健康复教育在冠心病疗养员二级预防中的作用

Background:Secondary prevention of coronary heart disease is to prevent patients with proofs(for example: painless myocardial ischemia,angina pectoris,heart failure and arrhythmia) of coronary heart disease actively from myocardial necrosis,cardiac death,to improve cardiac function and patients' living quality. Objective: To change the health idea,decrease the possibility of myocardial necrosis,cardiovascular death,and improve cardiac function through reasonable health education. Design:To evaluate the risk factors(for example: hyperlipemia,diabetes,smoking,much drinking,hyperadiposis,lacking sports,long-term nervousness,family history etc.)of in atients,make respective education plans according to the different conditions,carry on the health education,and evaluate cardiac function before and after the treatment. Unit:Cadre Curative Department of Navy Guangzhou Sanitarium. Subject:40 cases of coronary heart disease,male 29 cases,female 11 cases,average age(56.12± 3.53)years.     

心肌缺血/再灌注损伤后瘦素的改变及机制初探

Objective To explore the effect of rat myocardial ischemia/reperfusion (I/R) injury on serum Leptin, endothelin (ET), C-reactive protein (CRP) and myocardial Leptin expression, and discuss the role of Leptin in myocardial I/R injury.Methods Fifty Sprague-Dawley (SD) rats were randomly divided into sham-operation, ischemia and I/R 1, 2, 3 hours groups, with 10 rats in each group.Anterior descending artery of the left coronary artery was ligated for 45 minutes and released for 1, 2 and 3 hours to establish myocardial I/R model, and the said artery of the rats in sham-operation group was not ligated.Blood from left femoral artery was collected at different time points, and serum Leptin, ET and CRP contents were detected.Myocardial tissue was harvested, and stained with hematoxylin-eosin (HE)and immunohistochemistry for its observation of the myocardial pathological changes and Leptin protein expression.Results Serum Leptin content (μg/L) of ischemia group was significantly lower than that of sham-operation group (4.69 ± 1.67 vs.6.48 ± 2.02, P＜ 0.05); as the reperfusion time was prolonged,serum Leptin level increased gradually, and the level of I/R 3-hour group recovered to that before injury [(6.59±2.58) μg/L].ET content (ng/L) of ischemia group was significantly higher than that of sham-operation group (110.58 ± 37.86 vs.80.74 ± 34.43, P＜0.05), the levels of ET in I/R 1, 2 and 3 hours groups were significantly lower than those of ischemia group (35.87 ± 13.56, 31.98 ±10.88,34.56±14.37 vs.110.58±37.86, all P＜0.05).CRP content (mg/L) of ischemia group was significantly higher than that of sham-operation group (13.12±4.82 vs.3.24±1.72,P＜0.01); as the reperfusion time was prolonged, serum CRP level increased gradually,and the levels of I/R 1, 2 and 3 hours groups were significantly higher than those of ischemia group (18.37 ± 6.48, 24.30 ± 9.51, 27.08 ± 8.32 vs.13.12 ±4.82, all P＜0.05).Pathological examination showed that there was necrosis of ischemic myocardial cells in ischemia group, with mild congestion and edema in interstitial spaces.After I/R injury, the myocardial cells showed coagulative necrosis, and there was severe congestion of myocardial interstitia.Immunohistochemistry results showed that there was a tendency of decrease in Leptin protein expression in the early phase but increase in the late phase after the injury.Conclusion Leptin content in the serum and myocardial tissue decreases significantly in the early phase after myocardial I/R but increases gradually in the rehabilitative phase, suggesting that Leptin maybe a stress protective factor against I/R-induced myocardial injury.There is a possible association between Leptin and the early increase followed by a delayed decrease of ET as well as the increase of CRP.     

真彩色图像体视学分析系统对心脏功能受损的评估

Background:Some studies showed the significance of troponin-T in the diagnosis of acute myocardial ischemia.A number of studies evaluated level of troponin-T in blood,no expression of troponin-T has been reported. Objective:To investigate significance of troponin-T in abnormal cardiac function. Design:Descending anterior branch of left coronary artery in pigs was ligated to establish ischemic acute cardiac infarction model.Myocardial necrosis and expression of troponin-T in cardiac tissue were showed by histochemical techniques and immunohistochemical techniques respectively.Quantitative analysis of expression of troponin-T was performed with true color image and sterostatic analysis system.     

Evaluation of impaired cardiac function by true color image and sterotic analysis system

Background:Some studies showed the significance of troponin－ T in the diagnosis of acute myocardial ischemia.A number of studies evaluated level of troponin－ T in blood,no expression of troponin－ T has been reported. Objective:To investigate significance of troponin－ T in abnormal cardiac function. Design:Descending anterior branch of left coronary artery in pigs was ligated to establish ischemic acute cardiac infarction model.Myocardial necrosis and expression of troponin－ T in cardi…     

大剂量多巴酚丁胺负荷试验结合二维应变成像技术早期诊断冠心病的价值

目的 探讨大剂量多巴酚丁胺负荷试验结合二维应变成像技术早期诊断冠心病的价值.方法 对临床可疑的冠心病患者28例进行大剂量多巴酚丁胺负荷试验,分别在静息状态及各级负荷状态下观察室壁运动情况,测定左室各心肌节段心内膜下心肌的纵向收缩期峰值应变,比较大剂量多巴酚丁胺负荷试验目测法及大剂量多巴酚丁胺负荷试验结合二维应变成像技术诊断缺血心肌的敏感性和特异性;计算正常组、冠心病组缺血节段和非缺血节段的纵向收缩期峰值应变平均值并进行组内及组间比较,利用ROC曲线下面积评价纵向收缩期峰值应变预测缺血心肌的敏感性和特异性.结果 冠心病组多巴酚丁胺剂量为40μg·kg-1·min-1时目测法检出室壁运动异常6例(共20个节段),通过计算纵向收缩期峰值应变检出缺血心肌15例(共148节段);冠心病组大多数缺血节段纵向收缩期峰值应变较正常组及非缺血节段相同负荷状态明显减低(P＜0.05);大剂量多巴酚丁胺负荷试验目测法和大剂量多巴酚丁胺负荷试验结合二维应变成像技术诊断缺血心肌的敏感性分别为35.3%和88.2%(P＜0.01),特异性分别为100%和100%(P＞0.05)、准确性分别为60.7%和92.8%(P＜0.01).多巴酚丁胺剂量为40μg·kg-1·min-1时以纵向收缩期峰值应变绝对值≤14.9%为截断值,预测缺血心肌节段的敏感性和特异性分别为83.3%和91.7%.结论 大剂量多巴酚丁胺负荷试验结合二维应变成像技术可以提高检出缺血心肌的敏感性,定量评价心肌收缩功能的微小改变,发现隐匿性心肌缺血,为临床诊断早期冠心病患者提供了无创性新方法 .

Abstract：

Objective To investigate the value of high-dose dobutamine stress echocardiography combined with two-dimensional strain imaging in early diagnosis of coronary artery disease. Methods Highdose dobutamine stress echocardiography was performed to 28 patients with suspected coronary artery disease. All wall movements were observed during resting condition and at all stress levels,respectively;the peak systolic longitudinal strain in each endomyocardial segment of left ventricular was measured; the sensitivity and specificity between visual method and two-dimensional strain imaging in diagnosing myocardial ischemia with high-dose dobutamine stress echocardiography were compared. The average peak systolic longitudinal strain was calculated against control group, coronary artery disease group during ischemia segments and non-ischemia segments, and a comparison was made inside each group as well as against the other groups. The area under receiver operating characteristic curve of the peak systolic longitudinal strain was used to predict the sensitivity and the specificity of myocardial ischemia. Results With dobutamine dose of 40 μg·kg-1 · min-1 ,wall motion abnormalities were diagnosed in 6 patients (20 segments) through visual method, myocardial ischemia was found in 15 patients (148 segments) through computing the peak systolic longitudinal strain. Inside the coronary artery disease group during ischemic　segments,the majority of peak systolic longitudinal strain was significantly reduced ( P＜0.05) compared to the non-ischemic segments and the control group. In diagnosing myocardial ischemia in high-dose dobutamine stress echocardiography, the sensitivity of visual method and two-dimensional strain imaging were 35.3％ and 88.2％(P＜0.01), specificity 100％ and 100％(P＞0.05), and accuracy 60.7％ and 92.8％ (P＜0.01). The cutoff value of the peak systolic longitudinal strain was less than or equal to 14.9％, its sensitivity and specificity in predicting myocardial ischemia were 83.3％ and 91.7％,respectively. Conclusions High-dose dobutamine stress echocardiography combined with two-dimensional strain imaging can increase the sensitivity of detecting myocardial ischemia and detect concealed myocardial ischemia. High-dose dobutamine stress echocardiography combined with two-dimensional strain imaging can be used in early diagnosis of coronary artery disease.     

高压氧治疗脑梗死疗效观察

Background:Hypoxia and ischemia resulting from cerebral infarction can further cause a series of pathological changes such as hydrocephallus.Drug therapy can improve cerebral blood circulation and enhance flow volume and decrease infarction area.If hyperbaric oxygen is added,pathophysiological changes such as ischemia and hypoxia can be improved and normal metabolism of brain cells be restored.     

Relative analysis on mutilation disease and characteristics of dyslipidemia in the aged

Objective :To observe the character and the distribution of dyslipidemia and to explore the relationship between dyslipidemia and the incidence of certain diseases.Method :138 aged cases with dyslipidemia(group A) were observed.Compared with 103 aged cases with normal(group B),and with 126 non-aged cases with dyslipidemia(groupC) to explore the level of lipidemia,the distrbution of all kinds of dyslipidemia and the incidence of certain diseases in three groups.Result:The level of lipidemia in group A was showed that TC,TG and LDL-C were increased,HDL-C was decreased.The proportion of hypertriglydemia was the highest.Conclusion:Hypertriglydemia was closely related to atherosclerosis.     

两种激光并超短波治疗周围性面神经麻痹的疗效

Background: Peripheral facial nerve paralysis referred to injury of peripheral nerve trunk and its branches due to direct or indirect force.Physiotherapy could decrease ischemia.Swelling of nerve tissue and degeneration of myelin sheath and axon.Helium neon laser.Semiconductor laser and ultrashort wave were adopted in this group of peripheral nerve paralysis, effect was obvious.     

Homozygous factor Ⅴ Leiden mutation in type Ⅳ Ehlers-Danlos patient

Ehlers-Danlos syndrome(EDS) is a group of inherited connective tissue disorders caused by collagen synthesis defects. Several hemostatic abnormalities have been described in EDS patients that increase the bleeding tendencies of these patients. This case report illustrates a patient with an unusual presentation of a patient with type Ⅳ EDS, platelet δ-storage pool disease and factor Ⅴ Leiden mutation. Young woman having previous bilateral deep vein thrombosis and pulmonary emboli coexisting with ruptured splenic aneurysm and multiple other aneurysms now presented with myocardial infarction. Presence of factor Ⅴ Leiden mutation raises the possibility that the infarct was due to acute coronary thrombosis, although coronary artery aneurysm and dissection with myocardial infarction is known to occur in vascular type EDS. This is the first report in the medical literature of factor Ⅴ Leiden mutation in an EDS patient which made the management of our patient challenging with propensity to both bleeding and clotting.     

The protective effect of ischemic preconditioning occur in patients with acute myocardiac infarction

Ischemic preconditioning occur refers to the occurrence of many unstable angina pectoris before acute myocardial ischemia(AMI).It is generally recognized that ischemic preconditioning occur has protective effect on heart and can reduce infarction scope and improve contraction function of heart.Recently some authors whinks ischemic preconditioning occur will cause the exacerbation of patients‘ condition during the time of hospitalization and increase the incidence rate of angina and pectoris and death.OBJECTIVE:To explore the effect of ischemic preconditioning occur on prognosis of AMI.     

Pathophysiology of acute myocardial infarction

More than 80% of acute myocardial infarcts are the result of coronary atherosclerosis with superimposed luminal thrombus. Uncommon causes of myocardial infarction include coronary spasm, coronary embolism, and thrombosis in nonatherosclerotic normal vessels. Additionally, concentric subendocardial necrosis may result from global ischemia and reperfusion in cases of prolonged cardiac arrest with resuscitation. Myocardial ischemia shares features with other types of myocyte necrosis, such as that caused by inflammation, but specific changes result from myocyte hypoxia that vary based on length of occlusion of the vessel, duration between occlusion and reperfusion, and presence of collateral circulation.     

低温低氧对实验性心肌缺血家兔心电图的影响效应

背景在某些情况下,低温与低氧有交互影响的作用,缺氧和低温复合因素对心肌缺血的心电图也会产生较大的影响.目的探讨急性低氧加低温两个因素共同作用对正常家兔和心肌缺血家兔心电图的影响效应.设计完全随机分组设计,对照实验.单位右江民族医学院应用生理教研室.材料实验于2002-07/12在右江民族医学院应用生理研究室完成.选用健康家兔32只.采用随机数字法将实验家兔分为4组对照组、低温低氧组、低温低氧假心肌缺血组、低温低氧心肌缺血组,每组8只.方法①低温低氧心肌缺血组家兔双重结扎冠状动脉前降支;低温低氧假心肌缺血组方法同低温低氧心肌缺血组,但只分离冠状动脉前降支穿线,不结扎.②将低温低氧组、低温低氧心肌缺血组和低温低氧假心肌缺血组家兔置于低温[(-10±2)℃]和低氧(含氧体积分数0.085)冷柜中30 min,然后测定各组心电图的变化.③计量资料差异性比较采用单因素方差分析.主要观察指标低温低氧对正常和心肌缺血家兔心电图检测结果的影响.结果家兔32只均进入结果分析.①低温低氧组家兔心率慢于对照组(P＜0.05),P波电压、ST段电压和R波电压均明显高于对照组(P＜0.05～0.01);T波电压低于对照组(P＜0.05);P波时间、PR间期、QRS间期和QT间期明显长于对照组(P＜0.05).②低温低氧心肌缺血组家兔心率慢于对照组(P＜0.05);P波电压、ST段电压、T波电压和R波电压均明显高于对照组(P＜0.01),QRS间期和QT间期明显长于对照组(P＜0.01,0.05),S波深度明显大于对照组(P＜0.05).③低温低氧心肌缺血组家兔ST段电压和T波电压明显高于低温低氧假心肌缺血组和低温低氧组(P＜0.01,0.05).结论低温低氧对正常家兔的心电图有明显影响,对心肌缺血家兔的心电图影响更大,说明急性低温低氧双重作用可加重原有心肌缺血的发展.     

Added value of CT myocardial perfusion imaging

Multidetector CT angiography (MDCTA) has become an accurate, noninvasive test for the diagnosis of coronary atherosclerosis. Studies have established a good sensitivity and an excellent negative predictive value for the diagnosis of coronary stenoses of 50% or greater severity. However, MDCTA is more limited in patients with disease with a lower specificity and positive predictive value for predicting atherosclerosis causing myocardial ischemia. Although radionuclide myocardial perfusion imaging (MPI) has been the mainstay for evaluating the presence of myocardial ischemia and scar in patients at risk for coronary artery disease, contrast-enhanced multidetector CT (MDCT) alone, with or without vasodilator stress, has the potential to provide both anatomical and functional information on coronary atherosclerosis and its impact on myocardial perfusion. We review the current status of MDCT MPI, including its advantages, limitations, and pitfalls.     

组胺预测心肌缺血研究进展

不稳定粥样斑块内的肥大细胞释放组胺促进动脉粥样硬化进展及心肌缺血。组胺释放增加,引起心动过速、血压升高和室性心律失常。冠状动脉病变患者血组胺含量明显高于正常。本文就组胺的生物学特性及其预测心肌缺血的进展综述,以期全面理解组胺与心肌缺血的关系。     

Is silent myocardial ischemia clinically important? Does it have prognostic significance?

The precise mechanism responsible for silent myocardial ischemia has not been established, but available data suggest that both an increase in oxygen demand and a decrease in coronary blood flow may be responsible. Studies indicate that more than 60 minutes of silent ischemia during 24-hour ambulatory electrocardiographic monitoring correlates with an increased incidence of myocardial infarction, cardiac death, and recurrent symptoms requiring coronary revascularization. Even in patients with shorter, repeated episodes of silent ischemia, small areas of subendocardial necrosis may develop that eventually lead to progressive left ventricular dysfunction, which increases the risk of subsequent mortality. Antianginal therapy, even though effective in control of symptoms, does not abolish silent ischemia. Further study of the pathogenesis of silent ischemia is needed before an effective treatment plan can be established.     

Neutrophil-Derived Oxidative Stress After Myocardial Ischemia Induced by Incremental Atrial Pacing

We studied the effect of atrial pacing-induced myocardial ischemia on the generation of oxygen free radicals (OFR) in 8 patients with verified coronary artery disease (CAD) and in a control group of 4 patients without coronary atherosclerosis. Myocardial ischemia was measured metabolically by simultaneous lactate sampling from coronary sinus (CS) and arterial blood. Generation of OFR from purified viable polymorphonuclear neutrophils (PMN) was assessed by means of the chemiluminescence (CL) method. At peak pacing, 7 of 8 patients with CAD exhibited transient myocardial ischemia (mean lactate extraction ratio at rest: 23.6 ± 7.7 vs 5.21 ± 5.1 % at peak pacing, p= 0.012). In these patients, unstimulated PMN harvested from the CS depicted a significant increase of luminol-enhanced CL (from 1.06 ± 0.54 to 2.15 ± 1.28 cpm x 10⁵, p= 0.012) after atrial pacing. There was no additional effect from further ex vivo stimulation with phorbol myristate acetate.
This finding underscores the role of myocardial ischemia as a potent endogenous activator of PMN function and may have implications in the pathogenesis and progression of atherosclerosis.     

Myocardial microcirculation in patients with systemic lupus erythematosus

AIM: To examine myocardial microcirculation in patients with SLE. MATERIAL AND METHODS: Examination of 21 SLE patients consisted of perfusion tomoscintigraphy of the myocardium with Tl-201 at rest and in combination with bicycle exercise. Various protocols were used. RESULTS: The majority of SLE patients had resting disorders of myocardial perfusion: 5 had macrofocal scar lesion of the myocardium, 12 had disorders typical for small-focal myocardial fibrosis. Normal distribution of the perfusion occurred in 4 cases. Tomoscintigraphy performed in combination with exercise test revealed in 11 of 15 patients transient perfusion disturbances reflecting transient myocardial ischemia. One third of the patients had changes characteristic of myocardial ischemia due to coronary atherosclerosis. CONCLUSION: SLE patients have disorders of myocardial perfusion including those characteristic of scar lesion, small-focal cardiofibrosis and transient myocardial ischemia of different genesis: due to disorders in microcirculation and atherosclerotic lesion of major coronary arteries.     

Coronary insufficiency and metabolic hormone ratio in patients with myocardial infarction in the course of a long prospective study

An angiographic study of coronary bed status and relationships of insulin, cortisol, somatotropin (ST), T3, T4, glucose in 109 Q-wave myocardial infarction (MI) patients aged 47 +/- 0.8 years was performed at rest and during veloergometric stress-test ischemia modelling of exercise tolerance in early (21-26 days) and late (> 5 years) follow-up. The hormones level was found to be significantly related to coronary insufficiency as a result of coronary atherosclerosis both at rest and during muscular stress-test. Coronary failure limiting activity of metabolic processes in the myocardium by chronic hypoxia induces changed proportion of hormones regulating energy metabolism processes. In MI hypometabolic syndrome is developing with specific hormonal "ischemic profile" in which during exercise insulin and thyroxin become leading hormones regulating intracellular exchange of energy; the level of cortisol and ST decreases. Increased need in glucose as a main energy substrate during ischemia and therefore in insulin leads to disturbed carbohydrate metabolism in 33% of patients recorded 3-5 years after MI. The above metabolic changes manifest with increased glucose tolerance and/or clinical signs of diabetes mellitus.     

Release of Adenosine from Human Hearts during Angina Induced by Rapid Atrial Pacing

This study was designed to determine whether human hearts release adenosine, a possible regulator of coronary flow, during temporary myocardial ischemia and, if so, to examine the mechanisms involved. Release of adenosine from canine hearts had been reported during reactive hyperemia following brief coronary occlusion, and we initially confirmed this observation in six dogs hearts. Angina was then produced in 15 patients with anginal syndrome and severe coronary atherosclerosis by rapid atrial pacing during diagnostic studies. In 13 of these patients, adenosine appeared in coronary sinus blood, at a mean level of 40 nmol/100 ml blood (SE = +/-9). In 11 of these 13, adenosine was not detectable in control or recovery samples; when measured, there was concomitant production of lactate and minimal leakage of K(+), but no significant release of creatine phosphokinase, lactic acid dehydrogenase, creatine, or Na(+).THERE WAS NO DETECTABLE RELEASE OF ADENOSINE BY HEARTS DURING PACING OR EXERCISE IN THREE CONTROL GROUPS OF PATIENTS: nine with anginal syndrome and severe coronary atherosclerosis who did not develop angina or produce lactate during rapid pacing, five with normal coronaries and no myocardial disease, and three with normal coronaries but with left ventricular failure.The results indicate that human hearts release significant amounts of adenosine during severe regional myocardial ischemia and anaerobic metabolism. Adenosine release might provide a useful supplementary index of the early effects of ischemia on myocardial metabolism, and might influence regional coronary flow during or after angina pectoris.     

Intravenous isoproterenol administration for diagnosing ischemic heart disease in women: a comparison with the data from bicycle ergometry and selective coronary angiography

The significance of the test with intravenous injection of isoproterenol in the diagnosis of coronary heart disease (CHD) was evaluated in comparison with the clinical, bicycle ergometry and selective coronarography data obtained in 65 women. Twenty-four patients presented with stenosing coronary atherosclerosis and 41 patients had normal coronary arteries. On the use of the electrocardiographic signs of myocardial ischemia the sensitivity of the isoproterenol test in the diagnosis of hemodynamically appreciable coronary atherosclerosis was 74%, the specificity 78%. The sensitivity and specificity of bicycle ergometry were 66 and 90%, respectively.