103例激光心肌血运重建术心肌酶变化及相关因素分析

目的 :了解激光心肌血运重建术 (ＴＭＬＲ)围手术期心肌酶变化规律和影响因素 ,并统计ＴＭＬＲ术后心肌酶正常上限值 ,以利防治术后早期相关并发症。方法 :采用速率法测定 1 0 3例ＴＭＬＲ患者围手术期心肌酶变化。结果 :在 1 0 3例ＴＭＬＲ手术病例中 ,ＣＫ ＭＢ在术后第 1天达到其峰值 ,与术前比较差异有显著意义 ,随后明显下降。根据 87例术后未并发心肌梗死的病例统计出ＴＭＬＲ术后心肌酶正常上限值 ,并对可能影响术后心肌酶变化的各项因素进行统计学分析。结论 :心肌梗死是ＴＭＬＲ术后重要的并发症 ,本文根据87例术后未并发心肌梗死…     

高功率CO2激光心肌血运重建术50例临床报告

目的:总结应用高功率CO2激光对50例冠心病患者实施激光心肌血运重建术(TMLR)的临床经验并初步评价TMLR的临床效果.方法:经左前外侧第五肋间或肋床小切口进胸,在心脏跳动下行TMLR.分析术中使用的激光能量及左心室各壁穿透率.采用酶动力学法监测围术期心肌酶变化,以评价心肌损伤.术后随访患者心绞痛及心肌灌注的改善情况.结果:术后8 h血清肌酸磷酸激酶同工酶(CPK-MB)较术前明显升高(P＜0.05),24 h达峰值,为40 IU/L±24 IU/L,但未超过术前(15 IU/L±10 IU/L)的2倍.全组每孔平均使用脉冲激光能量为35.6 J±12.3 J,平均穿透率为93.6%;心尖处使用激光能量最大(37.4 J±10.8 J),穿透率则最低(83.8%).术后3、6、12个月心绞痛分级分别为2.1±0.3、1.7±0.3、1.7±0.3,较术前(3.7±0.7)均有明显改善(均为P＜0.05).术后单光子发射型计算机断层扫描示心肌灌注有不同程度的改善.术后早期(30天内)死亡率为2%(1/50).结论应用高功率CO2激光施行TMLR安全、有效.TMLR可明显缓解心绞痛,改善心肌灌注.术中打孔顺序适当可缩短手术时间,游离心尖部脂肪后打孔有利于提高穿透率.     

冠状动脉搭桥(CABG)围术期常规心肌酶学变化的分析

目的 研究冠状动脉搭桥(CABG)术后心肌酶学变化的特殊规律为临床治疗提供依据。方法 40例CABG患术前，术后0、4、16、28、40h，术后第3、4、5、7天晨静脉抽血，检测磷酸肌酸激酶(CK)、磷酸肌酸激酶同功酶(CK-MB)、乳酸脱氢酶(LDH)、谷草转氨酶(AST)、谷丙转氨酶(ALT)，并按体外循环(ECC)与非体外循环(OPCAB)搭桥及CK-MB正常与否分组分析，引用CK／AST对比分析。结果 除了ALT外所有指标都有明显变化，这些心肌酶在术后16～40h基本都升到高峰，LDH变化最早，CK与AST次之；CK与AST恢复较快，体外循环下CABG与0PCAB造成的主要差别表现在术后16h到术后第2天，若按CK／AST分析则主要在16～28h；LDH最慢，尤其表现在体外循环组几乎整个住院观察期都处于升高水平，术后CK—MB升高组的CK值在术后16h到第2天可以高出CK-MB正常组2．5～3．0倍，同时CK／AST在此期间在两组中无明显差异，而在第3天开始出现CK-MB升高组显升高。结论 CK-MB在评价冠脉搭桥术后心肌损伤中的作用应该高度重视；CK、AST、LDH的升高一定根据其升高的幅度、临床表现、必要参考CK-MB来分析，CK、AST的同步大幅度升高要警惕；ECC下搭桥术酶学变化要注意排除心脏外因素，尤其是LDH。     

冠状动脉搭桥围手术期心电图及心肌酶的变化特点

目的 观察冠状动脉搭桥术（CABG）围手术期心电图（ECG）及心肌酶的变化特点。方法 对41例冠状动脉三支病变行CABA术。术前、后多次描记ECG及抽静脉血进行心肌酶检测。结果 与手术前ECG比较,ST段抬高24人,ST—T改善5人,ST—T变化不明显4人,Q-T间期缩短5人,QRS波幅降低3人。心肌酶正常4人,异常37人。ECG与心肌酶呈同步性改变。当ST段弓背抬高或ST段明显下移或T波到置较深时,心肌酶明显增高;当ST段由弓背抬高变成水平下移或ST段下移减少或T波到置变浅时,心肌酶下降。结论 CABG围手术期ST—T和心肌酶变化特点对了解心肌血供情况有一定的帮助。     

大鼠高原严重烧伤后复方红景天参芪花粉制剂对心肌酶谱变化的影响

目的 :观察大鼠高原严重烧伤后心肌酶谱的变化和复方红景天制剂 (RACC)对其的影响 ;方法 :在 3 480m高海拔地区成功复制大鼠 3 0 %Ⅲ度烧伤模型 ,动态观察了烧伤后心肌酶谱 (包括LDH、α -HDH、AKP、同功酶MB型及GOT)的变化 ;结果 :伤后 3小时 ,在实验组和对照组的心肌酶均显著高于正常组 (P <0 .0 1 ) ,然后心肌酶谱逐渐下降 ,并在术后 72小时接近正常。实验组的心肌酶谱水平则显著低于对照组 (P <0 .0 1 ) ;结论 :RACC可对严重烧伤后心肌提供一定的保护作用 ,具有一定的临床意义     

激光心肌血运重建的临床研究

采用高功率ＣＯ2 激光器对 88例重症、高危、高龄、晚期冠心病患者施行激光心肌血运重建 (ＴＭＬＲ)治疗的同时开展临床和实验研究。临床研究阐明了ＴＭＬＲ术前诊断与评估的必要检查和辅助方法及其临床价值 ,讨论并提出手术适应证的观点。疗效随访 3个月至 3年 ,分析了影响疗效的因素 ,总结了围手术期并发症及处理经验 ,提出了合理的激光打孔操作程序。在围手术期心肌酶学 ,动态心电图 ,运动心电图 ,超声心动图 ,心肌核素显像等激光心肌血运重建的临床研究@屈正$首都医科大学附属北京安贞医院!北京市100029 @张兆光$首都医科大学附属北…     

高功率CO2激光心肌打孔机的研制及临床应用

目的：研制用于激光心肌打孔血运重建术（TMLR）的高功率CO2激光治疗仪，并对其生物学效应及临床应用效果进行评价。方法：采用激光合成方法研制产生大功率CO2激光的心脏打孔机，分别在有机玻璃块，犬离体心脏和活体心肌缺血模型上进行激光心肌打孔实验，以检验合成光束的生物物理特性，选择安全有效的激光心肌打孔参数。在此基础上，使用该仪器为65例冠心病病人行TMLR手术并观察效果。结果：在有机玻璃和离体猪心打孔显示孔道孔径，深度可以满足TMLR的使用要求，使用该仪器在犬缺血心肌打孔形成透壁孔道，1周年镜下可见孔道通畅，65例接受TMLR手术患者，3例分别于术后第3天、第4天及第8天因呼吸衰竭、心力衰竭及心律失常死亡，其余病人均顺利院，随访6－30个月，50例患者心绞痛明显减轻，其中37例较术前减少2级，15例减少1级，7例变化不明显，失访5例，26例术后行心肌放射性核素断层扫描，有21例心肌的孔区域的血流灌注比前术前明显增加。结论：合成高功率CO2心脏激光打孔机治疗仪在TMLR的动物实验及临床应用中安全有效。     

重症心脏瓣膜病瓣膜置换术围手术期处理57例分析

目的:总结重症心脏瓣膜病瓣膜置换术围手术期处理的经验。方法:对2003年5月~2006年4月57例重症以及瓣膜病患者的临床资料进行回顾性分析。结果:57例患者中55例安全度过围手术期;死亡2例,占3.5%,死亡原因分别为急性左心衰及严重肺部感染;手术并发症主要为低心排综合征、心律失常;术后随访心胸比例较术前不同程度的缩小,心功能较术前明显改善。结论:充分的术前准备,调整心功能及全身情况到最佳状态,选择最佳手术时机,术中良好的心肌保护,保留二尖瓣装置,彻底矫治三尖瓣病变,术后积极防治低心排综合征、心律失常、多器官功能衰竭,重视多巴胺、硝普钠等血管活性药物及洋地黄类强心药物的用量与维持时间,是重症瓣膜病置换术成功的关键。     

新生儿病理性黄疸对心肌酶影响的探讨

目的探讨新生儿病理性黄疸对心肌酶的影响。方法对50例病理性黄疸的新生儿和40例生理性黄疸的新生儿,抽取静脉血测定其胆红素和心肌酶。结果病理性黄疸组心肌酶AST、CK、CK-MB、LDH、a-HBDH均高于生理性黄疸组（P〈0.01）。结论新生儿病理性黄疸可出现心肌酶异常,心肌损伤,经及时治疗后,心肌酶可恢复正常。     

强化阿托伐他汀治疗对急性冠脉综合征患者PCI围手术期炎症反应和心肌损伤的影响

目的观察强化阿托伐他汀治疗对急性冠脉综合征（ACS）患者PCI围手术期炎症反应和心肌损伤的影响。方法将本院心内科2011年10月-2012年4月收治的ACS患者130例随机分为两组：强化治疗组65例于PCI术前2小时给予阿托伐他汀40mg口服,术后1个月内继续强化他汀治疗40mg/d,1个月后改为维持剂量20mg/d。标准治疗组65例PCI术前及术后均给予阿托伐他汀20mg/d,晚饭后顿服。随访30天,所有患者于PCI术前、术后24小时测定肌钙蛋白（IcTnI）、肌酸激酶同工酶（CK-MB）水平;PCI术前及术后1、7、30天测定血清C反应蛋白（CRP）、谷丙转氨酶（ALT）、肌酸激酶（CK）水平,PCI术前及术后7、30天测定总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）水平,观察并比较两组患者PCI术后30天内心脏不良事件与药物不良反应的发生情况。结果 PCI术后24小时两组患者cTnI、CK-MB水平均较术前有明显增高（P〈0.05）,但强化治疗组CK-MB、cTnI水平低于标准治疗组（P〈0.05）。术后第1天两组患者血中CRP均较术前显著升高（P〈0.05）,组间比较差异无统计学意义（P〉0.05）;术后第7天强化治疗组血中CRP水平下降至术前水平（P〉0.05）,标准治疗组中虽下降,但仍高于术前水平（P〈0.05）,组间比较差异有统计学意义（P〈0.05）;术后30天强化治疗组患者血中CRP水平明显低于术前（P〈0.05）,而标准治疗组CRP水平与术前比较无明显差异（P〉0.05）。两组患者用药前血脂无明显差异,用药后血脂均有所下降,且各时间点组间比较均无统计学意义（P〉0.05）。随访30天,两组患者均无1例心血管不良事件发生。两组药物不良反应发生率分别为6.15%、4.62%,无统计学差异（P〉0.05）。结论强化阿托伐他汀治疗可减少ACS患者PCI围手术期炎症反应和心肌损伤,值得临床推广应用。     

The radionuclide evaluation of septal wall motion following coronary bypass surgery

We investigated the diagnostic accuracy of radionuclide global and regional left ventricular (LV) function after coronary revascularization. A consecutive series of 43 patients was studied. First-pass radionuclide angiograms were performed preoperatively (4 days +/- s.d. 3 days, range 1-18 days) and postoperatively (7 days +/- s.d. 3 days, range 3-19 days). Regional radionuclide LV function was assessed using the two-dimensional display of systole and the three-dimensional ejection fraction image. Electrocardiograms were obtained the day prior to surgery and every 8 h for the first three postoperative days. Creatine kinase (CK) and lactate dehydrogenase (LDH) isoenzymes were obtained the day prior to surgery and every 8 h for the first three postoperative days. In 39 patients who did not develop perioperative myocardial infarction by isoenzyme or ECG criteria, we found that 38 patients showed unchanged or improved global and regional LV function, while one patient without isoenzyme or ECG evidence of perioperative myocardial infarction developed a new septal wall motion abnormality. Thus, the specificity of the radionuclide radioventriculogram for new septal wall motion abnormalities was very high. In four patients who developed isoenzyme and ECG evidence of myocardial infarction, septal wall motion worsened in all four patients while global left ventricular ejection function fell significantly in three patients. Thus, the radionuclide radioventriculogram also had high diagnostic sensitivity. In summary, contrary to past and recent reports, this investigation demonstrated that the radionuclide radioventriculogram can be used to assess global and regional LV function after coronary artery bypass surgery and furthermore, that it reliably indicates the presence of a new postoperative myocardial infarction.     

多排CT冠状动脉成像评价单纯心肌桥-壁冠状动脉与左心功能的相关性

目的利用多排螺旋CT冠状动脉成像准确评估左心功能及左前降支心肌桥-壁冠状动脉(myocardialbridge-mural coronary artery,MB-MCA)情况,并探讨二者的相关性。资料与方法回顾性分析78例单纯性左前降支MB-MCA(无冠状动脉粥样硬化)患者资料,观察并测量左前降支MB深度、MCA长度及MCA横截面积,计算MB指数、MCA缩窄率并与左心功能指标进行对比分析。结果多排CT能对左前降支各项参数进行准确测量,经统计学分析,左前降支MB厚度、MB指数(MCA长度与MB厚度的乘积)与左心室射血分数(EF)呈负相关;MCA缩窄率与EF呈正相关。结论多排CT能准确评价MB-MCA,且左前降支MCA缩窄率、MB厚度及MB指数与左心功能有一定相关性。     

Exercise training increases creatine kinase capacity in canine myocardium

INTRODUCTION: The creatine kinase (CK) energy shuttle of cardiomyocytes channels metabolic energy from the mitochondria to sites of energy utilization at contracting myofibrils and sarcolemmal and sarcoplasmic reticular ion pumps. Although plasticity of the myocardial CK system in response to hemodynamic overload has been repeatedly demonstrated, the effects of aerobic exercise training on myocardial CK are less well understood. This investigation tested the hypothesis that aerobic exercise training increases the capacity of the CK system in canine myocardium. METHODS: Mongrel dogs were conditioned by a 9-wk treadmill running program or cage-rested for 4 wk. Total CK activity was measured colorimetrically; CK(MB) was separated from other CK isoforms and measured by electrophoresis. RESULTS: Relative to sedentary controls, training increased left ventricular total CK activity 46% (P < 0.05) but did not alter total CK activity in right ventricular myocardium. Also in left ventricular myocardium, training increased CK(MB) isoenzyme activity 4.5-fold and the CK(MB) fraction of total CK threefold from 1.1+/-0.4 to 3.4+/-0.8% (P < 0.05). In contrast to left ventricle, CK(MB) activity and its fraction of total CK activity were not altered by training in right ventricular myocardium. CONCLUSIONS: Aerobic exercise training increases total myocardial CK activity and CK(MB) content in canine left ventricular myocardium, although CK(MB) remains a minor component of the myocardial CK system. The right ventricular CK system was not affected by training.     

经皮冠状动脉介入治疗中血栓抽吸导管的应用

目的 探讨经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）中出现无复流或慢复流时应用血栓抽吸导管的安全性和有效性.方法 选择行PCI时发生无复流或慢复流患者56例,随机分为抽吸组26例和对照组30例,抽吸组除常规处理外立即使用血栓抽吸导管,分析比较两组术后TIMI分级、TIMI心肌灌注（TMP）分级、心肌酶谱、ST-T改变、LVEF及随访30 d的主要心血管不良事件（main adverse cardiovascular event,MACE）发生率.结果 抽吸组TIMI及TMP分级,心肌酶谱及LVEF均优于对照组,出现缺血性ST段抬高的患者数少于对照组,差异均有统计学意义（P〈0.05）;但MACE在两组间无统计学差异（P＞0.05）.结论 PCI时出现无复流或慢复流时应用血栓抽吸导管有助于改善罪犯血管远端的心肌灌注及术后心功能,减轻慢复流或无复流对心肌的损伤.     

No evidence of sustained myocardial injury following an Ironman distance triathlon

We aimed to determine whether an Ironman distance triathlon resulted in sustained myocardial injury detected by electrocardiography, biochemical markers or echocardiographic assessment of left ventricular systolic and diastolic function. Electrocardiograms, blood for analysis of creatine kinase (CK) and its MB fraction, cardiac troponin I (cTnI) and echocardiograms were obtained in 15 male athletes prior to and at a mean of 4.7 days after competing in the Australian Ironman Triathlon. Regional wall motion scores, left ventricular ejection fraction (LVEF) and mitral inflow parameters were determined from the echocardiograms by a blinded investigator. Levels of cTnI were undetectable in all athletes and total CK was mildly elevated in 7/15 athletes prior to the event. Baseline wall motion, ejection fraction and diastolic filling were normal in all athletes. CK levels were increased post-race (p < 0.05) with a mean post-race level of 451U/l. Levels of cTnI were undetectable post-race in 14 athletes with a level of 0.9 microg/l recorded in one athlete, although all were within the laboratory's normal range for the assay. Mitral inflow parameters and LVEF did not change post-race and regional wall motion was normal in 14 of 15 athletes. Regional wall motion abnormalities detected in 1 athlete had resolved by 25 days post-race. These findings indicate that ultraendurance exercise does not result in sustained myocardial injury in this group of elite athletes.     

Assessment of left ventricular function by ECG-gated myocardial perfusion scintigraphy with image inversion technique: Comparison with equilibrium radionuclide angiography

BACKGROUND: Inversion of gated myocardial perfusion imaging has been proposed for the evaluation of left ventricular function. This study compared the results of inversion technique of gated left anterior oblique 45 degrees images (G-LAO 45 degrees) with those provided by equilibrium radionuclide angiography in the assessment of global left ventricular function in the same patients with suspected or known coronary artery disease. METHODS AND RESULTS: A total of 107 patients (85 men and 22 women, mean age 59 +/- 9 years) with suspected or documented coronary artery disease were studied. Eighty-seven underwent a 2-day stress/rest technetium-99m sestamibi single photon emission computed tomography with acquisition of G-LAO 45 degrees images on the day of rest, and 20 underwent thallium-201 stress/redistribution single photon emission computed tomography with G-LAO 45 degrees image acquisition immediately after redistribution imaging. An excellent correlation (P < .001) with no significant differences was found between left ventricular ejection fraction values provided by inversion G-LAO 45 degree and radionuclide angiography in 87 patients studied with Tc-99m sestamibi and 20 patients studied with TI-201. The Bland-Altman analysis demonstrated the difference in absolute ejection fraction values obtained by inversion G-LAO 45 degree images and radionuclide angiography as <8%. The inversion G-LAO 45 degrees left ventricular ejection fraction distinguishes the patients with myocardial infarction (ejection fraction = 43% +/- 13%) and without myocardial infarction (ejection fraction = 60% +/- 5%) (P < .001). In patients with left ventricular ejection fraction <40%, inversion G-LAO 45 degree images provide evaluation of left ventricular function comparable with that obtained by RNA. CONCLUSIONS: Semiautomated myocardial perfusion gated inversion technique analyzed with a count-based method is useful in the evaluation of left ventricular function and provides similar results to those of radionuclide angiography.     

Effect of transmyocardial laser revascularization on myocardial perfusion and left ventricular remodeling after myocardial infarction in rats

PURPOSE: To monitor perfusion changes in remote myocardium caused by transmyocardial laser revascularization (TMLR) and to investigate the influence of TMLR on left ventricular morphology and function. MATERIALS AND METHODS: The coronary arteries were ligated in 32 Wistar rats. Eight weeks later, cine magnetic resonance (MR) imaging was performed in both the treatment (n = 12) and control group (n = 8). TMLR was then performed in the remote myocardium in the treated group. Twelve weeks after myocardial infarction, cine MR imaging, including dobutamine-induced (10 micro g per kilogram of body weight per minute via the tail vein) stress, was repeated and followed with hemodynamic measurements in both groups and with perfusion MR imaging (in-plane resolution, 140 x 140 micro m) of the isolated heart at rest and during nitroglycerin-induced stress in the TMLR group (n = 10). RESULTS: Left ventricular dilatation and hypertrophy were enhanced in the TMLR group (change in end-diastolic volume at 8-12 weeks: control group, 24.6 micro L +/- 16.7 and TMLR group, 81.7 micro L +/- 15.7; change in left ventricular mass: control group, 54.5 mg +/- 19.2 and TMLR group, 124.1 mg +/- 30.7; P <.03 for both). Ejection fractions at rest were approximately equal (control group, 40% +/- 2; TMLR group, 38% +/- 2; P value not significant), but during dobutamine-induced stress, the ejection fraction was higher in the TMLR group (54.4% +/- 4.9; control group, 47.4% +/- 4.8; P <.05). TMLR-treated areas were better perfused than was untreated myocardium (difference in perfusion: TMLR-treated vs control region, 3.89 mL/min/g +/- 0.83 at rest vs 2.29 mL/min/g +/- 1.06 during nitroglycerin-induced stress; P <.05 for both). Hemodynamic measurements revealed no differences between groups. CONCLUSION: High-spatial-resolution perfusion MR imaging depicted a significant perfusion improvement after TMLR. Post-myocardial infarction remodeling of the left ventricle was found to be enhanced.     

The significance of determination of the fraction of creatinine-phosphokinase in patients with acute ischemic brain disease

Heart and brain vascular diseases are the leading causes of mortality in the world. Cardiac complications can frequently occur during the development of cerebral ischemia. The aim of this study was to establish the possible changes in fractions of creatinine-phosphokinase as the sensitive laboratory index of parenchymal lesion of brain parenchyma and the presence/absence of risk factors for ischemic brain and heart disease. The study comprised 80 patients with acute ischemic brain disease (AIBD), without the history of previous coronary disease. Blood samples were taken in all patients within the first 48 hours from AIBD onset aiming to determine a total (muscular MM) and heart fraction of creatinine-phosphokinase (MB), and brain parenchyma ischemia was confirmed by CT or MR scan of the head. A detailed history of the risk factors for ischemic brain disease (IBD) and ischemic heart disease was taken from all patients with AIBD, and the profile of glycemia and lipid status were determined, and blood pressure was measured 6 times a day. Independent variables in statistical analysis were: age, degree of severity and the side of neurologic event, size of ischemic lesion and maximal values of systolic and dyastolic pressure. Dependent variables were the values of fractions of creatinine-phosphokinase (CPK). Control group (n = 40) comprised patients with neurologic diseases of non-vascular origin. All parameters as well as their interrelations were statistically analyzed. The results revealed significant correlation of the increased levels of CPK of MM and MB fraction with the size and place of ischemic lesion in the right cerebral hemisphere, which was highly significant for MB fraction in the total group of patients with AIBD, and for MM fraction, only for cases of more severe IBD. Highly significant increased values of those fractions were also observed compared to the control group of patients.     

Late ventricular potentials in risk assessment of the occurrence of complex ventricular arrhythmia in patients with myocardial infarction and heart failure

AIM: To determine the prognostic significance of late ventricular potentials on signal-averaged electrocardiogram and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmia in patients treated with accelerated tissue-type plasminogen activator, using the rapid protocol, within six months of acute myocardial infarction. METHODS: In this analytic observational prospective study patients were divided into four groups: patients with left ventricular ejection fraction bellow 40% and late ventricular potentials, patients with left ventricular ejection fraction bellow 40% and without late ventricular potentials, patients with left ventricular ejection fraction over 40% and late ventricular potentials, and patients with left ventricular ejection fraction over 40% and without late ventricular potentials. Complex ventricular arrhythmias (Lown grade IVa, IVb, and V) were recorded using standard electrocardiography and 24-hour Holter monitoring 21, 60, and 90 days after acute myocardial infarction, respectively. Serial recordings of signal-averaged electrocardiogram were obtained 30, 90, and 180 days after acute myocardial infarction. Left ventricular ejection fraction was determined by echocardiography between 15 and 21 days after acute myocardial infarction. Multivariant logistic regression analysis was used to evaluate the relation between late ventricular potentials and left ventricular ejection fraction with the occurrence of complex ventricular arrhythmias. Sensitivity, specificity, positive and negative predictive values of late ventricular potentials and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmias were determined. RESULTS: The prospective study included 80 patients (73% men), mean age 64 +/- 3.5 years. Complex ventricular arrhythmias were recorded in 34 (42.5%) of patients, all 17 (50%) of which were from the first group (p < 0.01). Complex ventricular arrhythmias were recorded in 25 (73.5%) patients with late ventricular potentials, and in 23 (67.6%) patients with left ventricular ejection fraction bellow 40%. Left ventricular ejection fraction bellow 40% and late ventricular potentials represented independent predictors for the occurrence of complex ventricular arrhythmias (RR = 14.33, p < 0.01). When combined with left ventricular ejection fraction bellow 40%, late ventricular potentials had sensitivity (0.50), specificity (0.93), and positive predictive accuracy (0.85) higher than late ventricular potentials alone (0.44, 0.67, and 0.37, respectively) for the occurrence of complex ventricular arrhythmias following acute myocardial infarction. CONCLUSION: In this study, late ventricular potentials in patients with left ventricular ejection fraction bellow 40% represented the independent predictor for the occurrence of complex ventricular arrhythmias in the first six months after the first myocardial infarction treated with accelerated tissue-type plasminogen activator, using the rapid protocol.     

髓过氧化物酶在严重烧伤后早期心肌损伤中的变化规律及意义

目的：观察心肌髓过氧化物酶（MPO）在严重烧伤后大鼠中的变化规律，并探讨其与烧伤早期心肌损伤的关系。方法：采用大鼠20% TBSAⅢ度烧伤模型，动物随机分为正常对照组及烧伤组。检测各组心肌组织MPO含量及血清CK-MB、心肌肌钙蛋白T（cTn-T）含量的动态变化。结果：烧伤后2小时心肌MPO及血清cTn-T水平明显增高，至伤后镐、72小时仍保持高水平，而血清CK-MB于伤后4小时方明显升高，至伤后24、48小时已表现出下降趋势，至72小时己接近正常水平。相关分析显示，心肌MPO水平升高与血清cTn-T水平呈正相关。结论：心肌组织MPO水平的显著增高与心肌损害的水平密切相关，表明中性粒细胞在心脏组织中的长时间聚集可能与大面积烧伤后早期的心脏损害有密切关系；同时利用心肌组织MPO水平的检测有助于研究预防烧伤后早期心肌损害的有效治疗方法。