普罗帕酮治疗各类心律失常疗效及电生理效应

普罗帕酮已成为临床上广泛应用的抗心律失常药物。在治疗各类心律失常中，以治疗室上性心动过速疗效显著，国内外报道较多。但在治疗室性心律失常的疗效及其电生理效应，报道较少。本文报道本院自１９８５～１９９７年诊断心律失常查因及药物筛选病人，进行食道调搏术（ＴＥＡＰ），比较各类心律失常用药后疗效及急性电生理效应，以探讨其临床疗效与电生理效应，现报告如下。　　资料与方法　　１－临床资料：９０例收集本院１９８５～１９９７年临床诊断心律失常速查因和药物筛选的病人，由１８～７０岁，平均年龄（３９－３±３－２）岁，…     

VVI心脏起搏后发生尖端扭转性室性心动过速二例

例 1　男性 ,86岁 ,反复晕厥发作 2年半入院。 2年半前因晕厥以及Ⅲ度房室阻滞 ,室性逸搏心律 ,在我院行ＶＶＩ起搏器安置术。术前ＱＴ间期 0 .72ｓ ,术后 0 .68ｓ;起搏心率 70次 /分。术后 1年又因反复晕厥入院。心电图示人工心室起搏心律 ,ＱＴ间期延长 ( 0 .74ｓ)。入院后第 5天又突发晕厥 ,心电监护提示尖端扭转性室性心动过速 (ＴｄＰ)。急查血钾 :3 .5 2ｍｍｏｌ/Ｌ。经心前区拳击及心脏按压转复为心室起搏心律 ,此后反复短阵发作及自动终止。给予利多卡因静脉点滴维持 ,4ｈ后患者晕厥再次持续发作 ,经用心外按压、异丙肾上腺素、阿托…     

醒脑静抑制重组人肿瘤坏死因子介导的人脐静脉内皮细胞增殖

背景：前期研究将传统名方“安宫牛黄丸”经提取精制而成的新型水溶性静脉注射液醒脑静注射液应用于临床治疗冠心病 并取得很好的疗效,但其具体机制未完全明确。 目的：观察醒脑静对重组人肿瘤坏死因子介导的人脐静脉内皮细胞增殖的影响,探讨醒脑静抑制血管内皮细胞损伤增生的 应用价值。 方法：取3~5代人脐静脉内皮细胞,在培养基中添加10 μg/L重组人肿瘤坏死因子α诱导增殖,醒脑静组加入不同浓度的 醒脑静干预,阳性对照组添加氟伐他汀,并设立单纯细胞培养的空白对照组。 结果与结论：倒置相差显微镜下可见不同浓度的醒脑静均可使人脐静脉内皮细胞呈现胞浆收缩,贴壁细胞减少,坏死细胞 增多。醒脑静组的细胞增殖率低于肿瘤坏死因子α组(P < 0.05),且呈剂量及作用时间依赖关系。证实醒脑静能有效抑制重 组人肿瘤坏死因子α介导的人脐静脉内皮细胞增殖。     

中青年原发性高血压患者循环内皮祖细胞CD34+水平与颈动脉粥样硬化的相关性研究

Objective To explore the relationship between the level of circulating endothelial progenitor cells (EPCs) CD34+with the Framingham cardiovascular risk factors, or with the carotid artery intima-madia thickness (IMT), and to evaluate the value of circulating EPCs CD34+level as a cytologicalmarker of early vascular lesion in youth and middle aged essential hypertension (EH) patients.Methods A total of 62 patients with EH aged between 25 to 45 were enrolled as study group and 20 healthy people were enrolled as control group.EH patients were stratified with cardiovascular risk factors according to Framingham risk factors score into low-risk group with 18 cases, mid-risk group with 14 cases, high-risk group with 17 cases, and extremely high-risk group with 13 cases.The level of circulating EPCs CD34+,carotid artery IMT were respectively measured.The relationship between the level of circulating EPCsCD34+ and Framingham cardiovascular risk factors score, carotid artery IMT was analyzed.Results The level of circulating EPCs CD34+ was gradually decreased with an increase of the Framingham risk factors score in each hypertensive subgroup [low-risk group:(0.12±0.02)%, mid-risk group:(0.07±0.03)%,high-risk group:(0.04±0.03)%, extremely high-risk group:(0.01±0.01)%], and they were significantly lower than that in control group [(0.15±0.03)%], and there was a significant difference among hypertensive subgroups (P＜0.05 or P＜0.01).Carotid artery IMT was significantly thicker among hypertensive subgroups [low-risk group:(0.80±0.07)mm, mid-risk group:(1.11±0.08)mm, high-risk group: (1.26±0.10)mm, extremely high-risk group:(1.45±0.09)mm], and there was a significant difference between each hypertensive group and that of control group [(0.73±0.08)mm, all P＜0.01].There was also statistical significance among hypertensive subgroups(P＜0.05 or P＜0.01).There was a negative correlation between the level of circulating EPCs CD34+and Framingham risk factors score (r=-0.875, P＜0.01), and also a negative correlation with carotid artery IMT (r=-0.852, P＜0.01).Conclusion There was a significant correlation between the level of circulating EPCs CD34+with Framingham risk factors score and also carotid artery IMT in EH patients.Circulating EPCs CD34+could be a cytological marker of early vascular lesion in hypertension patients.     

主动脉夹层动脉瘤1例心电图酷似心包炎改变

１临床和心电图资料患者男性 ,４０岁 ,起病当日凌晨无诱因下突然感到心前区烧灼样疼痛 ,并向咽、背部放射 ,伴心悸、气促 ,疼痛持续３０小时无缓解。次晨到卫生院诊治 ,心电图示窦性心动过速 ,ＳＴ段Ｖ４～５ 抬高。经服用心痛定等药物后 ,症状缓解 ,偶有心前区不适 ,于３天后上午收入本院。临床诊断 :心绞痛 ,未排除心肌梗死。体检 :血压１２０／７５ｍｍＨｇ ,心尖区ＳＭⅡ／６°,柔和、局限。心电图示 :ＳＴ段Ⅱ、Ⅲ、ａｖＬ、ａｖＦ、Ｖ１～５ 呈弓背向下抬高 ,Ｔ波Ⅲ、ａｖＦ倒置 ,Ｖ４～６ 切迹 ,电压ＲⅠ +Ⅱ +Ⅲ＞１．５ｍｖ。２４…     

醒脑静对心肌缺血再灌注损伤的影响

目的探讨醒脑静预处理对心肌缺血再灌注损伤(MIRI)时的影响。方法20只新西兰兔随机分成安慰剂组和醒脑静组,每组10只。结扎冠脉造成MIRI模型,分别在冠脉结扎前、结扎后1 h、再灌注后1 h,取心房血分别检测肿瘤坏死因子-α(TNF-α)、内皮素(ET)、一氧化氮(NO)、血清肌酸激酶(CK)血浆水平。同时观察各组梗死范围。结果冠脉结扎后醒脑静组TNF-α,ET及CK水平较安慰剂组显著降低(P<0.01),NO水平显著升高(P<0.01),心肌梗死面积显著小于安慰剂组(P<0.01)。结论醒脑静预处理能减轻MIRI时的内皮细胞损伤和功能障碍,从而起到良好的心肌保护作用。     

雷帕霉素药物支架治疗冠心病的远期疗效

目的 评价雷帕霉素药物洗脱支架（Firebird^TM）在冠心病患者介入治疗中的疗效及其安全性。方法 药物支架组患者接受Firebird^TM支架治疗的老年冠心病患者52例（72枚），普通支架组为选择同期接受普通冠状动脉支架治疗的冠心病患者43例（53枚），比较两组的临床特征、支架置入情况及临床事件发生率。结果 药物支架组中的糖尿病患者占46．2％，明显高于普通支架组（34．9％，P〈0．05）；干预的病变血管呈弥漫性病变，药物支架组占40．9％，高于普通支架组（28.3％，P〈0．05）；病变血管平均参考内径，药物支架组为（2．63±0．23）mm，普通支架组为（3．12±0．17）mm，差异有统计学意义（P〈0．05）；置入支架内径和长度，药物支架组分别为（2．75±0．22）mm和（23．1±4．0）mm，普通支架组分别为（3．05±0．19）mm和（15．6±3．3）m，差异有统计学意义（P〈0．05）。随访12～18个月，心绞痛复发率，药物支架组3．8％，普通支架组16．3％；靶病变血管再次血运重建率，药物支架组0，普通支架组9．3％，P〈0．05）。结论 Firebird^TM支架治疗冠心病安全有效，对冠状动脉弥漫性病变、小血管病变的也有较好的疗效。其近期及远期临床效果均优于普通支架。     

Study of the Fibriolytic Inhibition and Clinical Prognosis in Acute Coronary Syndrome Patients Complicated with Type H Diabetes Mellitus

Objectives To study the status of fibrinolytic inhibition in patients of acute coronary syndrome(ACS) complicated with type Ⅱ diabetes mellitus (NIDDM) and to evaluate the effect of fibrinolytic inhibition to the clinical prognosis.Methods Type Ⅱ diabetes mellitus was defined by ADA 1997/WH0 1998 criteria. The subjects were divided into treatment groups that included 39 patients of ACS with 20 cases of acute myocardiac infarction (AMI), 36 patients of ACS + NIDOM with 20 cases of AMI. Twenty cases of healthy people were randomized to control group. The plasma level of tissue type plasminogen activator (t-PA), plasminogen activator in-hibitor type-1 (PAI-1) and plasma D -dimer were detected by using elisa technique. The index of statue in fibrinolysis was detected with the plasma level of D-dimer and the rate of PAI- 1/D- dimer in percentage. This index was used to evaluate the fibrinolytic inhibition and the clinical outcome in all the patients with AMI in treatment groups. The clinical outcome in patients with AMI consisted of the rate of reperfusion, the incidences of reinfarction, severi-ous arrhythmia, pump failure and death in the early period of AMI. Results The plasma level of PAI-1 and D-dimer was higher in the two treatment groups than that in the control group ( P < 0.01). The plasma level of PAI- 1 significantly higher in ACS + NIDDM patients than that in ACS (P<0.05), but the plasma level of D- dimer raised from basic level was significanfly lower in ACS + NIDDM than that in ACS ( P<0. 05) . The rate of PAI- 1/D - dimer in percentage was significantly higher in ACS + NIDDM than that in ACS or in control group (P< 0. 01). For AMI patients in two treatment groups, the rate of reperfusion after the throrabolytic therapy was signifi-candy lower in ACS + NIDDM than that in ACS( P<0. 01) . The rate of incidences in pump failure was significantly higher in ACS + NIDDM than that in ACS too ( P<0. 05). The morbidity of severious arrhythmia, re-infarction and the mortality were also higher in ACS + NIDDM; however the difference was not significant (P<0.05) . Conclusions The plasma level of D-dimer combined with the rate of PAl - 1/D - dimer in percentage could be used to be the evidence and the index to evaluate the status of fibrinolytic in-hibition in patients of ACS + NIDDM, and could be used to evaluate the effect of the fibrinolytic inhibition to the outcome of treatment and clinical prognosis in ACS patient.     

D-二聚体及与纤溶酶原激活物抑制剂-1比值评价合并糖耐量减低急性冠状动脉综合征患者纤溶受抑的研究

目的 :探讨合并糖耐量减低 (IGT)的急性冠状动脉综合征 (ACS)患者纤溶受抑状态及其对治疗和预后的影响。方法 :非糖尿病 ACS组 39例 ,IGT+ACS组 37例 ,非胰岛素依赖性糖尿病 (NIDDM) +ACS组 36例 ;同时设正常对照组 2 0例 ,检测各组组织型纤溶酶原激活剂 (t PA) ,纤溶酶原激活物抑制剂 1(PAI 1)及D 二聚体的血浆水平 ,并计算 PAI 1/ D 二聚体百分比。观察各组急性心肌梗死 (AMI)患者的临床及预后。结果 :IGT+ACS及 NIDDM+ACS组的 PAI 1显著高于正常对照组和 ACS组 (P均 <0 .0 5 ) ,而 D 二聚体上升幅值则显著低于 ACS组 (P<0 .0 5 ) ,两组 PAI 1/ D 二聚体比值也均显著高于正常对照组及 ACS组(P均 <0 .0 1)。两糖代谢异常组溶栓再通比例显著低于 ACS组 (P<0 .0 1) ,泵衰竭的发生率显著高于 ACS组(P<0 .0 5 )。结论 :IGT的 ACS患者存在纤溶受抑状态。 D二聚体血浆水平结合 PAI 1/ D二聚体比值能反映患者纤溶受抑的状态及预后。     

补肾活血法治疗绝经后女性冠心病40例

目的 研究中药补肾活血法治疗绝经后女性冠心病患者临床疗效.方法 将符合纳人标准的病例80例随机分为治疗组与对照组各40例,治疗组采用中药补肾活血法之左归丸合丹参饮加减,对照组予西药尼尔雌醇口服,均治疗3个月;比较两组中医证候、心电图疗效.结果 补肾活血法对比尼尔雌醇治疗绝经后女性冠心病患者临床症状总有效率和心电图疗效比较具有显著意义.结论 补肾活血法治疗绝经后女性冠心病患者临床疗效显著.