EFFECT OF A THROMBOXANE SYNTHETASE INHIBITOR UK-38, 485 ON THE TOLERANCE OF SKIN FLAPS OF PRIMARY ISCHAEMIA

The harmful effects of ischaemia or skin flaps were modified using the thromboxane synthetase inhibitor UK - 38,485. The epigastric island flaps of Sprague-Dawley rats (n= 288) were subjected to 10, 12 or 14 h of total pedicle occlusion, or 3, 5 or 7 h of venous occlusion of the sole vascular pedicle. Within each time period, rats received intravenous deoses of either physiological saline (controls) or UK - 38,485 at the beginning or end of the ischaemic episode. Flaps treated with UK - 38, 485 overall had a higher survival rate than control ischaemic flaps (P < 0.001). this applied both to total (arterial) ischaemia (P < 0.001) and partial (venous) ischaemia (P < 0.01). There was no significant difference between treatment given at the beginning or at the end of the ischaemic episode. These results may be explained by reduced platelet aggregation and thrombosis in the microvasculature due to the lower thromboxane/prostacyclin ratios for treated flaps. The possible inter-relationship of the prostanoids with free radical mechanisms in the no-reflow phenomenon is also discussed.     

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OBJECTIVE: To assess the effects of intracoronary diltiazem on no-reflow phenomenon of infarct-related artery (IRA) after emergent percutaneous transluminal coronary angioplasty or/and intracoronary stenting (PTCA/Stenting) in the patients with acute myocardial infarction (AMI). METHODS: We studied 34 AMI patients with no-reflow phenomenon of IRA after emergent PTCA/Stenting between January 1999 and August 2005. Urokinase-treated group (n=16) was given intracoronary urokinase 30,0000 - 50,0000 units within 15 - 30 minutes between January 1999 and April 2002 while diltiazem-treated group (n=18) was given intracoronary diltiazem 0.5 - 2 mg within 10 - 30 minutes between May 2002 and August 2005. Fifteen minutes later, coronary arteriography (CAG) was performed and the thrombolysis in myocardial infarction (TIMI) flow grade was measured. RESULTS: No apparent change of TIMI flow grade was found between pre-administration and post-administration of intracoronary urokinase, but TIMI flow grade was significantly improved after intracoronary diltiazem (P<0.01). TIMI flow grade of diltiazem-treated group was significantly higher than that of urokinase-treated group after the administration (P<0.05). The percentage of the patients who reached TIMI flow grade 3 after the intracoronary administration was higher in the diltiazem-treated group than that in the urokinase-treated group (P<0.01). CONCLUSION: The intracoronary administration of diltiazem 0.5~2mg can effectively improve the no-reflow phenomenon after emergent PTCA/Stenting in patients with AMI.     

Short-term intestinal ischemia-reperfusion alters intestinal motility that can be preserved by xanthine oxidase inhibition

While the effects of transient intestinal ischemia on mucosa have been well investigated, less is known about its effect on motor function. An experimental study was designed to investigate the effects of ischemia–reperfusion (I/R) on intestinal motility and intestinal muscular microcirculation. Wistar albino rats were divided into four groups: (1) baseline, (2) sham operation, (3) I/R, and (4) I/R with allopurinol pretreatment. Ischemia was induced by clamping the superior mesenteric artery (SMA) for 10 min. Gastroanal transit time (GATT) was measured with serial x-rays after instillation of barium sulfate to the stomach. Intestinal muscular microcirculation was evaluated by determining the number of carbon-perfused intestinal muscular microvessels (CPIMM). I/R prolonged GATT and decreased CPIMM significantly (P < 0.01). Pretreatment with allopurinol prevented prolongation of GATT and returned the number of CPIMM to the level of sham treatment (P < 0.01). In conclusion, reperfusion after 10 min of SMA ischemia alters intestinal motility. The no-reflow phenomenon plays an important role in this alteration of motility. Administration of allopurinol before reperfusion preserves intestinal motility by preventing the occurrence of no-reflow phenomenon.     

应用Albunex评估无复流时肌酸磷酸激酶同工酶和肌钙蛋白I释放动力学变化的实验研究

目的 :通过检测肌酸磷酸激酶同工酶MB(CK MB)和肌钙蛋白I(cTnI) ,了解无复流时CK MB和cTnI的变化与心肌微血管损害之间的关系 ,分析微血管损伤对CK MB和cTnI释放的影响。方法 :19只犬通过制作急性心肌缺血 再灌注动物模型 ,采用弹丸式注射声学造影剂Albunex进行心肌声学造影研究 ;测定外周循环中CK MB和cTnI在基础状态、6 0min心肌缺血 (T0 )、再灌注 6 0min时的浓度(T60 ) ,计算再灌注 6 0min时其上升斜率 (T60 -T0 6 0 )和相对增加值 (T60 -T0 T0 )。结果 :CK MB和cT nI在心肌缺血 6 0min时外周血液浓度明显高于基础状态 (P <0 .0 1) ,复流组明显高于无复流组 (P <0 .0 1) ;6 0min再灌注时CK MB和cTnI的浓度、上升斜率和相对增加值复流组仍显著高于无复流组 (P<0 .0 1和P <0 .0 0 1)。结论 :心肌微血管床的损害影响缺血再灌注心肌酶和结构蛋白的释放。     

急性心肌梗死患者冠脉再通后无复流与血栓调节蛋白的相关变化

目的测定AMI患者再灌注治疗前后血栓调节蛋白（TM）水平。方法对60例我院急诊确诊AMI患者．通过临床调查和病历记载记录患者的一般情况、危险因素及伴发疾病．在就诊时、再灌注治疗后第3d采集血标本，应用固相夹心法酶联免疫吸附试验（EUSA）测定AMI患者和健康对照组血浆TM水平。结果AMI患者再灌注治疗前后血浆TM水平均高于健康对照组（P〈0．05），无复流患者就诊时TM水平高于再灌流组（P〈0．05），再灌注治疗后第3d两组间差异更显著（P〈0．01）。结论血浆TM水平可反映AMI患者再灌注治疗前后血管内皮损伤程度；无复流患者血浆TM水平明显升高。     

地尔硫(艹卓)对急性心肌梗死患者急诊冠状动脉介入治疗中无再流的作用

目的:评价冠状动脉内应用地尔硫对急性心肌梗死(AMI)患者急诊经皮冠状动脉腔内成形和支架术(PTCA/Stenting)后梗死相关动脉无再流现象的疗效。方法:AMI急诊PTCA/Stenting后再通的梗死相关动脉存在无再流现象者34例。1999年1月至2002年4月16例患者(尿激酶组),冠状动脉内注射尿激酶30×104~50×104U,2002年5月至2005年8月18例患者(地尔硫卓艹组),冠状动脉内注射地尔硫卓艹0.5~2.0mg,15~30min内注完;注射完毕15min再行冠状动脉造影,评定冠状动脉血流TIMI分级。结果:尿激酶组治疗后冠状动脉血流TI-MI分级无明显变化,地尔硫组治疗后冠状动脉血流TIMI分级明显增加(1.0vs.2.44,P<0.01)。治疗后冠状动脉血流TIMI分级地尔硫组高于尿激酶组(2.44vs.1.43,P<0.05),达TIMI3级患者地尔硫组明显多于尿激酶组(66.7%vs.12.5%,P<0.01)。结论:冠状动脉内应用地尔硫0.5~2.0mg能有效改善AMI急诊PTCA/Stenting术无再流现象。     

急诊经皮腔内冠状动脉成型术（PTCA）无复流现象对预后的影响

目的:无复流现象被定义为经皮腔内冠状动脉成型术(PTCA)或支架植入后TIM I血流≤2级,但冠脉内无机械性阻塞。本研究探讨急诊PTCA中无复流现象的临床意义。方法:我们回顾性分析了2001年1月至2002年1月就诊于同仁医院的53例[男37例,女16例,年龄(54±12.35)岁]初发急性心肌梗死(AM I)行急诊PTCA的患者。病例被分为无复流组(18例,TIM I≤2级)和PC I后冠脉血流正常组(35例,TIM I3级),随访6个月,观察有无心脏病性猝死和非致命性心脏事件。组间差别采用t检验或x2检验。结果:无复流组发生充血性心衰(P<0.05)、恶≤2级性心律失常(P<0.05)、再发心绞痛(P<0.05)、心脏性猝死(P<0.05)高于冠脉血流正常组。无复流组6个月后左室射血分数显著低于冠脉血流正常组。结论:无复流现象强烈提示AM I预后不良。但需进一步的大规模临床试验验证。     

中药通心络(超微粉碎)对猪急性心肌梗死再灌注后无再流的影响

目的 评价通心络（超微粉碎）防治猪急性心肌梗死（AMI）再灌注后无再流的作用。方法 中华小型猪40只随机分为对照组,小剂量（0．05g/kg·d）、中剂量（0．2g/kg·d）、大剂量（0．5g/kg·d）通心络（超微粉碎）组和假手术组,每组8只。治疗组预给药3天后行冠状动脉结扎3h,松解1h制备AMI再灌注模型。AMI前后和再灌注后均行血流动力学测定和心肌声学造影（MCE）检查,最终行病理学分析。结果 与对照组比较,小、中和大剂量通心络（超微粉碎）可改善再灌注后的心功能,分别减少无再流面积由对照组的（78．5±4．4）％和（82．3±1．9）％至（43．4±3．2）％和（44．6±3．3）％,（25．2±2．4）％和（25．7±4．0）％,（24．0±1．9）％和（24．9±4．2）％（P〈0．05或P〈0.01）,分别减少心肌梗死面积由对照组的（98．5±1.4）％至（89．8±4．6）％,（80．2±3．1）％和（79.9±3．1）％（P〈0.05或P〈0．01）。结论 通心络（超微粉碎）能有效地防治心肌梗死再灌注后无再流,缩小梗死面积。     

远端保护装置在急性心肌梗死急诊经皮冠状动脉介入治疗中的应用

急诊经皮冠状动脉介入治疗是目前治疗急性心肌梗死的首选方法。在大部分急性心肌梗死的患者中，急诊冠脉造影均显示存在较重的血栓负荷，而对富含血栓的冠状动脉行介入操作必然会增加远端栓塞的可能性。约13％-80．9％的病人术后出现慢血流或无再流现象，远端微循环栓塞系造成无再流现象最重要的原因之一。近年来问世的各种远端保护装置为防治远端栓塞提供了一种有效的方法。     

急性心肌梗死患者冠脉再通后无复流与血栓调节蛋白的相关变化

本研究对急性心肌梗死（AMI）患者再灌注无复流现象进行探讨。分析无复流发生的相关因素，并测定AMI患者再灌注治疗前后血栓调节蛋白（TM）水平，探讨冠脉微栓塞在再灌注后无复流发生机制中的作用，通过研究再灌注后无复流患者血浆TM水平的变化以期为冠脉微栓塞致无复流提供筛查参考依据。