地尔硫卓治疗冠心病不稳定型心绞痛的效果及对冠脉血流储备及血管内皮的影响研究

目的：探讨地尔硫卓在冠心病不稳定型心绞痛患者中的短期应用效果及对冠脉血流储备及血管内皮的影响。方法：将2020年1月～2021年12月本院诊断与治疗的100例冠心病不稳定型心绞痛患者采用随机数字表法分为对照组(n=50)和观察组(n=50)。对照组进行常规冠心病治疗,观察组则在对照组常规冠心病治疗措施的基础上加用地尔硫卓。比较两组的总有效率、不良反应发生率、治疗前后的发作次数、持续时间、冠脉血流储备指标(D/R PDV及D/R PSV)及血管内皮指标(血清ET-1、vWF及sVCAM-1)。结果：治疗2周及4周后观察组的总有效率显著高于对照组(P<0.05),两组的各类不良反应发生率无显著差异(P>0.05),治疗2周及4周后观察组的发作次数、持续时间及血管内皮指标显著低于对照组,冠脉血流储备指标显著高于对照组(P<0.05)。结论：地尔硫卓在冠心病不稳定型心绞痛患者中的短期应用效果值得肯定,且可显著改善冠脉血流储备及控制血管内皮损伤。     

坎地沙坦对系统性高血压患者冠脉血流储备的作用

高血压患者的传导和阻力血管有结构性和功能性变化。通过研究冠脉储备可以分析无冠脉狭窄时冠脉微血管的功能。Tomas等通过无创方法评估坎地沙坦对高血压患者冠脉微血管功能的作用。     

尼可地尔对冠脉慢血流患者肱动脉血流介导的内皮依赖性血管舒张功能影响

目的探讨尼可地尔对冠状动脉慢血流(CSF)患者肱动脉血流介导的内皮依赖性血管舒张功能(FMD)影响。方法经冠脉造影诊断为CSF患者120例,根据治疗方法分为对照组(n=60)与尼可地尔组(n=60)。对照组给予常规治疗,尼可地尔组给予常规治疗加尼可地尔治疗。于治疗前、治疗后3个月分别检测FMD、APN、hsCRP的水平。结果尼可地尔组患者的FMD较治疗前明显改善(P0.05),APN较治疗前升高(P0.05),hsCRP较治疗前降低(P0.05),且ΔFMD与ΔAPN呈正相关、与ΔhsCRP呈负相关。常规治疗组的FMD、APN、hsCRP治疗前后差异无统计学意义(P0.05)。结论尼可地尔能显著增加CSF患者FMD,改善内皮功能。     

血流储备分数在冠脉多支病变中的应用价值

目的:探讨对于稳定型心绞痛冠心病患者的多支冠状动脉病变情况,应用血流储备分数(FFR)指导经皮冠脉介入治疗(PCI)的临床价值。方法:选择2012年6月—2014年9月在湘潭市中心医院接受冠脉造影(CAG)检查为冠脉多支病变,住院诊断考虑为稳定型心绞痛,并拟行PCI治疗的患者100例,随机分为通过CAG指导的PCI治疗组(CAG组)及通过FFR指导的PCI组(FFR组)。在FFR组,当FFR≤0.80时,行支架植入干预治疗,而在FFR>0.80的情况时,不考虑行支架植入治疗。所有入选的稳定型心绞痛的冠心病多支冠脉病变患者都采取最优化的药物治疗方案。随机对照研究的临床观察终点为12个月内主要心脏不良事件发生率(MACE),包括死亡、心肌梗死、血运重建等在内的全体事件。结果:CAG组与FFR组平均病变数分别是(2.79±0.73)支和(2.83±0.56)支,差异无统计学意义(P>0.05);每人平均使用支架的数量为(2.76±0.78)个和(1.45±1.07)个,差异有统计学意义(P<0.001);随访12个月的主要心脏不良事件的发生率分别是20%和6%,差异有统计学意义(P<0.05)。结论:在稳定型心绞痛冠心病的冠脉多支病变中,FFR组支架使用量明显减少,且可使死亡、心肌梗死、再次血运重建的复合事件发生率下降。     

辛伐他汀对急性冠脉综合征患者血管内皮功能的影响

急性冠脉综合征(ACS)是一临床病理生理症候群,包括不稳定型心绞痛(UAP),非ST段抬高的心肌梗死(NSTEMT)及ST段抬高的心肌梗死(STEMT).已有资料表明,内皮功能失调是冠心病(CHD)的早期表现之一,在ACS中发挥主要作用[1].有研究证实,他汀类药物可显著降低ACS患者的病死率[2],与改善其血管内皮功能有关[3].本研究旨在观察辛伐他汀对ACS患者血管内皮细胞功能的影响.     

冠脉血流储备分数在冠心病介入中的应用现状

目前对冠状动脉病变功能评价的指标有冠状动脉血流储备（CFR）、相对冠状动脉血流储备（rCFR）及血流储备分数（FFR）。因CFR的影响因素较多、rCFR依赖于正常冠状动脉而在临床上未能充分应用。FFR作为一个简单、可靠、重复性良好的生理学指标,已经广泛应用于指导合理的经皮冠状动脉介入术（PCI）。本文对FFR临床应用的研究现状进行综述。     

曲美他嗪联合尼可地尔治疗对冠脉慢血流患者血管内皮功能和临床治疗效果的影响

目的:探讨曲美他嗪联合尼可地尔治疗对冠脉慢血流患者血管内皮功能和临床治疗效果。方法:研究选择某院于2016年12月～2018年12月期间收治的冠脉慢血流患者92例进行研究,随机分为对照组和观察组各46例,对照组采用曲美他嗪治疗,观察组采用曲美他嗪联合尼可地尔治疗,观察两组患者血管内皮功能变化及治疗效果,并结合血清炎性因子、心功能检测等,对比分析两组患者在不同时间段(治疗前和治疗后)的身体状况。结果:治疗后,观察组血管内皮功能各指标FMD、ET-1、NO、hs-CRP均明显改善,且与对照组比较优势明显(P0.05);观察组治疗有效率为91.30%与对照组的69.57%比较明显更高(P0.05)。两组患者在治疗前的IL-10、CRP、IL-6水平差异不大(P0.05),而对比治疗后的IL-6、IL-10、CRP水平,两组间的差异显著(P0.05);检测对比两组中患者在治疗前后的心功能(LVEF(%)、LVEDd(mm)、6min步行距离(m)等),得到治疗前的结果差异不明显(P0.05),治疗后均有所改善,观察组的状况明显更优(P0.05)。结论:针对冠脉慢血流患者实施曲美他嗪联合尼可地尔治疗方案利于进一步改善血管内皮功能,获得良好的疗效,值得推广。     

扩张型心肌病心力衰竭病人卡维地洛治疗前后的冠脉血流储备评价

目的:利用无创腺苷激发经胸超声多普勒显像对卡维地洛治疗的扩张型心肌病心力衰竭病人冠脉血流储备(CFR)进行评价。方法:入选2004年6月至2005年6月因扩张型心肌病引起的慢性心力衰竭病人31例,在常规药物治疗基础上,加用卡维地洛至目标剂量或最大耐受剂量,治疗6mo。在卡维地洛治疗前后进行腺苷激发经胸超声多普勒显像检查,记录冠脉血流速度(CFV)及冠脉血流速度储备(CFVR),以CFVR评价CFR。结果:卡维地洛治疗前心力衰竭病人静息状态CFV与对照组无显著差别(P>0.05),最大冠脉扩张状态时CFV减低(P<0.05),CFVR较对照组明显下降(2.4±s0.3vs 3.2±0.4, P<0.05);治疗6mo后心力衰竭病人静息状态下CFV无明显改变(P>0.05)、最大充血状态时CFV升高(P<0.05),CFVR增加(2.7±0.3 vs 3.2±0.4,P<0.05);治疗后心力衰竭组CFV及CFVR与对照组比较仍有显著差别。结论:非选择性β受体阻滞剂卡维地洛能够改善扩张型心肌病心力衰竭病人的冠脉CFR,这可能也是β受体阻滞剂有效治疗扩张型心肌病的作用机制之一。     

急性冠脉综合征患者短期应用他汀类药物对血管内皮功能的影响

急性冠脉综合征患者存在脂质及血管内皮功能异常。他汀类药物可以有效地降低血清总胆固醇、低密度脂蛋白胆固醇、甘油三酯、载脂蛋白B及升高高密度脂蛋白胆固醇。近年来大规模的临床实验已经证实：应用他汀类药物能够降低冠心病发病率和主要冠脉事件,降低心肌梗塞的死亡率和发病率;并且可以通过一些其他的机制改善冠心病的预后,这些机制包括：改善内皮功能、抗细胞增殖、降低血栓形成的倾向、降低损伤部位炎症反应等。我们设计本研究旨在观察短期服用辛伐他汀对血管内皮功能的作用。     

疏血通对急性冠脉综合征介入治疗患者内皮功能的影响

目的观察急性冠脉综合征（ACS）患者冠脉支架植入术前后血管内皮功能的变化,在冠脉支架植入术后给予常规药物治疗,或疏血通注射剂干预,了解疏血通对该变化的影响。方法采用随机对照方法将60例急性冠脉综合征患者分为两组,每组30例;常规治疗组在冠脉支架植入术后给予常规药物治疗（按冠心病二级预防及ACS治疗指南用药）疏血通组在冠脉支架植入术后给予常规药物治疗的基础上,加用疏血通注射剂（单味中药水蛭提取物,主要成分为水蛭素）10毫升／天,疗程10天。冠脉支架植入术前后及疏血通治疗前后分别应用FDM法测定血浆内皮因子：血浆内皮素（ET1）、血栓烷B2（TXB2）、6-酮-前列腺素（6-keto—PGF1a）测定,双重评价其血管内皮功能;同时观察两组患者的近期预后。结果两组间冠脉支架植入术前比较,两组FDM、6-酮-前列腺素（6-keto—PGF1a）水平均差异无显著性,术后血浆内皮素（ET1）、血栓烷B2（TXB2）均较术前明显提高,6-酮-前列腺素（6-keto—PGF1a）水平明显下降（P〈0．05）经10天治疗后,两组FDM均明显提高,血浆内皮素（ET1）、血栓烷B2（TXB2）有所下降,6-酮-前列腺素（6-keto—PGF1a）有显著性升高（P〈0．05）,且疏血通治疗组与常规治疗组间比较差异有非常显著性（P〈0．01）;住院期间心血管事件发生率差异无显著性,但疏血通组较低。结论接受支架植入术患者的血管内皮功能在术后有明显-过性受损,疏血通可显著改善支架植入术治疗后急性冠脉综合征（ACS）患者的血管内皮功能,且有改善近期预后的倾向。     

The effect of electrical stimulation and drugs on the release of acetylcholine from the frog spinal cord

Summary The isolated frog spinal cord preparation, hemisected longitudinally, has been used to study concurrently the release of endogenous acetylcholine (ACh) and the electrical responses to stimulation of the ventral or dorsal roots. In unstimulated cords, ACh release was high initially and then fell to a plateau level. ACh release was reduced by tetrodotoxin and increased by high K⁺. Stimulation of the ventral roots enhanced the ACh release. The magnitude of this effect was dependent on the frequency of stimulation and was antagonized by tetrodotoxin or Ca²⁺-free Ringer. During prolonged ventral root stimulation (50 min), the evoked ACh release became progressively smaller but was restored to the original high levels by the addition of choline to the bath fluid. Stimulation of the dorsal roots failed to augment the ACh output. The application of hyoscine was followed by a large rise in the unstimulated ACh output. However no increase in the antidromically-evoked release, when compared with control stimulations, was seen. The application on -bungarotoxin was followed by a short-lasting decline in the unstimulated ACh output, whereas the electrically-evoked output was unaffected. In the frog spinal cord the determination of ACh release, together with the recording of the root potentials, offers the possibility of studying the output of a central transmitter in relation to the electrical activity of an in vitro central nervous system preparation.     

血管内皮功能与Hcy对冠心病型别的影响

目的 分析血管内皮功能与同型半胱氨酸(Hcy)对冠心病型别的影响.方法 选择2014年3月至2016年4月在本院就诊的200例冠状动脉心脏疾病患者,综合分析结果将所有患者分为三组,急性冠脉综合征63例、稳定型心绞痛65例、陈旧性心肌梗死72例.对三组患者高血压、TC(血清总胆固醇)、Hcy以及LDL-C(低密度脂蛋白-胆固醇)等做出对比,分析冠心病病人的症状程度与Hcy和血管内皮功能的关系.结果 急性冠状动脉综合征组的Hcy水平高于其余两组,陈旧性心肌梗死组的Hcy水平高于稳定型心绞痛组,差异有统计学意义(P＜0.05).急性冠状动脉综合征组内皮依赖型舒张率明显低于其余两组,陈旧性心肌梗死组内皮依赖型舒张率明显低于稳定性心绞痛组,差异有统计学意义(P＜0.05).结论 Hcy增高、内皮依赖性舒张率降低会加重冠心病病人的病情.临床上,应对Hcy进行着重检测,及时有效地对患者做出正确的诊断.     

膀胱功能锻炼对脊髓损伤患者排尿功能的影响

目的 观察膀胱功能锻炼对脊髓损伤患者排尿功能的影响.方法 将63例脊髓损伤患者随机分为干预组31例和对照组32例,对照组给予常规护理,干预组在此基础上采用膀胱功能锻炼.观察两组临床效果及对护理服务的满意度.结果 干预组的总有效率为90.3％,显著高于对照组的62.5％(P＜0.05).干预组的满意度(93.6％)显著高于对照组(68.8％)(P＜0.05).结论 膀胱功能锻炼能有效改善脊髓损伤患者的排尿功能,提高患者生活质量和对护理服务的满意度.     

Managing chronic pain with spinal cord stimulation

Since its introduction as a procedure of last resort in a terminally ill patient with intractable cancer-related pain, spinal cord stimulation has been used to effectively treat chronic pain of varied origins. Spinal cord stimulation is commonly used for control of pain secondary to failed back surgery syndrome and complex regional pain syndrome, as well as pain from angina pectoris, peripheral vascular disease, and other causes. By stimulating one or more electrodes implanted in the posterior epidural space, the patient feels paresthesias in their areas of pain, which reduces the level of pain. Pain is reduced without the side effects associated with analgesic medications. Patients have improved quality of life and improved function, with many returning to work. Spinal cord stimulation has been shown to be cost effective as compared with conservative management alone. There is strong evidence for efficacy and cost effectiveness of spinal cord stimulation in the treatment of pain associated with intractable angina, failed back surgery syndrome, and complex regional pain syndrome. In this article, we review the history and pathophysiology of spinal cord stimulation, and the evidence (or lack thereof) for efficacy in common clinical practice.     

Effect of M-cholinomimetics on nociceptive stimulation in the spinal cord

Two series of experiments were performed to study the effects of oxotremorine (5, 10 and 20 micrograms/kg), arecoline (0.25, 0.5 and 1.0 mg/kg), pilocarpine (5, 10 and 20 mg/kg) and aceclidine (0.25, 0.5 and 1.0 mg/kg) injected intravenously on nociceptive transmission in the spinal cord of spinal rats. It was established that the m-cholinomimetics inhibit in a dose-dependent manner the nociceptive reflex induced by intraarterial injection of bradykinin. When given in the same doses the drugs reduce the bradykinin-induced bioelectrical activity in the afferent tracts of the spinal cord. Atropine (1 mg/kg i. v.) abolishes the antinociceptive action of the cholinomimetics.     

阿魏酸钠对冠心病的疗效及其对血管内皮功能的保护作用

目的探讨阿魏酸钠治疗冠心病的疗效,并且分析其血管内皮功能的保护作用机制。方法 80例冠心病患者按抽签法分为治疗组与对照组各40例,治疗组给予注射用阿魏酸钠治疗,对照组采用复方丹参注射液治疗。观察两组的临床总体疗效,同时测量在治疗前、治疗后10 d与治疗后1个月的血浆NO和血浆内皮素-1(ET-1)浓度变化。结果治疗组总有效率为92.5%,明显高于对照组的70.0%(P<0.05)。治疗组治疗后血浆NO浓度明显升高(P<0.05),血浆ET-1浓度明显降低(P<0.05),而对照组无明显变化。结论阿魏酸钠辅助治疗冠心病能有效提高疗效,机制可能在于拮抗ET的分泌,促进NO的生成,从而加强对血管内皮功能的保护。     

The effect of levcromakalim (BRL 38227) on bladder function in patients with high spinal cord lesions.

The effects of the potassium channel opener levcromakalim (BRL 38227) 7.5 micrograms kg-1 were examined on urodynamic variables and blood pressure during inflow and voiding cystometry in six high spinal cord lesion patients. Levcromakalim administration significantly increased the duration of bladder contraction (197 +/- 128 s to 267 +/- 167 s, P < 0.05) and also reduced blood pressure (126 +/- 13/67 +/- 9 mm Hg to 104 +/- 25/52 +/- 12 mm Hg) but was without effect on other urodynamic parameters. Because of concerns about hypotensive responses, further studies involving higher doses of levcromakalim should be considered only if the drug was administered intravesically.     

Differential effect of pentazocine on primary cortical evoked potentials elicited by stimulation of the trigeminal tract and spinal cord pathways

The influence of pentazocine on primary cortical evoked potentials was studied in guinea pigs under pentobarbital anesthesia. Pentazocine (10 mg/kg, i.v.) increased the latency time of evoked responses to posterior limb stimulation, more than that of response to lip stimulation. This result suggests that pentazocine decreases the velocity of nervous conduction.     

The effect of angiotensin-converting enzyme inhibition on endothelial function and oxidant stress

Angiotensin-converting enzyme (ACE) inhibitors effectively interfere with the renin-angiotensin system and exert various beneficial actions on vascular structure and function beyond their blood pressure-lowering effects. Data from experimental studies showed that angiotensin-converting enzyme inhibitors can attenuate the development of atherosclerosis in a wide range of species. The postulated mechanisms of this atheroprotective effect are the antioxidant actions of angiotensin-converting enzyme inhibitors and their enhancement of the endothelial elaboration of bioactive nitric oxide. The aim of this study was to assess the comparative effects of three angiotensin-converting enzyme inhibitors on endothelial nitric oxide production and action, and on endothelial oxidative stress. Using bovine aortic endothelial cells in culture grown to confluence, we examined the effects of 1, 10, 30 and 60 microM of each of captopril, zofenopril and enalapril on nitrite/nitrate accumulation in the media, cyclic GMP accumulation in the cell lysate, and F(2)-isoprostanes in lipid extracts from the cells. Results showed that the sulfhydryl angiotensin-converting enzyme inhibitor zofenopril has unique properties compared with captopril and enalapril. This compound improves nitric oxide production and bioactivity, and does so in conjunction with decreased endothelial cell oxidant stress. The biochemical basis for this protective mechanism is not entirely clear; however, these actions suggest that zofenopril may reduce endothelial effects of risk factors for atherothrombotic disease.