Electrophysiologic follow-up in dogs receiving intracoronary ethyl alcohol injection.

96% ethyl alcohol was injected into a diagonal branch of the left anterior descending coronary artery of 10 out of 12 anesthetized dogs, and saline solution was injected in the remaining 2. After chest closure, the dogs were subjected to ambulatory monitoring (H) during days 1, 2, 3 and 7. The electrophysiologic study (EPS) and signal-averaged electrocardiography. (SA-ECG) were performed before the injection and again at day 7 after injection. H failed in one dog which died of ventricular fibrillation. In the other 9 dogs that received alcohol injection, H showed frequent ventricular premature and ventricular tachycardia (VT) after injection; six of the 9 dogs sustained VT, which was not inducible by EPS. VT was not found in 2 control dogs receiving saline solution injection. The SA-ECG showed no ventricular late potentials in dogs receiving alcohol injection. Post-ablation ventricular arrhythmia (including VT) occurred after intracoronary ethyl alcohol injection in all dogs. Arrhythmogenicity markedly declined during the first 3 days and almost completely disappeared on day 7 after ablation. There was no evidence in favor of reentry as the mechanism of these arrhythmias. Enhanced automaticity was considered as the mechanism for ventricular arrhythmia.

     

乙醇肝动脉栓塞的实验研究

In this experiment, 27 dogs underwent hepatic arterial embolization (HAE) with 99% ethanol in 10 (group A), 75% ethanol in 10 (group B) and 60% ethanol in 7 (group C). By the laparotomy, catheter was inserted into hepatic artery and ethanol at dose of 0.3 ml/kg was injected within 20 seconds. Arterial angiography was taken before and after HAE. The dogs were sacrificed in 1, 2, 4, 8 weeks. Liver specimens were examined grossly and microscopically. Both A and B group showed satisfactory results of embolization, but 99% ethanol caused severe damage to hepatocytes, perisinusoidal area and bile ducts. Eight of 10 dogs died of hepatic failure and infection within two weeks. 75% ethanol mainly occluded the smaller arterial branches. Hepatocellular and biliary tract lesions were slight and reversible. All the animals survived normally except two. Group C had some mild and limited liver damage and scattering thrombosis which might result from intima lesion. This article also discusses the clinical availability of ethanol HAE.     

犬自体骨髓间充质干细胞移植对心肌梗死后胶原纤维含量影响的实验研究

目的探讨犬急性心肌梗死后自体骨髓间充质干细胞(BMMSCs)心肌移植对胶原纤维含量的影响。方法结扎犬冠状动脉左前降支建立急性心肌梗死模型,将用Brdu标记的BMMSCs细胞悬液注入心梗区不同部位,取心梗区标本,行Massion三色染色测定胶原纤维含量。结果犬BMMSCs培养生长状况良好,传代后经Brdu标记,标记率达80%;梗死心肌组织切片发现,胶原纤维含量明显减少,血管周围胶原纤维沉积减少。结论犬经心肌内注射途径植入的自体BMMSCs可以在梗死心肌组织内定植、存活,减少胶原形成,从而有利于延缓AMI后的心室重构。     

乙醇肝动脉栓塞的实验研究

作者用99％、75％和60％三种浓度的乙醇分别作犬的肝动脉注射,通过血管造影和病理检查,观察了它们不同的栓塞效果和肝组织反应,结果99％乙醇导致了严重的肝坏死;60％乙醇未能达到确实可靠的血管栓塞,75％乙醇栓塞作用尚好而肝组织损害较轻。作者探讨了乙醇的致栓机理,并讨论了乙醇肝动脉栓塞术用于临床治疗的可行性。     

冠状动脉痉挛致急性心肌梗死12例诊治分析

目的: 总结冠状动脉痉挛导致急性心肌梗死的临床特点及诊治经验。方法: 回顾性分析2014年3月至2019年6月期间收治的12例冠状动脉痉挛致急性心肌梗死患者的临床资料。结果： 冠状动脉痉挛导致急性心肌梗死患者经冠状动脉造影、血管内超声、光学相干断层扫描检查呈现多种表现形式,其中右冠状动脉痉挛急性下壁心肌梗死8例（66.7%）,左前降支痉挛急性前壁心肌梗死2例（16.7%）,右冠、左前降支及左回旋支痉挛急性下壁合并前壁心肌梗死2例（16.6%）。术中经冠状动脉内给予硝酸甘油后冠状动脉痉挛均消失,术后经硝酸酯类、钙离子拮抗剂及他汀药物等治疗后,患者胸闷、胸痛临床症状缓解。结论： 冠状动脉造影及血管内超声、光学相干断层扫描能够及时明确诊断冠状动脉痉挛导致的急性心肌梗死,并有效地指导药物治疗,临床上硝酸酯类加钙离子拮抗剂药物治疗冠状动脉痉挛效果显著。     

乌拉地尔对急性心肌梗死再灌注后无复流的影响

目的 对冠脉内注射小剂量乌拉地尔对防治靶血管开通后的无复流现象的作用进行初步研究.方法 我院收治的急性心肌梗死患者并行急诊介入治疗者共48例随机分为为乌拉地尔组(术中加用乌拉地尔冠脉内注射)和对照组(各24例).比较两组患者的术后心肌灌注分级和无复流的发生率.结果 乌拉地尔组术后梗死相关血管血流Blush分级无复流发生率,显著低于对照组(16.67% vs 29.2%)P＜0.05.结论 冠脉内注射小剂量乌拉地尔对急性心肌梗死直接介入治疗后无复流现象有一定防治作用.     

Effect of intracoronary administration of anisodamine on slow reflow phenomenon following primary percutaneous coronary intervention in patients with acute myocardial infarction

Background Many basic and clinical studies have proved that anisodamine can produce significant effect on relieving microvascular spasm, improving and dredging the coronary microcirculation. It may be beneficial to the improvement of slow-reflow phenomenon (SRP) following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). So we investigated the effect of intracoronary administration of anisodamine on SRP of infarct related artery (IRA) following primary PCI in patients with ST segment elevated acute myocardial infarction (STEAMI). Methods Twenty-one patients with SRP from a total of 148 STEAMI patients accepted primary PCI were enrolled into this study from September 2004 to December 2005. When SRP happened, nitroglycerin (200 µg) was “bolus” injected firstly into IRA to exclude the spasm of epicardial artery and identify SRP as well as a baseline and self-control agent following PCI. Ten minutes later, 1000 µg of anisodamine was injected into IRA with SRP at 200 µg/s, while the coronary angiography (CAG) was taken before and at 1st, 3rd and 10th minute after administration of nitroglycerin or anisodamine, respectively. The corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG) and the diameter of IRA were calculated and analyzed by Gibson’s TIMI frame count method using quantitative computer angiography (QCA) system to evaluate the influence of anisodamine on coronary flow and vessel lumen. In the meantime the invasive hemodynamic parameters of intracoronary and systemic artery (systolic, diastolic and mean pressure) and electrocardiogram (ECG) were measured and monitored. The changes of ventricular performance parameters and the adverse reaction were evaluated and followed-up at 1 month post-PCI. Results No significant changes in cTFCs and TMPGs were found at 1st, 3rd and 10th minute after intracoronary administration of nitroglycerin as compared with the baseline control (P＞0.05). cTFCs were decreased by 58.3%, 56.2%, and 54.6%, respectively (P<0.001), and TMPGs were increased from 1.13±0.21 grade to 2.03±0.32, 2.65±0.45 and 2.51±0.57 grades (P<0.05) at 1st, 3rd and 10th minute after intracoronary administration of anisodamine as compared with those after intracoronary administration of nitroglycerine, respectively. The average coronary blood flow of TIMI grade was improved from 1.76±0.43 to 2.71±0.46 (P<0.05) while the diameter of middle segment in re-patented coronary artery was slightly increased from (3.20±0.40) mm to (3.40±0.50) mm at the 3rd minute after intracoronary administration of anisodamine (P＞0.05) as compared with those of nitroglycerine control. The systolic, diastolic and mean pressures of intracoronary artery after intracoronary administration of anisodamine increased from 115 to 123, 75 to 84, 88 to 95 mmHg (P<0.05), respectively, along with the rise of heart rate from 68 to 84 beats per minute (P<0.05). There were no significant changes in intervals of PR, QT and QRS (P＞0.05) and no any severe fast arrhythmia after intracoronary administration of anisodamine. The ventricular performance parameters were significantly improved and no major adverse cardiovascular events (MACE) were found during follow-up at 1 month post-PCI. Conclusions Intracoronary administration of 1000 µg anisodamine is effictive in reversing SRP following PCI in STEAMI patients, especially it is suitable for SRP patients with bradycardia or hypotension.     

冠状动脉支架植入术治疗急性心肌梗塞39例

目的：小结采用直接冠状动脉支架植入术治疗39例急性心肌梗塞患者的中期效果。方法：接受介入治疗距胸痛发作的平均时间为4．2h。经股劝脉采用Judkins技术完成冠状动脉造影及支架植入术,在38例患者42支血管共植入55个支架,1例患者仅行右冠状动脉球囊成形术。结果：术后即刻TIMI血流3级者36例（92．3％）,TIMI血流2级者3例（7．7％）。术中6例（15．4％）在便塞相关动脉开通后出现心室颤动,1例（2．6％）死于继发性心室颤动。术后平均随访8．1个月,除1例死于术后2周非梗塞相关动脉择期支架植入术外,无心肌梗塞、做外科冠状动脉搭桥术和再次做梗塞相关动脉介入治疗的病例。结论：直接冠状动脉支架术可以迅速获得便塞相关动脉TIMI3级血流,中期效果良好。     

Recurrent myocardial infarction secondary to Prinzmetal’s variant angina

Prinzmetal’s variant angina describes chest pain secondary to reversible coronary artery vasospasm in the context of both diseased and non-diseased coronary arteries. Symptoms typically occur when the patient is at rest and are associated with transient ST-segment elevation. Acute episodes respond to glyceryl trinitrate, but myocardial infarction and other potentially fatal complications can occur, and long-term management can be challenging. Although it is not well understood, the underlying mechanism appears to involve a combination of endothelial damage and vasoactive mediators. In this case, a 35-year-old woman with myocardial infarction secondary to coronary artery vasospasm experienced recurrent chest pain. Coronary angiography revealed severe focal stenosis in the mid left anterior descending artery, which completely resolved after administration of intracoronary glyceryl trinitrate. The patient was discharged on nitrates and calcium channel blockers. The patient re-presented with another myocardial infarction, requiring up-titration of medical therapy.     

急诊冠脉介入治疗急性心肌梗死310例分析

目的观察急性心肌梗死患者行急诊冠脉介入治疗的有效性和安全性。方法对发病在12 h内的310例急性心肌梗死患者行急诊冠状动脉造影和冠脉介入治疗。结果310例患者中共植入465枚支架,其中裸支架119枚,药物支架346枚。304例患者介入治疗获得成功,无一死亡病例,成功率达98%。结论 对急性心肌梗死患者行急诊介入治疗是安全有效的,药物支架和裸支架一样可安全应用于急性心肌梗死的治疗。     

心痛贴对麻醉犬冠状动脉循环及心肌氧代谢的影响

目的：观察心痛贴（XTT）对麻醉犬急性心肌梗塞的保护作用。方法：将24条犬随机分成4组：空白对照（NS）组(n=6)、心痛贴小剂量（0.6 g）组(n=6),心痛贴大剂量（1.2 g）组(n=6)及阳性对照药硝酸甘油（NG）贴剂组(n=6)。麻醉开胸结扎犬冠状动脉左前降支（LAD）,复制急性心肌梗塞模型,分别将贴剂贴于每只犬左前胸近腋窝部位,测定给药后5～360 min犬冠状动脉循环（简称冠脉循环）和心肌氧代谢参数,并测定给药后360 min梗塞面积及血清肌酸激酶（CK）、乳酸脱氢酶（LDH）及天门冬氨酸转氨酶（AST）变化。结果：XTT大、小剂量组与空白对照组比较,可降低冠脉阻力（P<0.05）,增加冠脉流量（P<0.05,P<0.01）,减少心肌耗氧量及心肌氧利用率（P<0.05,P<0.01）,缩小心肌梗塞面积（P<0.05,P<0.01）,降低CK、LDH、AST活性（P<0.05,P<0.01）。结论：XTT能改善冠脉循环,减少心肌耗氧量,对缺血心肌具有保护作用。     

经导管冠状动脉支架植入术治疗冠心病的疗效分析与随访

目的研究分析冠状动脉内支架置入术治疗冠心病心肌梗塞和不稳定心绞痛的安全性和有效性。方法回顾性分析本院2001年1月至2005年5月经皮冠状动脉支架植入术治疗142例冠心病心肌梗塞和不稳定心绞痛患者临床资料,随访评价其近、中期临床疗效和安全性。结果共处理病变血管162支,其中前降支病变79例,回旋支病变24例,右冠脉病变54例,第一钝缘支病变3例,第一对角支病变1例,中间支病变1例,血管平均狭窄程度(92.51±9.05)%,经股动脉途径110例,经桡动脉途径32例,植入支架179个,植入支架的总成功率97.2%,支架平均长度为21.38±5.08 mm,支架的平均直径3.04±0.35 mm,支架释放压力平均为12.55±1.74atm,平均住院天数21.88±11.92 d。主要并发症:死亡3例,发生心肌梗死1例,急性冠脉搭桥1例,术中出现室速、室颤6例,均除颤成功。随访3月~2年,支架植入术后因心脏事件再次住院患者30例(占21.1%),支架内再狭窄8例,均为Medtronic AVE系列裸支架,支架内再狭窄率4.5%,其余患者临床疗效均佳,无心脏事件及心绞痛发生,生活质量较好。结论本组资料显示,冠脉内支架置入术治疗包括复杂病变在内的冠心病心肌梗塞和不稳定心绞痛成功率高,并发症低,疗效确切,是治疗冠脉病变尤其是处理PTCA术中明显内膜撕裂和急性血管闭塞的有效方法。     

碱性成纤维生长因子对急性心肌梗死血管生成和碱性成纤维生长因子及血管内皮生长因子表达的作用

目的探讨心肌内注射碱性成纤维生长因子(bFGF)对急性心肌梗死(MI)血管生成和bFGF、血管内皮生长因子(VEGF)表达的作用。方法24只犬建立急性MI模型后随机分成对照组(MI区注射生理盐水15ml)和实验组(MI区注射50mg bFGF与生理盐水的混合液15ml)。每组观察4个不同的时间点(术后第1天、第3天、第10天、第17天)。各组分别在处死前应用敏感编码技术行磁共振电影成像。免疫组织化学方法检测各组心肌细胞中bFGF和VEGF的表达及微血管数量。结果实验组左心室射血分数自第10天明显增加;除第1天外各个时间点的微血管数量实验组比对照组明显增多;心肌缺血区对照组bFGF和VEGF的表达增多。结论局部心肌内注射bFGF有促进MI区域毛细血管形成及提高左心室功能的作用。     

自体骨骼肌星状细胞心肌成形的实验研究

目的 通过不同途径在心肌梗死的不同时期移植自体骨骼肌星状细胞,观察其移植后能否在心肌梗死区进一步增殖分化,形成心肌样横纹肌组织。方法 采用冠脉结扎与C形环冷冻相结合于犬左室游离壁做心肌梗死Ⅰ区,在其邻近位置单纯冷冻法做心肌梗死Ⅱ区。A组：在心肌梗死后立即将二咪基苯吲哚(DAH)标记的骨骼肌星状细胞悬液经冠状动脉及肌壁分别注射到自体犬的两个心肌梗死区。B组：在心肌梗死形成10～14.1后,二次开胸行自体骨骼肌星状细胞移植,方法同前。细胞移植后4周,取心脏标本行组织学检查结果冠脉结扎与半环形冷冻相结合及单纯冷冻法可成功制作小面积心肌梗死模型;冰冻切片荧光显微镜检查：组A心肌梗死Ⅰ区可见少量散在荧光,组B心肌梗死Ⅰ区未见荧光分布;两组实验动物心肌梗死Ⅱ区于注射部位均见线形荧光,但普通光学显微镜及透射电镜下均未见横纹肌组织。结论 用骨骼肌星状细胞移植替代受损坏死心肌尚不成熟,其临床应用有待进一步研究。     

急性心肌梗死临床介入治疗的护理

目的:通过分析急诊经皮穿刺冠状动脉腔内成形术(PTCA)及冠状动脉内支架(Intracoronary stent)置入术对急性心肌梗死(AMI)的急诊介入治疗方法,探讨急诊冠状动脉腔内成形术及冠状动脉内支架置入术对急性心机梗死行介入治疗的护理经验。方法:选取ST段抬高的35例急性心肌梗死发病时间在12 h以内,行急诊冠状动脉造影的急诊冠状动脉腔内成形术及冠状动脉内支架置入术治疗的患者的护理进行回顾性分析。结果:入选的急性心肌梗死35例行急诊冠状动脉造影。冠状动脉腔内成形术及冠状动脉内支架置入术成功率100%。术前梗死相关血管狭窄(93.1±5.8)%,术后残余狭窄(10.3±7.6)%。35例急性心肌梗死患者术后2例发生穿刺部位血肿,3例拔管时出现迷走反射性低血压,其余患者无并发症发生。结论:急性心肌梗死行急诊冠状动脉腔内成形术及冠状动脉内支架置入术成功率高,残余狭窄小,可获得较高的梗死相关血管再通率和较低的心肌梗死复发率和死亡率,同时可减少梗死面积,保护心功能。在急性心肌梗死急诊介入治疗的过程中,严密的观察,精心的、全方位的护理可降低心肌梗死的发生,促进患者的康复。     

经皮冠状动脉介入术治疗急性心肌梗死的初步体会

目的 观察急性心肌梗死（AMI）患者应用碰状动脉介入（PCI）术的安全性和有效性。方法 对12例AMI患者存发病12h内行PCI术，梗死相关血管（12支血管）：前降支5例（41．7％），右冠状动脉7例（58．3％）。TIMI血流：0级12例。结果 12例患者手术成功，TIMI血流3级，住院期间无死亡。12例患者置入13个冠状动脉内支架。结论 直接PTCA及原发性置入支架术是治疗急性心肌梗死的安全有效措施，成功率较高，并发症少。     

中药川芎嗪拮抗内皮素－1致冠脉收缩效应的初步观察

用冠脉造影方法观察中药川芎嗪（ＴＭＰ）对内皮素－１（ＥＴ－１）致狗冠脉收缩的拮抗效应。ＥＴ－１５０～１００ｐｍｏｌ冠脉内给药引起冠脉内径减小１７％～２０％（Ｐ＜０．０２），伴有心电图缺血改变。实验组静滴ＴＭＰ８０ｍｇ／ｋｇ后，冠脉内径增加２０％（Ｐ＜０．０３），而且再给相同剂量ＥＴ－１未引起冠脉内径减小，也无心肌缺血发生。可见，ＥＴ１可引起冠脉收缩及心肌缺血，ＴＭＰ能扩张冠脉并拮抗ＥＴ－１的冠脉收缩效应，防止心肌缺血发生。     

Effect of Salvia Miltiorrhiza on Coronary Collateral Circulation in Dogs with Experimental Acute Myocardial Infarction *

ＩｔｈａｓｂｅｅｎｋｎｏｗｎｔｈａｔＳａｌｖｉａＭｉｌｔｉｏｒ－ｒｈｉｚａｃａｎｐｒｏｔｅｃｔｔｈｅｉｓｃｈｅｍｉｃｍｙｏｃａｒｄｉａ．ＳａｌｖｉａＭｉｌｔｉｏｒｒｈｉｚａｍｉｇｈｔａｃｈｉｅｖｅｓｕｃｈｐｒｏ－ｔｅｃｔｉｏｎｂｙｄｅｃｒｅａｓｉｎｇ...     

Increased incidence of silent ischemia after acute myocardial infarction.

OBJECTIVE--To determine the incidence of angina pectoris during induced myocardial ischemia in patients who have had thrombolytic therapy for acute myocardial infarction in comparison with patients with angina pectoris. DESIGN--During percutaneous transluminal coronary angioplasty, both study groups had coronary artery occlusion by the balloon dilatation catheter for 5 minutes. SETTING--A tertiary, cardiology referral center. PATIENTS--Twenty-five patients with angina pectoris who were undergoing angioplasty were compared with 30 patients having angioplasty 2 days after thrombolytic therapy for acute myocardial infarction. OUTCOMES--Development of angina pectoris during balloon occlusion of the coronary artery was the primary end point; the ischemic response and muscle viability were assessed using both surface and intracoronary electrocardiograms and pulmonary artery wedge pressure. RESULTS--During balloon occlusion 16 (64%) of 25 patients in the angina pectoris group developed angina. In contrast, nine (30%) of 30 patients in the thrombolysis group had angina pectoris during balloon occlusion of the infarct artery (P less than .01). The electrocardiographic response to ischemia and changes in pulmonary wedge pressure were similar in the two study groups. CONCLUSION--After thrombolytic therapy for myocardial infarction, silent ischemia may be the rule rather than the exception.     

主动脉内球囊反搏辅助急诊冠状动脉内成形术治疗急性心肌梗死并心源性休克6例报道

目的 观察在主动脉球囊反搏（IABP）辅助下行急诊经皮冠状动脉内成形（PTCA）＋支架植入术治疗急性心肌梗死（AMI）并心源性休克的疗效。方法 选择AMI并心源性休克患者6例，在IABP辅助下行冠状动脉造影极（CAG），并对梗死相关动脉（IRCA）行急诊PTCA＋支架植入术，术后给予抗凝治疗及AMI的常规治疗。结果 6例患者全部存活出院。1例于术后30个月死于慢性心功能不全。结论 IABP辅助下行急诊PTCA＋支架植入术是治疗AMI合并心源性休克的有效方法，能显著降低死亡率。