犬缺血心肌心导纳环与心电图的对照观察

本实验旨在观察实验犬心肌缺血及再灌注状态下心导纳环 (ＡＤＬ)与ＥＣＧ的改变及ＡＤＬ特点 ,并探讨其产生机制。成年健康杂种犬 10条 ,常规麻醉 ,人工呼吸 ,开胸后分离冠脉左前降支第一分支远端二级分支并插管以测小冠脉内压 ,以自制可调微米缩窄器造成前降支主干狭窄 ,据电磁流量计测量的冠脉血流量确定狭窄程度 ,同时监测服动脉血压及左心室内压。用ＸＴＳ -ⅡＢ型心脏功能自动监测仪记录ＡＤＬ ,于实验前 ,左前降支重度狭窄 (冠脉血流量下降 70 %以上 )后即刻、5、10、2 0、30ｍｉｎ及再灌注后的上述时间点采样。结果　术前 :ＡＤＬ、…     

硝苯吡啶使缺血心肌倒置T波迅速恢复直立的实验观察

作者在猪的心肌缺血模型上发现，硝苯吡啶可使缺血所致的Ｔ波倒置迅速恢复直立。麻醉在体猪心，缩窄左冠状动脉前时间支（ＬＡＤ）至冠脉内压４．６７ｋＰａ，经ＬＡＤ插管分别输入腺苷或硝苯吡啶，在持续９分钟缺血期间，两组间的心率、左心室舒张末压、左心室发展压、冠脉流量、冠脉灌注压皆相似，且腺苷组的冠脉流量还略高。但腺苷并未使缺血所致的Ｔ波倒置改善，而硝苯吡啶却使倒置的Ｔ波迅速恢复直立，作者并对该改变的相关因素和机理进行了讨论。     

冠脉内多普勒血流速度描记评价介入治疗效果

目的 应用冠状动脉内多普勒血流速度描记技术,评价经皮冠状动脉球囊扩张术（ＰＴＣＡ）及支架植入术对冠脉血流储备的影响。方法 对２１支（１８例）有狭窄病变的冠状动脉进行ＰＴＣＡ术,其中１６支冠脉ＰＴＣＡ术后植入支架。在ＰＴ－ＣＡ前后和支架植入术后,采用Ｃａｒｄｉｏｍｅｔｒｉｃ ＦｌｏＭａｐⅡ血管腔内多普勒血流速度描记仪和多普勒导丝,测量狭窄近端和远端的平均峰值流速（ＡＰＶ）、舒张期与收缩期流速比（ＤＳ     

维吾尔族冠脉狭窄程度与血脂,ApoA,ApoB的相关关系

目的：了解维吾尔族冠心病（ Ｃ Ｈ Ｄ）冠脉狭窄程度与血脂和载脂蛋白 Ａ、 Ｂ的关系。方法：通过选择性冠状动脉造影,确定病人（冠脉狭窄≥５０％ ）及对照（冠脉狭窄＜ ５０％ ）,比较其血浆脂质和载脂蛋白 Ａｐｏ Ａ、 Ａｐｏ Ｂ的浓度。结果：（１）两组血浆胆固醇（ Ｔ Ｃ）,甘油三脂（ Ｔ Ｇ）、高密度脂蛋白（ Ｈ Ｄ Ｌ）,低密度脂蛋白（ Ｌ Ｄ Ｌ）及载脂蛋白 Ａ、 Ｂ浓度存在差异。（２）冠脉狭窄程度与 Ｔ Ｃ、 Ｌ Ｄ Ｌ及载脂蛋白 Ｂ呈正相关,与高密度脂蛋白呈负相关。结论：维吾尔族冠心病患者冠脉狭窄与 Ｌ Ｄ Ｌ及 Ａｐｏ Ａ、 Ａｐｏ Ｂ有密切关系。     

活血通脉片对实验动物血液流变性和高脂血症影响

目的：观察中药复方制剂活血通脉片对实验性心肌缺血犬的血液流变性和对ＳＤ大鼠实验性高脂血症的影响。方法：结扎冠状动脉,造成犬急性心肌缺血（“血瘀证”）动物模型,经十二批肠灌入受试药物,从犬心大静脉留取血样,动态观察实验性心肌缺血犬的血液流变性指标;连续喂高脂饲料２周,复制ＳＤ大鼠高脂血症模型,灌胃给予受试药物,于第１５ｄ测定实验性ＳＤ大鼠血脂指标。结果：活血通脉片能降低实验性心肌缺血犬的全血高切、低切粘度和血浆粘度,加快械细胞电泳时间,与对照组比较有显著差异（Ｐ〈０．０１）;能降低实验性大鼠血清ＴＣ及ＬＤＬ－Ｃ水平（Ｐ〈０．０１）。结论：活血通脉片能改善急性心肌缺血犬的血液流变性和实验性高脂血症大鼠的血脂。     

肾上腺髓质素对内皮素心肌损伤的保护

本实验在离体灌流大鼠心脏模型上观察了肾上腺髓质素（ＡＭ）和内皮素的相互作用。发现应用内皮素（１０－９ｍｏｌ／Ｌ）灌流可引起冠脉严重痉挛、心脏功能和组织损伤。ＡＭ（１０－８，１０－７ｍｏｌ／Ｌ）与内皮素同时灌流能有效地减轻内皮素所引起的心脏损伤，显著）曾加冠脉流量和ＬＶ±ｄｐ／ｄｔｍａｘ，抑制心室内压急剧升高和心肌脂质过氧化物形成，减少细胞内酶（ＬＤＨ）漏出、心肌ＭＤＡ释放和心肌钙含量的增高。ＡＭ的保护作用是剂量依赖的。提示，作为内源性内皮素拮抗剂，ＡＭ对防治心肌缺血损伤有临床意义。     

大豆磷脂脂质体对缺血再灌注家兔心脏血流动力学的影响

目的 观察大豆磷脂脂质体对家兔心肌缺血再灌注损伤时心脏血流动力学、血清乳酸脱氢酶（ＬＤＨ）和心肌梗死范围的影响。方法 阻断家兔冠脉４５ｍｉｎ后，分别灌注大豆磷脂脂体或生理盐水，３ｈ后测定各项指标。结果 脂质体保护组与非保护组相比，（１）左室内压上升最大速率和左室内压下降最大速率均升高非常明显（Ｐ〈０．０１），左室内压峰值升高；（２）心肌梗死范围明显缩小、ＬＤＨ活性显著下降（Ｐ〈０．０１）。结论 大     

N－单甲基左旋精氨酸对犬冠脉内皮依赖性舒张功能及内皮素－1含量的影响

作者在开胸麻醉犬心脏上，观察冠脉内灌注Ｎ－单甲基左旋精氨酸（Ｌ－ＮＭＭＡ）５ｍｇ／ｋｇ，前后冠脉血流动力学、冠脉血流储备（以阻断冠脉１５ｓ再灌注所致的反应性充血血流峰值表示）以及冠脉对不同浓度乙酰胆硷（Ａｃｈ）反应的变化，同时用放射免疫法（ＲＩＡ）测定冠脉前降支（ＬＡＤ）伴行静脉血中的内皮素－１（ＥＴ－１）含量．结果证明，Ｌ－ＮＭＭＡ灌注后心率下降，基础冠脉血流量（ＣＢＦ）下降（χ±ｓ，从２７±６ｍｌ／ｍｉｎ下降至２０±８ｍｌ／ｍｉｎ，Ｐ＜０．０５），冠脉储备下降（χ±ｓ，从９１±１９ｍｌ／ｍｉｎ下降至５０±１０ｍｌ／ｍｉｎ，Ｐ＜０．０１），平均主动脉压升高，ＥＴ－１含量明显升高（χ±ｓ，从６．５±１．０ｎｇ／Ｌ升至１５．５±３．０ｎｇ／Ｌ，Ｐ＜０．０１），Ａｃｈ引起的ＣＢＦ增加减弱（Ｐ＜０．０１）．实验结果提示，生理条件下犬冠脉一氧化氮（ＮＯ）形成对ＣＢＦ，冠脉储备有重要调节作用，同时可抑制冠脉ＥＴ－１释放．     

左冠状动脉主干狭窄时主动脉内气囊反搏的影响

测量了冠状动脉狭窄前、后主动脉内气囊反搏（ＩＡＢＰ）时各项血流动力学参数的变化，分析和对比了左冠脉主干不同程度的狭窄对ＩＡＢＰ作用所产生的影响。结果表明：左冠状动脉主干中等程度狭窄时ＩＡＢＰ促进冠脉血液灌注的作用明显减弱。严重及非常严重狭窄时ＩＡＢＰ不能增进冠脉血供，仅能减少心脏后负荷。     

前列腺素E_1对老年高血压患者血脂及血液流变学的影响

观察ＰＧＥ１对老年高血压患者的血脂及血液流变学的影响。用ＰＧＥ１治疗６０例（男４８例，女１２例，年龄６９．５±４．８岁）。用ＰＧＥ１１００～２００μｇ加０．９％生理盐水２５０～５００ｍｌ静滴，每天１次，３０天为１疗程。结果：ＰＧＥ１治疗１疗程后，血中总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬ－ｃｈ）均有明显降低（Ｐ＜０．０１），而对高密度脂蛋白（ＨＤＬ－ｃｈ）则无影响（Ｐ＞０．０５）。血液流变学中全血低切粘度、血球压积、红细胞聚集指数差异有高度显著性（Ｐ＜０．０１），而高切粘度、血浆粘度、纤维蛋白原差异有显著性（Ｐ＜０．０５），对血沉无影响（Ｐ＞０．０５）。表明：ＰＧＥ１对老年高血压患者有降低血脂和血粘度作用，为一种降脂和改善血液流变学的理想药物     

心肌对比超声评价多巴酚丁胺对冠状动脉微循环的直接效应:与腺苷对比

目的 评价多巴酚丁胺对正常和狭窄冠状动脉微循环的直接效应.并与腺苷对比.方法 实验应用9条健康杂种犬,制备左前降支静息无血流限制性狭窄.在静息状态和左冠状动脉主干内连续输注多巴酚丁胺(2mg·kg-1·min-1)和腺苷(5 mg·kg-1·min-1)时,进行间断谐波心肌对比成像评估心肌血流容积(A)和心肌血流速度(b),并同步应用放射性标记微球测定心肌血流量(MBF).计算心率血压乘积和心肌血管阻力(MVR).结果 两种药物引起正常和狭窄冠状动脉供血区MBF明显增加和MVR明显降低(P<0.05).在正常冠状动脉供血区,腺苷对A无明显影响.MVR的降低完全是阻力血管的扩张所致(99%),MBF增加主要是由于b的加快(△β/△A=13.6);多巴酚丁胺可引起部分A增加(28%),使总MVR降低中的32%来自这种毛细血管征募,但MBF增加主要还是由于b的加快(△β/△A=5.9).在狭窄冠状动脉供血区,两种药物引起MBF增加的程度相同,MBF增加均完全是由于b的加快;多巴酚丁胺和腺苷引起毛细血管的关闭分别导致14%和15%心肌毛细血管阻力的增加.结论 经冠状动脉内直接给药物时,多巴酚丁胺对冠状动脉微循环的直接效应与腺苷对冠状动脉微循环的直接效应非常相近,MBF增加主要由于心肌血流速度的增快所致.     

Value of Echocardiography for Evaluation of the Flow-dependent Epicardial Coronary Vasodilation In Vivo

Summary To assess the value of echocardiography for detection of the flow-dependent epicardial coronary vasodilation, the changes in internal diameter of the left anterior descending coronary arteries (LAD) induced by reactive hyperemia were studied by echocardiography in 12 health anesthetized open-chest dogs. Reactive hyperemia was induced by brief occlusion of the left anterior descending coronary artery for 30 s followed by rapid release. The two- dimensional images of the left anterior descending coronary artery before and after reactive hyperemia with and without intracoronary infusion of N^G-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide synthase (NOS) were investigated. The internal diameter of LAD was measured and its percent change induced by reactive hyperemia was calculated. Our results showed that the internal diameter of LAD was 2.23±0.19 mm before intracoronary infusion of L-NAME (baseline). The internal diameter of LAD significantly increased to 2.52±0.24 mm (P<0.01) after reactive hyperemia at baseline, and the percent change in internal diameter of LAD was (13.10±3.59)%. The internal diameter of LAD before and after reactive hyperemia under the condition of intracoronary infusion of L-NAME was not different from that before reactive hyperemia at baseline. The percent change in internal diameter of LAD was (1.07±2.97)%, and it was significantly lower than that at baseline (P<0.001). We are led to conclude that the change in internal diameter of LAD responding to reactive hyperemia was detected sensitively by echocardiography, and this change was associated with endothelium-derived nitric oxide. Li Tianliang, male, born in 1967, Associate Professor This project was supported by a grant from the National Natural Sciences Foundation of China (No. 30270560).     

Effect of intracoronary administration of anisodamine on slow reflow phenomenon following primary percutaneous coronary intervention in patients with acute myocardial infarction

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 &micro;g) 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 &micro;g of anisodamine was injected into IRA with SRP at 200 &micro;g/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&lt;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&lt;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&lt;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&lt;0.05), respectively, along with the rise of heart rate from 68 to 84 beats per minute (P&lt;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 &micro;g anisodamine is effictive in reversing SRP following PCI in STEAMI patients, especially it is suitable for SRP patients with bradycardia or hypotension.     

RELATIONS OF ENDOTHELIAL FUNCTION AND BLOOD FLOW IN BRACHIAL ARTERY AND CORONARY ARTERY

Objective To determine the relations between endothelium-dependent vasodilator functionand blood flow in the brachial and coronary arteries in patients with suspected coronary artery disease. Methods Twenty-eight patients with suspected coronary artery disease underwent brachial artery endothelial function test by using high-resolution B-mode ultrasound before coronary angiography (CAG) and coronary flow reserve (CFR) test by using intracoronary Doppler technique. The correlation of coronary artery dilatation induced by an increase in blood flow after intracoronary adenosine infusion and brachial artery flow-mediated dilatation (FMD) following reactive hyperemia was evaluated. The relation between the change of brachial artery blood flow and CFR was also studied. Results There was a positive correlation between brachial FMD and percent change of coronary diameter after adenosine infusion (12.50% ± 9 .35% vs 11 .38% ± 7.55% , r = 0 .425 ,P= 0.02). There was also a weak negative relation between brachia     

Restrictive effect of puerarin on myocardial infarct area in dogs and its possible mechanism

It has been known that puerarin can protectthe ischemic myocardia. Puerarin might achievesuch protection by decreasing heart rate and dilatelug vessels in the acute phase. A lot of studieshave been conducted on these mechanisms, but thelong--term mechanism was yet to be elucidated andthe effect of puerarin on coronary collateral circula.non was not reportedL" 2]. The purpose of thisstudy was to investigate the protection of puerarinon ischemic myocardia and the effect of puerarin oncoronary co…     

Non-invasive Assessment of Coronary Flow Velocity Reserve: A New Method Using Transthoracic Doppler Echocardiography

Coronary flow reserve (CFR) has been used toassess coronary microcirculation and epicardial coro-nary stenoses[1— 3 ] . CFR is defined as the ratio ofcoronary flow under maximal coronary vasodilatationto coronary flow under resting conditions[4 ] .Whenthe cross- sectional area of epicardial coronary arteriesis constant,coronary flow velocity (CFV) ratios areequal to volume flow ratios.The most common method used clinically formeasuring CFVR is intracoronary Doppler flow(ICD) analysis re…     

凯时治疗小儿外伤性脑梗塞的临床观察

目的探讨凯时注射液(前列腺素E1脂微球制剂)治疗小儿外伤性脑梗塞的临床疗效.方法应用凯时注射液治疗23例小儿外伤性脑梗塞,以神经功能缺损程度评分、血液流变学中血小板粘附率、红细胞压积、全血粘度、血浆比粘度为观察指标,评价疗效.结果血液流变学各项指标(全血粘度、红细胞压积、血小板粘附率及血浆比粘度均无明显改变(P＞005),神经功能缺损程度评分明显降低(P＜0.01),总显效率达87%.结论小儿外伤性脑梗塞的发生与血液粘稠无明显相关性,应用凯时治疗小儿外伤性脑梗塞具有良好的疗效.     

Cardio-protective Effects of Corocalm (疏冠胶囊)on Acute Myocardial Ischemia/Reperfusion Injury in Rats

Objective: To investigate the cardio-protective effects of Corocalm (疏冠胶囊) on acute myocardial ischemia in rats, and to explore its possible therapeutic mechanisms. Methods: The acute ischemic model was prepared by ligating the left anterior descending (LAD) coronary artery in rats. The animals were divided into 6 groups, 8 in each group. The sham operated group underwent heart exposure without ligation and were treated with normal saline 3 ml/kg, while the other 5 groups, the model groups, consisted of acceptable acute ischemic model rats and were also treated with normal saline, with the Guanxin Capsule ted with 85 mg/kg and 340 mg/kg of Corocalm respectively, and the Diltiazem group, treated with Diltiazem 5 mg/kg, with all the tested drugs prepared with normal saline into equal volume ( 3 mi/kg) and administrated once via duodenum 10 min before ligation. Myocardial infarction area was determined by the quantitative histological assay with nitroblue tetrazolium (N-BT) stain. And the levels of creatine phosphokinase (CK),lactate dehydrogenase (LDH), malondialdehyde (MDA) content, and the activity of superoxide dismutase (SOD) in serum were measured by biochemical assay and spectrophotometry respectively. Besides, the blood viscosity in another 50 rats was determined, who received for 7 successive days oral administration with different concentration of Corocalm or aspirin. Results: It showed that low and high dose Corocalm could significantly reduce the infarction area, inhibit the increase of serum CK, LDH activity and MDA content, and enhance the SOD activity after ischemia/reperfusion. The whole blood viscosity at different shear rates in rats treated with high dose Corocalm was significantly lower than those treated with normal saline (P＜0.05). Conclusion: Corocalm has favourable protective effects on heart in ischemic condition, the effect of which might be through its actions in inhibiting CK and LDH activity, scavenging oxygen free radicals, and lowering blood viscosity.     

糖尿病合并高脂血症患者血液流变性的改变

目的:探讨糖尿病合并高脂血症患者血液流变性的改变。方法:测定48例糖尿病合并高脂血症患者和52例正常对照组血液流变学指标,并对其结果进行统计学分析。结果:病例组无论男女,其低切全血粘度及还原粘度、红细胞聚集指数、红细胞变形指数、红细胞刚性指数较对照组有显著性差异(P<0.01及P<0.05);而中切全血粘度及还原粘度、血浆粘度、纤维蛋白原较对照组无显著性差异(P>0.05)。结论:糖尿病合并高脂血症可引起多项血液流变学指标异常改变,从而导致微血管循环障碍。因此,检测血液流变学对早期诊断和防治心脑血管疾病有重要的意义。