目的 探讨情景模拟教学联合床旁教学模式在心血管内科实践教学中的应用.方法 选取吉林大学临床医学2015级5+3专业的40名学生为研究对象,并将其随机分为2组.其中20名学生作为实验组,采取情景模拟教学+床旁教学模式;另外20名学生作为对照组,采用传统床旁教学模式.实习结束后对其进行出科理论考试、实践技能考试、综合考核及教学满意度调查.结果 情景模拟教学联合床旁教学组的实践技能成绩、综合考核成绩与总成绩均高于传统床旁教学组,差异有统计学意义(P<0.05).两组间的出科理论考试成绩无统计学差异(P>0.05).在满意度调查中,大多数实验组学生对床旁教学基础上的情景模拟教学满意度较高并能够积极参与.结论 情景模拟教学联合床旁教学模式适用于心血管内科实践教学,其教学效果理想.

1病例资料 患者,女,49岁.2018年4月患者因“阵发性心悸、胸闷10年余,加重2个月”入院.既往否认冠心病、风湿性心脏病等病史;否认高血压、糖尿病等病史.入院体检:T:36.5℃,R:18次/min,P:68次/min,BP:123/80 mmHg (1mmHg=0.133kPa),神志清楚,双肺呼吸音清,未闻及干湿性哕音;心率:68次/min,节律规整,胸骨左缘2～4肋间可及3/6级收缩期杂音.

在"5+3"医学人才培养模式推广初期,合格的临床实践带教教师资源匮乏,支持型教学是以教师的具体教育行为为主要途径,在优化教师教学行为的基础上,可以提高教师素质,强大师资队伍.通过解读支持型教学的内涵、影响及评估方式,探讨支持型教学在临床实践教学中的应用.

患者男,53岁.以"阵发性心悸3年"为主诉入院,既往否认高血压、冠心病等心脏病病史,查体无阳性发现,超声心动图正常,血清学检查:甲状腺功能、血清离子及心肌酶均正常.基础心电图为窦性心律,频发房性期前收缩,发作时心电图见图1,初步诊断:室上性心动过速(房性心动过速可能性大).

目的:随着代谢综合征发病率的逐年升高,代谢综合征患者急性心肌梗死(acute myocardial infarction,AMI)发生率也在增加,本文就其危险因素予以分析. 方法:确诊为代谢综合征患者192例,根据有否AMI发生分为MS合并AMI组和非AMI组,分别对其危险因素进行统计分析.结果:AMI组患者104例,占全部病例54.16%,男性及吸烟者比例高,体重指数无明显差异.AMI组与非AMI组相比:收缩压及舒张压均升高明显,且空腹血糖及餐后2h血糖、甘油三酯血症及高密度脂蛋白胆固醇血症均有显著性差异.AMI组纤维蛋白原水平升高明显,提示动脉粥样硬化及斑块形成比例高.结论:代谢综合征通过促使动脉粥样硬化及血栓形成,导致心血管意外的发生增加,积极控制可能的危险因素在预防急性心肌梗死发生中具有重要作用.

主动脉夹层是指循环血液从主动脉内膜撕裂处进入主动脉中膜,使中膜分离,并沿主动脉长轴扩展,形成主动脉壁的两层分离状态的一种致命性疾病.主动脉瘤是主动脉壁局部或弥漫性的异常扩张,压迫周围器官而引起症状.主动脉中层退行性病变或中层囊性坏死是发病基础.二者均系心血管的急危重症,临床表现复杂,病死率高.我科近期诊治主动脉夹层压迫右肺动脉主干1例.报道如下.

目的观察厄贝沙坦对急性心肌梗死大鼠心室重构的防治作用。方法结扎大鼠左冠状动脉前降支造成急性心肌梗死,同时应用厄贝沙坦进行治疗,给药4w后测定心室重构大鼠血液动力学、生化学及形态学参数。结果厄贝沙坦对急性心肌梗死心室重构大鼠,能明显升高左心室内压最大上升和下降速率(±dp/dtmax)及其校正值(±dp/dtmax/LVSP),降低左心室收缩压(LVSP)及左心室舒张末压(LVEDP),亦能明显降低左心室容积(LVV)、左心室长轴(LVLA)长度、左心室短轴(LVSA)长度、左心室绝对重量(LVAW)、左心室相对重量(LVRW)、右心室绝对重量(RVAW)和右心室相对重量(RVRW),但对心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)及体重(BW)均无明显影响。此外,可明显降低血清脂质过氧化物(LPO)及心肌血管紧张素Ⅱ(AngⅡ)和肾上腺素(E)含量,提高超氧化物歧化酶(SOD)及谷胱甘肽过氧化物酶(GSH-Px)活性。结论厄贝沙坦能有效防治急性心肌梗死大鼠的心室重构。

Objective To investigate the protective effect of Panax Quinquefolium L. Diol saponin (PQDS) on experimental ventricular remodeling in rats.Methods The rat model of overloading ventricular remodeling was established by abdominal aorta deligation. The male Wistar rats were divided into sham operation, model, benazepril and PQDS 50, 100 mg/kg groups. The myocardial hemodynamic and morphological parameters were determined and myocardial pathological changes were observed by light microscope 6 weeks later after treatment.Results PQDS decreased significantly the ventricular weight and cardiac coefficient in ventricular remodeling rats, heightened significantly systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP), lowered left ventricular end-diastolic pressure (LVEDP). PQDS also inhibited the thickening of cardiac muscle fiber and improved myocardial interstitial edema, having same effect as angiotensin-converting enzyme inhibitor (ACEI) benazepril.Conclusions PQDS maybe prevent and treat ventricular remodeling with improving systolic and diastolic function of cor sinistrum in ventricular remodeling rats.

目的观察腺苷对急性心肌梗死(AMI)患者行PCI后冠脉血流的影响。方法AMI患者分为腺苷组和生理盐水组,行PCI时一组冠脉内推注腺苷,一组推注生理盐水,并测定二组患者血管开通即刻及给药后5min冠脉血流TIMI帧数,同时测定血浆SOD、MDA、CK-MB峰值。结果腺苷组血流帧数较生理盐水组明显减少(26·65±17·46vs36·70±18·04,P<0·05)。腺苷组MDA较生理盐水组低(5·01±0·80vs6·97±0·86,P<0·05),腺苷组SOD较生理盐水组高(80·70±3·23vs61·63±3·49,P<0·05),腺苷组CK-MB峰值较生理盐水组明显降低(123·6±84·3vs186·1±92·2,P<0·05)。结论AMI患者行急诊PCI术时冠脉内应用腺苷能改善冠脉血流。

目的探讨心肌声学造影对急性心肌梗死(AMI)患者经皮冠脉介入术(PCI)后TIMI血流达Ⅲ级者心肌微循环的影响。方法采用Sequoia512型超声心动仪,应用二次谐波成像和高机械指数超声发射,对30例AMI患者PCI术后进行经静脉声诺维心肌声学造影显像和超声检查。结果共210个节段与梗死相关动脉再灌注有关,灌注正常即心肌造影计分(MCS)1分146段,灌注不良MCS 0.5分53段,无灌注MCS 0分11段。运动正常节段中MCS 1分者明显高于运动异常节段(P<0.05)。根据声学造影记分指数(CSI)将患者分为A组22例(CSI>0.8),B组8例(CSI≤0.8)。A组射血分数(EF)显著大于B组(P<0.05)。结论TIMIⅢ级血流并非再灌注成功的金标准。心肌微循环与心室收缩功能有一定相关性,微循环良好的患者EF值大于微循环较差者。经静脉声诺维心肌声学造影是一种安全无创的检测手段,是反映心肌微循环灌注的有效方法。

AIM To study the protective effect of Fosinopril on ischemia and reperfusion rat myocardium and the Caspase-3 expression in myocardium.METHODS Wistar rats were randomly divided into three groups: Control group(n=8),Ischemia-Reperfusion group(n=8),in which the left anterior descending of coronary artery was occluded for 30 min followed by 24 hours reperfusion and Fosinopril(20 mg/kg) group(n=8).Medication was fed through gastric gavage 24 hour and 2 hour before occlusion and the Caspase-3 expression in myocardium was observed.RESULTS The expression of Caspase-3 mRNA in Fosinpril group was less than that of Ischemia-Reperfusion group((0.37)±0.03 vs 1.14±0.05 and(0.39)±0.03 vs 1.14±0.05,P0.01) respectively.CONCLUSION Fosinpril can reduce Caspase-3 expression in myocardium,thus protecting ischemia and reperfusion rat myocardium.

Objective To observe the protective effects of Fosinopril on myocardial ischemia-reperfusion injury in rats. Methods The myocardial ischemia-reperfusion model was induced by 30 min coronary occulusion and 24 h reperfusion in opened-chest anesthetized rats. The changes of aspartate aminotransferase(AST), lactate dehydrogenase(LDH), MB isoenzyme of creatine kinase(CK-MB), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities, and malondialdehyde (MDA) content in serum were determined. Morphology of myocardial tissue was observed with optics and electron microscopes. Results Fosinopril decreased significantly the serum MDA content and AST, LDH and CK-MB activities as well as increased the serum SOD and GSH-Px activities. It also reduced edema and injury of ultrastructure in myocardial tissue. Conclusion Fosinopril has protective effects on myocardial ischemia-reperfusion injury, which may be related to scavenging the oxygen free radicals formed during reperfusion.

Objective To measure the levels of serum vascular cell adhesion molecule-1(VACM-1),intercellular adhesion molecule-1(ICAM-1) and C-reactive protein(CRP) in patients with acute coronary syndrome(ACS),and to explore their significances in diagnosis and treatment of coronary heart disease.Methods The levels of serum VACM-1,ICAM-1 and CRP were measured in 50 patients with ACS undergoing coronary angiography as well as(50 controls.) Results The levels of serum VACM-1,ICAM-1 and CRP in patients with ACS were higher than those in controls(701±54.6 μg·L~(-1)vs 556±42.2 μg·L~(-1),389±23.7 μg·L~(-1) vs 271±34.6 μg·L~(-1),7.05±(3.13 mg·L~(-1)) vs 4.22±1.41 mg·L~(-1))(P0.01);the levels of VACM-1 and ICAM-1 between acute myocardial infraction(AMI) and unstable angina(UA) patients were not difference(699.12±62.77 μg·L~(-1) vs(706.57±)53.65 μg·L~(-1),390.39±42.34 μg·L~(-1) vs 372.63±32.59 μg·L~(-1))(P0.05);CRP content in AMI patients was higher than that in UA patients(8.06±2.78 mg·L~(-1) vs 6.33±2.01 mg·L~(-1))(P0.05).(Conclusion The stenosis) and block caused by atherosclerosis plaque accompany the increase of VACM-1,ICAM-1 and CRP,and there is a relation with condition of the disease.The excess expression of adhesion molecules may be an important factor of atherosclerosis.Adhesion molecule might become a test index to monitor the occurrence and development of atherosclerosis.

1临床资料 患者女性,22岁.因双下肢乏力半年,加重伴头晕1周,于2004年1月12日人院.半年前无明显诱因患者出现双下肢乏力感到上、下楼梯吃力,但未诊治,持续约5天后逐渐缓解.1周前再次出现双下肢乏力行走困难,并渐出现双上肢和颈部活动困难伴头晕.在当地医院检查血压166/108 mmHg(1 mmHg =0.133 kPa),血清钾1.68 mmol/L,门诊以原发性醛固酮增多症收入我科.追问病史:患者18岁时曾因右侧腹股沟斜疝在当地医院做过手术,至今无月经,其父母否认近亲结婚,家族中无类似病例.入院时查体:血压160/110 mmHg,心率80次/分,女性外貌但皮肤较黑,可见胡须,喉结不大,乳房未发育,无腋毛,心肺查体未见异常,两侧腹股沟处未触及类睾丸肿块,右侧腹股沟可见约3.0 cm长的手术瘢痕.妇科检查:幼女型外阴,无阴毛,肛诊为盆腔空虚未触及子宫及卵巢,尿道口和阴道口分开,阴道深5 cm.血清钾1.7 mmol/L,二氧化碳结合力35mmol/L,促肾上腺皮质激素85.3 pg/ml,垂体泌乳素38.7 ng/ml,黄体生成素52.2 mIU/ml,促卵泡激素136 mIU/ml,雌二醇＜20 pg/ml,睾酮50 ng/ml,孕酮4.9 ng/ml,醛固酮卧位0.17 pg/L、立位0.24 pg/L,肌酸激酶5 989 U/L,肌型肌酸激酶同功酶100%.双腕骨片:双腕部各见7块腕骨,无豆骨,提示骨龄为11～12岁.盆腔超声:未探及子宫及附件,腹股沟管及内环无肿块.电子束扫描:双侧肾上腺增生,性别染色体46XY.临床诊断:17α-羟化酶缺乏症.现正用地塞米松2.25mg/d进行替代治疗.