早期他汀类药物治疗对急性心肌梗死患者的益处

目的:探讨早期他汀类药物治疗对急性心肌梗死患者带来的益处。方法:571例急性心肌梗死患者分为他汀类药物治疗组和非他汀类药物治疗组,观察两组患者CK和CK-MB的峰值变化、发生充血性心力衰竭的风险和院内死亡率的变化情况。结果:他汀类药物治疗组院内死亡率、CK和CK-MB的峰值降低,进展为CHF的风险降低。结论:对急性心肌梗死患者在一般治疗的基础上早期应用他汀类药物治疗可获得很大的益处,且安全、可靠。     

急性心肌梗死患者直接PCI后的心电图ST段回落分析

目的:联合应用TIMI心肌灌注分级(TMP)、心电图ST段变化(sumSTR)方法评价急性心肌梗死(AMI)急诊经皮冠状动脉介入治疗(PCI)后心肌灌注程度。方法:连续入选57例AMI患者,按梗死部位分为前壁组和下壁组,于6h～12h内行直接PCI,并于手术前后分别记录ST段变化和TMP变化,从而评价心肌灌注程度。结果:对比57例AMI患者PCI前后记录显示,术后ST段明显回落TMP数值上升。结论:PCI对AMI患者疗效显著。     

升降散对急性肺损伤大鼠肺细支气管粘膜上皮细胞ICAM-1表达的影响

目的:探讨升降散对急性肺损伤模型大鼠细气管粘膜上皮ICAM-1表达的影响。方法:40只雄性SD大鼠,随机分为正常组、模型组、升降散大剂量组、中剂量组及小剂量组。给药6天后,舌下静脉注射LPS复制急性肺损伤模型,取肺组织切片,免疫组化检测。采集图像,分析细支气管粘膜上皮细胞胞质的平均灰度。结果:药物治疗组与模型组比较,能明显抑制肺细气管粘膜上皮细胞胞质ICAM-1的表达,有显著性差异。结论:升降散可通过抑制肺细气管粘膜上皮细胞胞质ICAM-1的表达,抑制炎症反应对肺组织造成的急性损伤,对急性肺损伤起到防治作用。     

冠状动脉造影正常的青年人患急性心肌梗死13例临床分析

目的：探讨冠状动脉造影（CAG）正常的青年人患急性心肌梗死（AMI）的临床特点。方法：回顾性分析486例接受CAG检查的AMI患者，探讨CAG正常的青年人患AMI的临床特点。结果：在486例中，青年AMICAG正常者13例（2．67％），分析其临床特点，本组患者多无梗死前心绞痛、高血压病、血脂异常、糖尿病及冠心病家族史。吸烟者较多，多在应激、超量吸烟情况下发病。结论：在冠状动脉造影正常的青年人患AMI中，心肌梗死可能与冠状动脉痉挛、血栓形成、冠状动脉栓塞等因素有关，这些患者预后良好。     

脑梗死/短暂性脑缺血发作住院患者二级预防依从性研究及90天随访

目的 了解北京住院脑梗死/短暂性脑缺血发作(TIA)患者对于住院期间及出院90 d二级预防药物及行为修正的依从性现状.方法 调查2006年10月1日至2007年5月1日参加研究医院的符合入组标准的连续住院脑梗死及TIA患者对于肾素-血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)、他汀药物、抗血小板药物治疗的使用率,戒烟、控制体重等行为修正率并随访90 d.结果 入组患者中使用抗血小板及他汀等药物及行为修正率偏低,并且在出院90 d这一比例进一步降低.结论 医生应关注患者有明确循证医学依据的二级预防药物及行为修正的依从性,并采取行之有效的措施提高患者药物治疗及行为修正的依从性.     

刺五加总黄酮对大鼠脑缺血后神经元的保护作用

目的：探讨剃五加总黄酮对大鼠脑缺血后神经元损伤的影响。方法：采用大脑中动脉栓塞方法制备大鼠脑缺血模型;用神经元尼氏体甲苯胺蓝特殊染色法观察大鼠脑缺血后缺血区神经元损害情况。结果：与假手术组比较,模型组大脑皮层缺血侧神经元缺失以及尼氏体消失明显（P〈0.01）;治疗组虽然也存在神经元缺失及尼氏体消失情况,但完整神经元数明显多于模型组（P〈0.01）。结论：经大脑中动脉栓塞方法建立的大鼠脑缺血模型证实了刺五加总黄酮的脑保护脑作用,抑制缺血性脑损伤,对神经细胞起一定的保护作用。     

Intracoronary adenosine improves myocardial perfusion in late reperfused myocardial infarction

Background Myocardial perfusion associates with clinical syndromes and prognosis.Adenosine could improve myocardial perfusion of acute myocardial infarction within 6 hours,but few data are available on late perfusion of myocardial infarction (MI).This study aimed at quantitatively evaluating the value of intracoronary adenosine improving myocardial perfusion in late reperfused MI with myocardial contrast echocardiography(MCE).Methods Twenty-six patients with anterior wall infarcts were divided randomly into 2 groups:adenosine group(n=12) and normal saline group(n=14).Their history of myocardial infarction was about 3-12 weeks.Adenosine or normalsaline was given when the guiding wire crossed the lesion through percutaneous coronary intervention(PCI),then the balloon was dilated and stent(Cypher/Cypher select)was implanted at the lesion.Contrast pulse sequencing MCE with Sonovue contrast via the coronary route was done before PCI and 30 minutes after PCI.Video densitometry and contrast filled-blank area were calculated with the CUSQ off-line software.Heart function and cardiac events were followed up within 30 days.Results Perfusion in the segments of the criminal occlusive coronary artery in the adenosine group was better than that in the saline group(5.71±0.29 vs 4.95±1.22,P＜0.05).Ischemic myocardial segment was deminished significantly afterPCI,but the meliorated area was bigger in the adenosine group than in the saline group((1.56±0.60)cm2 vs(1.02±0.56) cm2,P＜0.05).The video densitometry in critical segments was also improved significantly in the adenosine group (5.53±0.36 vs 5.26±0.35,P＜0.05).Left ventricular ejection fraction(LVEF)was improved in all patients after PCI,but EF was not significant between the two groups((67±6)% vs(62±7)%,P＞0.05).There was no in-hospital or 30-day major adverse cardiac event(MACE)in the adenosine group but 3 MACE in the saline group in 30 days after PCI.Conclusions Adenosine could improve myocardial microvascular perfusion in the late reopening of an occluded infarct reIaled artery(3 to 12 weeks after AMI)and clinical outcome in the follow-up period,and myocardial microvascular perfusion is a powerful predictor of clinical events.     

Gender differences in efficacy of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

Background The clinical outcome of percutaneous coronary intervention （PCI） is poorer in women than that in men. This study aimed at comparing the impact of gender difference on the strategy of primary PCI in patients with acute ST-segment elevation myocardial infarction （STEMI）.
Methods Two hundred and fifty-nine patients with STEMI who underwent primary PCI within 12 hours of symptom onset were enrolled. The male group consisted of 143 men aged 〉55 years, and a female group included 116 women without age limitation. Procedural success was defined as residual stenosis 〈20% with thrombolysis in myocardial infarction flow grade 〉2 and without death, emergency bypass surgery or disabling cerebral events during the hospitalization. The rate of major adverse cardiac events （MACE）, including death, nonfatal myocardial infarction and target vessel revascularization during follow-up, was recorded.
Results Female patients were more hypertensive and diabetic and with fewer cigarette smokers than male counterparts. The prevalence of angiographic 3-vessel disease was higher in the female group, but the procedural success rate was comparable between the two groups （94.4% vs 92.2%）. The occurrence rate of MACE did not differ during the hospitalization （4.2% vs 6.0%, P=0.50）, but was significantly higher in the female group during follow-up （mean （16.0±11.2） months） than that in the male group （5.4% vs 0.7%, P=0.02）.
Conclusion Despite a similar success rate of primary PCI and in-hospital outcomes in both genders, female patients with acute STEMI still have a worse prognosis during the long-term follow-up.