幽门螺杆菌感染与功能性消化不良胃排空的关系

目的：探讨幽门螺杆菌（Ｈｐ）感染对功能性消化不良（ＦＤ）患者胃排空功能的影响。方法：１０６例ＦＤ患者，其中Ｈｐ阳性４６例，Ｈｐ阴性６０例。全部患者从胃窦粘膜取活组织做病理组织学检查并利用实时Ｂ型超声胃窦截面积法测定胃排空。结果：Ｈｐ阳性患者的空腹胃窦面积、餐后即刻胃窦面积、餐后６０分钟和１２０分钟的胃排空率（分别为０９４±１３９ｃｍ２、１３４±３１６ｃｍ２、９２３±１４０％和３５８±２３５％）与Ｈｐ阴性者（分别为１１９±２１２ｃｍ２、１２５±２７８２、９１２±１２２％和３２１％±２４０％）比较，无显著性差异（Ｐ＞００５）；活动性胃炎患者空腹胃窦面积、餐后即刻胃窦面积、餐后６０分钟和１２０分钟的排空率（分别为０７７±１４２ｃｍ２、１３２±３５ｃｍ２、１００±１２２％和３４７±２６０％）与非活动性胃炎患者（分别为１２８±２０７ｃｍ２、１２７±２５２ｃｍ２、９７４±１４５％和３３２±２４％）比较，也无显著性差异（Ｐ＞００５）。结论：Ｈｐ感染对ＦＤ患者胃排空功能无影响；与Ｈｐ感染有密切相关性的活动性胃炎也不足以引起胃排空的改变     

硝酸甘油介入心肌断层显像诊断心肌梗死患者存活心肌方法的研究

目的：探讨硝酸甘油介入９９ｍ 锝－甲氧基异丁基异腈（９９ｍ Ｔｃ－ＭＩＢＩ）心肌显像估测心肌梗死（ＭＩ）患者存活心肌的价值和方法。方法：５１ 例ＭＩ患者分成急性ＭＩ（ＡＭＩ）１３ 例、陈旧性ＭＩ组１３例和ＡＭＩ溶栓组１０ 例、非溶栓组１５ 例,先行静息态９９ｍ Ｔｃ－ＭＩＢＩ心肌显像,２４ ｈ 后分别静脉和口含硝酸甘油,行介入心肌显像。结果：５１ 例行硝酸甘油介入后心肌显像表明心肌节段灌注异常较介入前有一定程度改善（７９／１４１,５６．０３％ ）,硝酸甘油介入前后平均记分值分别为７．４８±２．３２、５．４５±２．１７（ Ｐ＜ ０．０１）。结论：口含硝酸甘油介入９９ｍ Ｔｃ－ＭＩＢＩ心肌显像方法简便,可有效提高ＭＩ患者存活心肌检出率。特别是溶栓治疗后ＡＭＩ患者存活心肌的检出率更高。     

心肌灌注断层显像对急性心肌梗死再灌注的研究

目的：通过心肌灌注断层显像研究急性心肌梗死（ＡＭＩ）患者经尿激酶及经皮冠状动脉腔内成形术（ＰＴＣＡ）治疗前后梗死范围的变化。方法：用９９ｍ锝甲氧基异丁基异腈心肌灌注断层显像测定３６例ＡＭＩ患者心肌再灌注前后的心肌梗死面积。结果：再灌注组和无再灌注组首次心肌显像心肌缺损面积无显著性差异（Ｐ＞０．０５）；再灌注组再次显像心肌缺损面积明显小于首次显像（１７．５±２．８％和３１．９±４．５％，Ｐ＜０．０５）；无再灌注组再次显像心肌缺损面积与首次显像无明显差异（２９．６±４．７％和３２．４±５．１％，Ｐ＞０．０５）；预后不良组（ｎ＝６）心肌缺损面积明显高于预后较好组（３４．６±５．１％和２１．４±３．６％，Ｐ＜０．０５）。结论：心肌灌注断层显像可作为ＡＭＩ再灌注疗效评价较准确的手段。     

单硝酸异山梨酯对血管内皮功能的影响

血管内皮功能异常在动脉粥样硬化和心肌缺血等的病理生理中发挥重要作用。本文旨在观察单硝酸异山梨酯治疗冠心病心绞痛患者的临床疗效和对血管内皮功能的影响。１　对象与方法１．１　对象冠心病患者３０例，男、女各１５例，年龄５９～８４（７０±９）岁。均有心绞痛症状和心电图心肌缺血表现。１．２　用药方法每日使用异舒吉２０ｍｇ加入５％葡萄糖液１０００ｍｌ中持续静脉滴注；长效异乐定５０ｍｇ口服，均连续用药１４ｄ。用药前１周及用药期间停用其他抗心肌缺血药物。１．３　观察指标用药前后测量心率、血压，测心电图以ＮＳＴ和…     

经皮球囊二尖瓣扩张术后再狭窄及远期疗效

目的对经皮二尖瓣球囊扩张术（ＰＢＭＶ）后病人长期随访资料作了回顾性分析，以确定再狭窄率、远期疗效及其影响因素。方法对１９８６年５月～１９９５年１２月随访资料完整的１６０例患者进行了回顾性研究，其中男５５例，女１０５例，年龄３８９±８９岁。随访时间１２～８１个月，平均３６±１５个月。对影响远期疗效的因素，用Ｃｏｘ风险模型作了分析。结果随访期间，１２７例（７９％）心功能持续改善。超声心动图测得的术前、术后及随访的二尖瓣口面积分别为１１５±０２ｃｍ２、２１５±０４ｃｍ２和１９２±０４ｃｍ２。２６例（１７％）发生再狭窄，其中１７例症状复发。结论ＰＢＭＶ术后可保持较好的远期疗效，平均３６个月的再狭窄率为１７％。术前超声心动图计分、心功能、有无心房颤动和左房压为长期疗效的独立预测因素。     

急性心肌梗塞后梗塞相关血管再灌注对QTc离散度的影响

目的观察２７例急性心肌梗塞（ＡＭＩ）患者梗塞相关血管（ＩＲＡ）早期再灌注对ＱＴｃ离散度（ＱＴｃｄ）的影响。方法对２７例ＡＭＩ予以静脉溶栓，于溶栓后９０分钟进行选择性冠状动脉造影，在溶栓前后作同步记录１２导联心电图测量ＱＴｃｄ，并与４３例冠状动脉造影正常者进行对照。结果ＡＭＩ组溶栓前与对照组间ＱＴｃｄ差异有极显著性（８６６±１２２ｍｓｖｓ３５．８±１６７ｍｓ，Ｐ＜０００１），前壁与下壁梗塞之间ＱＴ离散度差异无显著性。静脉溶栓后９０分钟冠脉造影显示ＩＲＡ血流达到ＴＩＭＩＩ～ＩＩ者，溶栓后２小时ＱＴｃｄ显著降低（８７２±１２８ｍｓｖｓ５９．５±１３６ｍｓ），而ＩＲＡ未开通者其ＱＴｃｄ在溶栓前后始终保持较高水平，恢复速度显著慢于开通组。６例溶栓前有恶性室性心律失常者其ＱＴｃｄ明显高于无伴心律失常者（９４８±９２ｍｓｖｓ８４．２±１２０ｍｓ，Ｐ＜００５），溶栓后其ＩＲＡ血流均达ＴＩＭＩＩＩ级，ＱＴｃｄ降至６８３±８８ｍｓ，室性心律失常消失。结论成功地溶栓再灌注可使ＱＴｃｄ显著降低，改变其自然演变过程。ＩＲＡ早期再灌注，可减少危险性心律失常的发生。     

胺碘酮、普罗帕酮对QTc离散度的影响比较及其临床意义

目的比较胺碘酮（２７例）和普罗帕酮（３４例）分别治疗室性心律失常前后ＱＴｃ离散度（ＱＴｃｄ）的变化及对复发的影响。方法采用随机、单盲的方法，测定两组病人用药前及用药２周后的ＱＴｃｄ。结果（１）胺碘酮组用药后ＱＴｃ明显延长，但ＱＴｃｄ反而降低（４４．３±１４．９ｍｓ与３３．９±１６．１ｍｓ，Ｐ＜０．０５）；普罗帕酮组用药前后ＱＴｃ及ＱＴｃｄ无显著变化（Ｐ均＞０．０５）。（２）胺碘酮组和普罗帕酮组的有效率分别为８５．２％和８２．４％（Ｐ＞０．０５）；停药后１月内的室性心律失常复发率分别为１８．５％和５０％（Ｐ＜０．０５），普罗帕酮组复发者较未复发者的ＱＴｃｄ明显延长（４８．７±１５．３ｍｓ与３９．８±１２．５ｍｓ，Ｐ＜０．０１）。结论ＱＴｃｄ的降低可能是胺碘酮治疗室性心律失常复发率较低的重要因素     

经颈静脉肝内门体静脉分流术

目的：评价经颈静脉肝内门体静脉分流术对肝硬化门脉高压症的疗效及优缺点。方法：先行预造影，经颈静脉插管至肝静脉，在肝内从肝静脉向门静脉穿刺，穿刺成功后选择性行胃冠状静脉栓塞，然后行球囊导管扩张建立分流通道，放置支架。结果：共２５例病例，２１例成功，４例失败。门脉压力从术前４０２±０３９ｋｐａ降至术后２５８±０２３ｋｐａ（Ｐ＜００１），门脉主干由１３４±０２４ｃｍ降至１１４±０２１ｃｍ（Ｐ＜００５），门脉主干血流速度由术前２３０±６５ｃｍ／ｓ增至术后４５５±１２３ｃｍ／ｓ（Ｐ＜００５），脾脏长径由１５８５±１７９ｃｍ缩小为１３８５±１８０ｃｍ（Ｐ＜００５）。食管静脉曲张消失１４例，明显减轻７例，６例伴顽固性腹水者术后明显减少。术后随访３～１５个月（平均１０个月），随访期间５例发生肝性脑病，３例分流通道发生明显狭窄（内径缩小０３ｃｍ以上），再出血及再发顽固性腹水各一例。结论：ＴＩＰＳＳ对迅速缓解门脉高压症，解除出血危险性是一种比较好的方法，近期疗效满意。但术后肝性脑病和分流通道发生狭窄值得重视。     

~(131)I抗AFP抗体-MMC双弹头导向治疗肝癌31例

目的观察化疗兼内照射的新型双弹头免疫导向治疗肝癌的疗效．方法以马抗人ＡＦＰ多克隆抗体（抗ＡＦＰＡｂ）和大鼠抗人ＡＦＰ单克隆抗体（抗ＡＦＰＭｃＡｂ）为载体，核素１３１Ｉ和丝裂霉素（ＭＭＣ）为双弹头，采用改良氯胺Ｔ法制备１３１Ｉ抗ＡＦＰＭｃＡｂＭＭＣ（双弹头１）和１３１Ｉ抗ＡＦＰＡｂＭＭＣ（双弹头２），静脉滴注，每月１次，治疗不能切除中晚肝癌３１例（治疗组）．治疗１，２，３次分别占４，１７和１０例，放射剂量（ＭＢｑ／例）均值依次为１９３５１±３７７４，６５１９±２３２４和９９２０±２３０５．结果治后肿瘤缩小率、血清ＡＦＰ下降率和１，２年生存率分别高于同期经动脉插管灌注（ＴＡＩ）或化疗栓塞（ＴＡＣＥ）的对照组（５００％，１５／３０比３００％，９／３０Ｐ＜００５；６６７％，１８／２７比２８０％，７／２５Ｐ＜００１和５００％比３３０％，３４０％比３３％Ｐ＜００１），治疗组病例的进展率（１００％）明显低于对照组（４００％，Ｐ＜００１）．结论双弹头疗效提高，由于抗体、核素１３１Ｉ和抗癌药的协同作用而增强了对癌细胞的杀伤力所致．     

硝酸异山梨酯直接静脉泵入治疗冠心病和高血压疗效分析

目的研究硝酸异山梨酯是否可以不加用液体稀释而通过静脉输液泵经静脉直接泵入.方法采用异舒吉5 mg/h、10 mg/h直接静脉泵入方法分别治疗43例冠心病、8例高血压急症病人.结果异舒吉泵入治疗冠心病组:治疗前后平均每例24 h心绞痛发作频率分别为:2.09±0.23和0.60±0.13(P＜0.05);治疗前后缺血ST-T段片段数分别为140和116(P＜0.05).与异舒吉经液体稀释后静脉滴注组比较,抗心肌缺血作用相似(P＞0.05),而副反应发生率为11.63%,明显降低(P＜0.05);异舒吉泵入治疗高血压急症组,异舒吉泵入后5 min收缩压下降24.41%,舒张压降低了21.42%%,血压下降迅速(P＜0.05),较硝普钠治疗高血压急症组起效快(P＜0.05).结论异舒吉不加液体稀释直接经静脉泵入方法在临床上用于治疗冠心病与高血压急症安全有效.     

Experience in using nitroglycerin in the acute period of myocardial infarct

To treat the left ventricular insufficiency, complicating myocardial infarction, and to limit the area of the ischemic damage of myocardium the authors used nitroglycerin solution. It is established that the nitroglycerin injection stops effectively the acute left ventricular insufficiency in myocardial infarction. Results of investigations show the decrease of the ischemic zone of the damaged myocardium in the acute period of infarction under the influence of nitroglycerin. It is concluded that intravenous drop administration of nitroglycerin is rational, under thorough control of the arterial pressure, the central venous pressure and intracardiac haemodynamics.     

Selection of angina-free patients with severe left ventricular dysfunction for myocardial revascularization

Stress thallium-201 myocardial imaging was used in two angina-free patients with severe congestive heart failure to identify clinically silent areas of ischemic myocardium and to distinguish between scar and reversibly ischemic myocardium as a cause for akinesia of left ventricular wall segments. Subsequent myocardial revascularization in these patients led to considerable improvement in their clinical state and findings in postoperative nuclear scans. Thus, stress myocardial imaging may be useful in selecting patients with severe left ventricular failure but no angina pectoris for myocardial revascularization.     

Efficacy of intravenous myocardial contrast echocardiography for assessment of perfusion area of the heart in mice

BACKGROUND AND OBJECTIVES: Intravenous myocardial contrast echocardiography is used clinically, but use in small animals has not been evaluated. The conditions for myocardial opacification and the feasibility of myocardial contrast echocardiography were examined in mice. METHODS: Closed chest mice were examined. The left ventricular short-axis view at the mid papillary muscle level was recorded before and after NC100100 injection using a SONOS 5500 (PHILIPS). Real time and intermittent triggering (every 5 beats) myocardial contrast echocardiography was performed with a mechanical index of low (0.3), middle (0.7), and high (1.5). Open chest mice were examined after left anterior descending coronary artery ligation. Myocardial contrast echocardiography was performed using intermittent triggering imaging (every 5 beats) with high mechanical index (1.5). The ratio of the non-perfused area to the whole left ventricular wall area was compared with that of the non-stained area by Evans Blue. RESULTS: The left ventricular myocardium was opacified in any setting. Good opacification was acquired at middle mechanical index (0.7) in real time myocardial contrast echocardiography and at high mechanical index (1.5) in intermittent myocardial contrast echocardiography. The opacified and non-opacified myocardium were clearly identified in all mice with coronary ligation. The non-opacified area ratio showed a good correlation with the non-stained area ratio (y = 0.93x + 0.51, r = 0.94, p < 0.05). CONCLUSIONS: Myocardial contrast echocardiography can be used to assess myocardial perfusion and determine the ischemic area accurately in situ in the mouse.     

Effect of acute ischemia, nitroglycerin and nitroprusside on regional myocardial thickening, stress and perfusion. Experimental echocardiographic studies.

The purposes of this study were to demonstrate that echocardiography can be used to demonstrate the systolic wall thinning of acutely ischemic myocardium, and to compare the effects of nitroglycerin and nitroprusside on systolic thinning, wall stress and perfusion of ischemic myocardium. In 37 dogs, the ratio of end-systolic-to-end-diastolic posterior wall thickness fell from 1.30 +/- 0.02 to 0.88 +/- 0.01 ((p less than 0.001) after circumflex coronary occlusion; perfusion of the area supplied by the occluded artery fell from 98.2 +/- 7.5 ml/100 g/min to 36.5 +/- 2.9 ml/100 g/min (p less than 0.001). Nitroglycerin and nitroprusside were given to lower mean arterial pressure by 7% and 15%. Despite the reduction in coronary perfusion pressure, transmural perfusion, endocardial/epicardial perfusion ratio and systolic thinning remained constant. Both drugs reduced the ischemic "wall stress index" (ventricular pressure x ventricular diameter/wall thickness) by almost 50%. Thus, both nitroglycerin and nitroprusside were equally beneficial in this model of acute myocardial ischemia.     

Effects of nitroglycerin on echocardiographic measurements of left ventricular wall thickness and regional myocardial performance during acute coronary ischemia.

The effects of nitroglycerin on regional left ventricular performance, assessed by echocardiographic techniques, were investigated in anesthetized, open-chest dogs during acute myocardial ischemia. During transient occlusion of the left anterior descending coronary artery, there was end-diastolic thinning and marked reduction in systolic thickening in the central ischemic zone. Similar changes of lesser degree were noted in the border zone. The normal zone was unaffected. Infusion of nitroglycerin during ischemia in dosages of 2.5--50 microgram/kg/min reduced left ventricular end-diastolic pressure without changing the abnormalities of systolic wall thickening. Effects of bolus injections of 20 and 50 microgram/kg of nitroglycerin were similar, although this also lowered aortic pressure. In a subgroup of animals in which nitroglycerin infusion was unaccompanied by tachycardia, there was also no evidence that ischemic dysfunction was altered. We conclude that nitroglycerin does not improve regional myocardial performance in acutely ischemic canine myocardium. The decrease in preload is probably entirely due to the peripheral effects of the agent.     

Acute coronary occlusion in the pig: Effect of nitroglycerin on regional myocardial blood flow

Myocardial blood flow was studied in 10 closed chest, anesthetized pigs after an acute balloon catheter occlusion of the left anterior descending coronary artery. With use of radioactive microspheres (15 μ), myocardial blood flow was measured before and during an intravenous nitroglycerin infusion and during a combined nitroglycerin-phenylephrine infusion. A significant zone of ischemia (myocardial blood flow less than 50 percent of normal zone flow) was produced by the occlusion and involved 15 percent of the combined left ventricular and interventricular septal mass. More than 50 percent of this ischemic zone was intensely ischemic (myocardial blood flow 0 to 3 percent of normal). Nitroglycerin resulted in a 20 to 30 mm Hg decrease in systolic blood pressure. Myocardial blood flow was unchanged in intensely ischemic areas but varied directly with the product of heart rate and systolic blood pressure in the moderately ischemic area (myocardial blood flow 26 to 50 percent of normal). S-T segment elevation was significantly increased during nitroglycerin infusion and returned to control level with the added infusion of phenylephrine sufficient to restore the systemic blood pressure to prenitroglycerin values. No improvement in ischemic zone perfusion could be demonstrated during the infusion of nitroglycerin alone or with phenylephrine. The endocardial/epicardial flow ratio in moderately ischemic areas was slightly lower than the normal zone flow ratio and decreased slightly during infusion of nitroglycerin. With the addition of phenylephrine, the ratios rose slightly and no longer differed from prenitroglycerin values.

Blood flow distribution in acutely ischemic pig myocardium differs considerably from that observed in the dog. Nitroglycerin was not shown to have any beneficial effects with or without its relative hypotensive effect. More extensive study in animal models other than the dog is needed.     

Multimodality Imaging for Assessment of Myocardial Viability: Nuclear,Echocardiography, MR,and CT

The assessment of myocardial viability may be an important component of the evaluation of patients with coronary artery disease and left ventricular dysfunction. The primary goal of viability assessment in such patients is to guide therapeutic decisions by determining which patients would most likely benefit from revascularization. In patients with chronic coronary artery disease, left ventricular dysfunction may be a consequence of prior myocardium infarction, which is an irreversible condition, or reversible ischemic states such as stunning and hibernation. Imaging techniques utilize several methods to assess myocardial viability: left ventricular function, morphology, perfusion, and metabolism. Each technique (echocardiography, nuclear imaging, magnetic resonance imaging, and x-ray computed tomography) has the ability to assess one or more of these parameters. This article describes how each of these imaging modalities can be used to assess myocardial viability, and reviews the relative strengths and limitations of each technique.     

心肌梗死区存活心肌对糖尿病急性心肌梗死患者PCI术后心功能的影响(英文)

目的:探讨糖尿病急性心肌梗死经皮冠状动脉介入治疗(PCI)术后患者心肌梗死区存活心肌对左室重构及左心功能的影响。方法:208例2型糖尿病并急性心肌梗死PCI术后的患者接受静息状态下18-氟脱氧葡萄糖正电子发射断层扫描术(18F-FDG PET)心肌代谢显像与99m锝-甲氧基异丁基异腈单光子发射型计算机断层成像术(99Tcm-MIBI SPECT)心肌灌注显像,根据心肌梗死区有无存活心肌,分为有心肌存活组(115例,灌注-代谢不匹配)和无心肌存活组(93例,灌注一代谢匹配)。检测两组PCI术前、术后超声心动图各指标,观察心肌梗死区心肌存活状态对于左室重构以及心功能的影响。结果:心肌梗死12个月后有存活心肌组左室射血分数(LVEF)显著高于无存活心肌组[(46.7±6.98)%比(44.1±7.12)%],左室舒张末期内径(LVEDd)[(53.17±4.77)mm比(55.46±4.75)mm],左房内径[(35.89±12.08)mm比(39.25±11.31)mm]显著小于无存活心肌组,P均<0.05。舒张期二尖瓣血流速度峰值的比值12个月后两组无显著差异(P>0.05)。结论:于2型糖尿病合并急性心肌梗死的患者,心肌梗死区有存活心肌患者较无心肌存活患者,LVEF明显改善,左室舒张末期内径显著缩小。     

Clinical relevance of hibernating myocardium in ischemic left ventricular dysfunction

Patients with chronic ischemic left ventricular dysfunction may have a substantial amount of viable, hibernating myocardium, which is a state of chronic contractile dysfunction with reduced blood flow at rest. Coronary revascularization in these patients may result in improvement of left ventricular function; in the absence of viability, left ventricular function will not improve postrevascularization. Various noninvasive imaging techniques are available for detection of viable myocardium, including magnetic resonance imaging, dobutamine stress echocardiography, and nuclear imaging with single photon emission computed tomography or positron emission tomography. Because these techniques probe different characteristics of viable myocardium, the sensitivities and specificities of the techniques are not precisely identical; in general, dobutamine stress echocardiography has the highest specificity, whereas the nuclear techniques have the highest sensitivity. The presence of myocardial viability also is related to prognosis: patients with viable myocardium who undergo revascularization have a good prognosis, whereas patients with viable myocardium who are treated medically have poor outcome. Accordingly, assessment of viability is important in the therapeutic decision-making process of patients with chronic ischemic left ventricular dysfunction.     

Comparative effects of nitroglycerin, nifedipine and metoprolol on regional left ventricular function in patients with one-vessel coronary disease

To compare acute effects of nitroglycerin (0.8 mg sublingually), nifedipine (5 ng/kg/min i.v.) and metoprolol (0.15 mg/kg i.v.) on normal, ischemic and scarred myocardial segments in man, we performed simultaneous hemodynamic and radionuclide measurements of left ventricular functions. Sixteen patients with isolated left anterior descending (LAD) disease were studied at rest and during exercise. Nine patients had angina and exercise-induced ischemia (LAD stenosis) and seven patients had previous transmural myocardial infarction and no ischemic changes during thallium imaging (LAD occlusion). The effects of the drugs on regional ejection fraction of the involved anteroseptal region and the normal posterolateral area were compared. Global ejection fraction at rest did not change after nitroglycerin, increased after nifedipine and decreased after metoprolol. In patients with ischemia, the exercise ejection fraction improved after all drugs due to increased regional ejection fraction in ischemic segments: i.e., a regional antiischemic effect evidenced by improved regional function could be demonstrated with all three agents. Regional ejection fraction increased from 35.8 +/- 19.5% to 66.2 +/- 15.2% (+/- SD) after nitroglycerin (p less than 0.001), to 61.7 +/- 8.7% after nifedipine (p less than 0.001), and to 48.4 +/- 7.0% after metoprolol (p less than 0.01). In regions of myocardial scar, regional ejection fraction was not changed after any drug. In normal areas, regional ejection fraction remained unchanged after nitroglycerin and nifedipine, but decreased after metoprolol. Despite similar antiischemic effects of all three drugs, underlying hemodynamic mechanisms were quite different and may provide a rationale for combined forms of treatment. These results may help to select optimal drug combinations to improve myocardial performance in patients with chronic ischemic heart disease.