从中医“阳气亏虚，痰瘀内阻”理论探讨中医药防治心肌缺血再灌注损伤的机制＊

目的 从文献探讨中医“阳气亏虚，痰瘀内阻”理论防治急性心肌梗死（Acute myocardial infarction，AMI）后心肌缺血再灌注损伤（Myocardial ischemia reperfusion injury，MIRI）的机制，为其科研及防治提供依据。方法 检索中国知网数据库、万方数据库、NCBI数据库从建库到2020年6月14日有关MIRI的文献，总结MIRI的发病机制及中医证治的新观点，分析可信度较高的相关实验数据，对运用中医“阳气亏虚，痰瘀内阻”理论防治MIRI进行探讨。结果 文献表明温阳化气、活血化瘀、祛痰化浊的中医方药可通过抑制细胞内Ca²⁺超载，稳定线细胞膜，减少氧自由基的生成，改善细胞能量代谢等多条途径参与缺血心肌的保护作用。结论 MIRI的发病机制文献表明，涉及多种病因，中医药可通过多靶点、多路径参与对MIRI的防治，且可能对MIRI的临床辨证论治提供理论依据。     

Bail-out intracranial stenting with Solitaire AB device after unsuccessful thrombectomy in acute ischemic stroke of anterior circulation

Background

Recent trials established the efficacy of mechanical stent-retriever thrombectomy for treatment of stroke patients with large vessel occlusion (LVO) in the anterior circulation. However, stent-retriever thrombectomy may not accomplish successful recanalization in all patients. The aim of this study is to report the role of bail-out permanent stenting after failure of mechanical thrombectomy.

急性缺血性脑卒中的诊治

急性缺血性脑卒中的分型有助于确定治疗原则。静脉溶栓治疗及血管取栓治疗是最有效的恢复脑再灌注的特异治疗方法。抗栓治疗、改善循环、降纤、扩容、神经保护、传统医药及对并发症的管理对预后有重要影响。康复治疗是促进卒中患者功能恢复、减少并发症、提高生活质量的重要措施。卒中后应尽早开始二级预防。     

Incidencia,pronóstico y factores asociados al infarto estriatocapsular aislado tras trombectomía mecánica

ObjectivesTo describe baseline and procedural characteristics and clinical outcomes of isolated striatocapsular infarct (iSCI) after mechanical thrombectomy in patients with large-vessel occlusion of the anterior cerebral circulation andits clinical outcome.MethodsWe performed a longitudinal study including all patients treated with mechanical thrombectomy at our centre between 2015 and 2017; patients were divided into 2 groups (iSCI and non-iSCI) according to whether they presented iSCI in a control CT scan at 24 h.ResultsOf the 83 patients identified, 22.9% developed an iSCI. There were no statically significant differences in baseline characteristics or in reperfusion times. Patients presenting iSCI showed better collateral circulation and better reperfusion rates in the bivariate analysis. No significant difference was observed for mortality at discharge or at 3 months, or for functional prognosis at 3 months.ConclusionsEven if successful reperfusion is achieved, iSCI is a common sequela, independently of reperfusion time, especially in patients with good collateral circulation.     

浮针治疗帕金森病伴发四肢疼痛临床研究

目的:对浮针治疗帕金森病伴四肢疼痛患者的临床疗效进行观察。方法:将确诊的40例住院患者随机分为观察组(20例)和对照组(20例)。在常规药物治疗的基础上,予观察组2天1次的浮针治疗,共进行2周;予对照组常规针刺治疗,每日1次,1周6次,共进行2周。比较两组治疗前及治疗2周后的McGill疼痛问卷简表(SF-MPQ)及39项帕金森病生存质量调查问卷(PDQ-39)评分;分别对两组临床疗效进行统计分析。结果:治疗2周后,两组患者的SF-MPQ单项评分及总分均较治疗前明显减少(均P<0.05),观察组评分明显低于对照组(P<0.05);两组患者的PDQ-39评分较治疗前明显减少(均P<0.05),观察组优于对照组(P<0.05)。总有效率方面,观察组为95%(19/20),高于对照组70%(14/20)(P<0.05)。结论:使用浮针对帕金森病伴发四肢疼痛患者进行治疗,可有效缓解患者疼痛症状,提升患者生活质量,疗效优于普通针刺。     

Vanillylmandelic acid protects against reperfusion injury in an experimental animal model of myocardial infarction

Vanillylmandelic acid, a catecholamine end-metabolite, has been shown to have several biological properties in previous studies, despite considered biologically inactive. We examined the potential effects of vanillylmandelic acid on the ischemic heart following myocardial infarction and reperfusion on a rat model. Thirty-four female Wistar rats were randomized into two groups, control and experimental. They were anesthetized and subjected to myocardial infarction through left anterior descending artery ligation. A previously studied dose of vanillylmandelic acid (10 mg/kg) was administered and the following parameters were studied during ischemia and reperfusion: a) mortality b) severity of ventricular tachyarrhythmias c) premature ventricular contractions and d) heart rate. Administration of vanillymandelic acid significantly reduced the severity of ventricular tachyarrhythmias and mortality rate during reperfusion, while it did not affect any other of the parameters studied. In conclusion, reperfusion injury was blunted through vanillylmandelic acid administration, which seems to be mediated by parasympathetic activation.     

血清生物学指标在急性肠系膜缺血早期诊断中的研究进展

急性肠系膜缺血是临床上较严重的外科急腹症之一,具有较高的病死率,早期诊断较为困难,患者确诊时病情一般已进展到了肠管壁不可逆性坏死,或合并其他脏器损伤。急性肠系膜缺血的症状及体征一般并不具有特异度,通常在剖腹探查手术时才能明确诊断。多层螺旋CT在急性肠系膜缺血诊断上显示了较高的特异度和灵敏度,但是对于非阻塞性肠系膜缺血的诊断仍较为困难。在临床实践中血清生物学指标在肠系膜缺血的诊断上还没得到广泛应用。本文总结了国内外一些传统的生物学指标如降钙素原、D-二聚体、L-乳酸等,以及一些更加符合早期肠系膜缺血病理生理改变的新兴生物学指标如氧化应激指标缺血修饰白蛋白、肠道细胞损伤标志物肠脂肪酸结合蛋白、肌肉蛋白等,为急性肠系膜缺血的早期诊断提供依据。     

电针预处理对急性心肌缺血再灌注损伤大鼠小脑顶核及下丘脑外侧区c-fos蛋白表达的影响

目的:观察电针预处理对急性心肌缺血再灌注损伤(MIRI)大鼠小脑顶核(FN)与下丘脑外侧区(LHA)c-fos蛋白表达的影响,探讨FN和LHA在电针心经抗急性MIRI效应中的作用及机制.方法:将70只Sprague-Dawley大鼠随机分为假手术组、模型组、电针心经组和电针肺经组,每组14只;以及损毁LHA+电针心经组(简称LHA+电针心经组)和损毁FN+电针心经组(简称FN+电针心经组),每组7只.除假手术组外,其余5组采用冠状动脉左前降支结扎法建立急性MIRI大鼠模型.采用电针心经治疗的3组针刺神门和通里;电针肺经组针刺太渊和列缺.所有电针组于造模前接受电针刺激,电流强度1 mA,频率2 Hz,每次20 min,每日1次,共7 d.假手术组及模型组不予电针.监测大鼠心电图,分析ST段位移和心律失常评分.采用免疫组织化学法检测FN及LHA中c-fos蛋白的表达.结果:与假手术组比较,模型组大鼠ST段位移、心律失常评分以及FN和LHA的c-fos蛋白表达明显升高(均P<0.05).与模型组比较,电针心经组大鼠ST段位移、心律失常评分以及FN和LHA的c-fos蛋白表达明显降低(均P<0.05).与电针心经组比较,电针肺经组、LHA+电针心经组和FN+电针心经组大鼠ST段位移和心律失常评分明显升高(均P<0.05);电针肺经组及LHA+电针心经组大鼠FN的c-fos蛋白表达明显升高(均P<0.05);电针肺经组及FN+电针心经组LHA的c-fos蛋白阳性表达明显升高(均P<0.05).结论:FN和LHA参与了针刺心经改善急性MIRI效应的作用机制,小脑可能是通过小脑-下丘脑投射参与了针刺改善心脏功能的作用.     

四氢巴马汀对大鼠心肌缺血再灌注损伤的保护作用

目的:探讨四氢巴马汀(l-THP)对大鼠心肌缺血再灌注损伤的保护作用。方法:Wistar大鼠24只,分为假手术组、模型组和l-THP治疗组,结扎大鼠冠状动脉左前降支30min再灌注120min造成心肌缺血再灌注损伤模型,分别于缺血30min、再灌注30min、60min、90min、120min观察l-THP对大鼠心功能、心肌酶学和脂质过氧化的影响。结果:l-THP能够对抗心肌缺血再灌注损伤引起的左心室内压(LVSP)、左心室内压最大上升与下降速率(±dp/dtmax)下降,左心室舒张末期压力(LVEDP)的升高,并能够稳定心肌组织Na -K -ATPase和Ca2 -Mg2 -ATPase活性,降低丙二醛(MDA)含量和增高超氧化物歧化酶(SOD)的活性。结论:四氢巴马汀(l-THP)对大鼠心肌缺血再灌注引起的心功能降低具有明显的保护作用,其机制可能与改善能量代谢障碍和抑制自由基生成或清除氧自由基作用有关。