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1.
Background Many basic and clinical studies have proved that anisodamine can produce significant effect on relieving microvascular spasm, improving and dredging the coronary microcirculation. It may be beneficial to the improvement of slow-reflow phenomenon (SRP) following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). So we investigated the effect of intracoronary administration of anisodamine on SRP of infarct related artery (IRA) following primary PCI in patients with ST segment elevated acute myocardial infarction (STEAMI). Methods Twenty-one patients with SRP from a total of 148 STEAMI patients accepted primary PCI were enrolled into this study from September 2004 to December 2005. When SRP happened, nitroglycerin (200 µg) was “bolus” injected firstly into IRA to exclude the spasm of epicardial artery and identify SRP as well as a baseline and self-control agent following PCI. Ten minutes later, 1000 µg of anisodamine was injected into IRA with SRP at 200 µg/s, while the coronary angiography (CAG) was taken before and at 1st, 3rd and 10th minute after administration of nitroglycerin or anisodamine, respectively. The corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG) and the diameter of IRA were calculated and analyzed by Gibson’s TIMI frame count method using quantitative computer angiography (QCA) system to evaluate the influence of anisodamine on coronary flow and vessel lumen. In the meantime the invasive hemodynamic parameters of intracoronary and systemic artery (systolic, diastolic and mean pressure) and electrocardiogram (ECG) were measured and monitored. The changes of ventricular performance parameters and the adverse reaction were evaluated and followed-up at 1 month post-PCI. Results No significant changes in cTFCs and TMPGs were found at 1st, 3rd and 10th minute after intracoronary administration of nitroglycerin as compared with the baseline control (P>0.05). cTFCs were decreased by 58.3%, 56.2%, and 54.6%, respectively (P<0.001), and TMPGs were increased from 1.13±0.21 grade to 2.03±0.32, 2.65±0.45 and 2.51±0.57 grades (P<0.05) at 1st, 3rd and 10th minute after intracoronary administration of anisodamine as compared with those after intracoronary administration of nitroglycerine, respectively. The average coronary blood flow of TIMI grade was improved from 1.76±0.43 to 2.71±0.46 (P<0.05) while the diameter of middle segment in re-patented coronary artery was slightly increased from (3.20±0.40) mm to (3.40±0.50) mm at the 3rd minute after intracoronary administration of anisodamine (P>0.05) as compared with those of nitroglycerine control. The systolic, diastolic and mean pressures of intracoronary artery after intracoronary administration of anisodamine increased from 115 to 123, 75 to 84, 88 to 95 mmHg (P<0.05), respectively, along with the rise of heart rate from 68 to 84 beats per minute (P<0.05). There were no significant changes in intervals of PR, QT and QRS (P>0.05) and no any severe fast arrhythmia after intracoronary administration of anisodamine. The ventricular performance parameters were significantly improved and no major adverse cardiovascular events (MACE) were found during follow-up at 1 month post-PCI. Conclusions Intracoronary administration of 1000 µg anisodamine is effictive in reversing SRP following PCI in STEAMI patients, especially it is suitable for SRP patients with bradycardia or hypotension.  相似文献
2.
替罗非班对心肌梗死急诊介入术中无复流的影响   总被引:2,自引:0,他引:2  
目的观察替罗非班对急性ST段抬高心肌梗死急诊冠状动脉介入无复流现象的治疗效果。方法冠状动脉介入术中出现无复流现象45例,依次给予硝酸甘油、维拉帕米和替罗非班,观察靶血管前向血流的TIMI分级。结果替罗非班可以明显改善PCI术中无复流现象,替罗非班组与硝酸甘油组或维拉帕米组比较差异有显著性,硝酸甘油组与维拉帕米组比较差异无统计学意义。术中即刻效果不理想者,持续应用替罗非班,24h再次造影均改善了无复流。结论替罗非班可以明显改善急性ST段抬高心肌梗死急诊冠状动脉介入无复流现象。  相似文献
3.
Background No-reflow phenomenon during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is a predictive factor of continuous myocardial ischemia, ventricular remodeling and cardiac dysfunction, which is closely associated with a worse prognosis. This study aimed to evaluate intracoronary nitroprusside in the prevention of the no-reflow phenomenon in AMI.
Methods Ninety-two consecutive patients with AMI, who underwent primary PCI within 12 hours of onset, were randomly assigned to 2 groups: intracoronary administration of nitroprusside (group A, n=46), intracoronary administration of nitroglycerin (group B, n=46). The angJographic results were observed. The real-time myocardial contrast echocardiography (RT-MCE), including contrast score index (CSI), wall motion score index (WMSI), transmural contrast defect length (CDL) and serious WM abnormal length (WML) were recorded at 24 hours and 1 week post-PCI. High sensitivity C-reactive protein (Hs-CRP) was examined by immune rate nephelometry. N-terminal prohormone brain natriuretic peptide (NT-proBNP) was tested with enzyme-linked immunosorbent assay. Patients were followed up for six months. Major adverse cardiac events (MACE) were recorded. Results The incidence of final TIMI-3 flow in group A was much higher than that in Group B (P 〈0.05), final corrected TIMI frame count (cTFC) in group A decreased significantly than that in group B (P 〈0.01). The CSI, CDL/LV length, WMSI and WL/LV length in group A were significantly lower than that in group B (P 〈0.01). Levels of Hs-CRP and NT-proBNP at 1 week post-PCI decreased significantly in group A than that in group B (P 〈0.01). Patients were followed up for 6 months and the incidence of MACE in group A was significantly lower than that in group B (P〈0.05).
Conclusion Intracoronary nitroprusside can improve myocardial microcirculation, leading to the decrease of the incidence of no-reflow phenomenon and better prognosis.  相似文献
4.
Background The incidence of no reflow phenomenon limits the clinical outcomes of percutaneous coronary intervention (PCI). This randomized controlled study was designed to evaluate the immediate protective effects of intensive statin pretreatment on myocardial perfusion and myocardial ischemic injury during PCI.
Methods Altogether 228 patients with acute coronary syndrome (ACS) were randomly assigned to standard statin group (SS group, n=115) and intensive statin group (IS group, n=-113). Patients in the SS group received 20 mg simvastatin and patients in the IS group received 80 mg simvastatin for 7 days before PCI. Thrombolysis in myocardial infarction (TIMI) flow grade (TFG), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the intervened vessel were recorded before and after stent deployment. Creatine kinase (CK) isoenzyme MB, troponin I and plasma level of high sensitive-C reactive protein (hs-CRP), P-selectin and intercellular adhesion molecule (ICAM) were measured before and 24 hours after the procedure.
Results The TFG after stent deployment was significantly improved with less TIMI 0-1 and more TIMI 3 blood flow in the IS group than in the SS group (all P〈0.05). Patients with no reflow phenomenon were less in the IS group (P〈0.001). The CTFC was lower in the IS group than in the SS group (P 〈0.001). TMPG was also improved in the IS group than in the SS group (P=0.001). Although PCI caused a significant increase in CK-MB 24 hours after the procedure, the elevated CK-MB value was lower in the IS group than in the SS group (18.74±8.41 vs 21.78±10.64, P=0.018). Similar changes were also found in troponin I (0.99±1.07 in the IS group vs 1.47±1.54 in the SS group, P=0.006). CK-MB elevation occurred in 27.8% (32/115) of the patients in the SS group vs 15.9% (18/113) in the IS group (P=-0.030). Myocardial necrosis was detected in 4.4% (5/115) of the patients in the SS group, whereas 0.9% (1/113) in the IS group (P=0.341). But no myocardial infarction was found. Similarly, the patients with increased level of troponin I were much more in the SS group (36.5%, 42/115) than in the IS group (19.5%, 22/113) (P=0.04). Among them, myocardial necrosis was detected in 13.0% (15/115) of the patients in the SS group, while 4.4% (5/113) in the IS group (P=-0.021). Myocardial infarction was found in 4.4% (5/115) of the patients in the SS group and 0.9% (1/113) in the IS group (P=0.213).
Conclusions Intensive statin pretreatment for 7 days before PCI can further improve myocardial blood perfusion, protect the myocardium from ischemic injury. These effects are associated with the lowered levels of hs-CRP, P-selectin and ICAM.  相似文献
5.
目的 观察岁格列酮对大鼠急性心肌梗死(acute myocardial infarction,AMI)再灌注后无再流的影响及其机制.方法 45只SD大鼠分为假手术组、生理盐水组、罗格列酮组(3 mg·kg-1·d-1,共14 d),每组15只,后2组人鼠行冠状动脉结扎3 h,松解2 h建立AMI再灌注后无冉流模型.以病理染色法检测无冉流而积;化学比色法检测再灌注区心肌髓过氧化物酶(myeloperoxidase,MPO)活性;以免疫组化及RT-PCR方法 检测冉灌注区细胞间粘附分子-1(intercellularadhesion molecule-1,ICAM-1)和P-选择素蛋白及mRNA的表达.结果 ①岁格列酬组心肌无再流范围较生理盐水组显著减小(P<0.01);②生理盐水组心肌MPO酶活性、ICAM-1及P-选择素蛋门及mRNA表达水平较假手术组均显著升高(P<0.01),罗格列酮组上述指标较生理盐水组显著降低(P<0.05).结论 罗格列酬能有效减小大鼠急性心肌梗死再灌注后无再流范围,其机制可能与抑制再灌注后内皮ICAM-1及P-选择素的表达,进而减少中性粒细胞的粘附及聚积有关.  相似文献
6.
阿魏酸钠对兔急性心肌梗死再灌注后无复流的影响   总被引:2,自引:0,他引:2  
目的 探讨阿魏酸钠对兔急性心肌梗死(acute myocardial infarction,AMI )再灌注后无复流的作用及机制.方法 随机将24只成熟雄性新西兰大白兔分为假手术组、对照组、阿魏酸钠组3组,每组8只,分别建立AMI缺血再灌注模型,于缺血前5min、结扎后240 min,再灌注后120 min取静脉血.采用酶联免疫吸附法(ELISA)测定血清白介素-6(IL-6);免疫组织化学法观察心肌组织P-选择素(Ps)的变化;应用硫黄素染色评估无复流面积.结果 ①对照组和阿魏酸钠组AMI后240 min、再灌注后120 min的血清IL-6均显著高于假手术组(P均<0.01);阿魏酸钠组各时间点除AMI前血清IL-6均显著低于对照组(P均<0.05).②Ps免疫组化显示,对照组及阿魏酸钠组中,Ps在复流区及无复流区血管内皮细胞有强表达,明显强于正常区及假手术组(P均<0.01);阿魏酸钠组与对照组比较,Ps在复流区及无复流区表达均明显减弱(P均<0.01).③病理染色分析示,阿魏酸钠组结扎区心肌范围与对照组相比差异无统计学意义(P均>0.05);无复流区心肌范围与对照组相比显著降低(P均<0.01 ).结论 阿魏酸钠能有效抑制炎症反应,防治AMI再灌注后无复流.  相似文献
7.
 目的研究组织因子途径抑制物(TFPI)对兔心肌梗死再灌注后无复流的影响,探讨TFPI改善心肌梗死再灌注后无复流
的作用机制。方法30 只日本大耳白兔随机分为假手术组、盐水对照组和TFPI 组。建立兔急性心肌梗死再灌注后无复流模型。
用硫黄素S 活体染色,观察兔心肌无复流范围;伊文斯蓝、四氮唑红染色,评估兔心肌缺血及梗死范围。免疫组化法检测心肌组
织梗死及周围区组织因子(TF)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)的表达。结果心肌梗死再灌注后90 min,盐水对照
组兔IL-6 和TF 水平明显高于TFPI组和假手术组(P 均<0.05)。各组TNF-α的表达无统计学差异(P > 0.05)。TFPI 组与盐水对
照组结扎区心肌范围相似(P > 0.05),但无复流范围及坏死心肌范围明显小于盐水对照组(P < 0.05,P < 0.01)。结论兔心肌
梗死缺血60 min再灌注90 min可发生无复流现象;TFPI可缩小无复流及坏死范围,其机制可能与抑制血栓形成和炎性反应有关。  相似文献
8.
目的:评价冠状动脉内注射国产盐酸替罗非班对急性冠状动脉综合征(acute coronary syndrome,ACS)介入术后无复流患者冠状动脉TIMI血流的影响及安全性。方法:将ACS患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后判定无复流者48例,随机分为替罗非班组(冠状动脉内注射维拉帕米及盐酸替罗非班10μg/kg)25例和维拉帕米组(冠状动脉内注射维拉帕米200μg)23例。观察给药后30min TIMI血流分级及校正的TIMI计帧数(CTFC),7天后左心室射血分数,出血并发症及30天内主要不良心血管事件(MACE)发生率。结果:替罗非班组介入术后无复流患者TIMIⅢ级血流获得率(64.0%)高于维拉帕米组(34.8%)(P〈0.05);CTFC显示替罗非班组血流快于维拉帕米组(P〈0.01);替罗非班组7天后左心室射血分数高于维拉帕米组(P〈0.01);出血并发症发生率和30天内MACE发生率与维拉帕米组差异均无统计学意义(P〉0.05)。结论:冠状动脉内注射国产盐酸替罗非班治疗ACS介入术后无复流患者是有效和安全的。  相似文献
9.
目的 探讨兔急性心肌梗死再灌注后无复流现象与炎症的关系,评价前列地尔(前列腺素E1)对炎症的影响及对无复流的作用.方法 建立大白兔心肌缺血再灌注损伤动物模型,随机分为假手术组、对照组和前列地尔治疗组,免疫组织化学法观察心肌P-选择素(Ps)的变化,最后计算心肌梗死面积及无复流面积.结果 Ps免疫组化显示,对照组及治疗组中,Ps在复流区及无复流区血管内皮细胞有强表达,明显强于正常区及假手术组(P均<0.01);无复流区表达强于复流区(P<0.01).前列地尔治疗组与对照组比较,Ps在复流区及无复流区表达均明显减弱(P <0.01).病理染色分析示,前列地尔治疗组与对照组比较:结扎区面积差异无统计学意义(P>0.05);无复流面积和坏死心肌面积均较对照组显著降低(P均<0.01).结论 前列地尔(PGE1)能通过抑制炎症反应起到保护心肌,减少心肌梗死面积,减少无复流面积的作用.  相似文献
10.
目的:观察内皮细胞凋亡对家兔缺血再灌注心肌无复流的影响.方法:24只家兔建立兔缺血再灌注模型后随机分成3组:假手术组(S组)、缺血再灌注组(IR组)和脂多糖(LPS)组(L组).S组开胸只穿线不结扎血管,麻醉维持120 min;IR组结扎30 min,松开再灌注120 min;L组开胸前耳缘静脉输注LPS液50 μg/kg,5 h后开胸按IR组操作进行.应用硫黄素染色评估缺血心肌再灌注后无复流面积;应用氯化三苯基氮四唑(TTC)染色观察心肌梗死范围;应用TUNEL法观察缺血心肌再灌注后无复流区内皮细胞凋亡发生的情况.结果:与IR组相比,L组冠状动脉内皮细胞凋亡指数升高,再灌注心肌无复流面积及心肌梗死范围增加(P均<0.05).与S组相比,IR组、L组内皮细胞凋亡指数均升高(P均<0.05).结论:冠状动脉血管内皮细胞凋亡可以促进无复流的发生.  相似文献
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