缺血后适应对老年急性心肌梗死患者的影响

目的观察缺血后适应(IPO)对急性心肌梗死(AMI)患者PCI后心肌灌注和临床事件的影响。方法选取12h内接受急诊PCI的老年AMI患者122例,分为对照组87例和IPO组35例。对照组梗死相关血管再通后,不施加干预;IPO组梗死相关血管再通后1 min内应用低气压充盈和回撤球囊,每一过程各30s,术后测定血肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、丙二醛,观察ST段回落,冠状动脉血流速度、住院期间临床事件发生情况。结果 IPO组CK、CK-MB和丙二醛峰值明显低于对照组(P<0.05);IPO组冠状动脉血流速度明显快于对照组(P<0.05),术后ST段回落>50%者明显高于对照组(74.3%vs 54.0%,P<0.05),再灌注心律失常发生率明显低于对照组(P<0.05)。结论 IPO可以缩小心肌梗死面积、减少自由基的生成,改善PCI后冠状动脉血流速度,改善心肌灌注,减少再灌注心律失常的发生。     

磷酸肌酸钠联合果糖二磷酸钠治疗病毒性心肌炎的疗效观察

目的 探讨磷酸肌酸钠联合果糖二磷酸钠治疗病毒性心肌炎的疗效.方法 选取2010年9月至2012年8月在新疆自治区人民医院北院就诊的病毒性心肌炎患者99例,按照随机数字表法将患儿分成联合用药组（50例）和基础治疗组（49例）.两组患儿均实施常规治疗,治疗组在常规治疗的基础上加用果糖二磷酸钠,每次150剂mg/kg,每日2次,静脉滴注;联合用药组在治疗组的基础上加用磷酸肌酸钠,50 mg/kg,静脉滴注.两组疗程均为2周.结果 联合用药组治疗后的总有效率为92.0%,显著高于治疗组的67.3%（Z=2.484,P＜0.05）,联合用药组经治疗后心电图及心肌酶谱各有1例未发生变化,治疗组经治疗后心电图无变化4例,心肌酶谱无变化7例,联合用药组经治疗后心电图及心肌酶谱改变均较治疗组显著.结论 磷酸肌酸钠联合果糖二磷酸钠治疗病毒性心肌炎疗效显著,不良反应轻微,安全可行,值得临床推广.     

磷酸肌酸钠治疗小儿传染性单核细胞增多症心肌损害的疗效观察

目的:探讨磷酸肌酸钠治疗小儿传染性单核细胞增多症(IM)伴心肌损害的疗效.方法:IM伴心肌损害患儿64例随机分为治疗组与对照组各32例,两组患儿均给予更昔洛韦及对症治疗,在此基础上治疗组加用磷酸肌酸钠(CP)治疗,对照组加用1,6-二磷酸果糖(FDP)治疗,疗程均为14天,观察治疗前后病人心肌酶谱、肌钙蛋白和心电图改变情况.结果:两组患儿治疗前心肌酶水平相似且高于正常值,治疗后两组心肌酶均显著下降(P＜0.01), 治疗组心肌酶改善及总有效率均显著优于对照组(P＜0.05);心电图改善率、肌钙蛋白I阴转率两组无明显差别(P＞0.05).结论:CP 可治疗小儿IM心肌损害,其效果优于FDP.     

Mulligan手法治疗腰椎小关节紊乱的临床疗效

目的：观察运用Mulligan手法治疗腰椎小关节紊乱的临床疗效。方法：82例腰椎小关节紊乱患者随机分为观察组(n = 41)和对照组(n = 41),观察组采用Mulligan手法治疗,对照组采用腰部斜扳法治疗。隔天治疗一次,共治疗三次。2组患者分别在治疗前、治疗后进行视觉模拟评分法和JOA腰背痛疗效评价系统评定,并进行肌酸激酶(CK)和乳酸脱氢酶(LDH)检验。结果：治疗后,观察组VAS评分较治疗前及对照组治疗后有明显下降(P<0.05);观察组血清CK检验数值较治疗前有明显下降(P<0.05);对照组血清CK检验数值较治疗前,观察组与对照组血清LDH检验数值较治疗前均无统计学差异(P>0.05);观察组显效率(含痊愈)及总有效率较对照组有明显升高(P<0.05)。结论：Mulligan手法对腰椎小关节紊乱的疗效明显,可以有效的减轻疼痛,调整腰椎关节,调节腰部周围肌群平衡,从而恢复腰部运动功能。     

小儿腹泻大便细菌培养及轮状病毒检测结果与血清锌、CK-MB水平的关系

目的：研究腹泻病患儿大便细菌培养及轮状病毒检测结果与血清锌、肌酸激酶同工酶（CK-MB）水平的关系。方法对2013年1～12月在该院儿科住院部确诊为腹泻病的620例患儿分别进行轮状病毒、锌元素和 CK-MB 检测及大便细菌培养,了解腹泻病患儿大便细菌培养及轮状病毒检测结果与血清锌、CK-MB 水平的关系。结果620例标本有320例细菌培养和轮状病毒阳性,阳性率为51.61％;感染组锌缺乏水平与 CK-MB 升高水平明显较非感染组高,差异有统计学意义（P ＜0.05）;锌缺乏的腹泻病患儿,CK-MB 水平明显高于锌正常的患儿,差异有统计学意义（P ＜0.05）。结论感染性腹泻患儿比例较高,应重视进行病原学检测;感染性腹泻患儿容易引起锌缺乏与 CK-MB 升高,特别是锌缺乏的腹泻病患儿更易引起 CK-MB 升高,值得临床医生重视。     

Metabolic changes of prefrontal cerebral lobe, white matter and cerebellum in patients with post-stroke depression*☆ A proton magnetic resonance spectroscopy study

BACKGROUND： Proton magnetic resonance spectroscopy （IH-MRS） non-invasively detects changes in chemical substances in the brain, which reflects the pathological metabolism.
OBJECTIVE： To investigate changes in N-acetyl-aspartate （NAA）, choline （Cho）, creatine （Cr）, and myoinositol （MI） in the gray and white matter of cerebral prefrontal lobe and cerebellum of patients with differential degrees of post-stroke depression （PSD） using ^1H-MRS.
DESIGN： A case control study.
SETTING： The First Affiliated Hospital of the Dalian Medical University.
PARTICIPANTS： A total of 38 patients with stroke （28 male and l0 female patients, aged 40 to 79 years） were selected from the Department of Neurology, 1st Affiliated Hospital, Dalian Medical University, from February to October in 2004. All subjects met the DSM-IV criteria for cerebrovascular disease and depression. The degree of depression was defined according to Hamilton criteria. 38 patients with PSD were divided into two groups according to the time after ischemia, 20 patients in the acute group with less than 10 days after ischemic attack （mild： 16 patients, moderate/severe： 4 patients） and 18 patients in the chronic group with more than l l days after ischemic attack （mild： 15 patients, moderate/severe： 3 patients）. Seventeen healthy volunteers with matching age from 41 to 80 years were examined as a control group. The study was approved by the Medical Ethics Committee of the University Medical Center Utrecht, and each participant signed an informed consent form.
METHODS： Spectra were acquired by multi-voxel point-resolved spectroscopy （PRESS） sequence with GE signal.5T MR/i, localized in prefrontal cerebral lobe and cerebellum. Values of NAA, Cho, MI, and Cr ere compared between different graded PSD patients and control subjects with one-way analysis of variance in software SPSS 11.5.
MAIN OUTCOME MEASURES： Metabolite concentration in different brain regions of interest. Difference in metabolites b     

Protective effects of Terminalia arjuna against Doxorubicin-induced cardiotoxicity

Terminalia arjuna has been marked as a potential cardioprotective agent since vedic period. The present study was aimed to investigate the effects of butanolic fraction of Terminalia arjuna bark (TA-05) on Doxorubicin (Dox)-induced cardiotoxicity. Male wistar rats were used as in vivo model for the study. TA-05 was administered orally to Wistar rats at different doses (0.42 mg/kg, 0.85 mg/kg, 1.7 mg/kg, 3.4 mg/kg and 6.8 mg/kg) for 6 days/week for 4 weeks. Thereafter, all the animals except saline and TA-05-treated controls were administered 20 mg/kg Dox intraperitonially. There was a significant decrease in myocardial superoxide dismutase (38.94%) and reduced glutathione (23.84%) in animals treated with Dox. Concurrently marked increase in serum creatine kinase-MB (CKMB) activity (48.11%) as well as increase in extent of lipid peroxidation (2.55-fold) was reported. Co-treatment of TA-05 and Dox resulted in an increase in the cardiac antioxidant enzymes, decrease in serum CKMB levels and reduction in lipid peroxidation as compared to Dox-treated animals. Electron microscopic studies in Dox-treated animals revealed mitochondrial swelling, Z-band disarray, focal dilatation of smooth endoplasmic reticulum (SER) and lipid inclusions, whereas the concurrent administration of TA-05 led to a lesser degree of Dox-induced histological alterations. These findings suggest that butanolic fraction of Terminalia arjuna bark has protective effects against Dox-induced cardiotoxicity and may have potential as a cardioprotective agent.     

补阳还五汤对窒息型大鼠心肺复苏后心肌损伤的影响

目的:观察补阳还五汤(BHD)对窒息型大鼠心肺复苏后心肌损伤的影响.方法:成年雄性SD大鼠24只,随机分为假手术对照组、复苏组、BHD组,每组8只.建立窒息型大鼠心肺复苏模型,测定复苏后早期左心室血流动力学指标,并于复苏24h取样,检测血清心肌酶变化.结果:与假手术对照组比较,复苏组和BHD组大鼠心率在自主循环恢复(ROSC)后0.5h、1h和2h均明显下降(P<0.01),左心室收缩压(LVSP)在ROSC后0.5h和1h明显下降(P<0.01),左心室舒张末压(LVEDP)在ROSC即刻和0.5h明显上升(P<0.01或P<0.05),左室内压的最大上升速率(+dp/dt?max)在ROSC后0.5h、1h和2h均明显下降(P<0.01或 P<0.05),左室内压的最大下降速率(-dp/dtmax)在ROSC后0.5h、1h和2h均明显下降(P<0.01或P<0.05).与复苏组各时间点比较,BHD组心率、LVSP、LVEDP、+dp/dtmax和-dp/dtmax变化差异均无统计学意义(P>0.05).与假手术对照组比较,复苏组和BHD组大鼠的血清CK-MB和cTnI均显著升高(P<0.01);与复苏组比较, BHD组血清CK-MB和cTnI浓度明显降低(P<0.01).结论:窒息型大鼠心肺复苏早期出现心肌血流动力学指标和生化指标的异常,心肌收缩、舒张功能受损.补阳还五汤不能直接改善血流动力学,但能降低心肌酶学水平,减轻心肌细胞损伤.     

蛇床子素预处理对大鼠心脏缺血再灌注损伤的作用

目的:探讨蛇床子素(osthole,Ost)预处理对大鼠心脏缺血再灌注损伤的作用及其机制。方法:建立大鼠心脏缺血再灌注损伤模型。30只雄性SD大鼠随机平均分为Ost组、模型组和假手术组。假手术组和模型组手术前1 h给予生理盐水(50 mg·kg~(-1),腹腔注射),Ost组缺血前1 h给予Ost(50 mg·kg~(-1),腹腔注射),模型组和Ost组血管夹夹闭左冠状动脉前降支,置于32℃温箱30 min后松开血管夹,4 h后收集各组大鼠心脏和血清。HE染色后观察心脏病理学形态学变化,Western blotting检测P38,p-P38和p-NF-κB;RT-PCR检测白细胞介素-6(interleukin-6,IL-6)、IL-1β和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)的心脏表达和分泌;ELISA检测乳酸脱氢酶(lactic dehydrogenase,LDH)、心肌型肌酸激酶同工酶(creatine kinase-MB,CK-MB)、肌酸激酶(creatine kinase,CK)、IL-6、IL-1β和TNF-α的水平。结果:与假手术组比较,模型组病理改变,p-P38、p-NF-κB、LDH、CK-MB、CK、IL-6、IL-1β和TNF-α表达均明显增加(P0.05),但P38和NF-κB表达无明显差异。与模型组比较,Ost组病理改变,p-NF-κB、LDH、CK-MB、CK、IL-6、IL-1β和TNF-α表达明显减少(P0.05),但p-P38表达进一步增加,而P38和NF-κB表达仍无明显变化。结论:Ost预处理可通过抑制炎症反应发挥对大鼠心脏缺血再灌注损伤的保护作用,其作用机制与促进P38信号通路激活相关。     

心肌肌钙蛋白I检测在重症肺炎儿童心肌损害中价值探讨

目的：探讨小儿重症肺炎并发心肌损害中心肌钙蛋白I（cardiac troponin I,cTnI）的测定及其意义。方法选取重症肺炎患儿200例为观察组,轻症肺炎患儿180例为轻症组,正常儿童200例为对照组,对比3组儿童cTnI水平、肌酸激酶同工酶（creatine kinase MB,CK-MB）水平。结果观察组 cTnI、CK-MB、肌酸激酶（creatine kinase,CK）、乳酸脱氢酶（lactate dehydrogenase,LDH）及天冬氨酸转氨酶（aspartate amino-transferase,AST）水平高于轻症组（P＜0．05）,观察组和轻症组 cTnI、CK-MB、LDH、AST水平高于对照组（P＜0．05）。观察组 cTnI阳性率高于轻症组（P＜0．05）。观察组与轻症组CK-MB阳性率差异无统计学意义（P＞0．05）。结论重症肺炎患儿多伴有不同程度的心肌损害,cTnI可作为监测心肌损伤的重要标志物。早期检测 cTnI有利于重症肺炎并发心急损害患儿的早期诊疗,从而预防心肌衰竭发生。