高血糖对急性心肌梗死患者冠状动脉介入术后心肌组织水平灌注的影响

目的探讨急性心肌梗死(acutemyocardial infarction,AMI)患者行急诊冠状动脉介入(percutaneous coronary intervention,PCI)术后心电图ST段下降与高血糖的关系,以揭示高血糖对心肌组织灌注的影响。方法急诊行PCI的AMI患者冠状动脉造影显示梗死相关血管(infarct-related artery,IRA)前向血流TIMI0～1级,PCI后IRA前向血流恢复到3级。术前行常规心电图、心肌酶检查及抗栓、抗心肌缺血等治疗。术后90min复查心电图。将患者分为两组:有糖尿病病史或者既往无糖尿病病史但入院血糖≥8mmol/L者列为I组,既往无糖尿病病史并且入院血糖<8mmol/L者列为Ⅱ组。比较两组患者术前、术后各导联ST段抬高的平均值及术前、术后ST段下降程度以及AMI并发症发生率。结果Ⅰ组患者无痛性心肌梗死较多见(P<0.05),导致发病到就诊的时间延长(P<0.05),其室性心律失常、心力衰竭、再发AMI、梗死后心绞痛及心血管死亡的发生率均高于Ⅱ组(P<0.05)。Ⅱ组和Ⅰ组相比,术后90min各导联抬高的ST段平均值及术前、术后ST段下降程度间差异有显著性意义(P<0.05)。结论AMI患者PCI治疗后心电图抬高的ST段下降程度受高血糖的影响;高血糖和高血脂影响PCI后心肌组织的微循环灌注;PCI后心肌组织的灌注状态与临床预后有关,高血糖患者发生AMI时预后不良。     

心电图在家兔急性心肌梗死诊断中的应用

目的探讨心电图各指标对家兔急性心肌梗死(AMI)的诊断价值。方法40只兔随机分为AMI组和假手术组(SH组),采用开胸结扎冠状动脉左前降支的方法建立AMI模型,检测术前、术后10min内和术后6周心电图的变化,6周后取出心脏作病理检查。结果两组术前心电图均正常。AMI组术后10min内心电图胸导联ST段较术前明显抬高(P<0.01),ST段抬高(>0.2mV)对AMI诊断的灵敏度为84.6%(11/13),特异度为100%(2/2)。和术前比较,两组术后均出现心率减慢、胸导联R波振幅降低(P<0.01),但两组间比较差异无统计学意义(P>0.05)。术后6周心电图胸导联显示病理性Q波只见于大体病理可见较明显的梗死瘢痕形成的兔中。结论心电图ST段抬高和病理性Q波对家兔AMI具有重要的诊断价值。     

急性心肌梗死静脉溶栓治疗后ST段再抬高的临床意义

目的探讨急性心肌梗死(AMI)静脉溶栓治疗后ST段再抬高的临床意义。方法将首发AMI并接受静脉溶栓治疗的77例患者,按静脉溶栓治疗后心电图有无ST段再抬高分为ST段再抬高组(A组)和ST段无再抬高组(B组),比较两组梗死相关血管再通率、再灌注心律失常、心功能、梗死后心绞痛及并存疾病等。结果①A组梗死相关血管再通率82.1%、B组81.6%(P>0.05);②两组再灌注心律失常、心功能分级、梗死后心绞痛、左室射血分值(LVEF值)比较,无统计学意义(P>0.05);③两组伴发糖尿病、原发性高血压及吸烟比较,无统计学意义(P>0.05)。结论AMI静脉溶栓治疗后ST段再抬高,可作为心肌再灌注成功的一种临床表现,可作为成功、有效的再灌注指标之一。     

STEMI患者中ST段抬高值与hs-CRP相关性研究

目的研究ST段抬高性心肌梗死(STEMI)患者体表心电图梗死相关导联ST段抬高总和值与血清超敏C反应蛋白(hs-CRP)水平的关系。方法50例STEMI患者发病后送至急诊室即刻及治疗后6h、12h分别行心电图及血清hs-CRP检查,观察治疗前后hs-CRP水平变化,计算梗死相关导联ST段抬高总和值并与hs-CRP水平进行相关性分析。结果患者入院时梗死相关导联ST段抬高总和值(1.41±0.78)mV与血清hs-CRP水平(16.30±22.77)mg/L呈显著正相关(r=0.732,P<0.01);与治疗前(16.30±22.77)mg/L相比,治疗后6h(2.42±3.63)mg/L与治疗后12h(1.58±0.66)mg/L血清hs-CRP水平均明显下降(P<0.01),且二者间的差异具有统计学意义(P<0.05);ST段抬高总和值≥1.5mV的患者中,各种临床事件发生的概率大大增加(P<0.01)。结论STEMI患者心电图ST段抬高总和值与hs-CRP水平呈显著正相关,治疗后hs-CRP水平下降,具有时间依从性。ST段抬高总和值对STEMI患者的预后评估具有指导意义。     

急性心肌梗塞溶栓治疗时ST段再抬高的临床观察

目的 探讨急性心肌梗塞静脉溶栓时ST段再抬高的临床意义.方法 观察尿激酶溶栓治疗AMI186例患者中有无ST段再抬高分为A,B两组,并对A,B两组进行对照性分析.结果 两组间临床表现中再通率,KillpⅡ-Ⅳ级,CK峰值,再灌注心律失常及伴发高血脂症,高血压,糖尿病的比较差异有统计学意义(P<0.05).结论 用标准12导联心电图观察AMI患者发病后短时间内ST段抬高,对判断AMI患者溶栓后再灌注损伤、冠脉痉挛及相关血管再闭塞不失为一种简便易行的方法,值得在基层医院推广应用.     

急性AMI患者急诊PCI术中心肌缺血后适应对再灌注心律失常的抗心律失常效应及手术时间的影响

目的:探讨急性心肌梗死(AMI)患者急诊经皮冠状动脉介入(PCI)术中心肌缺血后适应对再灌注心律失常的抗心律失常效应及手术时间的影响.方法:选择ST段抬高AMI(STEMI)并首次行PCI手术的患者90例,采用随机数字表法将其分为心肌缺血后适应(MIP)组和常规PCI组.MIP组患者给予临时起搏、药物、低压扩张罪犯血管病变处.常规PCI组开通罪犯血管后若出现再灌注心律失常,则采取常规处理措施.比较2组患者再灌注心律失常的类型、冠状动脉病变特点、再灌注心律失常的持续时间、PCI总手术时间、心电图相关导联ST段的回落值.结果:2组患者ST段回落值、再灌注心律失常的类型、冠状动脉病变特点差异均无统计学意义(P>0.05),而MIP组再灌注心律失常的持续时间及PCI总手术时间均短于常规PCI组(P<0.05).结论:AMI患者PCI治疗中MIP可使再灌注心律失常更短时间内结束,并且可以显著缩短手术时间.     

兔急性心肌梗死再灌注模型建立的研究

目的：探讨采用阻断及松解冠状动脉左回旋支之左室支的方法建立兔急性心肌梗死（AMI）再灌注模型方法的可行性及先进性。方法：日本大白兔24只为实验对象，随机分为缺血再灌注组、缺血未灌注组及假手术组，每组8只。阻断左室支血流5min后松开10min，再次阻断5min松开10min,再次阻断60min，然后缺血再灌注组松解进行再灌注，缺血未灌注组在穿线处结扎，假手术组只穿线不阻断血流。采兔术前、再灌注后各时段静脉血，检测cTnI,CK和CK-MB；行心电图观察II,III,avF导联ST段抬高振幅总和变化。结果：各组动物冠脉闭塞前、后体表心电图及冠脉阻断后II,III,avF导联ST段均抬高，缺血再灌注组松解后120分钟内ST段回落大于50%，而其它两组无此表现。结论：应用本研究制模方法可成功建立兔AMI再灌注模型，成功率高。     

ST段抬高型心肌梗死患者溶栓再灌注后心电图的临床研究

目的:研究ST段抬高型心肌梗死患者溶栓再灌注后的心电图临床分析。方法:选取收治的150例心肌梗死患者作为研究对象,150例心肌梗死患者均应用尿激酶进行溶栓治疗,根据有无再灌注把150例患者随机均分为两组,一组为对照组未再灌注,另一组为观察组再灌注,对两组患者再通率和心电图ST段抬高及心律失常、心肌梗死后的心绞痛等进行对比分析。结果:ST段抬高型心肌梗死溶栓后再灌注率是68%,观察组频发室性早搏、加速性室性自主心律和对照组对比,差异具有统计学意义(P<0.05)。而心律失常类型对比,差异无统计学意义(P>0.05)。结论:心肌梗死患者溶栓再灌注后的心电图有ST段的反常抬高和心律失常表现,这个参考指标可以当作患者进行心肌再灌注与灌注受到损伤时重要参考指标。     

缺血后适应对急性心肌梗死PCI术中再灌注心律失常的疗效评估

目的:探讨缺血后适应处理在急性心肌梗死急诊经皮冠状动脉介入(PCI)术中对再灌注心律失常的作用及临床应用价值.方法:将56例ST段抬高型急性心肌梗死行急诊PCI的患者随机分为常规处理组(29例)和缺血后适应组(27例).术中出现再灌注心律失常后常规处理组予以药物或临时起搏处理,缺血后适应组立即予以球囊低压扩张多次使罪犯血管造成短暂再通/闭塞.观察两组不同处理方法对再灌注心律失常的转复效果.结果:缺血后适应组再灌注心律失常的例数明显低于常规处理组(3/27 vs 12/29,P<0.05),术后心电图ST段回落值两组之间差异无统计学意义(P>0.05).结论:缺血后适应处理能快速终止急诊PCI术中的再灌注心律失常.     

急性心肌梗死静脉溶栓治疗后ST段再抬高临床意义探讨

目的:探讨急性心肌梗死(AMI)静脉溶栓治疗中ST段再抬高产生的原因及临床意义。方法:回顾性分析符合静脉溶栓标准的121例AMI患者的临床资料,据溶栓后有无ST段再抬高而分为ST段抬高组(A组)和ST段未抬高组(B组),比较两组间血管再通率、心律失常发生率、CK峰值水平、梗死后心绞痛、猝死发生率及心功能变化、冠脉造影结果。结果:A、B两组患者各项指标均有显著性差异(P<0.05)。A组血管再通率明显低于B组(P<0.05);梗死后心律失常发生率、心绞痛发生率、猝死率及心功能不全发生率均高于B组(P<0.05);A组伴发代谢综合征明显多于B组(P<0.05)。结论:静脉溶栓治疗时ST段再抬高与患者合并代谢综合征有密切关系。在溶栓后1~2h内出现ST段下降后再抬高或原有梗死相关部位ST段抬高再加重,其原因可能与溶栓后再灌注损伤及冠脉痉挛有关,其它部位ST段抬高,可能与溶栓后纤溶激活状态致冠脉痉挛或闭塞有关。而在24h后出现ST段再抬高可能与新的血栓形成引起再闭塞或梗死延展有关。     

Evaluation of Myocardial Viability after Myocardial Infarction with Intravenous Real-time Myocardial Contrast Echocardiography

The myocardial viability after myocardial infarction was evaluated by intravenous myocardial contrast echocardiography. Intravenous real-time myocardial contrast echocardiography was performed on 18 patients with myocardial infarction before coronary revascularization. Follow-up echocardiography was performed 3 months after coronary revascularization. Segmental wall motion was assessed using 18-segment LV model and classified as normal, hypokinesis, akinesis and dyskinesis. Viable myocardium was defined by evident improvement of segmental wall motion 3 months after coronary revascularization. Myocardial perfusion was assessed by visual interpretation and divided into 3 conditions： homogeneous opacification; partial or reduced opaciflcation or subendocardial contrast defect; contrast defect. The former two conditions were used as the standard to define the viable myocardium. The results showed that 109 abnormal wall motion segments were detected among 18 patients with myocardial infarction, including 47 segments of hypokinesis, 56 segments of akinesis and 6 segments of dyskinesis. The wall motion of 2 segments with hypokinesis before coronary revascularization which showed homogeneous opacification, 14 of 24 segments with hypokinese and 20 of 24 segments with akinese before coronary revascularization which showed partial or reduced opaciflcation or subendocardial contrast defect was improved 3 months after coronary revascularization. In our study, the sensitivity and specificity of evaluation of myocardial viability after myocardial infarction by intravenous real-time myocardial contrast echocardiography were 94.7% and 78.9%, respectively. It was concluded that intravenous real-time myocardial contrast echocardiography could accurately evaluate myocardial viability after myocardial infarction.     

磁共振心肌灌注成像评价心肌梗死PTCA治疗前后心肌存活

目的 评价磁共振心肌灌注成像(MRMPI) 检测心肌梗死存活心肌的作用. 方法 选择心肌梗死患者51 例.采用1.5 T MR扫描仪,反转恢复快速小角度激励( IR-turbo FLASH) 序列,全部患者均在静脉注射钆喷替酸葡甲胺(Gd-DTPA) 0.1 mmol/kg、MRMPI 首过期及5~30 min 延迟期成像.21 例行静息、负荷99锝单光子发射计算机体层摄影术( single photon emission computed tomography, SPECT) 进行对照研究.首过期行短轴面成像,延迟期行短轴面及长轴面成像.结果 51例心肌梗死患者,42 例(82.3%) 首过期显示灌注减低;50 例(98%) 延迟增强.在21例168个心肌段SPECT诊断无活性心肌段48个,MRMPI 示梗死区均有延迟增强,SPECT诊断存活心肌段120 个,MRMPI 示97段无延迟增强.以静息、负荷99m锝SPECT 作为参考标准,MRMPI 的敏感度、特异度分别为100%、80.8%. 结论 MRMPI 可有效地检测心肌梗死的存活和非存活心肌,以及其程度和范围.     

超声检测心内外膜下跨壁速度梯度在心肌缺血诊断中的应用

目的：探讨跨壁速度梯度（MVG）在诊断心肌缺血中的应用价值。方法：检测38例冠心病患者（病例组）和28例健康志愿者（对照组）心尖四腔观、两腔观各节段心肌收缩期跨壁速度梯度（MVG-L＋）、舒张期跨壁速度梯度（MVG—L-）。结果：对照组MVG—L＋和MVG—L-由基底段、中间段至心尖段差异无显著性意义。病例组缺血节段的MVG-L＋和MVG—L-较对照组相应节段明显降低。结论：MVG可定量评价局部心肌运动状态，为临床心功能评价提供有效指标。     

Acute myocardial infarction: myocardial salvage assessment

Primary coronary revascularization by means of percutaneous coronary intervention(PCI)is a highly effective treatment of acute myocardial infarction re-establishing coronary perfusion and stopping the ongoing necrosis in the dependent myocardium.Single-photon emission computed tomography(SPECT)is the most widely used modality assessing myocardial salvage as the difference between the acute perfusion defect before intervention and the remaining scar size measured in a second scan several days after the event.SPECT allows quantification of area at risk(AAR)and final infarct size(FIS)by tracer injection prior to revascularization and after 1 month,respectively.SPECT provides the most validated measure of myocardial salvage and has been utilized in multiple randomizedclinical trials.However,SPECT is logistically challenging,expensive,and includes radiation exposure.More recently,a large number of studies have suggested that cardiac magnetic resonance(CMR)can determine salvage in a single examination by combining measures of myocardial oedema in the AAR exposed to ischaemia reperfusion with FIS quantification by late gadolinium enhancement.     

Acute myocardial infarction due to myocardial bridge

Myocardial bridge (MB) is regarded as a common anatomic variant rather than a congenital condition anomaly,defined as the intramyocardial course of a portion of the coronary artery.It was first mentioned by Rayman in 1737 and first described by Grainicianu in the early 1920s.The current gold standard for diagnosing     

Relation of myocardial bridge to myocardial infarction: a meta-analysis

Background Small case series have suggested an association of coronary myocardial bridge （MB） with myocardial infarction （MI）.However,the relationship between MB and major adverse cardiac events （MACE） remains largely unknown.The aim of this study was to assess the relationship between MB and MACE involving MI.Methods We performed a systematic search of MEDLINE,PreMEDLINE,and all EMB Reviews as well as a reference list of relevant articles according to the SPICO （Study design,Patient,Intervention,Control-intervention,and Outcome） criteria using the following keywords：myocardial bridging,myocardial bridge,intramural coronary artery,mural coronary artery,tunneled coronary artery,coronary artery overbridging,etc.Bibliographies of the retrieved publications were additionally hand searched.Studies were included for the meta-analysis if they satisfied the following criteria：（1） they evaluate the association of MB with cardiovascular endpoint event; （2） they included individuals with MB and those without MB; 3） they excluded individuals with obstructive coronary artery disease （CAD）.Studies were reviewed by a predetermined protocol including quality assessment.Dates were pooled using a random effect model.Results Seven observational studies that followed 5 486 patients eligible for the enrolled criteria were included from 7 136 initially identified articles.The prevalence of MB was 24.8％ （1 363/5 486）.During 0.5-7.0 years of follow-up of this cohort of population,crude outcome rates were 8.0％ in the MB group and 7.7％ in the non-MB group.The odds ratio of overall MACE and MI were 1.34 （95％ confidence interval （CI）：0.57-3.17,P=0.51,n=7 studies） and 2.75 （95％ CI：1.08-7.02,P ＜0.03,n=5 studies） respectively for subjects of MB compared to non-MB.Conclusion Relationship between MB and MI appears to be a real one,although the study did not reveal a connection of MB to MACE,suggesting whether the necessity of antiplatelet therapy needs to be further studied in a larger cohort of patients with MB prospectively.     

心肌声学造影对急性心梗PCI术后心肌灌注的评价

目的:通过心肌声学造影(MCE)对急性心梗经皮冠状动脉支架术(PCI)后心肌灌注的情况进行判断,了解其对左心功能及左室重构的影响.方法:采用病例对照的研究方法,根据PCI术后1周的MCE检查,将急性心梗患者分为灌注正常组、灌注稀疏组和灌注缺失组,并随访检查3个月、6个月的左室射血分数(LVEF)及左室舒张末内径(LVDd)的变化情况,比较组内及组间不同时段LVEF与LVDd的变化.结果:PCI术后3个月灌注稀疏组LVEF恢复到正常;灌注缺损组PCI术后LVEF的平均水平随时间变化而逐渐降低;灌注缺损组患者的LVEF低于灌注稀疏组和灌注正常组(P<0.05);术后6个月灌注缺损组LVDd平均水平高于灌注正常组和灌注稀疏组(P<0.05),灌注缺损组随时间的变化左室内径逐渐增大(P<0.05).结论:急性心梗患者PCI术后心肌微循环较差时,其左室射血分数降低,左室内径增大;MCE有利于对急性心梗患者PCI术后左心功能及左室重构评估.     

超声心肌造影技术对心肌梗塞患者心肌微循环的定量评价

目的：探讨超声心肌造影技术在心肌梗塞(简称心梗)患者心肌微循环灌注改变中的应用价值。方法：对30例急性心梗患者进行超声心动图及心肌造影检查,观察患者梗塞区域(AMI组,同时以患者非梗塞区域为自身对照组)心肌微循环灌注并以CPS造影软件进行分析。结果：心肌梗塞患者梗塞区域心肌微循环灌注开始时间(AT)、达峰时间(APT)较同一切面内的非梗塞区域明显延长（P<0.05）,梗塞区域造影剂灌注的峰值强度(PI)及灌注速度(β)均明显低于同一切面内的非梗塞区域（P<0.05）。结论：超声心肌造影技术可以定量评价心梗患者心肌微循环灌注,具有重要的临床应用价值。     

急性心肌梗死心肌蛋白检测的临床评价

目的探讨心肌损伤标志物心肌蛋白检测在急性心肌梗死(AcuteMyocardialInfarction,AMI)诊断时的应用价值,减少急性心肌梗死漏诊、误诊发生率。方法测定35例AMI病人在发病的第4小时、8小时、24小时,5天等四个时间段的血清肌钙蛋白(IcTnI)、肌钙蛋白T(cTnT)及肌红蛋白(Mb)浓度,和对照组30例健康者体检时的血清相应项目数据对比并进行统计学处理。结果AMI患者发病后4￣8小时血清cTnI、cTnT开始上升,24小时达到峰值,5天仍维持在较高水平,其浓度以及阳性率与正常对照组比较均有显著性差异(P<0.05);而血清Mb在4￣8小时上升幅度更大,但24小时后浓度以及阳性率与正常对照组比较差异不显著(P>0.05)。结论在心肌梗死的早期诊断指标中,Mb的优势明显;cTnI、TnT可用于AMI的早期诊断,但更适用于那些因就诊时间较晚、心肌酶已正常的心梗病人。三者联测可更早、更可靠地提高心肌梗死诊断的准确率。