急性心肌梗死并发梗死后综合征的护理

梗死后综合征是急性心肌梗死的并发症之一,发生率约10%[1].发生机制尚不清楚,可能为机体对坏死物质的过敏反应.通常在心肌梗死后1～8周出现,临床表现为心包炎、胸膜炎或肺炎、发热、胸痛等症状.我科自2006-01～2008-10收治的急性心肌梗死患者中6例出现梗死后综合征,经治疗护理后均痊愈出院.现将护理经验报告如下.     

酒精性脂肪肝大鼠模型构建及中等强度运动后的变化

背景：有氧运动对于非酒精性脂肪性肝病有一定的预防和治疗作用，尚未见运动对于酒精性脂肪性肝病影响的报道。 目的：观察中等强度运动对大鼠酒精性脂肪性肝病模型各种指标变化的影响，探讨运动对酒精性脂肪性肝病的作用。 设计、时间及地点： 随机对照动物实验，于2007-07/09在成都体育学院动物房完成。 材料：4周龄健康雄性SD大鼠60只，实验分成3组，每组20只。 方法：①空白对照组：注射等量生理盐水，不进行跑台运动训练。②模型对照组：给予乙醇＋高脂饮食灌胃，放进静止的跑台不运动，0坡度，30 min/d。③造模运动组：给予乙醇＋高脂饮食灌胃，进行跑台运动训练，跑速25 m/min，15%坡度，30 min/d。运动持续4周。 主要观察指标：检测各组肝脏组织中超氧化物歧化酶、丙二醛含量以及光镜观察组织学变化。 结果：①空白对照组超氧化物歧化酶活性显著高于模型对照组和造模运动组(P < 0.01)，且前者超氧化物歧化酶达峰值。造模运动组超氧化物歧化酶活性高于模型对照组 (P < 0.05)。②空白对照组丙二醛含量显著低于模型对照组和造模运动组(P < 0.01)；造模运动组低于模型对照组(P < 0.05)。模型对照组肝细胞变性程度显著重于空白对照组(P < 0.01)，造模运动组肝细胞脂肪变性程度轻于模型对照组(P < 0.05)，但仍然比空白对照组严重(P < 0.01)。 结论：适度的训练可维持机体自由基代谢正常进行，能够对酒精性脂肪性功能恢复产生促进作用，降低对肝脏的损伤。     

急性缺血性脑卒中梗死灶面积与餐后血糖的关系

目的 探讨急性缺血性脑卒中患者梗死灶面积与餐后血糖的关系,为缺血性脑卒中患者血糖的管理、降低大面积脑梗死发生率提供临床依据.方法 入选2008年8月至2009年8月在佛山市第一人民医院神经内科住院的经临床诊断为急性缺血性脑卒中的患者186例,记录患者临床资料、生化指标.对患者进行头颅MR检查.按最大梗死灶平面直径分为3组,各组均有患者62例(≥5.0 cm、2.1～5.0 cm、0.5～2 cm),比较各组的年龄、性别、高血压、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-c)、1周餐后血糖(postprandial blood sugar,PBS1)、2周餐后血糖(PBS2)的有统计学差异.结果 各组患者的性别、高血压病、LDL-c水平的差异无统计学意义,年龄、餐后血糖(PBS1和PBS2)差异有统计学意义.结论 大面积脑卒中患者年龄高、餐后高血糖明显,且应激状态过后仍存在餐后高血糖状态.     

肌肉转录调节因子和连接蛋白43转基因成纤维细胞移植对心肌梗死大鼠脑钠素及梗死面积的影响

背景：研究表明基因工程将成纤维细胞改造为可兴奋细胞是可能的；而真皮成纤维细胞是机体内数量最大的“种子细胞库”。 目的：观察肌肉转录调节因子（myogenic determination,MyoD）和连接蛋白43(connexin 43,Cx43)基因共转染真皮成纤维细胞后在心肌梗死部位原位移植对急性心肌梗死大鼠血浆脑钠素浓度和心肌梗死面积的影响。 设计、时间及地点：随机对照动物实验，于2006-06/2007-03在同济大学附属东方医院细胞治疗室和上海中医药大学动物实验中心完成。 材料：雄性SD大鼠60只随机分成正常对照组、心肌梗死对照组、正常移植组和心肌梗死移植组，每组15只。 方法：结扎左冠状动脉前降支制备心肌梗死模型。4周后再次开胸在自结扎远端紧靠结扎处，心肌梗死区与非梗死区交界处用微量注射器将100 μL经BrdU标记的MyoD/Cx43-FB细胞悬液(细胞数1.0×106 )注入左冠状动脉前降支，在结扎远端已缺血的心肌上用同样的针头于靠近心尖部、室间隔部、左室前侧壁缺血的心肌上多点多位置将另外100 μL移植细胞悬液注入到心肌内，深度约4 mm；对照组同法等量注入未含细胞的DMEM细胞培养液。 主要观察指标：细胞移植前和移植后1 d，1，2，4周动态检测血浆脑钠素浓度；同时监测各组大鼠心率、动脉压、左心室内压及左心室等容收缩期室内压最大上升速率和下降速率等血流动力学指标的变化；4周后处死大鼠取心肌标本染色后测定心肌梗死面积。 结果：①免疫组织化学检测结果显示心肌瘢痕区边缘有BrdU阳性细胞存在。②细胞移植可显著改善心肌梗死大鼠的血流动力学。③心肌梗死对照组和心肌梗死移植组大鼠的血浆脑钠素浓度较正常对照组和正常移植组明显升高(P < 0.01)；在移植后1 d、1周、2周心肌梗死移植组与心肌梗死对照组血浆脑钠素浓度差异无显著性意义，4周后明显降低（P < 0.01）。④心肌梗死移植组的梗死面积显著小于心肌梗死对照组(P < 0.01)。 结论：MyoD和Cx43基因联合转染成纤维细胞后原位移植修复坏死心肌组织，能减小梗死面积。     

不同训练负荷条件下SD大鼠运动模型的构建与评价

背景：目前对运动训练中机体能量代谢的研究多集中于骨骼肌线粒体生物发生及线粒体氧自由基等各指标的变化,不同训练负荷条件下身体能量代谢的系统的机制研究较少。 目的：建立SD大鼠有氧、无氧及有氧无氧代谢交叉训练运动模型,评价各组SD大鼠能量代谢水平指标的变化。 方法：实验建立有氧、无氧、有氧和无氧交替运动SD大鼠跑台运动训练模型,有氧运动时采用递增负荷训练,无氧运动时采用高速间歇训练,并设立正常对照组。测量运动后大鼠体质量减轻程度的变化,检测运动后大鼠血清中乳酸、乳酸脱氢酶、肌酐、尿素氮、肌酸激酶、丙酮酸激酶和琥珀酸脱氢酶的活性。 结果与结论：实验结果显示无氧组体质量减轻程度明显(P < 0.05),乳酸水平增高(P < 0.05),琥珀酸脱氢酶水平低于有氧组(P < 0.05);无氧组和交替运动组乳酸脱氢酶水平均增高(P < 0.05);运动后大鼠尿素氮水平增高非常显著(P < 0.001);交替组肌酸激酶、肌酐水平显著增高(P < 0.01),丙酮酸激酶水平增高(P < 0.05)。结果表明运动后大鼠代谢水平符合有氧、无氧、有氧和无氧交替运动的代谢评价,运动模型构建成功。     

静脉应用血小板源性生长因子质粒减小梗死心肌面积的可行性

背景：过往研究已证实：心肌缺血前或缺血时心肌内注射血小板源性生长因子及其基因载体均可以明显减小缺血心肌的梗死面积,但心肌梗死后才经静脉使用血小板源性生长因子的基因载体是否具有相同的疗效,所知甚少。 目的：进一步验证对心肌缺血后,经静脉注射血小板源性生长因子质粒phPDGF-B对缺血心肌梗死面积的作用。 方法：20只SD大鼠随机分为4组,经结扎左冠状动脉前降支,建立心肌梗死模型。于结扎后30 min,雌、雄实验组静脉注射phPDGF-B质粒;雌、雄对照组静脉注射等体积PBS。2周后,进行常规的Masson,s Trichrome染色,对缺血心肌梗死区面积、纤维化及心室几何参数进行分析。 结果与结论：大鼠静脉使用phPDGF-B质粒2周后,雌、雄实验组的心肌梗死的面积均明显小于雌、雄对照组(P < 0.05);实验组梗死区存活的心肌细胞明显多于对照组;雌、雄实验组梗死区纤维化面积的比值均低于对照组,但差异没有显著性意义;实验组梗死区胶原沉积的密度明显小于对照组;实验组梗死边缘区的室壁厚度大于对照组(P < 0.05)。实验组梗死区室壁厚度大于对照组。结果证实,在心肌缺血30 min,经静脉使用phPDGF-B质粒对梗死区心肌细胞存活有保护作用,能有效减小缺血心肌的坏死面积,同时能有限度地改善存在心肌梗死的左心室重构,以及减小梗死区的纤维化程度,且上述作用没有性别差异。     

虚拟现实跑台训练对缺血性卒中患者肢体运动功能的影响研究

目的 探讨虚拟现实跑台训练对缺血性卒中患者肢体运动功能的影响.方法 2021年1-6月前瞻性连续选择符合入排标准的缺血性卒中患者,采用随机数字表法将患者随机分成试验组和对照组.对照组进行常规康复训练,试验组在常规康复训练基础上联合虚拟现实跑台训练.康复治疗前和治疗4周后由同一名评估者采用NIHSS、Fugl-Meyer...     

急性脑梗死患者血清闭锁蛋白水平与颈动脉粥样硬化、梗死面积及预后关系的分析

目的 探讨急性脑梗死(ACI)患者血清闭锁蛋白水平与颈动脉粥样硬化、梗死面积及预后的关系。方法 选取2020年1月至10月收治的ACI患者(ACI组)229例,另选取99例假性脑卒中患者为对照组。采用酶联免疫吸附法检测基线血清闭锁蛋白水平;应用颈动脉超声检查评估颈动脉狭窄程度,ACI组再分为颈动脉粥样硬化中/重度亚组(89例)和轻度亚组(140例);根据MR弥散加权成像(DWI)评估梗死面积,再分为大面积脑梗死亚组(29例)、中等面积脑梗死亚组(52例)和小面积脑梗死亚组(148例)。随访≥3个月,采用改良Rankin量表(mRS)评估预后。结果ACI组闭锁蛋白水平显著高于对照组(P<0.001)。颈动脉粥样硬化中/重度亚组闭锁蛋白水平显著高于轻度亚组(P<0.001)。大面积脑梗死亚组闭锁蛋白水平显著高于小面积脑梗死亚组和中等面积脑梗死亚组(均P<0.001)。Spearman等级相关系数分析示,ACI组闭锁蛋白水平与入院时NIHSS评分、白介素-6、肿瘤坏死因子α呈正相关(rs=0.372、0.430,0.267,P <0.001)。单因素和多因素Logis...     

脑梗死患者血浆纤维蛋白原与颈动脉内-中膜层厚度和梗死面积的关系

目的分析血浆纤维蛋白原水平与颈动脉内-中膜厚度和梗死面积的关系。方法对163例脑梗死患者行颈动脉超声检查,记录每例受检者双侧颈总动脉（common carotid artery,CCA）内-中膜厚度（Inti ma-medial Thickness,I MT）,抽取入院后24h内空腹静脉血3-4ml送检,测定纤维蛋白原水平。先依据颈动脉内-中膜厚度分为A组（〈1.2mm）和B组（≥1.2mm）,然后再按梗死面积大小分成两组（较大面积脑梗死组和腔隙性脑梗死组）,比较两组血浆纤维蛋白原水平的差异。结果B组血浆纤维蛋白原水平明显高于A组（P〈0.05）;腔隙性梗死患者纤维蛋白原水平高于较大面积脑梗死组。结论血浆纤维蛋白原水平和颈动脉内-中膜厚度明显相关,可能是颈动脉内-中膜增厚的危险因素;腔隙性梗死患者的发病与血浆纤维蛋白原水平密切相关。     

脑桥梗死后瞬目反射的变化及其对预后评估价值的研究

目的 通过脑桥梗死患者瞬目反射不同时间点的动态变化研究,探讨瞬目反射对脑桥梗死预后评估的价值.方法 纳入脑桥梗死患者49例(脑桥梗死组),分别于发病第3、7、14天和1、3个月时给予瞬目反射检查,发病3个月时再根据mRS神经功能评分分为预后良好组(mRS评分≤2分)和预后不良组(mRS评分>2分),同时纳入10例健康成...     

Effects of movement training on synaptic interface structure in the sensorimotor cortex and hippocampal CA3 area of the ischemic hemisphere in cerebral infarction rats

BACKGROUND:Movement is an effective way to provide sensory,movement and reflectivity afferent stimulation to the central nervous system. Movement plays an important role in functional recombination and compensation in the brain. OBJECTIVE: To observe movement training effects on texture parameters of synaptic interfaces in the sensorimotor cortex and hippocampal CA3 area of the ischemic hemisphere and on motor function in cerebral infarction rats. DESIGN,TIME AND SETTING: This neural morphology and patholog...     

Effects of movement training on synaptic interface structure in the sensorimotor cortex and hippocampal CA3 area of the ischemic hemisphere in cerebral infarction rats★

BACKGROUND： Movement is an effective way to provide sensory, movement and reflectivity afferent stimulation to the central nervous system. Movement plays an important role in functional recombination and compensation in the brain. OBJECTIVE： To observe movement training effects on texture parameters of synaptic interfaces in the sensorimotor cortex and hippocampal CA3 area of the ischemic hemisphere and on motor function in cerebral infarction rats. DESIGN, TIME AND SETTING： This neural morphology and pathology randomized controlled animal experiment was performed at the Center Laboratory, Affiliated Hospital of Luzhou Medical College, China from November 2004 to April 2005. MATERIALS： A total of 32 healthy male Wistar rats aged 8 weeks were equally and randomly assigned into model and movement training groups. METHODS： Rat models of right middle cerebral artery occlusion were established using the suture occlusion method in both groups. Rats in the movement training group underwent balance training, screen training, and rotating rod training starting on day 5 after surgery, for 40 minutes every day, 6 days per week, for 4 weeks. MAIN OUTCOME MEASURES： Texture parameters of synaptic interfaces were determined using a transmission electron microscope and image analyzer during week 5 following model induction. The following parameters were measured： synaptic cleft width; postsynaptic density thickness; synaptic interface curvature; and active zone length. Motor function was assessed using balance training, screen training, and rotating rod training. The lower score indicated a better motor function. RESULTS： The postsynaptic density thickness, synaptic interface curvature, and active zone length were significantly increased in the sensorimotor cortex and hippocampal CA3 area of the ischemic hemisphere of rats from the movement training group compared with the model group （P 〈 0.05 or 0.01）. Curved synapses and perforated synapses were seen in the sensorimotor cortex and hippocampal CA3 area at     

Recombinant human erythropoietin increases cerebral cortical width index and neurogenesis following ischemic stroke

The cerebral cortical expansion index refers to the ratio between left and right cortex width and is recognized as an indicator for cortical hyperplasia. Cerebral ischemia was established in CB-17 mice in the present study, and the mice were subsequently treated with recombinant human erythropoietin via subcutaneous injection. Results demonstrated that cerebral cortical width index significantly increased. Immunofluorescence detection showed that the number of nuclear antigen antibody/5-bromodeoxyuridine-positive cells at the infarction edge significantly increased. Correlation analysis revealed a negative correlation between neurological scores and cortical width indices in rats following ischemic stroke. These experimental findings suggested that recombinant human erythropoietin promoted cerebral cortical hyperplasia, increased cortical neurogenesis, and enhanced functional recovery following ischemic stroke.     

Effects of exercise training on microangiogenesis of rat ischemic lower limbs

目的：探讨运动训练促进大鼠缺血下肢微血管生成的机制,方法：SD大鼠30只随机分为A、B、C三组各10只,A、B组建立大鼠下肢缺血模型,C组正常大鼠。建模一周后A组大鼠跑步训练(30min/d)。B、C组日常活动,运动训练4周后处死大鼠,取大腿内收肌组织块免疫组化检测微血管密度（MVD）、血管内皮生长因子（VEGF）、碱性成纤维细胞生长因子（bFGF）表达,比较三组差异。结果：肌组织MVD、VEGF、bFGF免疫组化均显示：A组高于B组（P<0.01）,B组高于C组（P<0.01）;A、B、C组间均存在显著性差异。结论：下肢缺血刺激可以促进血管新生,运动训练可以增强该效应。     

Morphological changes of gonadotropin-releasing hormone neurons in the rat preoptic area across puberty

Gonadotropin-releasing hormone （GnRH） neurons in the preoptic area may undergo morphological changes during the pubertal period when their activities are upregulated. To clarify the regulatory mechanism of puberty onset, this study aimed to investigate the morphological changes of GnRH neurons in the preoptic area of GnRH-enhanced green fluorescent protein transgenic rats. Under confocal laser microscopy, pubertal GnRH neurons exhibited an inverted Y distribution pattern. Prepubertal GnRH neurons were generally unipolar and bipolar, and were distinguished as smooth type cells with few small processes or irregular type cells with many spine-like processes in the proximal dendrites. The number of GnRH neurons in the preoptic area and spine-like processes were increased during the course of reproductive maturation. There was no significant difference between male and female rats. Immunofluorescence staining revealed synaptophysin punctae close to the distal end of GnRH neurons, indicating that some presynaptic terminals may form a synaptic linkage with these neurons.     

Dynamic changes in neuronal autophagy and apoptosis in the ischemic penumbra following permanent ischemic stroke

The temporal dynamics of neuronal autophagy and apoptosis in the ischemic penumbra following stroke remains unclear.Therefore,in this study,we investigated the dynamic changes in autophagy and apoptosis in the penumbra to provide insight into potential therapeutic targets for stroke.An adult Sprague-Dawley rat model of permanent ischemic stroke was prepared by middle cerebral artery occlusion.Neuronal autophagy and apoptosis in the penumbra post-ischemia were evaluated by western blot assay and immunofluorescence staining with antibodies against LC3-Ⅱ and cleaved caspase-3,respectively.Levels of both LC3-Ⅱ and cleaved caspase-3 in the penumbra gradually increased within 5 hours post-ischemia.Thereafter,levels of both proteins declined,especially LC3-Ⅱ.The cerebral infarct volume increased slowly 1–4 hours after ischemia,but subsequently increased rapidly until 5 hours after ischemia.The severity of the neurological deficit was positively correlated with infarct volume.LC3-Ⅱ and cleaved caspase-3 levels were high in the penumbra within 5 hours after ischemia,and after that,levels of these proteins decreased at different rates.LC3-Ⅱ levels were reduced to a very low level,but cleaved caspase-3 levels remained high 72 hours after ischemia.These results indicate that there are temporal differences in the activation status of the autophagic and apoptotic pathways.This suggests that therapeutic targeting of these pathways should take into consideration their unique temporal dynamics.     

Evaluation of platelet changes in completed ischemic stroke

In a retrospective study we evaluated the platelet count in 45 patients mean age 73±9 years, with cerebral infarction (C.I.) documented by CT, and 45 age and sex-matched controls randomly selected. In 12 patients changes in platelet count were examined prospectively, starting from the acute event for 30 days. In the retrospective study the mean platelet count in C.I. was significantly lower than that found in controls: 260, 220±86,076/mm³ and 302, 422±65,747/mm³ (p<0.05) respectively. In the prospective study the mean count was 213,330±79,930/mm³. A progressive increase up to the 9–12^th day was observed, achieving a mean of 305,630±83,470/mm³ (p<0.01), not statistically different from controls. The 40–45% decrease of platelet count shows that about half of the circulating platelets had rapidly disappeared from the systemic circulation, presumably related to an increase in vivo platelet activation and aggregation.

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Sommario In uno studio retrospettivo è stata riconsiderata la conta delle piastrine in 45 pazienti con età media di 73±9 anni, affetti da infarto cerebrale acuto (I.C.), documentato all'esame TAC, ed in 45 soggetti di controllo. In 12 pazienti è stata condotta anche una valutazione prospettica per un periodo di 30 giorni. Nei pazienti con I.C. il numero delle piastrine è risultato in condizioni basali significativamente ridotto in confronto a quello dei controlli rispettivamente 260.220±86.076/mm³ e 302.422±65.747/mm³ (p<0.05). Il valore più basso è stato riscontrato nei primi due giorni dall'evento acuto con successiva normalizzazione entro 9–12 giorni. Il decremento massimo è risultato di circa il 40–45%. In conclusione: in corso di I.C. acuto una gran parte delle piastrine scompare dalla circolazione sistemica entro le prime 24–48 ore, verosimilmente per un aumento “in vivo” dell'attivazione e dell'aggregazione piastrinica.

     

肢体缺血预处理在未成熟心脏移植中的应用

背景：有学者提出远隔器官预处理概念,即在心脏以外的器官施行缺血预处理,同样能达到缺血预适应效果。肢体缺血预处理是一项机体自我调节的保护机制,但是对未成熟心肌保护的研究较少,在心脏移植方面的利用价值尚未明确。 目的：通过对未成熟幼犬进行肢体缺血预处理,与传统心脏保存方法比较,试图分析肢体缺血预处理在供体心脏保存中的应用价值。 方法：纳入未成熟幼犬12只,按随机数字表法分为2组,每组6只,采用有创性方法游离股动脉,肢体缺血预处理组夹闭股动脉10 min,开放5 min,3个循环后常规开胸,游离心脏,插灌注管,灌注st.Thomas停跳液,离体心脏于保护液中4 ℃保存(离体前取上腔静脉血3 mL)。对照组游离股动脉但不夹闭,余同实验组。在心脏保存时期(3 h)内每隔半小时取左心室心肌样本,3 h后取心尖部心肌烘干测得干湿比。测量心肌组织丙二醛含量、超氧化物歧化酶活性及肌钙蛋白Ⅰ含量。 结果与结论：离体前心肌组织肌钙蛋白Ⅰ含量无明显变化(P > 0.05),离体后肢体缺血预处理组的心肌丙二醛含量及干湿比均低于对照组(P < 0.05),超氧化物歧化酶活性高于对照组(P < 0.05)。结果提示,肢体缺血预处理对未成熟心脏有明显的保护作用,在未成熟供体心脏离体前进行缺血预处理可以提高供体心脏的保存效果,降低心肌水肿。离体前肌钙蛋白Ⅰ含量无变化说明肢体缺血预处理对心肌没有损伤,是一种安全的保护措施。 关键词：肢体缺血预处理;未成熟心肌;心脏移植;心肌保护;犬     

Clinical Features of Patients with a Myocardial Infarction During Acute Management of an Ischemic Stroke

Background and Aims  Ischemic stroke and myocardial infarction (MI) share some common risk factors and pathophysiological mechanisms. In addition, brain injury has been associated with abnormalities of heart function such as increased cardiac enzymes and EKG changes. However, there is little information on patients with post-stroke MI. In this study, we investigated the characteristics of ischemic stroke patients who had a MI during the acute stroke period. Methods  One thousand three hundred fifty-seven patients with acute ischemic stroke were studied by retrospective review of the stroke registry and inpatient charts. Among these patients, 12 that developed a post-stroke MI, during acute stroke management, were included in this study. The stroke subtype, pattern of arterial stenosis, and lesional dominance were analyzed. Results  The overall frequency of a post-stroke MI during hospitalization was 0.9% (12 of 1,357 patients initially studied). Eight of the 12 patients included had a painless MI. Significant intracranial arterial stenosis was observed in 10 patients (83%). According to the TOAST classification, seven patients (58.3%) had large artery atherosclerosis, three patients were classified as undetermined etiology and two patients were divided into the lacunar and cardioembolic group. Acute ischemia of the insular region was noted in six patients. Five patients died from their cardiac complications during the hospital stay. Conclusion  Post-stroke MI can be a potential complication of acute ischemic stroke; these events have a high mortality. Routine EKG monitoring, during the acute stroke period, may improve patient outcome due to the possibility of a painless post-stroke MI.