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慢性稳定型心绞痛(SAP)其治疗方法包括药物治疗和血运重建治疗。作者就SAP的药物治疗进展、中西医结合治疗现状、血运重建策略选择进行探讨。     

康复教育路径在经皮冠状动脉介入治疗患者康复中的应用

目的：探讨康复教育路径在经皮冠状动脉介入（PCI）治疗患者康复中的作用效果。方法将纳入首次PCI患者115例随机分为观察组58例和对照组57例,两组采用相同治疗和一般护理方案。对照组实施常规健康教育,观察组实施康复教育路径。结果PCI术后6个月,观察组血压达标率、有氧运动达标率显著高于对照组（P〈0.05）,观察组吸烟率、体重指数、糖化血红蛋白显著低于对照组（P〈0.05）,危险因素控制情况优于对照组。观察组GSES量表自我效能评分高于对照组（P〈0.05）,HPLPⅡ量表健康责任、自我实现、运动锻炼、营养、压力应对、人际关系维度及总分均高于对照组（P〈0.05）,观察组自我效能及健康行为好于对照组。结论康复教育路径干预有助于促进经皮冠状动脉介入治疗患者术后康复,改善危险因素控制、健康生活方式及自我效能。     

超声评价颈动脉粥样硬化与冠心病关系的临床分析

目的探讨超声检测颈动脉粥样硬化与冠心病之间的相关性。方法收集2005年8月~2013年5月来我院进行治疗的患者198例并将其分为两组,对照组69例。CHD组129例,采用超声探头测定颈动脉内中膜厚度及斑块厚度,对结果进行分析。结果 CHD组患者的血糖、甘油三酯及收缩压均明显高于对照组,差异具有显著性(P<0.05)。CHD组颈动脉斑块发生率为81.4%,对照组为15.9%,两组差异具有显著性(P<0.05)。CHD组颈动脉粥样硬化斑块0级的发生率明显低于对照组,而2级、3级的发生率明显高于对照组(P<0.05)。多支病变组患者斑块积分高于单支病变组,mIMTc显著增加,差异具有显著性(P<0.05)。颈动脉超声对CHD的预测总符合率为73.74%。结论在冠心病的发生中颈动脉粥样硬化是一个高危预测因子,颈动脉血管超声检测可以作为疑诊CHD但是又不适用冠脉造影患者疾病诊断的辅助依据,可以在临床推广应用。     

Effect of chinese herbal drug-containing serum for activating-blood and dispelling-toxin on ox-LDL-induced inflammatory factors’ expression in endothelial cells

<正>Objective:To investigate the effects of drug-containing serum of Chinese herbal compound, Xiongshao Capsule(芎芍胶囊,XS,for activating-blood) and Huanglian Capsule(黄连胶囊,HL,for dispellingtoxin) on the oxidized low-density lipoprotein(ox-LDL)-induced inflammatory factors in human umbilical vein endothelial cells(HUVECs).Methods:Thirty-two rats were randomly divided into four groups:the blank control group treated with distilled water,the positive control group treated with simvastatin(1.8 mg/kg),the test group I treated with Chinese herbal compound of XS(0.135 g/kg),and the test group II treated with Chinese herbal compound of XS(0.135 g/kg) and HL(0.135 g/kg).All the treatments were administered for 7 successive days by gastrogavage.Rats' blood serum was harvested 1 h after the last administration to prepare respective drugcontaining serum.HUVECs were exposed to ox-LDL(100μg/mL) to induce cell injury model and incubated with corresponding drug-containing serum for 24 h.Untreated HUVECs were set for blank control.Levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and soluble intercellular adhesion molecule-1(slCAM-1) in supernatant of cultured HUVECs were determined by enzyme-linked immunosorbent assay(ELISA).HUVEC surface expressions of ICAM-1 and E-selectin were determined by flow cytometry.Results:Levels of IL-6, TNF-α,and slCAM-1 in the supernatant of HUVECs as well as the cell surface expressions of ICAM-1 and E-selectin significantly increased after 24-h ox-LDL stimulation(P0.01),while the abnormal elevations,except slCAM-1 in the test groupⅠ,were all reduced in the treated groups(the positive control and the two test groups) significantly(P0.01 or P0.05).Besides,the effect in the test group II seemed somewhat higher than that in the test group I but with no statistical significance(P0.05).Conclusion:Drug-containing serum of XS plus HL has a certain inhibitory effect on the vascular endothelial inflammation response induced by ox-LDL.     

病证结合治疗快速性心律失常经验举隅

陈可冀老师临证倡导中西医病证结合,优势互补。每以辨证论治兼顾疾病特点,辨病用方贯穿辨证论治之精神,重视辨证论治与专病专方专药结合。快速性心律失常包括过早搏动,阵发性心动过速(室上性、室性),扑动与颤动(房性、室性),预激综合征等,属中医学"心悸"、"怔忡"的范畴。本文所论陈可冀老师治疗的快速性心律失常主要包括早搏、阵发性房颤、短阵室上性心动过速,其他类型未包括在内。1辨病辨证要点:多从虚、瘀、痰、火论治陈可冀老师临诊快速性心律失常多从虚、瘀、痰、     

芪丹液对急性心肌梗死大鼠心肌缺血损伤的影响

目的 观察益气活血方芪丹液对急性心肌梗死大鼠心肌梗死面积及心肌缺血性损伤的影响.方法 Wistar大鼠冠状动脉左前降支结扎法造成AMI模型,随机分为模型组、芪丹液大、中、小剂量组和消心痛阳性对照组,并设正常组和假手术组.分别于结扎后7 d、14 d取心肌进行光镜、电镜观察,并利用NBT染色法测定心肌梗死面积.结果 各治疗组14 d心肌梗死面积均小于7 d,但无统计学意义;7 d时,消心痛组、芪丹大剂量组梗死面积明显小于模型组(P<0.05);14 d时,消心痛组、芪丹液大剂量组、芪丹液中剂量组亦与模型组比较有统计学意义(P<0.05).心肌组织HE染色光镜下可见缺血区心肌肿胀、炎细胞浸润、空泡样变性,细胞溶解,梗死区可见纤维化.以上变化模型组最为明显,芪丹液大、中剂量组及消心痛组介于正常与模型组之间.同组间7 d与14 d差别不明显.结论 芪丹液可明显缩小急性心肌梗死大鼠梗死面积,对心肌缺血性损伤具有保护作用.     

参桂胶囊对心肌梗死后心功能不全大鼠ET、AngⅡ影响的研究

目的　观察参桂胶囊对心肌梗死 (AMI)后心功能不全大鼠血浆内皮素 (ET)、血管紧张素Ⅱ(AngⅡ )的影响。 方法　结扎Wistar大鼠冠状动脉左前降支 ,体表心电图Ⅱ导示ST段弓背抬高 ,证实AMI形成后 ,将大鼠随机分为 7组 ,于手术后第 2日开始灌胃给药 ,连续 8周。取颈动脉血检测ET、AngⅡ的含量。 结果　与模型组比较 ,参桂胶囊大、中剂量和开博通组皆可明显降低ET含量 (P <0 .0 1～P <0 .0 5 ) ,且参桂胶囊大剂量和开博通组AMI后心功能不全大鼠的AngⅡ含量显著降低。结论　参桂胶囊通过降低血浆ET和AngⅡ的含量 ,从而改善心脏收缩及舒张功能 ,血管紧张素Ⅱ对AMI后心功能不全具有一定的防治作用     

Effect of Propyl Gallate on Activity of Cyclooxygenase 1 and 2 in Mice's Peritoneal Macrophages*

Objective: To investigate the effect of Red Peony 801 (propyl gallate,PrG) on cyclooxygenase (COX) activity in murine peritoneal macrophages. Methods: A screening model for COX inhibitors in vitro based on murine peritoneal macrophages was used. COX-1 activity was reflected by the level of 6-ketoprostaglandin F1α (6-keto-PGF1α) in supernatants of cultured macrophages which were stimulated with calcium ionophore A23187 for a short-term, while COX-2 activity was reflected by the level of prostaglandin E2(PGE2) in supernatants of cultured macrophages which were stimulated with lipopolysaccharide (LPS) for a long-term. Results: PrG did not affect A23187-induced, COX-1-derived 6-keto-PGF1α synthesis at the concentrations of 1 × 10-5, 5 × 10 6 mol/L (P＞0.05), but enhanced 6-keto-PGF1α synthesis at the concentrations of 1×10-6, 5×10-7, 1×10-7 mol/L (P＜0.01) in vitro, and showed a good dose-dependent manner. It inhibited LPS-induced, COX-2-derived PGE2 synthesis at the concentrations of 1 × 10-5 , 1 × 10-6 mol/L ( P＜0.05). Conclusion: Within the range of 1 × 10-5 to 1 × 10-7 mol/L, PrG activated COX-1 at lower concentrations and inhibited COX-2 at higher concentrations in murine peritoneal macrophages.