目的:分析参蛤散对斑马鱼血管生长的干预作用.方法:制备参蛤散水煎液,以转基因斑马鱼(Fli1:EGFP)为研究对象,建立斑马鱼正常的血管生长模型,采用不同浓度参蛤散水煎液干预后,观察斑马鱼肠下静脉血管直径、平均交叉数和平均出芽数.使用血管内皮生长因子酪氨酸酶抑制剂(VRI)建立斑马鱼血管损伤模型,观察不同浓度参蛤散水煎液干预后斑马鱼脊背节间血管完整型和缺损型血管数量.结果:参蛤散各浓度组肠下静脉平均出芽数、平均交叉数及血管直径与正常组比较,差异均无统计学意义(P>0.05).参蛤散各浓度组及 VRI组完整型血管较正常组减少,缺陷型血管较正常组增多(P<0.01);与 VRI组比较,参蛤散各浓度组完整型血管明显增多,缺陷型血管减少(P<0.01).当参蛤散浓度为 3 μg/mL时,斑马鱼完整型血管数最多,缺陷型血管数最少(P<0.01).结论:参蛤散作用于斑马鱼正常血管生长并无明显作用,但可抑制 VRI的血管损伤作用.

目的:评价舒心饮结合西医常规疗法治疗气阴两虚证冠状动脉硬化性心脏病合并慢性心力衰竭的临床疗效.方法:纳入124例气阴两虚证冠状动脉硬化性心脏病合并慢性心力衰竭患者,随机分为对照组61例和治疗组63例.对照组患者给予西医规范治疗,治疗组患者在对照组治疗基础上加用舒心饮口服,观察周期为4周.比较两组患者治疗前后的中医证候总积分及主症积分的变化;评价两组患者的心功能分级和心电图改善疗效;比较两组患者治疗前后的脑钠肽(BNP)水平及6 min步行距离(6MWD);治疗前后采用心脏超声检测患者的射血分数(EF)、每搏输出量(SV)、左心室舒张末期内径(LVEDD);比较两组患者的汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、明尼苏达心力衰竭生活质量调查表(MLHFQ)评分.结果:治疗过程中,对照组剔除3例患者,最终治疗组63例、对照组58例纳入统计分析.①治疗后,两组患者的中医证候总积分均较治疗前明显降低(P＜0.01),且治疗组患者的积分低于对照组(P＜0.01);两组患者的胸闷胸痛、心悸气短、疲倦乏力积分较治疗前均明显降低(P＜0.01),且治疗组患者的上述各项症状积分均低于对照组(P＜0.05).②治疗后,治疗组患者的心功能分级改善总有效率为84.13％,对照组为72.41％,治疗组的疗效优于对照组(P＜0.05);治疗组患者的心电图改善总有效率为80.95％,对照组为60.34％,治疗组的疗效优于对照组(P＜0.05).③治疗后,两组患者的BNP水平较治疗前均明显降低(P＜0.01),但组间比较差异无统计学意义(P＞0.05).④治疗后,两组患者的6MWD较治疗前均明显延长(P＜0.01),且治疗组患者的6MWD较对照组亦明显延长(P＜0.01).⑤治疗前后,两组患者的EF、SV、LVEDD比较,差异均无统计学意义(P＞0.05).⑥治疗后,两组患者的HAMA、HAMD评分较治疗前均明显降低(P＜0.01),且治疗组患者的HAMD评分低于对照组(P＜0.05);治疗后,两组患者的MLHFQ评分较治疗前均明显降低(P＜0.01),且治疗组患者的评分低于对照组(P＜0.05).结论:舒心饮结合西医常规疗法治疗气阴两虚证冠状动脉硬化性心脏病合并慢性心力衰竭患者,可明显改善患者的临床症状及生活质量,提高患者的心功能分级.

目的:探讨疏血通注射液对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)治疗后冠状动脉微循环及血清细胞间黏附分子-1(ICAM-1)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)水平的影响.方法:纳入急性STEMI患者64例,随机分为对照组和疏血通组,每组各32例.所有患者均行PCI治疗,入院当日即开始药物干预,对照组患者给予西医常规治疗,疏血通组患者在西医常规治疗基础上加用疏血通注射液,连续用药7d.于术前(治疗前)和术后7 d(治疗后)评价患者的中医证候积分,比较两组的中医证候疗效;术后30 min、2h、24 h、7d,评价并比较两组ST段完全回落患者的分布差异;治疗前和治疗后检测并比较两组患者的血清ICAM-1、TNF-α、hs-CRP水平.结果:研究过程中,对照组2例患者被剔除,最终疏血通组32例、对照组30例纳入统计分析.①治疗后,两组患者的中医证候主症、次症积分较治疗前均明显降低(P＜0.01),但组间积分比较差异无统计学意义(P＞0.05);治疗后,疏血通组和对照组患者的中医证候疗效总有效率分别为93.75％和90.00％,疏血通组的疗效优于对照组(P＜0.05).②术后7d,疏血通组心电图ST段完全回落患者的占比较对照组明显增加(P＜0.05).③治疗后,两组患者的ICAM-1水平较治疗前均升高(P＜0.05,P＜0.01),TNF-α、hs-CRP水平较治疗前均降低(P＜0.05,P＜0.01),且疏血通组患者的ICAM-1、TNF-α、hs-CRP水平均明显低于对照组(P＜0.05,P＜0.01).结论:疏血通注射液结合西医常规疗法治疗STEMI患者PCI术后,可改善患者的临床症状及冠状动脉微循环障碍,减缓心肌梗死后黏附分子水平上升,降低炎症因子水平.

目的:探讨麝香通心滴丸对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)后炎性因子和心功能的影响.方法:选择2015年1月—2017年12月连续82例STEMI并接受急诊PCI的患者,以1:1随机分为常规治疗组和麝香通心滴丸组(入院后立即口服麝香通心滴丸6丸,次日起2丸/次,每日3次,持续30 d).测定PCI前及术后7 d血清炎性因子水平及超声心动图左室功能变化.结果:两组患者PCI前血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hsCRP)水平相近(P均>0.05),术后7 d时上述指标均有一定程度的降低,但麝香通心滴丸组炎性因子降低幅度较常规治疗组更大(P均<0.05).两组PCI前左室收缩末期容量(LVESV)、左室舒张末期容量(LVEDV)、左室射血分数(LVEF)无明显差异,术后7 d左心室容量无显著变化,但LVEF较术前明显增高(P<0.05).术后30 d时,两组患者LVESV和LVEDV均较术前明显减低,LVEF较术前明显增高,且麝香通心滴丸组LVEF改善的程度优于常规治疗组(P<0.05).结论:急诊PCI可改善STEMI患者的炎性反应及左心功能,加用麝香通心滴丸有助于进一步改善上述作用.

1 病例简介 患者女性,81岁,于2020年2月28日因“胸闷7h”人院.患者入院当天因与家人争执于上午9时出现胸闷,伴心慌气急,乏力明显,少许冷汗,否认胸痛.患者既往有高血压、肝功能损害、贫血病史.查体:血压124/68 mmHg,呼吸18次/min,两肺呼吸音粗,未闻及干湿哕音.心界不大,心率100次/min,律齐,各瓣膜区未闻及杂音,双下肢无水肿.辅助检查:肌酸激酶同工酶(CK-MB)5.6 ng/mL,肌红蛋白(MYO)259 ng/mL,肌钙蛋白(TNI)0.42 ng/mL,脑钠肽(BNP)287 pg/mL,D-二聚体199 ng/mL.心电图示Ⅱ、Ⅲ、aVF导联ST段压低,V1～V3呈Qr型.入院诊断:急性冠脉综合征,高血压病3级(极高危).

[目的]观察速效救心丸对气滞血瘀型急性冠脉综合征(ACS)经皮血管重建术后患者的干预作用.[方法]采用随机、双盲、安慰剂对照方法,纳入58例接受血管重建术治疗的气滞血瘀型ACS患者,且辨证为气滞血瘀证型,随机分为对照组和治疗组,每组各29例,在标准化西医药物治疗基础上,对照组加予安慰剂,治疗组加予速效救心丸,干预6个月后,记录治疗前后患者的心绞痛积分、中医证候积分、左室射血分数和冠脉造影结果.评价速效救心丸疗效.[结果]治疗6个月后,与治疗前比较,两组心绞痛积分,中医证候积分,左室射血分数(LVEF)均有明显改善(P<0.01),且治疗组改善更明显(P<0.01).治疗后复查冠脉造影,治疗组无支架再狭窄,对照组发生支架内再狭窄1例.治疗后患者安全性指标未见明显异常.[结论]速效救心丸的联合干预可更好的改善ACS血管重建术后患者气滞血瘀症状和左室射血分数,增加疗效且无明显不良反应.

Objective :To explore therapeutic effect of emergency percutaneous coronary intervention (PCI) combined ticagrelor on patients with acute ST elevation myocardial infarction (STEMI ) and its influence on level of tumor necrosis factor (TNF)—α.Methods : A total of 98 patients with acute STEMI treated in our hospital from Jan 2016 to Jan 2017 were selected .Patients were randomly and equally divided into clopidogrel group and ticagrelor group , each group received corresponding medication before PCI .LVEF ,LVEDd ,TNF—α level before and one month after treatment and TIMI grade before and after PCI ,recanalization time ,postoperative corrected TIMI frame (CTFC) , percentages of thrombus aspiration ,auxiliary IABP and no—reflow ,and incidence of adverse events during six—month follow—up after PCI were observed and compared between two groups .Results : Compared with before PCI and treatment ,there were significant rise in LVEF on one month after treatment and TIMI grade after PCI ,and signifi—cant reductions in LVEDd and TNF—α level in two groups on one month after treatment , P＝0.001 all.Compared with clopidogrel group on one month after treatment ,there was significant rise in LVEF [ (49.80 ± 4.17 )% vs. (57.32 ± 5.10)%] ,and significant reductions in LVEDd [ (57. 94 ± 4. 70) mm vs .(47.11 ± 3.49) mm] ,TNF—α level [ (17. 82 ± 2.84) pg／ml vs .(8.40 ± 2. 04 ) pg／ml] and postoperative percentage of no—reflow (24.44% vs. 4.44%) in ticagrelor group , P＜0. 01 all ,there were no significant difference in other operative related indexes be—tween two groups , P＞0.05 all.After six—month follow—up ,incidence rate of composite endpoint events in ticagrelor group was significantly lower than that of clopidogrel group (11. 11% vs.31. 11%) , P＝0.021 ,there were no sig—nificant difference in percentages of in—stent thrombus ,infarct related artery revascularization and recurrent unsta—ble angina pectoris between two groups , P＞0.05 all .Conclusion : Short—term therapeutic effect of emergency PCI combined ticagrelor is significant .It can significantly improve prognosis ,which is worth extending .

Objective To analyze the application effect of recombinant human pro-urokinase combined with tirofiban in high thrombus burden ASTEMI patients undergoing emergency PCI. Methods A total of 100 high thrombus burden ASTEMI patients undergoing emergency PCI were selected in Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from June 2015 to May 2017,and they were divided into control group and treatment group according to therapeutic scheme,each of 50 cases. Patients in the two groups received emergency PCI and conventional medical treatment,meanwhile patients in control group received tirofiban during emergency PCI,while patients in treatment group received recombinant human pro-urokinase based on that of control group. TIMI flow grades,CTFC and TMPG before and after medication,and index of cardiac function 1 week after emergency PCI were compared between the two groups,and incidence of MACE during hospitalization was observed. Results No statistically significant differences of TIMI flow grades,CTFC or TMPG was found between the two groups before medication,nor was TIMI flow grades or TMPG after medication(P＞0.05),while CTFC in treatment group was statistically significantly lower than that in control group after medication(P＜0.05). No statistically significant differences of LVEF,LVEDD or LVESD was found between the two group 1 week after emergency PCI(P＞0.05). No statistically significant differences of incidence of MACE was found between the two groups during hospitalization(P＞0.05). Conclusion Compared with single use of tirofiban,though recombinant human pro-urokinase combined with tirofiban can significantly reduce the CTFC in high thrombus burden ASTEMI patients undergoing emergency PCI,but has limited improvement effective on coronary flow,myocardial perfusion and cardiac function,with receptible safety.

冠心病缺血心肌血管新生的研究逐渐受到重视，成为防治冠心病的新途径，在血管新生的过程中，缺血诱导了生长因子的分泌，促进细胞生长因子的表达为诱导缺血心肌的血管新生的分子生物学基础之一，中药以其多靶点的作用方式对缺血心肌的调节作用日渐受到重视，并有了较多的研究，本文从中药单体及复方对心肌细胞生长因子的作用作一个概述。

目的探讨经桡动脉行冠状动脉（冠脉）介入诊疗中桡动脉痉挛发生的可能危险因素。方法2012年1月—2013年4月,选取经桡动脉途径行冠心病介入诊疗患者293例,记录所有患者的病史资料及冠脉造影特征,均经桡动脉行冠脉造影术（CAG）或冠脉介入治疗（PCI）。应用Logistic回归模型分析各因素对冠心病介入诊疗过程中桡动脉发生痉挛的影响。结果 239例中,59例（20.1%）发生桡动脉痉挛。多元Logistic回归分析显示女性（OR=3.093,P=0.034）、高脂血症（OR=2.897,P=0.023）、吸烟史（OR=3.894,P=0.009）、桡动脉鞘置入时前臂疼痛（OR=5.393,P＜0.001）、桡动脉路径解剖异常（OR=3.590,P=0.005）是桡动脉痉挛发生的独立危险因素。结论女性、高脂血症、吸烟、桡动脉路径解剖异常、术中前臂疼痛是桡动脉痉挛发生的可能相关危险因素。

<正>急性心肌梗死常发生在院外,可因严重恶性心律失常而发生猝死,极少数患者在急性心肌梗死超急性期内达到医院救治,在发生室颤后第一时间给予除颤并开通闭塞冠脉,对降低急性心肌梗死病死率至关重要。本文报告1例急性心肌梗死超急性期患者,探讨其救治特点。