介入联合早期心脏康复治疗老年急性心肌梗死并高血压90例分析

目的 急性心肌梗死并高血压老年病人应用介入与早期心脏康复联合干预治疗效果、心脏功能与不良事件情况分析.方法 选取2018年1月至2019年1月武汉市第六医院诊治180例急性心肌梗死并高血压老年病人资料,按随机数字表法分为两组,各90例.对照组予以介入与常规康复干预,研究组予以介入与早期心脏康复联合干预,均直到半年.分析...     

Serum contains a potent factor that decreases β-adrenergic receptor-stimulated L-type Ca2+ current in cardiac myocytes

L-type Ca²⁺ current (I _Ca) was measured in cultured atrial myocytes from hearts of adult guinea-pigs using whole-cell voltage clamp. Potentiation of I _Ca induced by -adrenergic stimulation (isoprenaline 2· 10^–7 M) could be completely antagonized by diluted sera (1100 v/v). Half-maximal inhibition of -receptorstimulated I _Ca occurred at about 11000. Basal I _Ca was not affected by serum. Atropine in a concentration (10^–6M) that completely antagonized the anti-adrenergic effect of acetylcholine (ACh, 2·10^–6 M) did not interfere with the effect of serum. In cells dialysed with cyclic adenosine monophosphate (cAMP)-containing (10^–4 M) pipette solution, potentiated I _Ca was insensitive to both ACh and serum. Preincubation of the myocytes with pertussis toxin almost completely abolished the anti-adrenergic effects of both ACh and serum. The potency of serum was not reduced by dialysis. It is concluded that serum contains a factor which, like ACh, inhibits -receptor-stimulated adenylyl cyclase via G_iprotein.A preliminary report of this work has appeared in abstract form [11]     

实时三维超声心动图在婴幼儿原发性心脏肿瘤诊断中的临床价值

目的 探讨实时三维超声心动图（RT-3DE）诊断婴幼儿原发性心脏肿瘤的临床价值。方法 回顾性分析3例婴幼儿原发性心脏肿瘤术前RT-3DE表现,并与术中所见和术后病理结果进行对比分析。结果 3例患儿RT-3DE表现均与手术所见相符合,经病理证实为心脏脂肪瘤1例,横纹肌瘤2例。结论 RT-3DE能快速显示婴幼儿原发性心脏肿瘤的特征,对临床诊断有重要价值。     

右室流出道与右室心尖部起搏对心脏收缩功能和左室重构的影响

目的评价右室流出道(RVOT)和右室心尖部(RVA)起搏对心脏收缩同步性、收缩功能和左室重构的影响。方法82例高度或III度房室传导阻滞患者随机分为RVOT起搏组(A组,n=43)和RVA起搏组(B组,n=39),以术前左室12节段达峰时间标准差(Ts-SD)是否>32.6ms对两组患者进行亚组分组,Ts-SD>32.6ms者为A1亚组与B1亚组,Ts-SD≤32.6ms为A2亚组与B2亚组。于术前及术后6个月分别进行超声心动图检查,测量舒张末左室容积(LVEDV)、收缩末左室容积(LVESV)、左室射血分数(LVEF),并采集组织多普勒图像(TDI)进行脱机分析,测量主动脉瓣射血前时间(APET)、肺动脉瓣射血前时间(PPET)、左室12节段收缩达峰时间(Ts),计算室间电机械延迟(IVMD)和Ts-SD。结果术后6个月,两组的IVMD均较术前增加;两组Ts-SD与术前比无差异。亚组分析表明术前同步性好的A2、B2亚组术后Ts-SD升高;术前同步性差的A1亚组术后Ts-SD降低。术后6个月两组LVEDV、LVESV及LVEF与术前比较均无差异,组间比较亦无差异。结论RVOT和RVA起搏短期内对左室收缩功能及左室重构均无影响,术前收缩不同步者可从RVOT起搏中获益。     

Time course and mechanisms of phosphorylation of phospholamban residues in ischemia-reperfused rat hearts. Dissociation of phospholamban phosphorylation pathways.

Sarcoplasmic reticulum (SR) dysfunction is one of the multiple alterations that occurs in ischemia-reperfused hearts. Because SR function is regulated by phosphorylation of phospholamban (PLB), a SR protein phosphorylated by cAMP-dependent protein kinase (PKA) at Ser(16)and Ca(2+)-calmodulin-dependent protein kinase (CaMKII) at Thr(17), the phosphorylation of these residues during ischemia and reperfusion was examined in Langendorff-perfused rat hearts. Ser(16)phosphorylation increased significantly after 20 min of ischemia from 2.5+/-0.6% to 99.8+/-25.5% of maximal isoproterenol-induced site-specific phosphorylation and decreased to control values immediately after reperfusion. Thr(17)phosphorylation transiently increased at 2-5 min of ischemia and at 1 min of reperfusion (R1, 166.2+/-28.2%). The ischemia-induced increase in Ser(16)phosphorylation was significantly diminished in hearts from catecholamine-depleted animals and/or after beta-blockade and abolished in the presence of the PKA-inhibitor, H-89. Thr(17)phosphorylation at the beginning of ischemia was blunted by nifedipine, whereas at R1 it was significantly diminished by perfusion with 0 m m Ca(2+)in the presence of EGTA and by the Na(+)/Ca(2+)exchanger inhibitor KB-R7943. KN-93, used to specifically inhibit CaMKII, decreased Thr(17)phosphorylation at R1 and significantly prolonged half relaxation time. The results demonstrated a dissociation between the phosphorylation of PLB sites, being phosphorylation of Ser(16)dependent on the beta-adrenergic cascade during ischemia and phosphorylation of Thr(17)on Ca(2+)influx both, at the beginning of ischemia and reperfusion. Phosphorylation of Thr(17)at the onset of reflow may provide the cell a mechanism to cope with Ca(2+)overload, transiently favoring the recovery of relaxation during early reperfusion.     

慢性心力衰竭患者氨基末端B型钠尿肽与心肌肌钙蛋白Ⅰ水平分析

目的了解氨基末端B型钠尿肽（NT-proBNP）在慢性心力衰竭（CHF）患者中的水平变化以及与心肌肌钙蛋白I（cTnI）之间的关系。方法将166例CHF患者心功能按美国纽约心脏病协会（NYHA）分级方案分为Ⅰ～Ⅳ级（Ⅰ级15例、Ⅱ级57例、Ⅲ级54例、Ⅳ级40例）,同时测定166例CHF患者和45名正常对照者血清cTnI及NT-proBNP水平并作比较,分析NT-proBNP与cTnI及患者年龄之间的相关关系。结果 CHF组以及NYHA分级各组患者的血清NT-proBNP、cTnI水平均高于正常对照组（P〈0.01）;且随着NYHA分级的提升,NT-proBNP、cTnI水平也随之增高（P〈0.01）,超过正常参考范围的例数也随之增多。CHF组NT-proBNP与cTnI、年龄呈正相关（r分别为0.664、0.217,P均〈0.01）。结论 NT-proBNP是诊断CHF较好的心肌标志物,能反映CHF病情的严重程度。cTnI有随着NT-proBNP升高而增高的趋势。