家兔实验性心肌梗塞时心肌细胞凋亡研究

目的：探讨急性心肌梗塞时心肌细胞凋亡情况。方法：采用ＤＮＡ缺口末端标记法（ＮＥＬＭ）、透射电镜和琼脂糖凝胶电泳对家兔实验性心肌梗塞时不同损伤区心肌细胞凋亡情况进行研究。结果：在梗塞交界区心肌组织中可见散在大量ＭＥＬＭ染色阳性细胞；电镜检查细胞呈凋亡特征。在坏死区和正常心肌组织中均未发现ＮＥＬＭ染色阳性细胞。梗塞交界区ＤＮＡ电泳呈梯状，符合细胞凋亡图谱。坏死区心肌ＤＮＡ电泳图谱呈均匀弥散状态，正常心     

老年急性心肌梗死病人便秘的预防及护理

总结分析了老年急性心肌梗死病人便秘的原因及危害,并对其预防和护理措施进行综述,包括心理护理,饮食护理,腹部按摩,药物防治及其他处理。     

综合医疗对心肌梗塞二级预防的影响

目的：探讨综合医疗对心肌梗塞患者长期预后的影响。方法：７３例患者分为二组：综合医疗组５６例（即Ａ组）,对照组１７例（即Ｂ组）。综合医疗方法包括心理指导、卫生宣教、饮食调理、运动训练及常规药物治疗。对照组仅采用常规药物治疗,经平均５年以上跟踪观察。结果：Ａ组的临床状况、身体活动能力、心脏功能和冠心病危害因素控制等方面都明显优于对照组。Ａ组的病死率和心脏事件发生率（０、７．１％）均明显低于Ｂ组（１１．８％、１７．６％）。结论：综合医疗对心肌梗塞患者二级预防有着良好的作用     

Myocardial Infarction

In the past, physicians considered certain QRS changes, particularly when they occurred serially, as nearly diagnostic of myocardial infarction. Yet myocardiopathies with normal coronary arteries can produce similar changes. Still, in the presence of typical symptoms, electrocardiographic and vectorcardiographic studies of evolving QRS and acute ST-T changes offer a solid basis for diagnosing infarction.     

血管内皮生长因子对心肌细胞移植治疗心肌梗死有改善血供作用

目的：探讨腺病毒介导血管内皮生长因子165基因（AdVEGF165）转染的乳鼠心肌细胞移植对慢性心梗（MI）大鼠一心功能的影响。方法：体外培养新生大鼠心室肌细胞、标记BrdU、转染AdVEGF165基因；收集培养液上清，ELISA法检测转染细胞VEGF的表达。结扎同种大鼠前降支建立心梗模型，4周后将心梗大鼠随机分为3组。分别注射移植转染心肌细胞（组Ⅰ）、单纯心肌细胞（组Ⅱ）、和DMEM培养基（组Ⅲ）。超声心动图检测移植前厦移植4周后的心功能。处死大鼠，留取心脏标本作HE病理染色厦免疫组化检测，并计数血管密度。结果：AdVEGF165基因转染的心肌细胞表达VEGF升高，较对照组有显著差异（P〈0．01）；超声检测心功提示转染细胞组（组Ⅰ）心功能较其他2组显著改善（P〈0．01）；免疫组化检测显示，移植细胞在移植区存活；HE染色血管计数显示转染组（组Ⅰ）有更多的新生血管形成（P〈0．01）。结论：AdVEGF165基因转染心肌细胞后表达分泌VEGF增加，可促进梗死区新生血管形成，改善心肌血供，有利于移植细胞的存活，能更好的改善心功能。     

Myocardial Infarction in Diabetics

The hospital mortality of acute myocardial infarction amongst285 known diabetics treated in the last decade was 39.7 percent at one month and had increased to 51 per cent at 12 months.Treatment in a coronary care unit during the acute stage hadlittle effect on the mortality amongst patients on insulin,but was beneficial for patients whose diabetes had been controlledby oral hypoglycaemic drugs. Female patients on oral hypoglycaemicdrugs had the highest mortality. When considering age, durationof diabetes and presence of retinopathy, acute myocardial infarctionin diabetics controlled on oral therapy appeared to have a worseoutcome than in patients on insulin. Independently of whetherpatients were on insulin or on oral hypoglycaemic drugs 12 monthsafter the acute episode, only about half of them were stillalive.     

心肌细胞坏死和凋亡与心肌梗死后心室重构

以往认为心肌细胞坏死是急性心肌梗死后心肌死亡的惟一形式,但近年的研究提示心肌细胞坏死或心肌细胞凋亡是急性心肌梗死后心肌死亡的两种形式,在心室重构中起重要作用。     

Complications of Myocardial Infarction

This department offers the latest, proved methods for the treatment and management of commonly encountered conditions based on the extensive experience of the physicians who prepare these summaries for POSTGRADUATE MEDICINE.     

声学密度定量技术在急性心肌梗塞早期预测再灌注心肌的存活

目的：本试验是利用声学密度定量技术（ＡＤ－ＩＢＳ）预测再灌注心肌存活。方法：在发病当天,发病后第３天,第２１天分别对２０例急性心肌梗塞患者进行ＡＤ－ＩＢＳ检查。结果：标化ＣＶＩＢ在发病后第３天有所恢复（不依赖于室壁运动的恢复）的梗塞区心肌,其在发病后第２１天的室壁增厚率可达到与正常心肌区无明显差异。结论：帮可认为心肌梗塞后标化ＣＶＩＢ可早期预测再灌注心肌的存活。     

Determinants of Myocardial Strain in Experimental Chronic Myocardial Infarction

We evaluated the relationships between regional myocardial strain measured by speckle tracking echocardiography and viability, fibrosis, hypertrophy and oxygen consumption in the infarcted or remote myocardium in a pig model of chronic myocardial infarction (MI). Thirteen farm pigs with surgical occlusion of the left anterior descending coronary artery and five sham-operated pigs were studied 3 mo post-MI. Computed tomography revealed significant left ventricle remodeling. Reduced radial or circumferential strain identified areas of transmural infarction (area under the curve: 0.82 and 0.79, respectively). In the remote non-infarcted area, radial strain correlated inversely with the amount of fibrosis (r?=?–0.66, p?=?0.04) and myocyte hypertrophy (r?=?–0.68, p?=?0.03). Radial strain rate inversely correlated with myocardial resting oxygen consumption assessed with ¹¹C-labeled acetate positron emission tomography (r?=?–0.71, p?=?0.006). In conclusion, myocardial strain and strain rate reflect fibrosis, hypertrophy and oxygen consumption of the remote areas after MI.     

护理干预前移对急性心肌梗死患者便秘的预防

目的探讨护理干预措施前移对急性心肌梗死患者便秘的预防。方法将70例急性心肌梗死可能发生便秘的患者,随机分为对照组和观察组,各35例。对照组按急性心肌梗死常规护理加预防便秘常规药物治疗及发生便秘后的护理干预;观察组除按急性心肌梗死常规护理加预防便秘的常规药物治疗外,还采取针对性的护理干预前移措施。结果观察组患者发生排便费力、大便硬结、腹胀、腹痛、焦虑、并发症,以及死亡率等均低于对照组(P<0.05)。结论采取有针对性的护理干预前移措施可降低急性心肌梗死患者的死亡率。     

小心肌梗死的MRI诊断

目的：探讨小心肌梗死的MRI诊断价值;材料和方法：对12例心绞痛患者进行MRSE和MR电影成像,分析MRI表现与心肌核素显像（单光子发射计算机断层,SPECT）、冠状动脉狭窄和临床表现的关系;结果：12例心绞痛中MRI（T2WI和Gd－DTPAT1WI）发现5例有高信号的小心肌梗死灶（≤2cm）,与无高信号病冽（7例）相比,其心绞痛持续时间长、硝酸甘油效果差,冠状动脉狭窄严重,SPECT有明显局限性灌注缺损或稀疏区,心酶谱阳性率高,心电图有缺血表现（P＜0.05）;结论：MRI是检测小心肌梗死敏感而有效的方法。     

多普勒超声心肌作功指数评价急性心肌梗塞左室功能的价值

目的　采用多普勒超声心肌作功指数评价急性心肌梗塞患者左室功能的价值。方法　急性心肌梗塞患者 (AMI) 5 2例 ,其中killip分级 1～ 2级 36例 ,3～ 4级 16例 ;正常对照组 32例。测定左室射血分数 (EF) ,每搏量 (SV) ,心脏指数 (CI) ,射血前期 射血时间 (PEP ET) ,等容收缩时间 射血时间 (ICT ET) ,等容舒张时间 (IRT)及计算心肌作功指数(MPI)。MPI =(ICT +IRT) ET ,由二尖瓣关闭至开放时间减去ET所得值再除以ET而得。结果　MPI对照组为 0 .48±0 .0 9;killip分级 1～ 2级组为 0 .67± 0 .15 ;3～ 4级组为 1.0 0± 0 .19;各组间均具有显著性差异 (P <0 .0 1)。MPI与心率无关。结论　MPI是综合评价左室收缩和舒张功能的简便指标     

心梗患者的颈动脉粥样硬化与脑梗塞

目的：观察心肌梗塞后患者一年内发生脑梗塞的心源性病因及颈动脉粥样硬化情况。方法：应用超声心动图和颈动脉超声。结果：９２．３％的心梗患者合并有颈动脉粥样硬化。脑梗塞组（５例）患者中３例（６０％）存在颈动脉内膜粗糙（Ｐ＜０．０５）；１例有心腔内附壁血栓；心功能指标二组间无差异。结论：为了防止心梗后并发脑梗塞，心脏和颈动脉病变的情况同样需要充分的了解     

ARBs and Myocardial Infarction

A recent editorial in the British Journal suggested that ARBs used for treatment of hypertension may increase the risk of myocardial infarction.     

Treatment After Myocardial Infarction

Persons after myocardial infarction (MI) should have their modifiable coronary artery risk factors intensively treated. Hypertension should be treated with beta blockers and angiotensin-converting enzyme (ACE) inhibitors. The blood pressure should be reduced to <140/90 mmHg and to <130/80 mmHg in persons with diabetes or renal insufficiency. The serum low-density lipoprotein cholesterol should be reduced to <70 mg/dl with statins if necessary. Diabetics should have their hemoglobin A_1c reduced to <7.0%. Aspirin or clopidogrel, beta blockers, and ACE inhibitors should be given indefinitely unless contraindications exist to the use of these drugs. Long-acting nitrates are effective antianginal and antiischemic drugs. Postinfarction patients at very high risk for sudden cardiac death should have an implantable cardioverter-defibrillator. The two indications for coronary revascularization are prolongation of life and relief of unacceptable symptoms despite optimal medical management. Dr. Aronow has no real or apparent conflicts of interest relating to the subject under discussion.     

兔心肌梗死模型的建立及心功能的超声评价

目的 建立简单、有效的兔心肌梗死模型及梗死后重构心肌心功能的检测。方法 不用气管插管和呼吸机，经胸骨左缘切口开胸，保持胸膜腔完整，缝扎左室支；存活6周后，不用麻醉，兔在清醒状态下用超声心动图检测其心功能并与有创检查结果比较。结果 围手术期死亡率23．1％，与假手术组相比，6周后冠脉结扎组左室增大，左室收缩舒张功能受损，病理检查示心肌梗死存在，梗死面积平均为26．6％，有统计学差异；且超声心动图检测心功能与有创检查结果及心肌梗死面积比较，具有相关性。结论 本法成功建立了兔心肌梗死模型，具有简便、实用、成功率高之特点；超声心动图为兔心功能的检测提供了可靠、可随访的无创伤性检查方法。兔可作为有关心肌梗死临床研究模型所用合适动物。