复苏后心功能不全犬模型心肌凋亡的变化

目的观察犬心跳骤停复苏后心肌细胞凋亡的变化.方法体外电击诱发犬室颤,3min后复苏,12只犬随机分为2组,CPR组,空白对照组,每组6只,采用Swan-Ganz漂浮导管监测复苏前和后6h的CO和PAWP,6h后取心肌组织,TUNEL法检测心肌组织凋亡的形态学改变.结果两组各血流动力学指标在心跳骤停前无统计学差异,CPR组的MAP在复苏成功即时高于空白对照组,随后开始下降,在复苏后4、6h低于空白对照组.CPR组的PAWP从心跳骤停前的(5.00±1.26)mmHg一直上升,到复苏后达高峰(28.83±4.79)mmHg,各观察点均高于空白对照组,CO在复苏成功后随时间延长而下降,6h降至最低,复苏后各观察点均低于空白对照组.CPR组心肌细胞凋亡指数高于空白对照组.结论电击诱发室颤犬复苏成功后存在着心功能不全和心肌细胞凋亡增加.     

复苏后心功能不全

心跳骤停者在复苏后出现心功能不全，并影响患者的预后．实验表明：在复苏后出现可逆性左室收缩及舒张功能不全，复苏时间过长、血管收缩剂的应用、除颤的能量和方式可以加重心功能不全．本文对近年的研究进行综述．     

复苏后心功能不全

心跳骤停者在复苏后出现心功能不全,并影响患者的预后.实验表明:在复苏后出现可逆性左室收缩及舒张功能不全,复苏时间过长、血管收缩剂的应用、除颤的能量和方式可以加重心功能不全.本文对近年的研究进行综述.     

心肌肥厚与心功能不全时冠脉微循环障碍

我们已经知道在心肌肥厚和扩张型心肌病的动物模型上,通过快速起搏负荷等即可诱发心肌缺血.在这些疾病当中,一般在心脏表面大的冠状动脉并没有发现狭窄性病变.所以,人们把目光转移到管理和调节冠脉血流的微小血管的机能上.本文就是基于基础实验结果和近年大量的临床实验观察,对在心肌肥厚和心功能不全时的冠脉血流调节异常进行阐述.     

联合用药O治疗老年性心功能不全的疗效观察

目的:观察联合用药治疗老年慢性心衰取得的疗效。方法:老年慢性心衰患者110例,随机分为治疗组和对照组,治疗组56例,对照组54例。两组年龄、性别、心功能及病因构成均无显著性差异(P>0.05)。治疗组用倍他乐克开始为6.25mg2/d,病情稳定后逐步调整到25-50mg/d,每日2次,加螺内酯40mg/d、地高辛0.25mg/d,7天后改为0.125mg/d半月、卡托普利12.5mg,3/d。病情稳定后逐步调整到25mg3/d。对照组:双氢克尿塞25mg2/d,、卡托普利、地高辛用法同治疗组。给药期间患者血压不低于90/60mmHg,心率不低于55次/分;结果:两组病人经治疗6～12月后治疗组较对照组HR、CI、EF、6-MWT有明显改善(p<0.05),两组6～12月后因心衰恶化再住院率有显著差异(p<0.05)。结论:联合用药对老年患者长期治疗可减少住院率,明显提高LVEF和运动耐量,改善患者的生活质量,提高患者的生成率。我们认为倍他乐克、加螺内酯、地高辛、卡托普利联合治疗老年慢性心功能不全安全、有效、副作用小。     

心室重构中的心肌细胞凋亡

心力衰竭的最重要特征是心肌结构和功能改变而引起的心室重构,这不仅与细胞肥大、蛋白合成及细胞外基质增多有关,而且还涉及到心肌细胞凋亡,并且认为心肌细胞凋亡可能是心肌功能进行性恶化的重要机制之一。     

老年心功能不全病人甲状腺激素测定的临床应用

目的 :了解老年心功能不全病人的甲状腺激素水平的变化规律。方法 :用放射免疫分析检测 1 30例心功能不全的老年病人和 4 0例心功能正常的老年健康志愿者血清甲状腺激素水平。结果 :心功能Ⅰ级和Ⅱ级病人其TT3 值和FT3 值的下降与正常的对照组相比 ,有显著差异 (p <0 0 1 ) ,而TT4及FT4无差异 ;Ⅲ和Ⅳ级心功能的病人其FT4的下降有差异 (p <0 0 5 ) ,TT3 和FT3 的下降有显著差异 (p <0 0 1 ) ,而TT4无差异。结论 :临床上对老年心功能不全的病人检测其甲状腺激素水平的变化 ,有一定的反映病情状况及观察预后的作用 ,亦可了解老年心功能不全病人内分泌代谢的变化 ,同时在分析甲状腺功能时 ,应了解病人心功能情况     

大鼠心肺复苏后血清硫化氢浓度变化

目的:寻找心肺复苏后大鼠血清硫化氢(H2S)浓度的变化规律以探讨H2S在心肺复苏(CPR)后病理生理发展中的作用。方法:将30只雄性SD大鼠随机分为对照组6只和实验组24只,实验组采用经皮电刺激心外膜建立大鼠心脏骤停(CA)模型,分别于CA前、自主循环恢复(ROSC)后2、4、6、8、10和12h采血测定H2S浓度并记录体温、平均动脉压、心率和呼吸频率,分析血清H2S在CPR后的动态变化规律及其与上述生命体征的相关性。结果:①实验组24只大鼠全部诱发心脏骤停并复苏成功,观察终点时(ROSC后12h)有14只大鼠存活且生命体征稳定;对照组无死亡现象。②实验组与对照组大鼠心肺复苏后血清H2S浓度动态变化趋势明显不同(F=12.226,P=0.003);实验组大鼠在心肺复苏后血清H2S浓度迅速升高,于ROSC后6h时达到高峰,然后回落至与对照组相似的水平。③血清硫化氢浓度与体温(偏相关系数r=-0.556,P=0.000)和平均动脉压(偏相关系数r=-0.240,P=0.002)呈负相关,而与心率和呼吸频率的相关性无统计学意义。结论:血清H2S变化可能是CA大鼠ROSC后代偿性反应的一种表现并参与体温和血压等生理过程的调节,但其确切机制还有待于进一步深入研究。     

经冠状动脉灌注不同类型的干细胞对慢性心功能不全兔心功能影响的比较研究

研究非选择性冠状动脉灌注移植干细胞治疗非缺血性心功能不全的可行性；比较自体骨髓单个核细胞（BMCs）、间充质干细胞（MSCs）和成肌细胞（SMs）移植对心功能的影响。使用阿霉素制作兔心功能不全模型，经双球囊封堵主动脉根部后分别灌注自体BMCs、MSCs、SMs和无血清DMEM。比较移植前后左室射血分数（LVEF）及左室舒张末期内径（LVED）变化。结果表明，干细胞移植术中及移植后4周内病死率为7．1％和16．7％。假手术组移植后LVEF有继续恶化的趋势（P〉0．05）。移植4周后，BMCs组LVEF明显改善（P〈0．05，n=8）；MSCs组LVEF有改善的趋势（P〉0．05，n=8）；SMs组LVEF未见改善（P〉0．05，n=6）。假手术组移植后LVED继续扩大（P〈0．05）；各移植组LVED有继续扩大的趋势（P〉0．05）。移植各组心肌组织切片上均发现了存活的移植细胞。移植的BMCs和MSCs表达了肌钙蛋白I。说明，经冠状动脉灌注细胞移植可用于治疗非缺血性心功能不全的实验研究。     

慢性心功能不全患者血浆心钠素RIA的临床意义

本文报道了我院52例各级心功能的心脏病患者血浆中心钠素的浓度，并与20例健康人进行对照对心钠素与心功能不全的相互关系及其变化的临床意义进行了探讨。     

Life Changes in Patients After Out-of-Hospital Cardiac Arrest

Background

Cardiac arrest is a traumatic event that often affects patients’ lives in many ways. Patients after near-death experiences (NDEs) often express strong and permanent change of their values, beliefs and principles.

Purpose

The aim of this study was to determine the association between NDEs and life changes in patients 6 months after out-of-hospital cardiac arrest.

Method

This was a prospective observational study, which included 37 patients (average age 54.0 years, range 22–81 years, 29 males) 6 months after out-of-hospital cardiac arrest. The presence of NDEs was assessed with a self-administered Greyson’s NDE scale. The intensity of life changes was assessed with a self-administered Ring’s life change inventory. Univariate analysis was performed.

Results

NDEs were reported by seven (18.9%) patients. In comparison to the non-NDEs group, patients in the NDEs group expressed significantly stronger changes in the following items: tolerance for others, understanding of myself, appreciation of nature, sense that there is some inner meaning to my life and concern with questions of social justice.

Conclusions

Cardiac arrest survivors do not express extensive life changes. But, the presence of NDEs is significantly associated with the change of interest in some aspects of patients’ lives. Such patients should be prepared for significant life changes that might occur after NDEs by health workers and receive professional help to accommodate to them.     

Myocardial Degeneration and Cardiac Arrest in Squirrel Monkey: Physiological and Psychological Correlates

Behavioral factors and cardiovascular changes associated with myocardial degeneration and cardiac arrest induced by shock avoidance stress were studied. Pairs of avoidance and yoked squirrel monkeys were exposed to a 24-hr session. Myocardial degeneration and cardiac arrest were more readily induced in avoidance than yoked monkeys. The cardiac lesions were not related to body weight, aggressive behavior, or number of shocks received during stress, but an increased heart rate without hypertension during the first stress hour was more evident in avoidance than yoked monkeys. These cardiac changes were attributed to an autonomic disturbance associated with the response contingencies of the avoidance situation. An autonomic effect also appeared to be involved with stress-induced death. These deaths were characterized by a sudden, severe bradycardia without initial hypotension and cardiac arrest which was attributed to either parasympathetic activation or sympathetic inhibition. While heart rate decreased in all monkeys, stress-induced death followed only in monkeys which gave up and stopped contending with the stress. Thus, stress-induced myocardial changes and death were related to autonomic disturbances precipitated by psychological stress.     

Epidemiology and Outcomes in Out-of-hospital Cardiac Arrest: A Report from the NEDIS-Based Cardiac Arrest Registry in Korea

Sudden cardiac death (SCD) is a significant issue affecting national health policies. The National Emergency Department Information System for Cardiac Arrest (NEDIS-CA) consortium managed a prospective registry of out-of-hospital cardiac arrest (OHCA) at the emergency department (ED) level. We analyzed the NEDIS-CA data from 29 participating hospitals from January 2008 to July 2009. The primary outcomes were incidence of OHCA and final survival outcomes at discharge. Factors influencing survival outcomes were assessed as secondary outcomes. The implementation of advanced emergency management (drugs, endotracheal intubation) and post-cardiac arrest care (therapeutic hypothermia, coronary intervention) was also investigated. A total of 4,156 resuscitation-attempted OHCAs were included, of which 401 (9.6%) patients survived to discharge and 79 (1.9%) were discharged with good neurologic outcomes. During the study period, there were 1,662,470 ED visits in participant hospitals; therefore, the estimated number of resuscitation-attempted CAs was 1 per 400 ED visits (0.25%). Factors improving survival outcomes included younger age, witnessed collapse, onset in a public place, a shockable rhythm in the pre-hospital setting, and applied advanced resuscitation care. We found that active advanced multidisciplinary resuscitation efforts influenced improvement in the survival rate. Resuscitation by public witnesses improved the short-term outcomes (return of spontaneous circulation, survival admission) but did not increase the survival to discharge rate. Strategies are required to reinforce the chain of survival and high-quality cardiopulmonary resuscitation in Korea.

Graphical Abstract

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益景汤对糖尿病大鼠心脏血流动力学指标和心肌细胞凋亡的影响

目的:观察益景汤对糖尿病(DM)大鼠心脏血流动力学、心肌肥大和心肌细胞凋亡的影响。方法:采用链脲佐菌素(STZ)成功诱导DM大鼠模型,将成模大鼠分为益景汤治疗组(每天汤药灌胃3ml,相当于生药10.71g/kg)、贝那普利治疗组(每天腹腔注射10μg/kg)、模型组(每天给予3ml生理盐水灌胃),每组20只,另选20只为正常组(每天灌胃3ml生理盐水)。连续12周后采用动脉插管测定心脏血流动力学指标左室压力(LVP)、左室内压最大上升/下降速率(+dp/dtmax和-dp/dtmax)及左室舒张末压(LVEDP)。之后称取大鼠体重(BW),并取各组大鼠心脏称重(HW),再取左室称重(LVH),计算心脏质量指数(HMI)和左室质量指数(LVMI);切取部分左室制备心肌组织切片,采用TUNEL法检测心肌细胞凋亡。结果:方差分析显示,各组大鼠心脏血流动力学指标及HMI和LVMI均有统计学差异(P均0.01)。两两比较表明,DM各组LVP、+dp/dtmax及-dp/dtmax均低于正常组,且模型组益景汤治疗组贝那普利治疗组,差异均有统计学意义(P均0.01);DM各组LVEDP均高于正常组,且模型组益景汤治疗组贝那普利治疗组,差异也有统计学意义(P均0.01);DM各组HMI和LVMI均明显高于正常组(P0.01),但益景汤治疗组与模型组之间无统计学差异(P0.05);DM大鼠治疗组较模型组心肌细胞的凋亡程度轻,差异具有统计学意义(P0.05)。结论:DM大鼠在第12周已经出现心肌凋亡,益景汤能改善DM大鼠心脏血流动力学,抑制心肌细胞凋亡。     

美托洛尔对心肌梗死后心力衰竭的疗效观察

目的探讨美托洛尔对心肌梗死后心力衰竭的临床疗效. 方法将132例同期心肌梗死后心力衰竭患者分为2组,观察组66例在常规治疗基础上加用美托洛尔治疗.观察心率、血压、心功能及副作用发生率,并作近期预后比较,对存活者定期行超声心动图测定左室收缩末期内径(LVIDs)、左室舒张末期内径(LVIDd)和左室射血分数(LVEF).对照组66例予常规治疗. 结果观察组治疗期间心率、血压均下降,心功能明显改善,2组近期预后比较,观察组梗死后心绞痛的发生率和住院病死率明显低于对照组,LVIDs、LVIDd和LVEF较对照组明显改善,观察组效果明显优于对照组,差异有显著意义(p<0.05).本组无因美托洛尔的副作用而停药者. 结论美托洛尔治疗心肌梗死后心力衰竭效果良好、安全.     

美托洛尔对心肌梗死后心力衰竭的疗效观察

目的 探讨美托洛尔对心肌梗死后心力衰竭的临床疗效。方法 将132例同期心肌梗死后心力衰竭患者分为2组，观察组66例在常规治疗基础上加用美托洛尔治疗。观察心率、血压、心功能及副作用发生率，并作近期预后比较，对存活者定期行超声心动图测定左室收缩末期内径（LVIDs）、左室舒张末期内径（LVIDd）和左室射血分数（LVEF）。对照组66例予常规治疗。结果 观察组治疗期间心率、血压均下降，心功能明显改善，2组近期预后比较，观察组梗死后心绞痛的发生率和住院病死率明显低于对照组，LVIDs、LVIDd和LVEF较对照组明显改善，观察组效果明显优于对照组，差异有显著意义（P＜0．05）。本组无因美托洛尔的副作用而停药者。结论 美托洛尔治疗心肌梗死后心力衰竭效果良好、安全。     

Sudden Cardiac Arrest in Athletic Medicine

OBJECTIVE: To emphasize the importance of decreasing the response time by a trained target responder to increase the survival rate among athletes experiencing sudden cardiac arrest at an athletic event. BACKGROUND: Death due to sudden cardiac arrest that is witnessed is preventable in many cases. However, most people who experience this condition die because of a prolonged response time from onset of the fatal arrhythmia to defibrillation by trained treatment providers. If athletic trainers or other members of the athletic care medical team are trained as target responders and equipped with automated electronic defibrillators, they can immediately treat an athlete who experiences a sudden, life-threatening tachyarrhythmia. This prompt response to the life-threatening emergency should result in a higher survival rate. DESCRIPTION: We review the causes of sudden cardiac arrest during athletic events, note some unusual clinical presentations, discuss improved methods of response and new equipment for treatment, and define the athletic trainer's role as a target responder trained to treat people experiencing sudden cardiac arrest at an athletic event. CLINICAL ADVANTAGES: An athletic care team willing to become part of an emergency response team can help improve the survival rate of athletes experiencing sudden cardiac arrest at an athletic event.     

Effect of Lipoxin A4 on Myocardial Ischemia Reperfusion Injury Following Cardiac Arrest in a Rabbit Model

In the present study, we investigated the effect of lipoxin A4 on myocardial ischemia–reperfusion injury (IRI) following cardiac arrest (CA) in a rabbit model. Lipoxin A4 is a metabolite of arachidonic acid in the eicosanoid, it is called “brake signal” for its anti-inflammatory activity. Some inflammatory factors (IL-1β, IL-6, TNF-α, and IL-10), NF-κB p65, infarct ratios, apoptotic index, cardiac troponin I (cTnI), hemodynamic and myocardial structures were measured or observed in different groups. Lipoxin A4 inhibits the expression of IL-1β, IL-6, and TNF-α, the values of the infarct ratios, apoptotic index, the level of serum cTnI and NF-κB p65. Meanwhile, it improves the expression of IL-10, hemodynamic, myocardial structure, and function. These indicate that lipoxin A4 mitigates postresuscitation myocardial IRI in which anti-inflammation and suppression of NF-κB activation may play an important role.