急性心肌梗死患者中性粒细胞氧自由基改变及维生素C的干预作用

目的 评价急性心肌梗死（AMI）患者中性粒细胞（PMN）氧化代谢功能以及维生素C的抗氧化损伤作用。方法 共有60例AMI患者被列入研究对象,随机分成两组,Ⅰ组（30例）给予AMI的常规治疗,Ⅱ组（30例）在常规治疗的基础上加用维生素C静脉滴注,每天3g ,连续应用7d后停药,在入院后第1,3,7,10天检测中性粒细胞化学发光（PMN－CL）参数,并行心电图检查,62例与AMI患者年龄性别匹配的健康人作为对照组（Ⅲ组）。结果 AMI患者PMN－CL各项参数显著性高于健康对照组。在第3、7天,Ⅱ组PMN－CL的各项参数较Ⅰ组明显下降,在偏旁 用维生素C后3d仍较Ⅰ组明显下降（P分别＜0.05,0.01,0.001）,心电图ST段改善的积分明显高于Ⅰ组。结论 AMI患者PMN产生大量的氧自由基（OFR）,造成机体氧化损伤;静脉滴注维生素C能有效抑制AMI患者PMN产生OFR,从而能减轻AMI患者心肌的进一步坏死。     

中性粒细胞与急性肺损伤

在急性肺损伤(ALI)及ARDS的发生中,中性粒细胞(PMN)过度活化起着重要作用。其机制涉及PMN与肺血 管内皮细胞间的粘附反应、PMN的效应反应,如呼吸爆发、脱颗粒,释放炎性细胞因子、凋亡抑制、脂质介质释放等多个方面。     

冠心病患者服用硝苯吡啶前后中性粒细胞氧化代谢的变化

以鲁米诺依赖的化学发光法检测２３例冠心病，急性心肌梗塞１２例，心绞痛１１例，服用硝苯吡啶前后中性粒细胞氧化代谢的变化。北与２０例正常对照者比较。     

家兔烫伤早期中性粒细胞凋亡变化

目的 通过检测烧伤早期中性粒细胞（ＰＭＮ）凋亡,观察烧伤血清和创面水肿液对ＰＭＮ体外自发凋亡的影响。方法 应用全血荧光染色观察３０％家兔Ⅲ度烫伤早期ＰＭＮ凋亡;应用流式细胞分析等方法观察血清和痂下组织液培养ＰＭＮ的体外凋亡。结果 伤后４、８、１２、２４ｈ循环ＰＭＮ凋亡减少,约为伤前的１／６,且４个时相间差异无显著意义;烧伤血清和痂下组织液能抑制ＰＭＮ凋亡,使ＰＭＮ凋亡率下降,ＤＮＡ断裂百分率降低,     

中性粒细胞死亡在急性肺损伤中的作用

急性肺损伤（acute lung injury, ALI）是临床常见的危重病,严重时会发展成急性呼吸窘迫综合征,甚至导致死亡,目前尚无有效的治疗方法。在不同病理生理条件下,中性粒细胞呈现多种不同的死亡形式,如中性粒细胞外诱捕网、铁死亡、焦亡、凋亡、自噬、坏死及坏死性凋亡等。不同形式的中性粒细胞死亡在ALI的发生、发展进...     

肠缺血/再灌注损伤时中性粒细胞呼吸爆发活性的变化

目的:研究肠缺血/再灌注(I/R)时中性粒细胞(PMN)呼吸爆发活性的变化.方法:30只成年雄性Wistar大鼠,按照随机数字表法分为假手术,缺血45 min,缺血45 min再灌注60min、120min、360min等5组.阻断肠系膜上动脉血流45min后复流,复制I/R模型:假手术组只进行同样的手术操作但不阻断肠系膜上动脉血流.在各时间点分别取门静脉血测定白细胞计数,并分离PMN进行化学发光(CL)测定.结果:肠I/R损伤过程中,缺血组与假手术组比较,PMN的CL峰值无明显差异(P＞0.05),再灌注组PMN的CL峰值均明显升高(P＜0.01).肠缺血组白细胞数量较假手术组降低,再灌注后开始回升,再灌注360 min时白细胞计数最高.PMN化学发光峰值变化和血白细胞计数的变化趋势呈显著正相关(r=0.748,P＜0.05).结论:肠I/R损伤可激活循环中的PMN,使血中的PMN数量增加,PMN的呼吸爆发化学发光活性明显升高,可能是引起全身炎症反应和器官损害的因素之一.     

中性粒细胞的杀菌机理

中性粒细胞的吞噬和杀菌功能在机体抗感染过程中占重要地位。过敏毒素C_5~a及某些血小板因子不仅是中性粒细胞的趋化因子,同时也是其激活因子。中性粒细胞被激活后,其胞膜上CR_1及CR_3表达的增加,增进了其吞噬功能。中性粒细胞的杀菌作用依赖于两大系统,分别通过呼吸爆炸和脱颗粒杀灭细菌。呼吸爆炸过程中起杀菌作用的是氧自由基,而其脱颗粒释放的杀菌因子均与嗜天青颗粒有关。研究表明,中性粒细胞由不同功能的亚群所组成。各亚群间在趋化性、吞噬性和杀菌性方面也各不相同。     

烧伤急性期中性粒细胞的激活

烧伤机体内的一系列介质可最先激活中性粒细胞，使之表达膜表面分子，并与内皮细胞粘附而游出血管，激发氧自由基等物质的产生和释放。但大量中性粒细胞在血管内同时激活，水但会导致机体早期抗感染能力下降，还会带来组织继发损伤，因此应设法使其活化保持有利于机体的水平上。     

中性粒细胞凋亡与细胞因子

机体在严重感染或遭受创伤应激后的高炎症反应与中性粒细胞的凋亡及体内众多细胞因子的产生和参与密切相关，而细胞因子可能通过介导中性粒细胞的凋亡来影响机体的炎症反应。     

原发性肾病综合征患者中性粒细胞明胶酶相关脂质运载蛋白的变化及意义

目的 探讨原发性肾病综合征(PNS)患者中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的变化以及与病理类型、肾小管间质损伤程度、临床指标的关系. 方法 40例PNS患者按有无急性肾小管坏死(ATN)分急性肾损伤(AKI)组及非AKI组,按病理类型分微小病变型肾病(MCD)组、系膜增生性肾小球肾炎(MsPGN)组、局灶性节段性肾小球硬化(FSGS)组、膜增生性肾小球肾炎(MPGN)组、膜性肾病(MN)组;20例健康体检者及20例因肾肿瘤做肾切除术但远离肿瘤部位的正常肾组织作正常对照.采用酶联免疫吸附试验(ELISA)法检测血清、尿液NGAL水平,免疫组织化学染色法观察肾组织NGAL表达.结果 (1) AKI组患者血、尿NGAL水平及肾组织NGAL表达显著高于非AKI组及对照组(P＜0.05).(2)MPGN组及FSGS组患者血、尿NGAL水平及肾组织NGAL表达显著高于其他病理类型组(P＜0.05).(3)在肾小管间质发展至重度病变之前,随着肾小管间质损伤程度的加重,血、尿NGAL水平及肾组织NGAL表达逐渐升高;在肾小管间质发展至重度病变时,血NGAL水平及肾组织NGAL表达下降(P＜0.05).(4)血、尿NGAL水平及肾组织NGAL表达与血肌酐呈正相关(r值分别为0.198、0.352、0.146,P值分别为0.048、0.000、0.028),与尿素氮呈正相关(r值分别为0.199、0.278、0.325,P值分别为0.043、0.000、0.019),与血白蛋白呈负相关(r值分别为-0.384、-0.318、-0.259,P值分别为0.028、0.024、0.020),与尿渗透浓度呈负相关(r值分别为-0.250、-0.256、-0.277,P值分别为0.012、0.027、0.002).结论 NGAL可作为预测PNS患者AKI的敏感指标,在一定程度下可用于评价肾小管间质病变程度及肾功能.     

Treatment of cardiac arrhythmias in patients with acute myocardial infarction

Cardiac arrhythmias and conduction disturbances are commonly observed in patients with acute myocardial infarction. The available data suggest the administration of prophylactic lidocaine, either through a large intramuscular dose (300 mg), which is particularly suited for out-patient situations, or through intravenous loading doses followed by a constant lidocaine infusion. Patients with ventricular arrhythmia should be treated with direct-current countershock if hemodynamic deterioration is present. Drug therapy for patients with ventricular arrhythmias who are resistant to lidocaine include procainamide, bretylium, or intravenous amiodarone (experimental drug).Treatment of atrioventricular block in acute infarction depends on the site of atrioventricular block, the infarct location, and the hemodynamic status. Generally, atrioventricular block associated with inferior infarction and normal hemodynamic states generally does not require insertion of a pacemaker. In contrast, patients with anterior myocardial infarction and Mobitz II or third degree atrioventricular block should be treated with emergent temporary insertion of a pacemaker. In addition, prophylactic pacing is clearly indicated for those with acute myocardial infarction complicated by the bifascicular block pattern or first degree atrioventricular block and new onset bundle branch block.     

Phaeochromocytoma and acute myocardial infarction

Phaeochromocytoma is uncommonly associated with myocardial infarction. We present a patient who, despite established alpha adrenoceptor blockade, sustained an acute myocardial infarction and was found to have coronary artery disease. Indications for coronary revascularization were not met, and adrenalectomy was successfully performed four weeks later. Factors contributing to the myocardial infarction, the role of beta adrenoceptor blockade, the timing of adrenalectomy and the place of coronary revascularization are discussed.     

老年急性心肌梗死患者衰弱评价及危险因素分析

目的探讨老年急性心肌梗死行择期冠状动脉介入术(PCI)患者的衰弱现状及危险因素,为早期筛检和预防急性心肌梗死老年患者预防衰弱提供参考。方法选取心血管内科行择期PCI的老年急性心肌梗死患者158例,采用Fried表型衰弱量表于术前评估其衰弱状况,采用单因素及Logistic多因素分析老年急性心肌梗死患者合并衰弱的危险因素。结果急性心肌梗死合并衰弱患者44例(27.85%);衰弱较非衰弱者在机体的生理、心理及心脏功能方面差异显著,且增龄、长期服用多种药物、查尔森共病指数(CCI)评分、日常生活能力障碍、肌钙蛋白I为老年急性心肌梗死患者发生衰弱的危险因素(P0.05)。结论老年急性心肌梗死患者衰弱发生率较高,影响衰弱的危险因素较多,衰弱的预防及改善需结合老年人生理、心理及客观实验室指标等多领域的综合干预。     

护理对多层螺旋CT头CTA检查的影响

回顾性分析我院成功救治45例急性心梗患者的护理方法,从常用溶栓药物及使用方法、溶栓中的护理操作技能及监测技术、静脉溶栓中的病情观察和整体护理方面总结急性心肌梗死病人行静脉溶栓治疗的相关护理问题.     

Perioperative mortality rate in patients with unstable angina selected by exclusion of myocardial infarction.

Coronary bypass surgery may be associated with an increased perioperative mortality rate in patients with unstable compared to stable angina. The mortality rate is excessively high when surgery is performed during evolving myocardial infarction. Elevated plasma MB CPK isoenzyme activity is a remarkably sensitive and specific marker of myocardial damage. Accordingly, we studied 111 patients with unstable angina to determine whether exclusion of patients with initially elevated MB CPK improves the perioperative mortality rate. Plasma MB CPK activity was assayed prior to catheterization and every 2 hours therafter. Of the 111 patients, 16, with initially elevated MB CPK activity, were excluded and managed medically. Catheterization was performed in 59 patients, and severe vessel obstruction was documented in 55. Coronary bypass surgery performed in 47 patients was associated with a mortality rate of 4 per cent. Thus, after exclusion of patients with evolving infarction by MB CPK isoenzyme analysis, catheterization and coronary bypass surgery in patients with unstable angina resulted in a mortality rate comparable to that in patients with stable angina.     

Effect of insulin-glucose infusion on mortality following acute myocardial infarction in patients with diabetes: the diabetes and insulin-glucose infusion in acute myocardial infarction studies

People with type 2 diabetes and other glucose abnormalities are very common among today's patients with acute coronary syndrome (ACS) and recent studies indicate that they still have an unfavorable prognosis compared to patients with normal glucose metabolism. In fact, they account for a substantial proportion of the residual morbidity and mortality in the ACS population. The common denominator seems to be an elevated blood glucose during the acute event and current evidence indicates that acute and long-term tight glucose control will improve the prognosis for this rapid growing patient population.