瑞舒伐他汀对脑梗塞患者脑血流动力学的影响

目的 探讨瑞舒伐他汀对脑梗塞患者脑血流动力学的影响效果.方法 选择我院2013年8月至2014年2月收治的80例脑梗塞患者为研究对象,随机分为对照组40例,观察组40例,对照组行常规抗血小板聚集、营养脑神经药物治疗,观察组在常规治疗基础上,加用瑞舒伐他汀治疗,对两组患者行多普勒超声检查,对比两组患者的脑血流动力学状况.结果 观察治疗后双侧大脑动脉Vm为(62.35±15.68) cm·s-1,双侧大脑动脉Vs为(88.62±25.31)cm·s-1,双侧大脑动脉PI为(0.63±0.31),对照组治疗后双侧大脑动脉Vm为(57.51±12.56) cm·s-1,双侧大脑动脉Vs为(80.51±21.54) cm·s-1,双侧大脑动脉PI为(0.73±0.51),差异有统计学意义(P＜0.05).结论 对脑梗塞治疗时,加用瑞舒伐他汀,可显著改善患者脑血流动力学,能帮助患者的病情恢复,值得临床进一步推广使用.     

Cardiovascular Effects of Medical Marijuana: A Systematic Review

Utilization of marijuana as a medicinal agent is becoming increasingly popular, and so far, 25 states have legalized it for medical purposes. However, there is emerging evidence that marijuana use can result in cardiovascular side effects, such as rhythm abnormalities, syncope/dizziness, and myocardial infarction, among others. Further, there are currently no stringent national standards or approval processes, like Food and Drug Administration (FDA) evaluation, in place to assess medical marijuana products. This review includes the largest up-to-date pooled population of patients with exposure to marijuana and reported cardiovascular effects. Although purported as benign by many seeking to advance the use of marijuana as an adjunctive medical therapy across the country, marijuana is associated with its own set of cardiovascular risks and deserves further definitive study and the same level of scrutiny we apply in research of all other types of medications. When used as a medicinal agent, marijuana should be regarded accordingly, and both clinical providers and patients must be aware of potential adverse effects associated with its use for early recognition and management.     

Astragalus polysaccharide attenuates isoproterenol-induced cardiac hypertrophy by regulating TNF-α/PGC-1α signaling mediated energy biosynthesis

We previously reported that Astragalus polysaccharide (APS) extracted from Chinese medicine Astragalus membranaceus (Fisch.) Bge, attenuates hypertrophy of neonatal rat ventricular myocytes (NRVMs) induced by isoproterenol (Iso). The present study was designed to investigate the effects and the possible mechanism of APS on Iso-induced hypertrophy in rats and NRVMs with focus on tumor necrosis factor α (TNF-α)/peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) signaling mediated energy biosynthesis. 36-Week old rats were randomly divided into 3 groups: (1) Control, rats received vehicle; (2) Iso, rats received isoproterenol injections; (3) Iso+APS, rats received isoproterenol injections and APS. NRVMs were divided into similar groups as rats. The results showed that combination of APS with Iso significantly attenuated the pathological changes, reduced the ratios of heart weight/body weight (HW/BW) and left ventricular weight/BW (LVW/BW), improved the cardiac hemodynamics, down-regulated mRNA and protein expression of atrial natriuretic peptide (ANP), increased the ratios of ATP/ADP and ATP/AMP, and decreased the content of free fatty acid (FFA) in heart tissue of rats compared with Iso alone. In addition, pretreatment with APS significantly decreased the surface area and protein content, down-regulated mRNA and protein expression of ANP, increased the ratios of ATP/ADP and ATP/AMP, and decreased the content of FFA in NRVMs compared with Iso alone. Furthermore, APS increased the protein expressions of ATP5D, the σ subunit of ATP synthase, PGC-1α and pyruvate dehydrogenase kinase 4 (PDK4) in tissue and NRVMs respectively and inhibited the production of TNF-α in serum and culture medium compared with Iso alone. The results suggested that APS attenuates Iso-induced cardiac hypertrophy through regulating TNF-α/PGC-1α signaling mediated energy biosynthesis.     

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Introduction

The purpose of this study is to describe a case where methylene blue improved hemodynamics in a poisoned patient.

Case Report

This is a single case report where a poisoned patient developed vasodilatory shock following ingestion of atenolol, amlodipine, and valsartan. Shock persisted after multiple therapies including vasopressors, high-dose insulin, hemodialysis, and 20% intravenous fat emulsion. Methylene blue (2 mg/kg IV over 30 min) was administered in the ICU with temporal improvement as measured by pulmonary artery catheter hemodynamic data pre- and post-methylene blue administration. Within 1 h of methylene blue administration, systemic vascular resistance improved (240 dyn s/cm5 increased to 1204 dyn s/cm5), and vasopressor requirements decreased with maintenance of mean arterial pressure 60 mmHg.

Discussion

Methylene blue may improve hemodynamics in drug-induced vasodilatory shock and should be considered in critically ill patients poisoned with vasodilatory medications refractory to standard therapies.     

肝右静脉与下腔静脉位置对布-加综合征产生机制的影响

目的探讨不同肝右静脉与下腔静脉夹角变化对布-加综合征患者下腔静脉隔膜发生机制的影响。方法运用Mimics软件对临床磁共振成像血管造影下腔静脉和主要肝静脉图像进行三维实体模型重建,测得正常模型下腔静脉与肝右静脉夹角为56°。在保持模型基本结构不变基础上,分别构建肝右静脉与下腔静脉夹角为30°和120°的模型,并数值模拟计算3个模型的壁面剪切力、壁面压强、速度分布。结果 3个模型壁面压强、壁面剪切力差异显著。与正常人56°模型相比,30°模型有较高的壁面压强和较低的血液流速,120°模型有较低的壁面剪切力和血液流速,并伴随有涡流的出现,这些血流动力学因素的改变更易于血栓的形成。56°模型血管内血流流速最快。结论对下腔静脉与肝右静脉血液流场的数值模拟有助于了解布-加综合征的发病机制,提高下腔静脉阻塞隔膜形成风险的预测,为治疗提供理论依据。     

急性中型颅脑损伤后脑血流动力学改变的经颅多普勒超声诊断

目的 探讨经颅多普勒超声(TCD)对中型颅脑损伤早期诊断中的作用及脑血流动力学特点。方法 对40例脑挫伤患者应用TCD观察脑血流动力学改变，并与正常对照组40名健康者进行比较。结果 40例患者中脑血流异常3l例(占77.5％)，异常患者中26例(83.9％)出现脑血流速度增快，7例(22．6％)出现脑血流速度减慢，13例(41.9％)出现搏动指数(PI)增高，收缩峰高尖频谱，以椎基底动脉为主；有3例(9.7％)颅内外各动脉血流速度广泛增快。中型颅脑损伤脑血液流速各期均呈增高趋势。结论 TCD可以早期发现颅脑损伤时的脑血流动力学的异常，是动态观察脑血流动力学变化的理想方法和手段。     

子痫前期产妇血清MMP2、MMP9含量检测及胎盘床血流动力学异常情况评估

目的:研究子痫前期产妇血清基质金属蛋白酶2、9(MMP2、MMP9)含量及胎盘床血流动力学异常情况.方法:将2011年3月～2013年8月期间在我院确诊的子痫前期产妇50例纳入研究的观察组,同期在我院进行产前检查和分娩的正常妊娠产妇50例纳入研究的对照组,采用酶联免疫吸附法检测血清中MMPs的蛋白含量,采用Western-blot的方法检测胎盘组织中MMPs的蛋白含量;采用彩色多普勒超声检测胎盘床的血流动力学.结果:两组产妇血清中和胎盘组织中MMP1、MMP3的蛋白含量无差异;观察组产妇血清中和胎盘组织中MMP2、MMP9的蛋白含量均低于对照组(P＜0.05);观察组产妇胎盘床血管的搏动指数(PI)、阻力指数(RI)、收缩期最大速度与舒张末期速度比值(S/D)高于对照组,时间平均流速(TAV)低于对照组(P＜0.05).结论:子痫前期产妇胎盘组织和血清中MMP2、MMP9含量异常降低,胎盘床血流阻力增大、灌注量减少.     

血液流变学及动力学在妊娠期高血压患者中的变化及临床意义

目的:探讨血液流变学及动力学在妊娠期高血压疾病患者中的变化及临床意义.方法:选择146例妊娠期高血压疾病孕妇(纳入观察组)及同期正常妊娠孕妇145例(纳入对照组)作为研究对象,采用全自动血粘度仪和无创伤监测仪监测两组孕妇血液流变学和血液动力学指标并进行组间比较.结果:观察组全血粘度(包括高切、中切、低切)、血浆粘度、红细胞压积、纤维蛋白原均明显高于对照组,差异有统计学意义(P＜0.05);观察组MAP明显高于对照组,而心输出量(CO)、心脏指数(CI)、心搏量(SV)、心搏指数(SI)及血管顺应性(AC)等则均明显低于对照组,差异均有统计学意义(P＜0.05).结论:监测孕妇血液流变学结合血液动力学指标对妊娠期高血压疾病发生有一定的预测价值,同时根据上述参数变化合理用药以改善患者血液流变学及血液动力学情况,对预防及控制妊娠期高血压疾病的进一步恶化有利.     

早期微量泵控制输注去甲肾上腺素对失血性休克兔血流动力学和心肌功能的影响

目的:探讨失血性休克早期微量泵控制输注去甲肾上腺素,对家兔血流动力学、心肌和心功能的影响。方法:实验采用健康成年新西兰兔,随机分为失血性休克去甲肾上腺素治疗组(NE组,n=7)和失血性休克生理盐水治疗组(NS组,n=7);股动脉放血法制备失血性休克模型成功后,NE组立即给予10min去甲肾上腺素的微量泵泵入,速度为0.2-1mg/(kg·h),同时静脉输注与丢失血量等量的生理盐水;NS组立即给予10min生理盐水补液治疗,补液量为3倍的丢失血量,同样采取微量泵匀速补液。10min强化治疗结束,记录为0h。随后维持并记录0,0.5,1,2,4h各时间点血流动力学指标,并留取血清进行心肌酶学(CK和CKMB)和肌钙蛋白(cTnI)分析。结果:NE组较NS组心率明显提高;NS仅在治疗前期(0h和1h)改善平均动脉压(MAP),NE则可在各时间点持续有效改善MAP;NE在一定的使用时程内(0-2h)可改善失血性休克动物的左室平均压(LVAP);NE较NS可明显提升失血性休克的左心室收缩功能;NE较NS从0.5h起可明显改善左心室舒张功能;心肌酶学和TnI结果显示NE组与NS组整体存在明显差异:CK[(23.87±16.85)vs.(13.22±2.50)ng/ml,P<0.05],CKMB[(8.80±5.68)vs.(5.27±1.14)ng/ml,P<0.05]和cTnI[(109.09±37.81)vs.(84.87±10.73)pg/ml,P<0.05]。结论:早期微量泵控制给予去甲肾上腺素治疗失血性休克,有助于改善早期血流动力学和心功能指标,但可能增加失血性休克心肌的损伤。