心电图非特异性ST段和T波异常改变与腹膜透析患者并发心血管不良事件的关系研究

目的:研究心电图非特异性ST段和T波异常改变与腹膜透析患者并发心血管不良事件的关系,分析其在预后的价值.方法:回顾性选择 2019 年 2 月～2021 年 2 月于我院接受腹膜透析治疗的 84 例患者作为研究对象,根据患者入院时心电图非特异性ST抬高、压低、延长、缩短及T波低平、平坦、增高、倒置、双向变化,将入组患者分为ST段-T波异常组(n=40 例)和ST段-T波正常组(n=44 例).收集两组性别、病史、血清指标、实验室检查水平、心血管不良事件发生率等临床资料,采用Cox比例模型分析心电图非特异性ST段和T波异常改变与腹膜透析患者并发心血管不良事件的关系.结果:两组在性别比、年龄、血脂水平、血压等方面均无统计学差异(P＞0.05),但ST段-T波异常组与ST段-T波正常组在心血管不良事件发生率、透析时间、血清可溶性生长刺激基因表达蛋白 2(sST2)水平上有显著差异(P＜0.05);经Cox比例模型分析显示ST段-T波异常与心血管不良事件发生、透析时间、sST2 水平呈正相关(P＜0.05).结论:ST段-T波异常与并发心血管不良事件发生、透析时间、sST2 水平呈正相关,可作为ST段-T波异常的危险因素,根据结果加强此类患者的监管,以改善患者预后.     

注射用黄芪冻干粉一般药理研究

目的:观察注射用黄芪冻干粉对动物心血管系统、中枢神经系统、呼吸系统的影响。方法:以不同剂量黄芪冻干粉给予小鼠和麻醉犬静脉注射,观察药物对动物各系统的影响。结果:注射用黄芪冻干粉各剂量(生药70.0g/kg、35.0g/kg、7.0g/kg)组对麻醉犬血压、心率有显著降低和减慢作用;对心电图PR间期、QT间期、ST间期有显著延长影响(P<0.01);但对QRS、T波、P波、心动节律无明显影响;对犬呼吸系统无明显影响(P>0.05);对小鼠自主活动无明显影响,并不影响小鼠戊巴妥钠阈下催眠剂量(P>0.05)。结论:注射用黄芪冻干粉明显降低犬血压、减慢心率,显著延长心电图PR间期、QT间期、ST间期,但对QRS、T波、P波、心率节律和呼吸系统(呼吸频率、深度、节律)无明显影响;对小鼠中枢神经系统无抑制作用。     

注射用黄芪冻干粉一般药理研究

目的:观察注射用黄芪冻干粉对动物心血管系统、中枢神经系统、呼吸系统的影响。方法:以不同剂量黄芪冻干粉给予小鼠和麻醉犬静脉注射,观察药物对动物各系统的影响。结果:注射用黄芪冻干粉各剂量(生药70.0g.kg-1、35.0g.kg-1、7.0g.kg-1)组对麻醉犬血压、心率有显著降低和减慢作用;对心电图PR间期、QT间期、ST间期有显著延长影响(P<0.01);但对QRS、T波、P波、心动节律无明显影响;对犬呼吸系统无明显影响(P>0.05);对小鼠自主活动无明显影响,并不影响小鼠戊巴妥钠阈下催眠剂量(P>0.05)。结论:注射用黄芪冻干粉明显降低犬血压、减慢心率、…     

癫癎发作时心率和心电图变化及其影响因素

目的:探讨癫患者癫发作时心率和心电图(ECG)变化及其影响因素。方法:选择在我院癫中心进行录像脑电/心电(VEEG/ECG)监测时有癫发作的患者46例,对其癫发作时的EEG、ECG及其行为学进行分析。结果:在共106次发作中,97次(91.5%)癫发作时心率加快,发作时心率平均增加58.6次/min,癫发作时心率最快达182次/min。19例(41.3%)患者在38次(35.8%)的癫发作时伴有ECG异常改变,主要表现为房性早搏、房室传导阻滞、房颤、心脏停搏、ST段降低、ST段抬高、T波倒置。全身性发作、颞叶癫以及在睡眠中发作三个因素对癫发作时的心率变化有一定的影响。结论:癫患者发作时心率和ECG有明显变化,这种变化可能与癫患者突然意外死亡有关。     

不同浓度没食子儿茶素没食子酸酯对离体蟾蜍心脏功能的影响

目的:观察不同浓度没食子儿茶素没食子酸脂(Gollatecatechin gallate,GCG)对离体蟾蜍心脏功能的影响。方法:采用斯氏蛙心灌流法制备离体蛙心标本,分为4组,分别用任氏液(川北医学院机能中心配制)和以任氏液为溶剂配制的0.002mg·ml~(-1)、0.02mg·ml~(-1)、0.2mg·ml~(-1)浓度GCG溶液对离体蟾蜍心脏进行灌流,采用BL-420生物机能实验系统记录心率(频率)和心肌收缩力(峰值)的变化。结果:与对照组比较,离体蟾蜍心脏心率明显增加(P0.05,P0.01);心肌收缩力随着GCG溶液灌注浓度的增加明显下降(P0.05,P0.01)。结论:GCG溶液对离体蟾蜍心功能有明显影响。     

β-受体阻滞剂在改善心脏β受体亢进综合征的心电图及运动引发的心律失常中的作用

运动对心脏的代谢,血液动力学和电生理有广泛的影响。心脏β受体亢进综合征患者在安静状态下可表现心电图T波倒置及ST段下移。在临床上可观察到有器质性心脏病和无器质性心脏病的人做运动试验时出现室性或房性心律失常,对此曾有人观察运动时引起室性心     

渐进性肌肉放松训练结合疼痛管理对下肢骨折患者疼痛、心理状态和康复效果的影响

目的:探讨应用渐进性肌肉放松训练联合疼痛管理对下肢骨折患者疼痛、精神心理状态和康复效果的影响.方法:选取2018年3月-2019年3月入院的45例下肢骨折患者纳入对照组,采用常规模式干预,2019年4月-2020年3月入院的45例下肢骨折患者纳入观察组,采用渐进性肌肉放松训练联合疼痛管理干预,两组均为期干预8周.观察两组患者的疼痛情况、舒适度、心理状态、下肢功能恢复情况、躯体自理能力及生活质量状况.结果:干预后观察组Kolcaba简化舒适度量表(GCQ)评分明显高于对照组(t=3.245,P＜0.05);观察组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分明显低于对照组(t=2.497,2.171;P＜0.05),观察组下肢功能评价量表(LEFS)评分明显高于对照组(t=3.467,P＜0.05),而躯体自理量表(PSMS)评分则明显低于对照组(t=3.504,P＜0.05),观察组生活质量量表(GQOLI-74)中躯体功能、心理功能、社会功能、物质生活状态评分明显高于对照组(t=3.656,3.869,5.069,2.733;P＜0.05).结论:渐进性肌肉放松训练联合疼痛管理能有效缓解下肢骨折患者的负性情绪和疼痛程度,提升躯体自理能力、治疗的舒适度和生活质量,有助于促进下肢功能恢复.     

大鼠离体作功心脏对冠脉压强变化的反应

目的:研究离体作功心脏对其冠脉压强变化的反应.方法:采用分离式离体作功心脏模型.用上海产SJ-42型四导生理记录仪测定生理参数左心室收缩压LVSP,左心室内压上升的最大速率(dp/dt)max,冠脉流量CF,心率HR和心电图ECG.结果:离体作功心脏的工作状态受其冠脉压强变化的影响,当灌注压Pc=9 kPa时,心脏处于最佳状态.灌注压过高或过低均可导致心脏功能减弱.结论:心脏自身存在冠脉压强感受系统,在冠脉压强发生变化时,心脏自主地调节着工作状态.     

不同浓度酒精对蟾蜍心脏电活动的影响

本文以蟾蜍为实验对象,进行在体心脏灌流,研究酒精对心脏电活动的影响。将蟾蜍随机分为三组,每组14只。以任氏液为灌流液,观察了三种不同浓度(20mM、60mM、100mM)的酒精对蟾蜍心脏电活动的影响,灌流时间为40min。结果:20mM酒精对高频心电图(HF-ECG)各项时域值基本无影响,而增加各高频频段的相对能量。60mM酒精显著抑制心率,缩短QRS波宽,增加高频切迹和扭挫的数目,对各高频频段相对能量均降低。100mM酒精显著抑制心率,对其他各项心电指标影响不大。由上述结果看,60mM酒精对蟾蜍心脏电活动的影响最为显著。     

丹冰通颗粒对心肌缺血的保护作用

目的探讨丹冰通颗粒治疗心肌缺血的保护作用。方法采用异丙肾上腺素致大鼠心肌缺血实验模型,检测心电图ST段、心肌丙二醛(MDA)、超氧化物歧化酶(SOD)和乳酸脱氢酶(LDH)的含量;采用垂体后叶素致大鼠心肌缺血实验模型,检测对T波的影响,并检测离体大鼠心脏冠脉流量。结果丹冰通颗粒能明显抑制异丙肾上腺素所致的心肌缺血大鼠心电图ST段偏移,使血清LDH活性和MDA含量降低,SOD活性增高(P0.05)。丹冰通颗粒能明显抑制垂体后叶素所致的心肌缺血大鼠心电图T波高度的变化,可明显增加离体大鼠心脏冠脉流量。结论丹冰通颗粒对心肌缺血具有保护作用。     

中重度抑郁症患者心电图及心率变异性分析

目的:探讨中重度抑郁症患者心电图及心率变异性特点,为临床评估中重度抑郁症心脏自主神经功能变化提供依据.方法:选择2018年6月至2019年12月就诊于湖南省脑科医院的中重度抑郁症患者38例为研究组,32例健康志愿者为对照组,比较两组心电图异常率及心率变异性,并统计分析各指标之间的差异.结果:研究组心电图异常ST-T改变...     

Protein kinase A increases the rate of relaxation but not the rate of tension development in skinned rat cardiac muscle

To clarify the contribution of cross-bridge kinetics to the contraction profile of cardiac twitch during beta-adrenergic stimulation, we studied the rate of tension development and relaxation following laser flash photolysis of caged compounds in rat-skinned ventricular trabeculae before and after treatment with the catalytic subunit of protein kinase A (PKA, 0.5 U/microl, 40 min). Tension development following nitrophenyl (NP)-EGTA photolysis was fitted with a single exponential function. The rate constant increased with an increase in postphotolysis steady tension, and the relation between the rate constant and the tension was not influenced by PKA. The rate of relaxation following diazo-2 photolysis was fitted with a double exponential function. The rate of both initial rapid and subsequent slow relaxation was independent of the extent of relaxation. PKA increased the rate of initial rapid relaxation by about twofold, but showed no significant effect on the rate of subsequent slow relaxation. These results suggest that in beta-receptor stimulated rat cardiac muscle, the increased rate of tension development and the facilitated relaxation rate during twitch can be partly explained as being due to the combined effects of decreased Ca(2+) affinity of troponin C and increased cycling rate of cross-bridges (subtractive combination for tension development and additive combination for tension relaxation).     

慢性高输出量型心功能不全发展过程中心室舒、缩功能和顺应性的变化及其与心泵功能的关系

本文研究了大鼠慢性高输出量型心功能不全发展过程中心室舒,缩功能和顺应性的变化规律及其与心泵功能的关系。疾病模型采用动静脉造瘘(ACF)加单侧肾动脉缩窄(RAS)的方法建立。本实验中,全部ACF+RAS大鼠均呈现出慢性高输出量型心功能不全的特征,在静息状态下心脏指数(CI)显著升高,而心泵贮备功能(CORF)却不同程度地降低。结果表明:随心泵功能的恶化,心室的舒、缩功能进行性降低,心室的舒张顺应性显著升高,心室的舒,缩性能和顺应性在心功能不全发展的不同阶段对心泵功能所起的作用不同。     

Troponin I phosphorylation does not increase the rate of relaxation following laser flash photolysis of diazo-2 in guinea-pig skinned trabeculae

 In vivo, two effects of β-adrenergic stimulation in cardiac muscle are phosphorylation of troponin I and an increase in relaxation rate. In vitro, cardiac TnI can be phosphorylated by protein kinase A (PKA). We have used the technique of laser flash photolysis of the calcium chelator diazo-2 to investigate the effect of phosphorylation of TnI on the relaxation rate of skinned trabeculae from the guinea-pig at 12°C. The fibres were phosphorylated by PKA, and double exponential curve fits of the average relaxation transients showed no significant difference between the rate constants of the phosphorylated and control cases. We conclude that TnI phosphorylation has no effect on the rate of relaxation in skinned trabeculae from the guinea-pig following diazo-2 photolysis. Received: 30 October 1996 / Received after revision and accepted: 20 January 1997     

Non-invasive assessment of electrophysiological effects of histamine infusion in mam

The electrophysiological changes induced by sequential infusion of histamine (H) (0.4 and 1.0 mcg/kg/min for 10 min each) were investigated by conventional ECG and High Resolution ECG (H.R.ECG). The latter permits external non-invasive recording of the potentials generated in the cardiac conduction system. H was infused i.v. in 5 normal volunteers with a mean age of 30 years. H infusions were begun with 0.4 mcg/kg/min and continued for 10 min. After a 60 min recovery period a second 10 min infusion (1 mcg/kg/min) was administered. In man H produced a dose-dependent increase in heart rate, a significant depression of the ST-T complex, and a depression in STJ point. The QRS complex duration was unmodified. H.R.ECG showed significant changes in the morphology and voltage of the atrial activity. The electrophysiological effects disappeared within a few minutes after discontinuing the infusions of H.     

Exercise test in patients with sarcoidosis. The importance of repolarization disturbances

The study population comprises 28 patients with sarcoidosis who all had repolarization disturbances in their exercise ECGs. None of the patients had hypertension or known cardiovascular disease, and all but two were non-smokers. The mean age was 45 years. Exercise test with beta-adrenergic blockade was performed within one month of the first examination. Persisting abnormal ST-T changes in exercise ECGs after beta-blockade were seen in 12 (43%) patients. No significant relationship was found between persisting ST-T changes and age, sex, chest X-ray stage, lung function or working capacity. In an earlier study, we found ST-T abnormalities in exercise ECG in 56 of 127 individuals (44%) in a consecutive 5-year study of patients with newly detected sarcoidosis. From this and the present report we postulate that, in our region, as much as 20% of the patients with newly detected sarcoidosis might have organic myocardial disease, possibly of sarcoid origin, as shown by repolarization disturbances in exercise ECG. If ECG abnormalities in the ST-T region are present in patients with sarcoidosis, exercise ECG with beta-blockade is a simple way of establishing suspicion of organic myocardial lesions. If exercise ECG abnormalities in the ST-T region persist after beta-blockade, careful clinical follow-up is recommended, and, in some patients early steroid therapy should be considered.     

Effect of chemical sympathectomy on cardiac hypertrophy and hemodynamics following myocardial infarction in the rat

The effects of sympathectomy on cardiac structure and function were studied in an animal model of myocardial infarction. Ninety-six rats were double randomized to control or infarction disease state and to placebo or chemical sympathectomy (guanethidine, 30 mg/kg daily, intraperitoneal). Five weeks after anterior infarction, there was hypertrophy in placebo-treated animals in myocardial fibers remote from the infarct (9.8 +/- 1.8 microns in infarction vs 8.1 +/- 1.0 microns in control, p less than 0.05). However, myocardial hypertrophy was not present in guanethidine-treated animals (8.6 + 1.6 microns in infarction vs 8.0 + 0.6 microns in control, p = N.S.). Guanethidine treatment caused significant reductions in systolic arterial blood pressure and indices of left ventricular contractility and relaxation (p less than 0.05), but these effects were not different between infarct and control treatments (p = N.S.). Although both effects of guanethidine treatment (sympathectomy and hemodynamic) were correlated with myocardial fiber diameter by univariate analysis, only sympathectomy was significant by stepwise regression analysis (p less than 0.05). Therefore, the cardiac sympathetic nerves have important effects on the development of hypertrophy after myocardial infarction, and sympathectomy alters this process in the rat model.     

Hormone replacement therapy can augment vascular relaxation in post-menopausal women with type 2 diabetes

BACKGROUND: Diabetes is a major risk factor for coronary heart disease in women and event rates increase substantially after the menopause. Observational studies have suggested that estrogens may provide cardioprotection by regulating endothelial nitric oxide synthase. METHODS: In order to examine the effect of hormone replacement therapy (HRT) on endothelium-dependent and -independent vascular relaxation in post-menopausal women with type 2 diabetes, an open study was conducted in which gluteal biopsies were collected from 17 women before and after 6 months of transdermal 17 beta-estradiol (80 microg twice weekly) in combination with oral norethisterone (1 mg daily). Small arteries (<550 microm) were dissected from fat and mounted on a wire myograph for assessment of relaxation in response to acetylcholine (ACh), bradykinin (BK) and sodium nitroprusside (SNP). RESULTS: Maximal relaxation responses to ACh, BK and SNP in women with diabetes and non-diabetic control subjects were 52 +/- 8 versus 96 +/- 2% (P < 0.05), 76 +/- 7 versus 97 +/- 1%, (P < 0.05) and 91 +/- 2 versus 98 +/- 1% (P < 0.05) respectively. After 6 months of HRT, maximal relaxation responses to ACh, BK and SNP in women with diabetes (compared with pre-HRT) were: 88 +/- 4 (P < 0.05), 93 +/- 3 (P < 0.05) and 98 +/- 1% (P < 0.05) respectively. At baseline and after HRT, EC50 (concentration required to obtain 50% of maximum response) data exhibited similar changes. CONCLUSIONS: HRT had potentially beneficial effects on vascular relaxation. Data were consistent with improvements in endothelial function, vascular smooth muscle function, or both. Controlled studies are required to confirm and extend these findings.     

肾交感神经去除术对心肌肥厚和心肌纤维化的影响

 目的:观察肾交感神经去除术（renal sympathetic denervation, RDN）对心肌肥厚和心肌纤维化的影响,并探讨其可能机制。方法:选用12周龄的健康SD雄性大鼠60只,随机分为假手术组、假手术+RDN组、主动脉缩窄组、主动脉缩窄+RDN组,8周后用介入生理记录仪检测血流动力学和心功能指标,HE染色、苦味酸-天狼星红染色分别观察心肌肥厚和心肌纤维化情况,放射免疫分析法测量血浆肾上腺素浓度、肾素活性、血管紧张素II浓度及心脏血管紧张素II含量。结果:与主动脉缩窄组相比,RDN可显著改善主动脉缩窄大鼠心脏舒张功能［左室舒张末期压力（LVEDP）：(8.03±1.66) mmHg vs(15.77±2.14) mmHg;等容舒张期左室压力下降最大速率（-dp/dt）：(7 793±587) mmHg/s vs(6 353±475) mmHg/s;P＜0.01］、防止其心肌肥厚和纤维化［左心室重量指数：3.340±0.121 vs4.244±0.102;心肌细胞面积：(332.9±28.9) μm2 vs(401.6±33.2) μm2;胶原容积分数：7.76%±0.85% vs12.48%±1.82%;P＜0.01］。然而,RDN不能降低主动脉缩窄大鼠的血压（P＞0.05）。RDN导致主动脉缩窄大鼠的血浆肾上腺素浓度、肾素活性、血管紧张素II浓度及心脏血管紧张素II含量均明显减少（P＜0.01）。结论: RDN可以通过降低交感和肾素-血管紧张素系统活性直接抑制心肌肥厚和心肌纤维化,从而改善心脏功能。     

The effects of nonconcurrent and concurrent relaxation training on cardiovascular reactivity to a psychological stressor

Eight patients in a cardiac rehabilitation program, after exposure to two psychological stressors approximately equivalent with respect to cardiovascular reactivity, were given nonconcurrent progressive muscle relaxation training and retested for reactivity. They were then provided with relaxation training concurrently with one of the stressors and exposed again to the two stressors. No significant effects for nonconcurrent progressive muscle relaxation training were detected. Concurrent training, in contrast, produced reductions in both systolic and diastolic blood pressure. Reductions resulting from training on the target stressor showed little tendency to generalize to the nontarget stressor; the discrimination was particularly well defined for systolic blood pressure. We conclude that muscle relaxation techniques are maximally effective in reducing reactivity to psychological stressors when relaxation training is provided concurrently with the stressor. Our findings further suggest that to inculcate the relaxation response reliably across different situations, specific training to enhance generalization may be needed.