成为战争或灾害时早期静脉复苏的替代方法。     

对比剂对行PCI 术STEMI患者发生CIN及预后的影响

目的探讨对比剂对行经皮冠状动脉介入治疗(PCI)术对ST段抬高型心肌梗死(STEMI)患者发生对比剂肾病(CIN)及预后的影响。方法选取在2015年8月～2018年8月期间我院收治的SIEMI患者80例进行观察。采用随机数字表法,随机将患者分成观察组和对照组,每组均为40例。其中对照组采取低渗对比剂行PCI术,观察组则实施等渗对比剂行PCI术。之后比较两组患者不同时间点血清肌酐的水平、CIN的发生情况、CIN的影响因素及预后情况。结果观察组患者在术后24h、术后48h及术后72h的血清肌酐水平显著低于对照组(P0.05)。观察组术后CIN发生率(7.50%)显著低于对照组(25%)(χ~2=4.501,P0.05)。发生CIN组慢性肾功能不全患者比例及对比剂使用量上显著高于未发生CIN组,但是在入院血红蛋白水平上却显著低于未发生CIN组(P0.05)。入院血红蛋白、慢性肾功能不全及对比剂使用剂量是PCI术后发生CIN的独立影响因素。在PCI术后30天,两组患者在终点事件的总发生率差异无统计学意义(P0.05)。结论相比于低渗对比剂,等渗对比剂有利于降低行PCI对STEMI患者CIN的发生率且肾功能安全更高;入院血红蛋白、慢性肾功能不全及对比剂使用剂量是PCI术后发生CIN的独立影响因素。     

B型利钠肽在肾移植患者呼吸困难鉴别诊断中的作用(附25例回顾分析)

目的 探讨B型利钠肽(BNP)在肾移植患者呼吸困难鉴别诊断中的价值.方法 对2007年9月-2010年3月收治的25例肾移植术后伴有呼吸困难症状的患者,在发病即刻、对症治疗后48h进行血浆BNP测定,并行超声心动图等检查,对其诊疗经过进行回顾性分析.依据BNP测定值将患者分为2组:Ⅰ组患者19例BNP＞400pg/ml;Ⅱ组患者6例BNP≤400pg/ml,对两组治疗前后的BNP、左室射血分数(LVEF)进行比较.结果 Ⅰ组发病即刻BNP明显高于警戒水平(1893.21±350.34pg/ml),超声心动图提示LVEF低下(42.38%±6.74%),其中12例为容量超负荷引起的急性左心功能不全而无其他合并症,7例为移植肾功能不全合并重症感染诱发的急性左心功能不全.Ⅰ 组患者经强心、利尿或透析等抗心力衰竭治疗48h后,复查血浆BNP明显降低(305.35±45.21pg/ml),LVEF升高(55.36%±6.26%),呼吸困难症状明显改善.Ⅱ 组患者在发病即刻血浆BNP为78.52±23.26pg/ml,明显低于Ⅰ组水平,其LVEF(59.72%±4.92%)明显高于I组水平(42.38%±6.74%).6例患者中有5例为移植肾功能正常但合并重症肺部感染,1例在接受猪抗人淋巴细胞免疫球蛋白诱导治疗时,发生严重过敏反应导致的呼吸困难.Ⅱ 组经对症治疗48h后复查血浆BNP和LVEF均无明显变化(分别为67.44±31.05pg/ml和62.31%±10.08%).结论 快速血浆BNP检测是判断血容量的敏感指标,有助于鉴别心源性呼吸困难与非心源性呼吸困难,对肾移植术后患者的容量管理具有较高的参考价值.     

原发性高血压患者冠状动脉造影术前水化对血压的影响

目的探讨原发性高血压患者行冠状动脉造影术前水化对血压的影响。方法选取行冠状动脉造影术的患者220例,根据估算的肾小球滤过率(eGFR)分为水化组及对照组,水化组术前12 h开始行水化治疗,测量所有患者术前12 h及术前即刻血压。结果水化组术前即刻血压较术前12 h血压明显升高;对照组术前即刻血压与术前12 h血压比较未见明显改变。结论原发性高血压患者冠状动脉造影术前水化可导致血压升高,应根据导致血压升高的原因采取综合措施降压,避免血压升高影响冠状动脉造影手术及增加不良事件的发生。     

Segmentation of small structures in MR images: Semiautomated tissue hydration measurement

Segmentation of small anatomic structures In noisy magnetic resonance (MR) images is inherently challenging because the edge Information is contained in the same high-frequency image component as the noise. The authors overcame this obstacle in the analysis of the sural nerve in the ankle by processing images to reduce noise and extracting edges with an edge detection algorithm less sensitive to noise. Anatomic accuracy of the segmentation was confirmed by a neuroradiologist. A nerve hydration coefficient was determined from the signal intensity of the nerve in these segmented images. These semiautomated measurements of hydration agreed closely with those obtained with a previously described manual method (n=44, P=.76). Each image in the study was analyzed identically, with no modification of the computer algorithm parameters. The data suggest that this robust method may be useful in a multicenter evaluation of diabetes treatment protocols.     

超声评价蛋白多糖对关节软骨水合作用的影响

目的 应用高频超声测量技术监测蛋白多糖降解导致的关节软骨水合膨胀行为的改变,探讨蛋白多糖对关节软骨水合作用的影响.方法 将12块表面光滑无损伤的猪髌骨关节软骨样本随机均分为2组,每组6块:正常组不做任何处理;胰蛋白酶消化组在0.25％的胰蛋白酶溶液中浸泡8h,以消化软骨组织内的蛋白多糖成分,从而建立经蛋白多糖降解软骨的离体退化模型,以模拟自然骨性关节炎关节软骨的退化.利用中心频率为25MHz的A型超声系统扫描两组样本,计算软骨的水合应变及软骨厚度.光镜观察关节软骨的病理组织学变化.结果 正常组软骨大约20min时达到水合平衡状态,而胰蛋白酶消化组在大约5min时即达到平衡.正常组软骨的平衡应变值为3.5％±0.5％,明显高于胰蛋白酶消化组(1.8％±0.2％,P＜0.05).胰蛋白酶消化组的软骨厚度(1.34±0.04mm)与正常组(1.34±0.07mm)比较差异无统计学意义(P＞0.05).光镜观察结果显示,正常组软骨表面光滑,软骨细胞排列规则,无裂隙,组织呈均匀红色;胰蛋白酶消化组软骨表面较光滑,可见软骨细胞破坏,番红染色中度减少,提示蛋白多糖减少.结论 正常关节软骨具有膨胀特性,蛋白多糖成分缺失可导致软骨结构、水合作用及脱水后恢复能力降低.     

Educational intervention on water intake improves hydration status and enhances exercise performance in athletic youth

We aimed to evaluate whether an intervention program emphasizing in increased fluid intake can improve exercise performance in children exercising in the heat. Ninety-two young athletes participated in the study (age: 13.8 ± 0.4 years, weight: 54.9 ± 1.5 kg). Thirty-one (boys: 13, girls: 18) children served as the control group (CON) and 61 (boys: 30, girls: 31) as the intervention (INT). Volunteers had free access to fluids. Hydration was assessed on the basis of first morning urine. A series of field tests were used to evaluate exercise performance. All tests occurred outdoors in the morning (mean ambient temperature=28°C). After baseline testing, INT attended a lecture on hydration, and urine color charts were mounted in all bathrooms. Additionally, water accessibility was facilitated in training, dining and resting areas. Hydration status was improved significantly in the INT [USG: pre=1.031 ± 0.09, post=1.023 ± 0.012, P<0.05; urine osmolality (mOsm/kg water): pre=941 ± 30, post=782 ± 34, P<0.05], while no statistically significant changes were found in the CON [USG: pre=1.033 ± 0.011, post=1.032 ± 0.013, P>0.05; urine osmolality (mOsm/kg water) 970 ± 38 vs 961 ± 38, P>0.05]. Performance in an endurance run was improved significantly only in INT (time for 600 m: pre=189 ± 5 s, post=167 ± 4 s, P<0.05). Improving hydration status by ad libitum consumption of water can enhance performance in young children exercising in the heat.     

Influence of hydration status in normal subjects: fractional analysis of parameters of Tc-99m DTPA and Tc-99m MAG3 renography

RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the influence of hydration status upon renogram patterns and renal physiological parameters and clarify the differences between DTPA and MAG3 studies in normal volunteers. MATERIAL AND METHODS: The study populations were 22 kidneys of 11 volunteers with no history of hypertension or renal disease with normal serum creatinine levels. They were 6 men and 5 women aged from 24 to 48 yrs (mean age: 33.4 yrs). Renal scintigraphies with both 185 MBq (5 mCi) of Tc-99m DTPA and Tc-99m MAG3 were performed after dehydration (urine specific gravity > 1.025) and adequate hydration (urine specific gravity < 1.010) in each subject at least with a 5-7-day interval. Renograms were generated from the whole kidney and cortical ROIs. We analyzed the clearance, renogram pattern, mean transit time, time to maximum activity, time from maximum activity to half activity, and residual cortical activity. Paired t-test and Wilcoxon signed rank test were used as statistical analysis methods. Statistical analysis was considered significant at p < 0.05. RESULTS: In the dehydrated state, with Tc-99m DTPA and whole kidney ROI, parameters such as time to maximum activity, time from maximum activity to half activity, residual cortical activity, and mean transit time were delayed as compared to parameters in the adequately hydrated state, but the clearance was not changed. With the cortical ROI, the changes of parameters due to dehydration were partially offset. There were insignificant differences between most parameters of Tc-99m DTPA and Tc-99m MAG3 with the whole kidney and cortical ROIs. CONCLUSIONS: Dehydration may bring about a false positive curve pattern on renograms which can be prevented or minimized by using the cortical ROI. There were insignificant differences between most parameters of Tc-99m DTPA and Tc-99m MAG3.     

Markers of hydration status

This paper reviews the literature, describes and discusses methods by which whole body hydration status can be determined in humans. A method of determining whether or not an individual is hypohydrated is of particular significance in an exercise situation as even moderate levels of hypohydration have a negative impact on exercise performance. Inspection of the published literature indicates that a number of methods have been used to determine hydration status. Body mass changes, urinary indices (volume, colour, protein content, specific gravity and osmolality), blood borne indices (haemoglobin concentration, haematocrit, plasma osmolality and sodium concentration, plasma testosterone, adrenaline, noradrenaline, cortisol and atrial natiuretic peptide), bioelectrical impedance analysis, and pulse rate and systolic blood pressure response to postural change are discussed. The urinary measures of colour, specific gravity and osmolality are more sensitive at indicating moderate levels of hypohydration than are blood measurements of hematocrit and serum osmolality and sodium concentration. Currently no "gold standard" hydration status marker exists, particularly for the relatively moderate levels of hypohydration that frequently occur in an exercise situation. The choice of marker for any particular situation will be influenced by the sensitivity and accuracy with which hydration status needs to be established together with the technical and time requirements and expense involved.     

Bioelectrical impedance to estimate changes in hydration status

Bioelectrical impedance analysis (BIA) has been suggested as a simple, rapid method to assess changes in hydration status. BIA measures the electrical impedance to a low amperage current that is affected by both water and electrolyte content of the body. While BIA can reliably estimate total body water and body density in euhydrated individuals under standardized clinical conditions, changes in fluid and electrolyte content can independently alter bioimpedance measurements. Because hydration changes typically involve concomitant changes in fluid and electrolyte content, the interpretation of a change in bioimpedance will often be confounded. This paper examines the assumptions underlying estimations of total body water from BIA and addresses the factors known to influence bioimpedance independently from actual change in total body water. The results indicate that current BIA methodology may not provide valid estimates of total body water when hydration state is altered.