The endothelium inhibits the penetration of serotonin and norepinephrine in the isolated canine saphenous vein

Serotonin can accumulate in the adrenergic nerves of vascular tissues. We have determined whether in the isolated perfused dog saphenous vein 1) luminal administration of serotonin can result in its accumulation in the adrenergic nerves and 2) endothelium can interfere with the transport of the amine into the vessel wall. Saphenous veins were perfused with medium containing [3H]serotonin, [3H]norepinephrine or [3H]epinephrine; after washout, significant amounts of 3H were detected in the veins. The 3H-accumulation was augmented when the endothelium was removed mechanically; the augmented accumulation was only observed when the [3H]amines reached the tissues from the intimal side. In coronary arteries perfused with [3H]serotonin, similar results were obtained. No increased 3H-accumulation was noted in veins without endothelium perfused in the presence of cocaine. Nerve stimulation of veins labeled with [3H]serotonin caused an augmented release of 3H from the tissues without endothelium. Pargyline augmented the accumulation of [3H]serotonin and [3H]norepinephrine and decreased the difference between tissues with or without endothelium only for norepinephrine. Perfusion of venous segments with platelets, labeled with [3H]serotonin, resulted in a 3H-content which was significantly higher in the veins without endothelium. Our experiments show that serotonin and other amines, applied luminally to perfused blood vessels, can accumulate in the adrenergic nerves and that the endothelium can reduce this accumulation. Serotonin, originating from aggregating platelets, can penetrate the vessel wall much easier at sites of endothelial denudation and this serotonin also can enter the adrenergic nerves.     

The role of the endothelium in the control of venous tone: studies on isolated human veins

Summary. The role of the endothelium in the vasomotor control of veins was investigated in 14 isolated ring preparations of presumably normal saphenous veins obtained from vein grafts in connection with vascular surgery. The investigations were performed with the specimens mounted for recording isometric tension in organ baths. Paired rings were used, one normal and the other de-endothelialized by gentle rubbing. The responses to noradrenaline (10^-8-2 × 10^-5M), acetylcholine (10^-6M) and 120 mM KCI solution were tested. After precontraction with 10^-7M noradrenaline, acetylcholine at 10^-6M did not induce cholinergic relaxation, but in the majority of experiments induced a further increase in tone. Maximal contraction with noradrenaline was significantly higher in normal compared to de-endothelialized vessels. Therefore, endothelium-derived relaxation as in arteries did not occur in human saphenous veins and the existence of an endothelial-derived contracting factor in response to acetylcholine and noradrenaline is a possibility.     

Influence of diazepam, alpidem, zolpidem and zopiclone, on the response to adenosine of the guinea pig isolated trachea

It has been reported that dipyridamole and some benzodiazepines potentiate the responses to adenosine in peripheral organs and in particular in the guinea pig isolated atria or trachea by inhibition of adenosine uptake and/or metabolism. In this study, we have examined the sensitization of guinea pig isolated trachea to relaxant responses to adenosine produced by dipyridamole, diazepam and 3 compounds chemically unrelated to benzodiazepines but which display selective agonistic activity towards the central (zolpidem and zopiclone) or peripheral (alpidem) type benzodiazpine receptors. In preparations under spontaneous tone and in the absence of adenosine, dipyridamole (10(-5) M) and diazepam (10(-5)-10(-4) M), alpidem (3 x 10(-6) M-10(-5) M) and zopiclone (10(-6)-10(-4) M) induced a relaxation of the airway smooth muscle. In addition, dazepam (10(-4) M) attenuated the phasic response to histamine (10(-5) M). Dipyridamole (10(-5) M) and diazepam (10(-4) M) respectively produced a 56.2 and 32.4-fold potentiation of adenosine relaxant effects. Alpidem (10(-6)-10(-5) M), zolpidem (10(-6)-10(-4) M) and zopiclone (10(-6)-10(-4) M) were without any significant effect on the adenosine concentration-response curves. Moreover, alpidem, zolpidem, and zopiclone did not modify the 2-chloroadenosine dose-response curves nor the diazepam induced sensitization of adenosine-induced relaxation. In conclusion, adenosine sensitization of the guinea pig isolated trachea caused by diazepam might involve a peripheral benzodiazpine receptor subtype coupled to a nucleoside transporter system which is different from those recognized by compounds derived from the imidazopyridine series.     

Involvement of the L-arginine-nitric oxide pathway in hyperglycaemia-induced coronary artery dysfunction of isolated guinea pig hearts

Abstract. The effects of hyperglycaemia and L-arginine on flow-induced reduction of coronary artery resistance were investigated in isolated guinea pig hearts. In the presence of indomethacin, hyperglycaemia caused an increase in flow-induced vasodilatation ( P <0.05). Hyperosmotic controls failed to mimic this effect. Addition of L-arginine strongly enhanced this effect. Addition of D-arginine failed to mimic the effects of L-arginine. The effect of L-arginine was abolished by co-administration of N ^G-nitro-L-arginine. In the absence of indomethacin and L-arginine, the effect of hyperglycaemia was blunted, suggesting the formation of vasoconstrictive prostanoids. Addition of L-arginine again resulted in a significant increase in flow-induced vasodilatation. In conclusion our results suggest that increased flow-induced vasodilatation under hyperglycaemic conditions depends on an adequate supply of L-arginine to maintain sufficient formation of nitric oxide.     

低温下尼可地尔对冠状动脉内皮细胞功能的影响

背景目前尼可地尔可(nicorandil)对改善供心的低温保存的良好效果已经证实.有关低温下其对冠状动脉内皮细胞影响也日趋受到关注.设计随机对照试验.目的探讨冷低温缺血期高钾溶液中尼可地尔对猪冠状动脉内皮细胞的影响及机制,为改善心脏移植期间供心的保存效果提供实验依据.地点、材料和干预本实验在北京阜外医院体外循环研究室完成,实验所用猪心来源于2000-06/09从北京大红门肉联厂随机选取的17只刚宰杀的生猪.将新鲜猪心外膜下冠状动脉前降支切成3段,长3 mm,共42条血管环,随机分为6组,每组7条.在4℃条件下分别用重碳酸盐缓冲液(KH液,对照组)、高钾(20,50 mmol/L,A,B组)溶液、添加尼可地尔(0.1 mmol/L)的KH液、高钾(20,50 mmol/L)溶液(C,D,E组)保存4 h.主要观察指标前列腺素F2α引起冠状动脉最大预收缩强度;非受体介导钙离子载体引起内皮源性舒张(占预收缩高度的百分比).结果各组血管的收缩反应差异无显著性意义(P＞0.05);A,B,E组[(25.21±6.78)%,(35.97±6.81)%,(35.97±6.81)%]血管的舒张反应明显低于对照组[(62.03±9.65)%](F=28.621,P＜0.01),C,D组[(58.78±10.12)%,(57.56±10.38)%]组差异无显著性意义(P＞0.05).结论低温下尼可地尔对冠状动脉内皮源性超极化因子介导的血管舒张功能有保护作用.此结论可为心脏移植、心脏康复提供实验室依据.     

Psychologic response to coronary artery bypass.

This study reports the psychologic findings in 30 patients undergoing this operation. Approximately one third developed postcardiotomy delirium, an occurrence consistent with that after other forms of open-heart surgery. Acceptance of the operation as opposed to preoperative anxiety, depression or denial, adequate comprehension of the proposed procedure, and a stable postoperative environment seem associated with less postcardiotomy delirium. Preventive preoperative therapeutic suggestions based on these findings are given.     

Comparison of serotonergic receptor subtypes on the smooth muscle and endothelium of the canine coronary artery

To characterize the responses of the canine coronary artery to serotonin, rings with and without endothelium were suspended in organ chambers for isometric tension recording. Serotonin evoked an endothelium-dependent relaxation of prostaglandin F2 alpha-contracted rings which was inhibited by antagonists with affinity for 5-hydroxytryptamine (5-HT)1 and 5-HT2 receptors, methiothepin and metergoline, but was not mimicked or antagonized by the 5-HT1A-selective ligand, 8-hydroxy-2-di-n-propylamino tetralin. This relaxation is not mediated by 5-HT1B receptors as it was not antagonized by cyanopindolol; similarly, lack of inhibition by ketanserin and MDL 72222 rule out contributions of 5-HT2 receptors or 5-HT3 receptors. Rings without endothelium contracted to serotonin; this contraction was not blocked by cyanopindolol and was only weakly inhibited by ketanserin, but was antagonized in an apparently competitive fashion by methiothepin and was mimicked by 8-hydroxy-2-di-n-propylamino tetralin (although at higher concentrations than would be expected for its action at a 5-HT1A receptor). At high concentrations, serotonin evoked a relaxation of endothelium-denuded rings, which was blocked by very low concentrations of methiothepin but was unaffected by ketanserin or cyanopindolol. Thus, there appear to be three different serotonergic receptors in the coronary artery. Although available agents do not allow their precise classification as yet, none of them is of the 5-HT2 type.     

Role of the vascular endothelium in the contractile response to prostacyclin in the isolated rat aorta

Prostacyclin (PGI2) relaxes vascular smooth muscle in several species but, in high doses, PGI2 has been reported to contract several isolated arteries. Vascular endothelium is known to be obligatory for the vasodilatory responses to acetylcholine and several other substances. We therefore investigated the contractile effect of various prostanoids on rat abdominal aorta in which the endothelium was left intact or was removed. PGI2 (4-2000 ng/ml), 6-keto-prostaglandin (PG) E1, PGE1 and PGE2 (4-800 ng/ml) contracted both intact and de-endothelialized aortic segments in a dose-dependent manner. PGI2 (8-2000 ng/ml) increased the force generated by aortic rings with intact endothelium from 77.3 +/- 24.6 to 685 +/- 99.2 mg. The response to similar doses of PGI2 in aortic rings with the endothelium removed was reduced significantly (22.7 +/- 14.1 to 260 +/- 116.4 mg). This contractile response to PGI2 in both intact and de-endothelialized aortic rings was abolished by indomethacin pretreatment (20 micrograms/ml for 30 min) and was also blocked completely by the thromboxane receptor antagonist SQ 29548 (100 ng/ml). In contrast, the thromboxane synthase inhibitor OKY 1581 (2.5 micrograms/ml) did not significantly reduce the contractile response to PGI2. Unlike PGI2, the force generated by PGE2 (4-800 ng/ml) in aortic rings with intact endothelium (0-550.0 +/- 107.2 mg) was not significantly different from that generated by aortic rings without endothelium (35.0 +/- 23.6 to 650.0 +/- 193.2 mg).(ABSTRACT TRUNCATED AT 250 WORDS)     

Influence of the vascular endothelium on angiotensin II-induced contractions in rabbit renal artery

Summary— The influence of vascular endothelium on angiotensin II-induced contraction and the underlying mechanisms in the rabbit renal artery were investigated. In endothelium-intact preparations, angiotensin II (3–100 nM) caused a concentration-dependent increase in tension by maximally (E_max) 0.74 ± 0.05 g. Removal of the endothelium significantly enhanced the angiotensin II-induced contractions (E_max: 3.91 ± 0.19 g). Indomethacin (10 μM) did not influence the angiotensin II-induced contractions. Methylene blue (10 μM) and N^G-methyl-1-arginine (L-NMMA, 5 μM) significantly enhanced angiotensin II-induced contractions by 418 ± 29% and 200 ± 14%, respectively, in endothelium intact preparations, but not in those devoid of endothelium. L-arginine (1 mM), but not D-arginine, reversed the L-NMMA-induced enhancement of the angiotensin II-induced contraction. The present results suggest that angiotensin II-induced contractions in rabbit renal artery are largely subject to the influence of the endothelium. The endothelium-derived relaxant factor (EDRF), rather than cyclo-oxygenase products, appears to be involved in mediating the inhibitory effects of the endothelium. Nitric oxide (NO) derived from endothelium may play a major role in inhibiting angiotensin II-induced contractions in this preparation.     

单纯性冠状动脉扩张的临床分析

目的研究单纯性冠状动脉扩张的发生率、影像学及临床特点、预后。方法回顾性总结分析自1998—02～2004—06期间在哈尔滨医科大学第一临床医学院行选择性冠状动脉造影术的2863例冠状动脉造影人群。结果2863例行选择性冠状动脉造影术的人群中，共检出单纯性冠状动脉扩张20例，发生率0．698％；好发部位依次为左主干、右冠状动脉、前降支、回旋支；大多数单纯性冠状动脉扩张的病人是男性（85％）、吸烟者（90％）；随访期间1例死亡，2例发生心肌梗死，12例仍有阵发性心绞痛发作；糖尿病是与单纯性冠状动脉扩张呈负相关的独立因素。结论单纯性冠状动脉扩张在冠状动脉造影中少见，与除糖尿病外所有冠心病的危险因素相关。单纯性冠状动脉扩张不是良性病变，必须小心监控。     

Influence of age on control of norepinephrine release from the rat tail artery.

Stimulation-evoked norepinephrine release from the rat tail artery increases with age; therefore, the sensitivity of prejunctional alpha-2 adrenergic receptors to antagonists and agonists was compared in perfused tail arteries from Fischer-344 rats, aged 6 and 20 months. The increase in endogenous fractional norepinephrine release produced by blockade of alpha-2 adrenergic receptors with submaximal concentrations of either yohimbine or idazoxan was significantly greater in 6-month-old animals as compared to 20 months; however, the effect of a maximal concentration of idazoxan was not significantly different. Inhibition of norepinephrine release by the alpha-2 receptor agonist UK14304 was reduced in 20-month-old animals compared to 6 months. In contrast, there were no age-related differences in inhibition of contractile responses to nerve stimulation by the prejunctionally acting dopamine D2 agonist, N-0923. These data suggest that age-related changes in the sensitivity of prejunctional alpha-2 receptors to agonists and antagonists may not reflect any fundamental alteration in the function of this receptor system, but may be related to competition between alpha-2 agonists or antagonists and increased biophase concentrations of norepinephrine. This conclusion is supported by lack of an age-related change in function of prejunctional dopamine D2 receptors. Persistence of age-related increases in norepinephrine release when alpha-2 adrenergic receptors are fully blocked may reflect an alteration in other fundamental mechanisms that control norepinephrine release.     

Contribution of Ca++ and calmodulin to the action of norepinephrine on renal prostaglandin synthesis and vascular tone

We have investigated the contribution of Ca++ and calmodulin to the action of norepinephrine (NE) on prostaglandin (PG) synthesis and vascular tone in the Tyrode's perfused rat kidney. Lowering the Ca++ concentration (0.6 mM) reduced and raising the Ca++ concentration (5.4 mM) enhanced the renal vasoconstriction and PG output elicited by NE. Calcium channel blockers diltiazem or nimodipine inhibited the vasoconstriction and PG output caused by NE. Ca++-free Tyrode's solution containing ethylene glycol bis(beta-aminoethyl ether)-N,N'-tetraacetic acid abolished NE-induced vasoconstriction and reduced PG output by 25 to 38%. Addition of intracellular Ca++ antagonists 8-(diethylamino) octyl 3,4,5 trimethoxybenzoate, dantrolene or ryanodine to Ca++-free Tyrode's solution inhibited NE-induced PG output. Calmodulin inhibitors trifluoperazine, N-(6-aminohexyl)-5-chloro-1-naphthalene sulfonamide or calmidazolium diminished PG output and the renal vasoconstriction elicited by NE in the presence and absence of Ca++. Mepacrine and indomethacin inhibited NE-induced renal vasoconstriction and PG output. Arachidonic acid-induced PG output was abolished by indomethacin but was unaltered by mepacrine, Ca++ antagonists or calmodulin inhibitors. We conclude that NE produces renal vasoconstriction by a mechanism that depends primarily on extracellular Ca++ and calmodulin, whereas NE-induced PG output depends on both extra- and intracellular Ca++ and calmodulin.     

冠状动脉钙化对320排容积CT冠状动脉血管成像的影响

目的 探讨320排容积CT（DVCT）冠状动脉钙化（CAC）对冠状动脉图像质量及诊断准确性的影响.方法 回顾性分析济南军区总医院2011年12月至2012年3月行DVCT扫描及常规冠状动脉造影检查（ICA）的患者60例,计算每例患者总的钙化积分（CS）及四大分支的CS,以图像质量4级（优）至1级（差）对每支血管图像质量进行评价,分析患者每支血管的CS与图像质量的相关性.对患者及每支冠状动脉血管的明显狭窄（狭窄≥50%）进行判断,以ICA为金标准,作出该60例患者冠状动脉狭窄≥50%的ROC曲线,获得患者总CS的最佳截断点.以最佳截断点为界,将60例患者分为高CS组和低CS组,以每支冠状动脉为研究对象,不可评价的血管作为假阳性处理,对高、低CS组的诊断准确性进行比较,同时比较两组DVCT冠状动脉成像结果 与ICA结果 的差异性,分析CS对冠心病诊断准确性的影响.结果 冠状动脉钙化积分（CACS）与图像质量呈负相关,CS越高,图像质量越差.该60例患者的冠状动脉狭窄≥50%的ROC曲线的CS最佳截断点为381.5分（灵敏度为81.5%,特异度为78.8%）.高CS组的诊断准确性低于低CS组（P=0.009）,而两组DVCT结果 与ICA结果 的差异均无统计学意义（P=0.134,0.607）.结论 CAC仍是320排容积CT图像质量及诊断准确性下降的重要原因.     

糖尿病对不停跳冠状动脉旁路移植术的影响

目的 探讨糖尿病对不停跳冠状动脉旁路移植术(CABG)患者的围术期影响.方法 回顾性分析2006 年9月至2010年7月692例行不停跳CABG患者的临床资料.根据术前是否合并糖尿病分为糖尿病组(276例)及非糖尿病组(416例).围术期严密监测患者的血糖,并给予胰岛素严格控制血糖.采用单因素分析糖尿病与CABG术后疗效、围术期并发症发生率及院内病死率的关系.结果 糖尿病组与非糖尿病组患者切口并发症分别为5.8%(16/276)与4.3%(18/416),输血量分别为(890.7±520.6)ml与(825.2±518.4)ml,差异无统计学意义(P均>0.05).2组患者术后心律失常(13.0%与13.5%)、围术期肾功能不全(5.1%与2.4%)以及病死率(2.9%与1.9%)差异均无统计学意义(P均>0.05),糖尿病组患者的主动脉内球囊反搏使用时间[(3.7±1.6)d与(3.5±1.6)d]、呼吸机使用时间[(2.6±1.9)d与(2.4±1.5)d]差异均无统计学意义(P均>0.05).糖尿病组与非糖尿病组患者住院时间分别为(22.0±8.8)d与(20.6±7.6)d,住院费用分别为(8.11±2.40)万元与(7.63±2.20)万元,2组差异有统计学意义(t值分别为2.22、2.71,P均<0.05).结论 糖尿病组与非糖尿病组患者行CABG的围术期并发症及病死率无明显影响,但对患者的住院费用以及住院时间影响较大.

Abstract：

Objective To investigate the impact of diabetes on coronary artery bypass grafting (CABG)in peroperative patients. Methods Clinical data of 692 CABG patients were collected retrospectively from Sep. 2006 to Jul. 2010. The CABG patients were divided into diabetic group (n = 276) and nondiabetic group (n = 416) according to with the status of diabetes or not before operation. Blood glucose was dynamicaly monitored and treated with insulin to control blood glucose in perioperativeperiod. The postoperative effect,perioperative complication and inhospital case fatality and their relationship with diabetes were analyzed using univariate analysis. Results No significant differences were found regarding the incision complications (5. 8%vs. 4. 3 % , P > 0. 05). The volume of blood transfusion was (890. 7 ± 520. 6) ml in the diabetes group, which was not significantly different from that of (825. 2 ±518. 4)mlin the non-diabetes group (P>0. 05). No significant difference was found on cardiac arrhythmia (13.0% vs. 13. 5%),renal function insufficient (5. 1% vs. 2.4%)and case fatality (2. 9% and 1. 9%) between the diabetes and non-diabetes group (Ps >0. 05). In the diabetes group and non-diabetes group, the duration of IABP (3.7 ± 1. 6) d vs (3.5 ± 1.6)d, use of ventilator (2. 6 ± 1.9)d vs. (2. 4±1.5)d were not sigfnificantly different (Ps >0.05). The length of hospital stay and cost were (22. 0 ±8. 8)d and (8. 11 ±2. 40) thousand RMB in the diabetes group, which were significantly higher than that of (20. 6 ±7. 6)d and (7. 63 ±2. 20) thousand RMB in the non-diabeties group (t =2. 22 and 2. 71 ,Ps <0.05) . Conclusion There are no significant differences in the operative case fatality and complications between patients with diabetes and without nondiabetes. However,diabetes increases hospital stay and expense.     

Influence of epithelium on the reactivity of guinea pig isolated, perfused trachea to bronchoactive drugs.

The mechanisms by which the epithelium affects reactivity of guinea pig trachealis to agonists were examined using the isolated, perfused trachea preparation. Contractile agonists (acetylcholine, methacholine, carbachol or histamine) were more potent when applied to the serosal (extraluminal, EL) surface compared to the mucosal (intraluminal, IL) surface, and the IL maximum responses to these agents were smaller. In epithelium-denuded tracheae, IL reactivity to the agonists was increased to the EL level. Physostigmine (10(-7) M) increased the EL and IL potency of acetylcholine to that of carbachol (+/- epithelium), and elevated the IL acetylcholine maximum response (+ epithelium); the relative role of epithelial acetylcholinesterase could not be defined. Indomethacin (3 x 10(-6) M) increased, in an epithelium-dependent manner, the IL acetylcholine, carbachol and histamine maximum responses to the EL level. Phentolamine plus propranolol (both 10(-6) M) potentiated the IL maximum response to methacholine, Isoproterenol also was more potent extraluminally than intraluminally, and the EL and IL maximum responses were similar. IL isoproterenol reactivity was elevated to the EL level in rubbed tracheae. Corticosterone (5 x 10(-5) M) potentiated EL and IL responses to isoproterenol (+/- epithelium); the relative role of epithelial extraneuronal uptake could not be delineated. The epithelium reduces reactivity to mucosally applied drugs by acting as a diffusion barrier. In addition, responses to mucosally administered contractile agonists are inhibited by a physiological antagonism caused by modulatory prostanoids, catecholamines and, possibly, epithelium-derived relaxing factor.     

运动试验血流动力学反应异常辅助诊断冠心病

目的探讨心电图平板运动试验后,收缩压恢复延迟与冠脉病变程度的相关性及二者之间的半量化关系。方法经症状限制性运动试验检查,并于30d内行冠脉造影患者。运动后收缩压恢复延迟定义为：运动后3min收缩压除以运动后1min收缩压比值大于1．0（即：收缩压恢复比值rSBPR 3min／1min≥1．0）。冠脉病变程度的量化指标：应用杜克预后评分方法（分值范围0～100分）,将积分≥42分确定为重度冠脉病变。结果入选164例[年龄（57±8）岁,男性82％],重度冠脉病变患者73例（44％）。研究显示：收缩压恢复比值与冠脉病变严重程度杜克预后评分明显相关（r=0．84。P〈0．001）,其升高值与冠脉狭窄程度呈正相关。线性回归分析在运动试验各组参数中,收缩压恢复比值（rSB—PR）对预测冠状动脉病变程度的作用最大（β=0．24,P=0.002,R^2=0．06）。冠脉造影阳性组的收缩压恢复比值较冠脉造影阴性组明显增高（P组内〈0．05）,但与是否合并高血压病无关（P组间〉0．05）。结论应用收缩压恢复比值异常升高（rSBPR 3min／1min≥1．0）,可以预测冠脉病变及其病变严重程度,运动后收缩压恢复延迟与重度冠脉病变明显相关。运动试验血流动力学反应异常可辅助诊断冠心病。     

冠状动脉旁路移植术对QT间期离散度的影响

目的　探讨冠状动脉旁路移植术 (CABG)对QT间期离散度 (QTd)的影响及其临床意义。方法　 6 2例非体外循环下行CABG的冠心病患者 ,分为不稳定型心绞痛 (A组 )、稳定劳力型心绞痛 (B组 )、合并陈旧性心肌梗死 (C组 ) ,15例冠脉造影正常者作为对照组 (D组 )。分别于术前和术后当天、2、4周及对照组相应时间记录 12导联同步心电图 ,对其QT间期测量 ,计算出QTd ,并进行统计学分析。结果　术前A、B、C 3组的QTd显著大于D组 (P <0 0 1～ 0 0 0 1) ,且A、C组大于B组(P <0 0 5 )。术后 2、4周各组QTd与术前相比均有缩短 (P <0 0 5～ 0 0 1)。A、B两组术后 4周QTd缩短值大于C组 (P <0 0 5 )。术后 4周LVEF恢复至 5 0 %以上者QTd缩短值显著大于LVEF仍低于 5 0 %者 (P <0 0 5 )。C组QTd≤ 70ms者术后QTd缩短值显著大于术前QTd >70ms者 (P <0 0 5 )。结论　QTd作为一种简单、可靠、廉价、无创的方法 ,可用于判断病情严重程度、不同类型冠心病手术疗效、评价和预测血运重建术的效果。