结扎犬前降支冠脉后的乳头肌血流量

结扎犬前降支冠脉是复制急性心肌缺血模型的主要方法之一。Blair利用冠脉铸型法证明犬左室前壁主要由左前降支冠脉供血,而左室前乳头肌主要由间隔动脉供血。本文目的在于观察当结扎左前降支冠脉后,左室前乳头肌和左室前壁的血流量将发生怎样的不一致性变化,并讨论该变化在实验性心肌缺血的研     

左冠状动脉曲率与左前降支狭窄对局部血流动力学的影响

目的 探究不同的左前降支(left anterior descending, LAD)狭窄程度和分叉血管曲率对血流动力学的影响。方法 建立不同分叉血管曲率半径和 LAD 分支狭窄率的理想模型,使用流固耦合( fluid-structure interaction, FSI)方法评估不同曲率半径和不同狭窄率情况下对血流和壁面剪切力相关指标的影响。 结果 LAD 发生狭窄后,高震荡剪切指数(oscillatory shear index, OSI)和高相对滞留时间(relative residence time, RRT)区域主要分布于 LAD 分叉脊对侧、弯曲外侧狭窄位置下游近端和弯曲内侧下游远端,并且随着狭窄程度的增加会扩大其区域与程度;由于曲率半径减小,弯曲内侧中的高 OSI 和 RRT 会向 LAD 下游远端分布,高 RRT 区域面积相对整个血管面积平均降幅能够达到 35. 68% 。 结论 LAD 狭窄的存在会增加狭窄位置下游和 LAD 分叉脊对侧发生继发性狭窄的风险。 曲率降低会促进弯曲内侧斑块的形成与发展,但从整个血管来看,又会细微地降低斑块形成概率。 研究结果可为治疗 LAD 病变与预防继发性狭窄提供方案设计与优化的理论参考。     

应用聚乙烯泡沫封堵法建立Beagle犬心肌梗死模型

目的： 通过心导管技术用聚乙烯泡沫封堵法封堵Beagle犬的左冠状动脉,建立慢性心肌梗死的动物模型。方法: 30只10-12 kg Beagle犬,全麻后经颈总动脉用聚乙烯泡沫经导管栓塞左前降支第2对角支远端,造成心肌梗死模型。结果： 所有犬造影均成功,术中1只犬因为冠脉破裂,心包填塞死亡,2只犬术中室速室颤死亡。2只犬术中出现III度房室传导阻滞死亡。其余的犬均造模成功。手术即刻存活率为83.3％,术后2周内的存活率为66.6％。结论： 在X光下用聚乙烯泡沫封堵法制作心肌梗死模型效果明确,接近临床病理生理过程,可重复性好,比传统的开胸结扎冠状动脉更安全,可作为研究心肌缺血的实验模型。     

血管内皮细胞病理生理作用的研究进展

血管内皮细胞广泛分布于全身各处,是机体中唯一直接与血流接触的细胞,也是组织和血液之间的第一道具有半透膜性质的通透性屏障。由于其携有不同生物活性物质的受体而积极参与大分子、血管内血细胞、血管壁平滑肌和细胞外基质成分的复杂反应,具有合成代谢、分泌功能,并涉及凝血、免疫、炎症和组织修复过程,几乎所有组织都受其影响和调节,以保持机体内环境的稳定。内皮细胞结构的完整性与否,已被视为创伤、休克、水肿、感染、肿瘤、心脑血管疾病和糖尿病等多种疾病和综合征发生发展的病理生理学基础。因此,深入探讨血管内皮细胞病理生理作用机制,对研究如何保护和修复内皮细胞功能,改善相关疾病的预后有积极的意义。     

丹参提取物促大鼠心肌梗死后心肌组织血管新生的作用

目的:观察丹参提取物对大鼠心肌梗死后心肌组织血管新生的作用并分析其可能的机制。方法:采用经典的冠状动脉左前降支结扎造模方法成功复制大鼠心肌梗死模型后,随机将大鼠分为模型组以及丹参提取物低(10 mg·kg-1·d-1)、中(20 mg·kg-1·d-1)、高(40 mg·kg-1·d-1)剂量治疗组,另设假手术组大鼠为对照组,各组大鼠数量均为8只。丹参提取物各治疗组给予上述对应的各药物剂量灌胃给药,模型组及对照组大鼠给予等量的生理盐水灌胃,连续饲养4周后应用HE染色、Masson染色和电镜法观察大鼠左心室心肌组织和血管结构病理成分变化,免疫组化染色分析心肌组织中血管内皮生长因子(VEGF)及CD34蛋白的表达变化。结果:组织病理学分析表明,与假手术组相比,模型组大鼠心肌组织形态较为紊乱,部分心肌细胞轮廓消失,坏死心肌组织呈现明显的纤维化,血管不完整,血管超微结构模糊或者消失;丹参提取物治疗之后,新生的血管数量明显增多,且超微结构分析表明,内皮细胞形态相对完整。心肌组织中VEGF及CD34蛋白表达结果证实,模型组较假手术组大鼠表达略有增加,但没有统计学差异;和模型组比较,丹参提取物各治疗组VEGF及CD34蛋白表达明显增多(P0.01)。结论:丹参提取物可明显促进大鼠心肌梗死后心肌组织的血管新生。     

兔冠状动脉结扎后血管紧张素Ⅱ水平的变化

兔冠状动脉结扎后血管紧张素Ⅱ水平的变化何振山，宁佩萸，吴广礼，崔俊玉，张荣莲，李洁（解放军白求恩国际和平医院，石家在０５００８２）我们建立了兔急性心梗（ＡＭＩ）模型，用放射免疫的方法检测ＡＭＩ后２４ｈ及４周两个时间点周围静脉血，冠状窦血和不同状态的心...     

结扎大鼠左冠状动脉后心壁内血管变化的实验形态学观察

本文用119例大鼠,观察左心室壁内血管和结扎左冠状动脉后心壁内血管的变化。其中75例心脏经主动脉灌注20％中国墨汁明胶液后,作火棉胶切片;另外44例心脏直接固定,作石蜡幼片观察。大鼠左心室游离壁内血管类型与人及家兔基本相似。室间隔内毛细血管分布与家兔相似。左心室游离壁毛细血管数目为3,903±48条/mm~2,毛细血管与心肌纤维数目比例约为1:1。毛细血管互相吻合成网,其走行与心肌纤维方向一致。结扎大鼠左冠状脉后,左心室壁内血管变化可分为缺乏血管、血管密集和血管稀疏等三个阶段,其演变规律与修复过程相适应,并提示大鼠心肌梗塞后1～2天,侧支循环开始建立;3～7天,侧支循环逐渐丰富。与人类心肌梗塞和家兔心肌梗塞模型相比,大鼠心肌梗塞模型的血管自然演变过程较快,但规律是相似的。     

心肌缺血犬经激光心肌血管重建后VEGF和bFGF的变化及心肌血管新生

目的：观察激光心肌血管重建术（TMLR）后血管内皮细胞生长因子（VEGF）和碱性成纤维细胞生长因子（bFGF）与新生血管密度的关系。方法：北京地区杂种犬25只,以单纯缺血为对照组5只（3 d、1、2、4周和8周）5个时相检测血浆中VEGF、bFGF水平;实验组行心肌打孔后（1、2、4、8周）4个时相,每时相均为5只活杀显微镜下观察心肌血管密度的变化。结果：实验组VEGF和bFGF血浆浓度分别在术后2周和1周达高峰,心肌血管密度在术后4周达高峰（10.23‰±2.23‰）。结论：TMLR术可通过介导致血管生成的生长因子（如VEGF和bFGF）的表达来达到其部分血管新生的作用。     

强利尿心钠素对实验犬冠脉循环及心肌氧代谢的影响

本文利用结扎犬冠脉左前降支造成急性缺血模型，观察了冠脉内灌注强利尿心钠素０．６μｇ．ｋｇ＾－１．ｍｉｎ＾－１，０．２μｇ．ｋｇ＾－１．ｍｉｎ＾－１及生理盐水对冠脉侧支循环及心肌氧代谢的影响。     

兔腹主动脉狭窄后剪切力的变化对局部内皮细胞形态和通透性的影响

兔腹主动脉狭窄至正常的55.2％，伊文思蓝对动脉染色，在扫描电镜下观察内皮细胞形态，计算细胞形态指数。动脉狭窄血管内流动壁面剪切率的分布由计算机数值模拟确定。结果表明，在紧接狭窄处的近远两侧，血流受到严重干扰，内皮细胞的形态和对伊文思蓝白蛋白复合物通透性发生明显改变。研究表明，这些改变不但与剪切应力的大小有关，还与血液流动的状态有关。这与动脉粥样硬化一般好发于血液流动受到干扰，流动发生分离区域的解剖观察一致。     

Adherence to lifestyle changes after coronary artery bypass graft: Outcome of preoperative peer education

ObjectiveThis study was done to investigate the effect of preoperative peer education on patients' adherence to medication and lifestyle changes after Coronary Artery Bypass Graft (CABG).MethodsIn this randomized clinical trial, the peers of CABG patients conducted preoperative educational sessions at the ward in groups of 4–5 (n = 36) while the control group (n = 34) received routine education by a nurse. Adherence of both groups to medication and recommendations for lifestyle modification including physical activity, smoking, and diet was measured one and two months after discharge.ResultsA multivariate analysis of co-variance showed the significant effect of peer education on adherence (F = 32.586, p < 0.001; η² = 0.671). Univariate ANCOVA revealed a significant difference in adherence to diet between the two groups (F = 62.316, p = 0 0.0001; η² = 0.482). Based on the repeated measures ANOVA, peer education significantly improved the CABG patients' adherence to diet (F = 55.373, p = 0.0001) and their total adherence (F = 9.911, p = 0.002) compared to the control group.ConclusionPreoperative peer education had a significant effect on improving CABG patients' adherence to lifestyle changes after hospital discharge.Practice implicationPeer education can be used as an effective method to improve the CABG patients ' adherence to lifestyle changes.     

Position-dependent changes in vagal modulation after coronary artery bypass grafting

Reduced cardiac vagal modulation increases propensity to arrhythmias. Right decubitus position is a vagal enhancer in coronary and congestive heart disease. We evaluated vagal modulation before and after coronary artery bypass grafting (CABG) in 30 patients. Heart rate variability (HRV) indexes in frequency domain were calculated from 10-min digital electrocardiograms. Kolmogorov-Smirnov and paired t-tests were applied, p<0.05 was considered significant. The HRV indexes decreased after CABG. Higher LF/HF ratio and shorter mean RR were observed in right recumbent position postoperatively. Right lateral decubitus position did not give rise to higher vagal modulation after heart surgery.     

老年冠状动脉粥样硬化性心脏病患者冠状动脉病变影响因素的探讨

目的探讨循环人血管紧张素1～7(Ang1～7)、内皮细胞微颗粒CD31^＋、单核细胞CD14^＋CD16^＋和超敏C－反应蛋白(hs－CRP)对老年冠状动脉粥样硬化性心脏病患者冠状动脉病变的影响。 方法选择2010年1月至2014年3月老年冠状动脉粥样硬化性心脏病患者140例,健康对照组50例。根据冠状动脉狭窄程度将患者分为3组：75%～84%组,85%～94%组和95%～100%组;根据冠状动脉病变支数将患者分为4组：单支、双支、三支和四支病变组;再根据美国纽约心脏病学会(NYHA)分级将患者分为4组：NYHAⅠ、Ⅱ、Ⅲ、Ⅳ级组;又根据左心室射血分数(LVEF)进一步将患者分为3组：48%～58%组、36%～47%组和25%～35%组;根据6 min步行试验的步行距离又将患者分为3组：>450 m组、150～450 m组和<150 m组。采用流式细胞术检测血清CD31^＋和CD14^＋CD16^＋水平的变化,使用双夹心抗体酶联免疫吸附法定量检测Ang1～7水平,应用免疫散射比浊法测定hs－CRP的水平。多组间差异采用单因素方差分析,组间两两比较采用t检验。 结果冠状动脉狭窄75%～84%组Ang1～7(34.8±6.9)pg/mL、CD31^＋(471±29)个/μL、CD14^＋CD16^＋(1.4±0.3)%、hs－CRP(1.7±0.8)mg/L分别与冠状动脉狭窄95%～100%组Ang1～7(9.1±0.4) pg/mL、CD31^＋ (1554±40)个/μL、CD14^＋CD16^＋(5.9±0.8)%、hs－CRP(17.1±1.5) mg/L比较,差异均有统计学意义(P值均小于0.05);冠状动脉单支病变组Ang1～7(38.7±7.9)pg/mL、CD31^＋(496±30)个/μL、CD14^＋CD16^＋(2.1±0.7)%、hs－CRP(1.9±0.9)mg/L与分别冠状动脉四支病变组Ang1～7(11.2±2.0)pg/mL、CD31^＋(1583±52)个/μL、CD14^＋CD16^＋(10.6±1.4)%、hs－CRP(14.9±1.9)mg/L比较,差异均有统计学意义(P值均小于0.05);NYHAⅠ级组Ang1～7(38.5±2.7)pg/mL、CD31^＋(511±32)个/μL、CD14^＋CD16^＋(1.7±0.5)%、hs－CRP(1.9±0.2)mg/L与分别NYHA Ⅳ级组Ang1～7(10.0±1.2)pg/mL、CD31^＋(1598±49)个/μL、CD14^＋CD16^＋(12.1±1.4)%、hs－CRP(15.0±1.9)mg/L比较,差异均有统计学意义(P值均小于0.05);LVEF 48%～58%组Ang1～7(32.9±6.8)pg/mL、CD31^＋(385±28)个/μL、CD14^＋CD16^＋(2.9±0.8)%、hs－CRP(2.1±0.8)mg/L与分别LVEF 25%～35%组Ang1～7(9.5±2.0)pg/mL、CD31^＋(1644±54)个/μL、CD14^＋CD16^＋(13.0±1.6)%、hs－CRP(14.1±2.0)mg/L比较,差异均有统计学意义(P值均小于0.05);6 min步行试验>450 m组Ang1～7(36.4±7.1)pg/mL、CD31^＋(561±30)个/μL、CD14^＋CD16^＋(1.9±0.5)%、hs－CRP(2.1±0.9)mg/L与分别6 min步行试验<150 m组Ang1～7(10.1±0.9)pg/mL、CD31^＋(1338±41)个/μL、CD14^＋CD16^＋(7.2±0.9)%、hs－CRP(18.7±1.5)mg/L比较,差异均有统计学意义(P值均小于0.05)。 结论Ang1～7水平下降,CD31^＋、CD14^＋CD16^＋和hs－CRP表达水平的增高可能影响老年冠状动脉病变的严重程度。     

Pathological evaluation of coronary lesions in cases of cardiac rupture during acute myocardial infarction: An autopsy study of 148 out-of-hospital sudden death cases

We pathologically evaluated coronary artery lesions of left ventricular ruptures during acute myocardial infarctions (148 sudden out-of-hospital death cases; 93 men and 55 women; age range 42–94 years; mean age 68.9 years; 143 atherosclerotic and 5 non-atherosclerotic lesions). Among the 143 hearts with atherosclerotic coronary lesions, three-vessel disease was most frequent, and plaque rupture or erosion and occlusive thrombus were identified in most cases. Ages of the main component of the occlusive thrombus in the culprit coronary artery corresponded histopathologically to those of myocardial infarction. One of the most outstanding features in this pathological study is that acute thrombus in the culprit coronary artery was identified morphologically in most of the cases with advanced myocardial infarction (3 or more days). On the other hand, in cases of fresh myocardial infarction, a preceding mural non-occlusive organizing thrombus was observed mostly underneath the main component of the thrombus. It is suggested that, in most cases, cardiac rupture during acute myocardial infarction occurs at the time of a new ischemic event caused by a new thrombotic coronary lesion.     

Short-term response of metabolic hormones to coronary artery bypass surgery

PurposeTo explore the response pattern of plasma adipokine and ghrelin levels to coronary artery bypass graft (CABG) surgery in patients with (on-pump) and without (off-pump) cardiopulmonary bypass (CPB).Material/methodsSixteen consecutive patients (age: 62 ± 10 years, male: 10) with obstructive coronary artery disease (CAD) who underwent elective CABG surgery with CPB and intraoperative GIK infusion were selected for on-pump group and 19 CAD patients (age: 63 ± 10 years, male: 16) were included in the off-pump group. Blood samples were taken before, during and after surgery. Intraoperative samples were withdrawn simultaneously for peripheral vein and sinus coronarius (SC). Plasma adipokine concentrations were measured by ELISA, those of ghrelin by RIA kits.ResultsIn response to surgical intervention there was an early, transient fall in plasma levels of adiponectin (p < 0.0001) and resistin (p = 0.002) followed by an increase to approach their initial values. Plasma ghrelin also increased (p = 0.045), this increase, however, was confined to the period of GIK supported CPB. Plasma insulin (p = 0.003) and resistin (p = 0.009) was significantly higher in the peripheral vein than in SC. The perioperative hormone profile of patients without CPB (off-pump) proved to be comparable to that of on-pump patients in spite of the insulin administration and greater oxidative and inflammatory stress.ConclusionsAdipose tissue-derived factors appear to mediate the metabolic and vascular changes that occur in patients with CABG surgery. Epicardial adipose tissue is unlikely to have major contribution to the development of CAD as adipokines are not elevated in SC independent of the mode of intervention.     

纳洛酮对急性冠脉闭塞后家兔心功能的影响及其机制的研究

本实验观察了阿片受体拮抗剂纳洛酮对急性冠脉闭塞家免心肌舒缩性能的影响以及这种影响和肾上腺素能β受体的关系。结果表明:在家兔急性冠脉闭塞早期,纳洛酮可显著增强心肌舒缩性能,改善心功能;β受体阻滞剂心得安可取消纳洛酮的这种作用。说明纳洛酮增强急性冠脉闭塞家兔心肌舒缩性能的作用与肾上腺表能神经活动密切相关。     

旋股外侧动脉降支作为冠状动脉旁路移植血管的研究进展

目的 总结旋股外侧动脉降支(DBLCFA) 作为冠状动脉旁路移植血管的研究进展。方法 将“旋股外侧动脉降支”“冠状动脉旁路移植术”“心肌血运重建”“全动脉化”“解剖”以及“coronary artery bypass grafting” “descending branch of the lateral circumflex femoral artery”“myocardial revascularization”“total arterial revascularization”等作为关键词在中国知网、万方数据以及PubMed数据库中进行文献检索,根据纳入和排除标准最终纳入1996年1月—2020年11月相关文献共30篇,其中中文2篇、英文28篇。结合临床经验,从DBLCFA的解剖学特点、组织学表现以及在冠状动脉旁路移植术中应用的疗效和手术技术等方面进行总结。结果 DBLCFA在解剖上具有足够的可获取长度以及与冠状动脉相匹配的血管直径等特点,在组织学上具备抗动脉粥样硬化的稳定性,且获取途径便捷、中期通畅率良好,因此成为心肌血运重建手术中动脉桥血管材料的一种可靠选择。结论 DBLCFA作为冠状动脉旁路移植血管具有良好的临床应用价值,在技术上安全可行,拥有较好的中期效果和较低的并发症发生率,但其远期应用效果尚需进一步评估。     

Metal allergy to stainless steel wire after coronary artery bypass grafting

 To our knowledge, this is the first reported case of a manganese metal allergy to stainless steel wire. A 51-year-old man suffered from a refractory pruritic erythematous wheal after the insertion of a stainless steel wire. The patch test showed strong reactions to manganese, one of the constituents of stainless steel wire. After the removal of all stainless steel wires, the symptoms were much improved, except for mild pruritus on his face. Received: March 28, 2002 / Accepted: October 16, 2002 Correspondence to:K. Takazawa