排便体位对急性心肌梗死早期患者心肌耗氧量的影响

目的明确排便体位对急性心肌梗死早期患者排便过程中不同时段心肌耗氧量的影响,为临床护士指导急性心肌梗死早期患者采取合理、有效的促排便措施,减少排便时严重并发症的发生提供依据。方法采用多功能心电监护仪,记录23例急性心肌梗死早期患者的25例次排便过程中的心率和血压,并比较两组患者排便过程中不同时段心率、血压及心肌耗氧量的变化。结果平卧位排便者与半卧位排便者在排便过程中各时段的心率、血压及心肌耗氧量差异均无统计学意义。结论平卧位排便并不能有效减少排便过程中心率、血压及心肌耗氧量的增加,半卧位排便也可考虑作为急性心肌梗死早期患者排便的一种合理选择。     

急性心肌梗死早期患者不同排便方式的效果观察

目的 探讨急性心肌梗死早期患者不同排便方式的效果,为临床护士指导急性心肌梗死早期患者采取合理、有效的排便措施,减少排便引起并发症的发生提供依据.方法 将50例急性心肌梗死患者随机分为实验组25例和对照组25例,实验组采用床旁坐便椅坐位方式排便,对照组为传统床上平卧位排便.排便过程中持续心电血压监测,比较两组患者排便时间、有无解出、排便费力程度、舒适度.结果 实验组与对照组在排便时间上差异无统计学意义,在有无解出、费力程度、舒适度上差异均有统计学意义（P＜0.05）.结论 床上平卧位排便结果 不佳,且未能有效减少并发症的发生;急性心肌梗死早期无严重并发症,血流动力学稳定患者床旁使用坐便椅坐位排便是一种合理、科学的选择.     

Women's narratives during the acute phase of their myocardial infarction

AIM: The purpose of this study was to illuminate the meaning of lived experiences during the acute phase of an acute myocardial infarction (AMI). METHOD: Ten women (< 60 years old) afflicted with AMI narrated their experiences during their stay in the coronary care unit (CCU). The interview texts were interpreted using a method with a phenomenological hermeneutic approach, inspired by the philosophy of Ricoeur. The text was divided into meaning units that were condensed and abstracted. Three themes were then extracted from the text. FINDINGS: One theme was 'oneself as vulnerable' with the subthemes: 'the feeling of being dependent upon others', 'the feeling of being insulted' and 'the feeling of being a troublesome person'. Another theme was 'oneself as distanced', with the subthemes: 'not facing the reality', 'captive in an unreal situation', and 'inhibition out of concern for others'. The last theme was: 'oneself as making sense' with the subthemes: 'acquirement of some insight' and 'discovery of a new meaning with life'. CONCLUSION: The reported comprehensive understanding revealed the phenomena guilt and shame. These, in combination with the experience of being in an unreal situation and the withholding of feelings may have led to a deterioration of communication. It seems that relatives and the staff at CCU were not allowed to share the burden of being afflicted with an AMI.     

急性心肌梗死缺血后处理对患者发生心肌梗死后心力衰竭的影响

目的探讨缺血后处理对急性心肌梗死后患者心力衰竭的影响。 方法选取2014年1月至2015年12月于吉林大学附属吉林医院心血管诊治中心第二疗区住院患者200例,起病时间在12 h内,并急诊行经皮冠状动脉介入(PCI)治疗的患者,根据随机数字表法随机分为两组,对照组(100例,常规PCI治疗)和缺血后处理组(IPTC组)(100例,给予缺血后处理)。比较两组患者的血清同工酶(CK-MB)、肌钙蛋白I(cTnI)、脑钠肽(BNP)水平和心脏彩超中的左室射血分数(LVEF)和左室舒张末内径(LVEDD)值。 结果心肌梗死后3 d时,对照组cTnI为(40.40±3.85)ng/ml,IPTC组为(23.12±2.36)ng/ml,两组间比较差异有统计学意义(t＝7.30,P<0.05),对照组显著高于IPTC组。心肌梗死后14 d时,对照组BNP为(2 595±239)pg/mL,IPTC组为(1 391±154)pg/mL,两组间比较差异有统计学意义(t＝6.54,P<0.05),对照组显著高于IPTC组。在随访3个月时,对照组LVEF值为(48.16±4.62)mm,IPTC组LVEF值为(57.11±4.43)mm,两组间比较差异有统计学意义(t＝21.50,P<0.05),对照组显著低于IPTC组。在6个月时随访复查LVEF值,对照组为(49.78±6.22)mm,IPTC组为(60.41±3.94)mm,两组间比较差异有统计学意义(t＝4.67,P<0.05),对照组显著低于IPTC组。在6个月时随访复查LVEDD值,对照组为(52.19±6.42)mm,IPTC组为(44.24±5.47)mm,两组间比较差异有统计学意义(t＝7.70,P<0.05),对照组显著高于IPTC组。 结论缺血后处理可以改善急性心肌梗死后患者的心功能,减少急性期心肌梗死损伤。     

Metabolic modulation of acute myocardial infarction.

Acute myocardial infarction continues to be the major determinant of death and disability in Western countries. Despite large improvements in management during the last 20 years, its high morbidity and mortality rates provide a stimulus to search intensively for different and widely applicable therapeutic options.     

Men's experiences during the acute phase of their partners' myocardial infarction.

The men's narratives about the women reveal a disturbance in the balance of their daily life, showing how they, the men, perceive powerlessness, and also how they passively adapted themselves to what happened. The narratives reveal that the women are 'ignoring and withholding' their feelings and that they want to be as 'responsible and independent' as they used to be. The women are disclosed as 'not wanting to face reality': there is an enervating lack of communication.     

Effects of progressive exercise during phase I cardiac rehabilitation on the heart rate variability of patients with acute myocardial infarction

Purpose.?Heart rate variability (HRV) decreases after an acute myocardial infarction (AMI) due to changes in cardiac autonomic balance. The purpose of the present study, therefore, was to evaluate the effects of a progressive exercise protocol used in phase I cardiac rehabilitation on the HRV of patients with post-AMI.

Material and methods.?Thirty-seven patients who had been admitted to hospital with their first non-complicated AMI were studied. The treated group (TG, n?=?21, age?=?52?±?12 years) performed a 5-day programme of progressive exercise during phase I cardiac rehabilitation, while the control group (CG, n?=?16, age?=?54?±?11 years) performed only respiratory exercises. Instantaneous heart rate (HR) and RR interval were acquired by a HR monitor (Polar®S810i). HRV was analysed by frequency domain methods. Power spectral density was expressed as normalised units (nu) at low (LF) and high (HF) frequencies, and as LF/HF.

Results.?After 5 days of progressive exercise, the TG showed an increase in HFnu (35.9?±?19.5 to 65.19?±?25.4) and a decrease in LFnu and LF/HF (58.9?±?21.4 to 32.5?±?24.1; 3.12?±?4.0 to 1.0?±?1.5, respectively) in the resting position (p?<?0.05). No changes were observed in the CG.

Conclusions.?A progressive physiotherapeutic exercise programme carried out during phase I cardiac rehabilitation, as supplement to clinical treatment increased vagal and decreased sympathetic cardiac modulation in patients with post-AMI.     

Comparison of different pharmacological interventions on enzymatic parameters during acute myocardial infarction

The concept that acute myocardial infarction is a dynamic event and that different interventions can modify the extent of the necrosis, has led to renewed interest in early pharmacological and surgical treatments designed to reduce the ischemic injury. To evaluate the effects of different pharmacological interventions aimed to reduce the extent of necrosis, we studied 166 patients (138 male and 28 female, mean age of 59.4 ± 11.3 years) admitted within 6 h after chest pain and treated with a single therapy during the first 72 h. Enzymatic infarct size (IS) was calculated by serial creative kinase isoenzyme MB determinations using a compartmental model. Six groups of patients were evaluated: 33 patients were treated only with antiplatelet drugs, 38 with anticoagulants, 34 with intravenous thrombolytic therapy, 20 with calcium channel blockers, 25 with nitrates, and 16 with beta-blockers. Estimated IS (gEq/m²) and elemination constant (Kd, U/L/h) did not differ in the six groups, but patients treated with streptokinase had higher release constant (Ka, U/L/h) and shorter time to peak CK-MB value. Farly treatment (2 h after chest pain) had a favourable effect on the enzymatic IS only in patients treated with calcium channel blockers (p < 0.005).     

骨髓间充质干细胞移植对心肌梗死后心功能的影响

目的 探讨移植同种异体骨髓间充质干细胞（MSCs）是否具有改善家兔心肌梗死后心功能、缩小梗死面积的作用以及两者间的相关关系。方法 将24只大白兔随机分为急性心肌梗死（AMI）组和MSCs组,每组12只。采用局部注射法,将5-溴脱氧尿核苷（BrdU）标记的MSCs移植到兔梗死心肌边缘带和中心区。通过超声心动图测定两组手术前和术后6周心功能指标。取心脏标本用免疫组化法鉴定植入细胞,病理组织学测定梗死面积。分析心功能与梗死面积的关系。结果 MSCs组梗死心肌边缘带和中心区可见BrdU阳性细胞,AMI组未见BrdU阳性细胞。与AMI组比较,MSCs组术后6周左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）均明显缩小（P均〈0.05）,左室射血分数（LVEF）、短轴缩短率（ΔFS%）明显增大（P均〈0.05）,组织学测量梗死面积明显缩小（P〈0.05）。两组LVEF与梗死面积均成显著负相关（P均〈0.01）。结论 MSCs移植可能通过缩小心肌梗死面积改善心功能,可用于心肌梗死的治疗。     

两种方法治疗急性心肌梗死伴急性心力衰竭患者的疗效观察及护理

目的比较重组人脑利钠肽（rhBNP）和硝普钠（SNP）治疗急性心肌梗死伴急性心力衰竭患者的效果,并总结护理经验。方法将60例急性心肌梗死伴急性心力衰竭的患者随机分为rhBNP组和SNP组,每组各30例。用药期间严密监测血压,维持血压在90／60mmHg以上,共治疗72h。比较两组患者治疗前后血压、心率、尿量、呼吸困难改善情况、血肌酐和住院时间。结果rhBNP组患者的平均住院时间为（19．2±2．0）d,硝普钠组为（25．1±3．7）d,经统计学分析,P〈0．05,差异具有统计学意义;两组患者用药后血压下降的幅度、心率减慢、尿量增加和呼吸困难改善情况比较。经统计学分析,均P〈0．05,差异具有统计学意义。结论rhBNP治疗急性心肌梗死伴急性心力衰竭患者更加有效和安全。     

心脏康复治疗对急性心肌梗死患者心率变异性的影响

目的探讨Ⅰ期心脏康复对急性心肌梗死(AMI)患者心率变异性(HRV)的影响。方法选取我院2016年6月至2018年6月收治的104例急性ST段抬高型心肌梗死(STEMI)患者作为研究对象,按照是否接受院内Ⅰ期心脏康复治疗将其分为观察组(接受心脏康复治疗,48例)和对照组(未接受心脏康复治疗,56例)。比较两组患者的HRV指标、入院时与出院前的心理状态、运动能力。结果观察组患者的SDNN、SDANN、RMSSD、pNN50、VLF、HF均高于对照组(P<0.05);两组患者的LF、LF/HF比较,差异无统计学意义(P>0.05)。出院前,两组患者的SAS评分均低于入院时,且观察组低于对照组(P<0.05)。出院前,观察组患者的心率无氧阈水平高于对照组(P<0.05)。结论Ⅰ期心脏康复能提高STEMI患者的HRV,改善其焦虑情况及运动能力。     

Effect of mesenchymal stem cells transplantation on heart function after acute myocardial infarction]

OBJECTIVE: To investigate whether mesenchymal stem cells (MSCs) transplantation after acute myocardial infarction (AMI) can improve heart function and decrease infarct size in rabbits and their correlation. METHODS: Twenty-four rabbits were randomly divided into AMI group and MSCs group, each n=12. Exogenous MSCs labeled with bromodeoxyuridine (BrdU) were injected into the border and central area of the ischemic myocardium. Heart function was assessed with echocardiography before transplantation of MSCs and in 6th week after the transplantation. Surviving MSCs in infarcted myocardium were identified by immunohistochemistry. Infarct size was measured histologically. Correlation of heart function and infarctsize were analysed. RESULTS: Immunohistochemical stain revealed that BrdU-positive cells were seen in the infarcted myocardium in MSCs group but not in AMI group. Transplantation of MSCs was associated with a significant diminution of left ventricular end-diastolic dimension (LVEDD), and left ventricular end-systolic dimension (LVESD, both P<0.05), and left ventricular ejection fraction (LVEF) and fractional shortening (DeltaFS%)increased (both P<0.05) as compared with AMI group. Infarct size as measured histologically was significant smaller in MSCs group than AMI group (P<0.05). There were negative correlations between LVEF and infarct size in two groups (both P<0.01). CONCLUSION: Exogenous MSCs transplantation can improve heart function by decreasing infarct size and therefore it might be beneficial in the treatment of AMI.     

再灌注预处理对急性心肌梗死患者的影响

目的探讨急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)治疗时再灌注预处理对急性心肌梗死患者的影响。方法 87例急性心肌梗死患者行急诊PCI时,45例于支架植入前行低流量灌注10min(预处理组),42例直接行球囊扩张和支架植入(对照组)。观察2组支架植入后罪犯血管无复流发生率、再灌注心律失常、心肌损伤标志物水平和心功能变化。结果预处理组支架植入后罪犯血管无复流发生率(6.7%)低于对照组(16.7%)(P<0.01),术中及术后2h内再灌注心律失常发生率(24.4%)低于对照组(40.1%)(P<0.01),血清肌酸激酶同工酶峰值(52.5±19.4)μg/L低于对照组(66.8±22.9)μg/L(P<0.05),术后第7天左心室射血分数(55±12)%高于对照组(48±13)%(P<0.05)。结论急性心肌梗死患者行急诊PCI时采用低流量灌注进行再灌注预处理可减少心肌再灌注损伤,提高治疗效果。     

血运重建治疗对合并心力衰竭的急性心肌梗死患者预后的影响

目的 探讨合并心力衰竭的急性心肌梗死患者的临床特征和预后,并分析影响其预后的因素.方法 前瞻性连续纳入349例行急诊经皮冠脉介入治疗(PCI)的急性ST段抬高心肌梗死(STEMI)同时合并急性心力衰竭患者,按左室射血分数是否正常(定义为LVEF≥50％)将患者分为左室射血分数正常组(LVEF≥50％,n=225)和左室射血分数降低组(LVEF＜ 50％,n=124),分别评价患者住院期间的临床、血管造影、超声心动图等相关资料并对患者进行长期随访.平均随访时间为367 d,一级终点为全因病死率.结果 左室射血分数正常组和左室射血分数降低组分别有4例(1.8％)和6例(4.8％)死亡,差异无统计学意义(P=0.314).两组二级终点随访期间主要不良心脑血管事件差异具有统计学意义(P=0.022).Cox回归分析发现,患者心功能Killip分级水平(HR=1.092,95％ CI:1.040 ～1.149,P＜0.01)是影响患者死亡的独立预测因子.结论 影响行经皮冠状动脉介入治疗的急性心肌梗死合并心力衰竭患者的预后因素为患者心功能分级水平;左室射血分数正常组和左室射血分数降低组长期病死率相似.     

Growth hormone decreases phase II ventricular tachyarrhythmias during acute myocardial infarction in rats

GH (growth hormone) administration during acute MI (myocardial infarction) ameliorates subsequent LV (left ventricular) dysfunction. In the present study, we examined the effects of such treatment on arrhythmogenesis. A total of 53 Wistar rats (218+/-17 g) were randomized into two groups receiving two intraperitoneal injections of either GH (2 international units/kg of body weight; n=26) or normal saline (n=27), given at 24 h and 30 min respectively, prior to MI, which was generated by left coronary artery ligation. A single-lead ECG was recorded for 24 h post-MI, using an implanted telemetry system. Episodes of VT (ventricular tachyarrhythmia) and VF (ventricular fibrillation) during the first hour (phase I) and the hours following (phase II) MI were analysed. Monophasic action potential was recorded from the lateral LV epicardium at baseline and 24 h post-MI, and APD90 (action duration at 90% of repolarization) was measured. Infarct size was calculated 24 h post-MI. Infarct size and phase I VT+VF did not differ significantly between groups, but phase II hourly duration of VT+VF episodes was 82.8+/-116.6 s/h in the control group and 18.3+/-41.2 s/h in the GH group (P=0.0027), resulting in a lower arrhythmic (P=0.016) and total (P=0.0018) mortality in GH-treated animals. Compared with baseline, APD90 was prolonged significantly 24 h post-MI in the control group, displaying an increased beat-to-beat variation, but remained unchanged in the GH group. We conclude that GH decreases phase II VTs during MI in the rat. This finding may have implications in cardiac repair strategies.     

Variations in the composition of low- and high-density lipoproteins during the acute phase of myocardial infarction

We analyzed correlations between apolipoprotein B (apo B), cholesterol and phospholipids (preponderant lipids) in low-density lipoproteins (LDL) as well as between apolipoprotein A1 (apo A1) and these same lipids in high-density lipoproteins (HDL), during the acute phase of myocardial infarction. In LDL, a very elevated and stable correlation (r) was observed between these parameters, and the coefficients of regression (b) did not differ significantly during the period studied. In HDL, there was a decrease in r and b values from day 1 to day 2, then an increase after day 2. We hypothesize that these disturbances in HDL composition may be due to a greater endocytosis of LDL at day 2, leading to intracellular increase in cholesterol and phospholipids. Part of these lipids could be taken up by HDL molecules, causing a transient overload.     

美托洛尔对急性心肌梗死早期QT离散度的影响

目的 :探讨急性心肌梗死早期应用美托洛尔对QT离散度 (QTd)的影响。方法 :选择符合条件的 14 2例急性心肌梗死 (AMI)患者 ,男 95例 ,女 47例 ,平均年龄 5 7± 12 3岁 ,随机分为治疗组 78例 ,对照组 64例 ,两组病例性别、年龄等基本情况相似。在AMI常规治疗的基础上 ,治疗组给予美托洛尔 6 2 5～ 5 0mg口服 ,2次 /d ;对照组仅常规治疗。治疗前及治疗 1周后同步记录体表常规 12导联心电图 ,每一导联连续测量 3个Q -T间期 ,取其均值。最大QT间期 (QTmax)与最小QT间期 (QTmin)之差为QTd。结果 :治疗组在常规治疗基础上早期给予美托洛尔后 ,QTd、QTcd显著缩小 (P <0 0 1) ,QTmax无明显改变 (P >0 0 5 ) ,QTmin显著延长 (P <0 0 5 ) ,心率显著减慢 (P <0 0 1)。而对照组QTd、QTcd、QTmax、QTmin、HR均无明显变化 (P >0 0 5 )。结论 :AMI早期应用 β1 受体阻滞剂美托洛尔治疗 ,可显著延长正常心肌的复极过程 ,从而防治早期恶性心律失常 ,降低猝死率。     

糖尿病对急性心肌梗死病死率的影响

目的探讨糖尿病对急性心肌梗死(AMI)病死率的影响。方法在624例AMI患者中,有糖尿病者136例为A组,非糖尿病者488例为B组,然后将两组的发病年龄、临床特征及并发症进行比较,并对可能影响AMI患者住院病死率的因素进行多因素回归分析。结果与非糖尿病组相比,糖尿病组患者年龄较大[(66 10)岁比(64 9)岁,P0.01],空腹血糖较高[(10.8 3.9)mmol/L比(5.3 1.5)mmol/L,P0.01],心功能≥KillipⅢ级者较多(12.5%比6.1%,P0.01),A组发生的高血压、血脂异常及心律失常明显高于B组,两组之间比较差异有统计学意义(P0.05),且A组患者住院病死率显著高于B组(15.4%比5.9%,P0.01)。结论糖尿病是影响AMI患者住院病死率的独立危险因素。     

延迟经皮冠状动脉介入治疗对急性心肌梗死患者心肌灌注及心功能的影响

目的：采用99 m 锝甲氧基异丁基异腈(99 m Tc-MIBI)门控静息心肌断层显像,研究延迟经皮冠状动脉介入(percutaneous coronary intervention,PCI)对急性心肌梗死(acute myocardial infarction,AMI)的疗效。方法选首次发病时间超过12小时但不超过72小时,未行溶栓治疗且无持续胸痛的 AMI 患者62例,随机分为对照组(n =31),只给予常规药物治疗,延迟 PCI 组(n =31)在常规药物基础上,发病后7~14天行 PCI 治疗。两组均于发病1周及治疗后4周行99 m Tc-MIBI 门控静息心肌断层显像,比较两组治疗前后左心室舒张末期容积(left ventricular end diastolic volume,LVEDV),左心室收缩末期容积(left ventricular end systolic volume,LVESV)、左心室射血分数(left ventricular ejection fraction,LVEF)、心肌缺血面积(ischemic area,IA)的变化。结果两组患者发病1周时的LVEDV、LVESV、LVEF 及 IA 差异无统计学意义。治疗4周后延迟 PCI 组 LVEDV、LVESV 明显下降,分别为(73.87±5.90)ml vs (81.20±7.14)ml,(26.51±3.51)ml vs (30.90±3.84)ml(P <0.01);与对照组比较 LVEF明显升高,(66.23±5.20)% vs (60.97±4.58)%(P <0.01)、IA 明显缩小(10.67±3.01)% vs (12.93±3.54)%(P <0.01)。结论对于 AMI 患者,延迟 PCI 可以更完全地血运重建,明显改善心肌灌注及恢复心室功能,可以改善预后;99m Tc-MIBI 门控静息心肌断层显像可以定量分析心肌灌注及心功能变化,可以准确评价延迟 PCI 治疗 AMI 效果。     

Effect of flosequinan in patients with acute-onset heart failure complicating acute myocardial infarction

We studied the hemodynamic effect of a single dose of the new direct-acting vasodilator, flosequinan, in ten patients with severe acute-onset heart failure complicating acute myocardial infarction (MI) resistant to high iv doses of diuretics, nitrates, and dobutamine. Flosequinan was added to conventional therapy at 3.8 +/- 0.5 days after infarction in the form of a single 100-mg oral dose. Hemodynamic measurements were performed every hour for 4 h after administration, without any other drug being added. The nitrate infusion rate was kept constant. Flosequinan produced hemodynamic improvement in this group. The effect peaked at 1 to 2 h and remained at this level at 4 h. Pulmonary capillary wedge pressure decreased from 27.2 +/- 5.4 to 16.4 +/- 3.0 mm Hg, and cardiac output increased from 3.5 +/- 0.3 to 4.1 +/- 0.4 L/min (p less than .001 for both). Cardiac index, stroke index, and left ventricular stroke work index were significantly increased. Pulmonary arterial and right atrial pressures, and systemic and pulmonary vascular resistances were also significantly reduced. Heart rate was not significantly altered. Mean systemic arterial pressure was slightly reduced. Flosequinan administration was not associated with symptomatic hypotension, cardiac arrhythmias, or other adverse events, and the hemodynamic effect was not related to the pretreatment serum sodium concentration. We conclude that flosequinan is effective in producing acute hemodynamic improvement in patients with heart failure complicating acute MI resistant to conventional therapy.