建立大鼠心肌梗死模型的若干问题探讨

目的　探讨如何成功建立心肌梗死大鼠模型 ,减少动物死亡率。方法　 6 0只Wistar大鼠 ,采用结扎左冠状动脉前降支造成心肌梗死 ,分析麻醉、人工呼吸、开胸、冠脉结扎等操作过程中的细节问题对大鼠死亡率的影响。结果　随着对制模过程中若干问题的重视 ,术后 1周动物死亡率由前期 6 0 %降为后期的 13% (P <0 .0 5 )。结论　麻醉药的正确使用、人工呼吸的科学管理、肺损伤的减少、冠脉结扎的准确判断等是成功建立Wistar大鼠心肌梗死模型的基础     

大鼠急性心肌梗死模型的制备及对肌钙蛋白T的影响

目的探讨建立大鼠急性心肌梗死(AMI)模型的方法,研究心肌梗死大鼠血浆中肌钙蛋白T(cTn-T)的动态变化。方法大鼠经结扎左冠状动脉前降支造成心肌梗死,建立稳定的心肌梗死模型;分别在结扎后31 h、48 h、69 h、168 h检测cTn-T含量和计算心肌梗死重量指数。结果成功制备心肌梗死大鼠模型,并对常规技术进行改进,降低动物死亡率。大鼠左冠状动脉结扎31 h、48 h模型组与假手术组cTn-T含量差异极显著(P0.001);各时间点心肌梗死重量指数比较,差异极显著(P0.001)。cTn-T值与梗死重量指数呈显著性正相关(r=0.90,P0.01)。结论结合大鼠心肌梗死程度进一步佐证了模型制备较成功。cTn-T表现出特异性和敏感性,并在31 h最接近达峰时间,有早期诊断心肌梗死的价值,也可作为判断AMI时心肌梗死程度和预后的参考指标。     

大鼠心肌梗死模型建立方法选择及心电图表现

目的 探讨构建心肌梗死模型的大鼠左冠状动脉结扎位置及心电图特点.方法 SD大鼠经麻醉后,气管切开插管及连通呼吸机,打开左侧胸腔后分别在距离左心耳尖端约2 mm水平处(低位结扎组)与在距主动脉根部约3 mm处(高位结扎组)结扎左冠动脉,假手术组除不结扎冠脉外步骤同低位结扎组,术前术后分别行心电图检查,且4周后取出心脏行病理学检查及测定心肌梗死面积.结果 高位结扎组大鼠心肌梗死面积约55.5％,总存活率13.3％;低位结扎组大鼠心肌梗死面积约36.2％,总存活率66.7％;假手术组大鼠无心肌梗死,存活率100％.大鼠体表心电图在非心肌梗死者QRS -T波群呈成“M”型波,在心肌梗死者R波与T波融合成高大的帐篷状单波,无明显ST段.4周后心肌组织形态学特点符合心肌梗死的病理改变.结论 距大鼠主动脉根部约3 mm结扎左冠状动脉,不能满足实验需要;距离左心耳尖端约2 mm水平结扎左冠状动脉,能满足实验需要;大鼠的体表心电图无明显ST段.     

针刺心经心包经对急性心肌缺血大鼠心电图J点、T波振幅及心肌梗死面积的影响

目的观察并比较电针心包经和心经抗急性心肌缺血的作用。方法将SD大鼠随机分为正常对照组、伪手术组、模型组、肺经组、心经组、心包经组。采用冠状动脉左前降支结扎法复制大鼠急性心肌缺血模型。肺经组选取＂太渊（LU9）—列缺（LU7）＂段,心包经组选取＂大陵（PC7）—内关（PC6）＂段,心经组选取＂神门（HT7）—通里（HT5）＂段。观察并比较各组大鼠心电图J点、T波振幅及心肌梗死面积。结果①与伪手术组比较,模型组结扎即刻,结扎72 h J点振幅、ΔJ,结扎72 h T波值、ΔT值均显著增大（P〈0.01）;与模型组、肺经组比较,心经组与心包经组结扎72 h J点值、ΔJ值、T波值、ΔT值均显著减小（P〈0.05,或P〈0.01）。②与伪手术组比较,模型组左心室梗死面积、梗死百分比显著增加（P〈0.01）。与模型组、肺经组比较,心经组与心包经组左心室梗死面积、梗死百分比显著降低（P〈0.01）。结论电针心经、心包经可明显改善急性心肌缺血大鼠心电图J点、T波的异常变化,减少心肌梗死面积,从而改善急性心肌缺血;两者在作用方向和作用程度上具有相似性。     

热休克因子1基因剔除对小鼠生长繁殖的影响

目的采用左冠状动脉结扎法,建立和评价大鼠心肌缺血再灌注损伤模型。方法麻醉大鼠21只,开胸,穿线结扎左冠状动脉造成缺血45min、松解造成再灌注180min;记录标准Ⅱ导联心电图、MAP和心肌收缩功能、心肌缺血／坏死面积以及大鼠存活时间变化。结果左冠状动脉结扎后,QRS波增宽、增高,ST段上移,T波增高,与缺血前有非常显著差别（P〈0．01）;再灌注后,QRS波宽和波高、ST段和T波非常显著下降（P〈0．01）,但仍高于缺血前水平。与缺血前比较,缺血后MAP、HR、LVSP、＋dp／dtmax、-dp／dtmax非常显著下降（P〈0．01）,LVEDP非常显著升高（P〈0．01）,再灌注后变化趋势相同。180min后,缺血区／左室、坏死区／缺血区的的平均面积比分别为34．3％、49．6％,存活率为52．4％。结论采用左冠状动脉结扎法,复制大鼠心肌缺血再灌注损伤模型,心电图、MAP和心肌收缩功能、心肌缺血／坏死变化明显,成功率较高,是一种较好的建模方法。     

益气回阳注射液对心肺复苏后大鼠血白细胞ICAM-1表达的影响

目的研究益气回阳注射液对大鼠缺氧型心脏骤停模型（CA）心肺复苏（CPR）后血白细胞黏附分子ICAM-1表达的影响。方法将50只清洁级雄性Wistar大鼠随机分为空白组、心脏骤停组、肾上腺素组、益气回阳组和肾上腺素＋益气回阳组,每组10只;采用夹闭气管窒息法制作大鼠心脏骤停动物模型,造模成功后根据不同分组给予不同药物从股静脉内注射,每5分钟1次,直至复苏成功,或复苏时间达到30min为止,流式细胞仪（FCM）检测血白细胞ICAM-1表达量。结果模型组ICAM的表达与空白组比较差异有显著性（P〈0．05）;肾上腺素组、益气回阳组以及肾上腺素＋益气回阳组白细胞ICAM-1的表达受抑制,与模型组比较差异均有显著性（P〈0．05）,组间比较无差异（P〉0．05）。结论益气回阳注射液可能通过抑制白细胞ICAM-1表达,在一定程度上减轻复苏引起的炎症反应,心肌细胞的损伤。     

MIJ和HFJ近交系大鼠心电图表现

目的测定近交系MIJ、HFJ大鼠心电图,并与Wistar大鼠比较分析,观察MIJ和HFJ大鼠心电图表现。方法大鼠麻醉后, 仰卧位固定于大鼠固定板上, 用短针电极刺入皮下2~3 mm位置,麻醉5 min后,用福田青岛FX-102B心电图机做心电图,并对心电图进行分析。 结果三种大鼠均为窦性心律,心律齐整,雄性HFJ、MIJ心率均高于同性别Wistar。HFJ和MIJ品系、性别间心率差异均无显著性。HFJ和MIJ心电轴与Wistar相同,主要在0°～90°间。三种大鼠的P波方向及QRS波群基本相同,但各波振幅和各波时限,在不同品系和性别之间存在较明显的差异。结论近交系MIJ和HFJ大鼠各有其独特的心电图表现。     

建立大鼠心肌梗死模型时如何选择结扎位点和控制心肌梗死面积

目的:研究不同结扎位点对大鼠心肌梗死面积的影响,寻找有效?准确建立心肌梗死模型的方法?方法:实验组建模前通过直视解剖显露大鼠心脏冠状动脉前降支,明确肺动脉圆锥与左心耳右缘之间交点和心尖的假想连线为大鼠冠状动脉前降支走行标志,选择在此连线上左心室最高点为缝扎位点建立大鼠心肌梗死模型(n=58)?对照组按传统方法建立大鼠心梗模型(n=38)?建模后,观察大鼠心电图和超声心动图改变,对比2组大鼠建模成功率;氯化三苯四唑 (TTC法)检测比较2组大鼠心肌梗死面积?结果:建模后心电图示:实验组建模成功率明显高于对照组(88.9% vs 65.5%,P < 0.01)?TTC法检测结果示:实验组中心肌梗死面积在中等梗死面积范围内的大鼠只数明显高于对照组(40只vs 11只,P < 0.01)?结论:直视下显露大鼠心脏冠状动脉前降支,有助于准确识别冠状动脉前降支结扎位点,控制心肌梗死面积,提高建模成功率?     

心肌梗死致心力衰竭大鼠模型构建方法的改进

【目的】 探索提高心肌梗死致心力衰竭大鼠模型构建成功率的方法,及心肌梗死后2周能否有效形成心力衰竭的问题?【方法】 将40只雄性SD大鼠随机分为对照组(不结扎冠脉,n =10)和心衰模型组(n = 30)?分别对大鼠实施戊巴比妥钠腹腔注射麻醉?经口腔气管插管?开胸后通过悬吊结扎法准确地结扎冠状动脉左前降支根部?2周后行超声心动图?血流动力学?血浆炎症因子水平和心肌Masson染色及胶原容积分数的测定?【结果】 与对照组比较,心衰模型组的EF%(78.05 ± 7.36 vs. 45.69 ± 7.54)呈显著的下降,而LVEDP/mmHg(-3 ± 3 vs. 9 ± 5)呈显著的升高(P < 0.05)?另外,心衰模型组血浆炎症因子水平(IL-1β?IL-6及TNF-α)及心肌间质CVF呈显著的上升(P < 0.05)?【结论】 心肌梗死后2周即可成功构建心衰模型,通过悬吊结扎法结扎冠状动脉可大大提高心衰模型构建的成功率?     

无辅助呼吸大鼠心肌梗死模型的制备

目的:建立简单、有效的大鼠心肌梗死模型,不用气管插管和呼吸机,直接开胸,在直视下结扎冠状动脉,制备大鼠心肌梗死模型。方法:不用气管插管和呼吸机,经胸骨左缘切口开胸,保持胸膜腔完整,缝扎左室支。术后6周,做病理检查,明确梗死存在并测量梗死面积。结果:大鼠围手术期死亡率23.1%,与假手术组相比,6周后冠脉结扎组左室增大,左室收缩舒张功能受损,病理检查示心肌梗死存在,梗死面积平均为26.6%,两组大鼠心肌梗死面积有显著性差异(P<0.05)。结论:本法成功建立了大鼠心肌梗死模型,具有简便、实用、成功率高之特点;大鼠可作为有关心肌梗死临床研究模型所用合适动物。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.