<正>患者男,46岁。2007年8月23日下午突发心前区压榨样疼痛,伴大汗,持续3h不缓解到医院就医。急诊心电图提示急性前壁心肌梗死,行急诊冠状动脉造影发现前降支近端完全闭塞,经导丝通过、球囊扩张、血栓抽吸和支架植入,患者恢复TIMI3级血流,胸痛缓解。回到CCU后生命体征平稳,体温37.6℃,血

<正>他汀类药物在临床应用中存在个体化降脂不均衡的现象,如何才能使每个个体都获得用药的最大的生物学效应和最小的不良反应是临床医师面临的一个重要问题。不同的遗传背景会导致药物反应的差异,而这些差异是由基因多态性引起的[1]。血脂代谢是一个复杂的生物过程,ABC转运蛋白超

Objective:To evaluate the effect of aspirin and cilostazol on aggregation of platelet in coronary heart disease(CHD) patients with or without diabetes.Methods:The 45 CHD patients with type 2 diabetes mellitus(DM) and 45 CHD patients without DM were selected according to inclusive criteria.Two groups were divided into aspirin groups,cilostaxol groups and combinative groups according to administer drugs respectively.The aggregation of activated platelet,TXB2,6-K-PGF1a and MPO were detected and analyzed for their correlation.Those data were compared among groups.Results:(1)Multivariate correlative analysis showed that blood glucose was the most important factor correlated with the aggregation of activated platelet(R=0.914,P0.01);(2)Compared the without diabetes group,the level of aggregation of activated platelet,TXB2,MPO increased,the level of 6-K-PGF1a decreased in CHD patients with diabetes group;(3)For patients without DM,the level of aggregation of activated platelet and TXB2 had no significant difference between aspirin and cilostazol groups,the level of 6-K-PGF1a was higher,while the level of MPO was lower in cilostazol group than those of aspirin group(P0.001).For patients with DM,the level of the aggregation of activated platelet,TXB2,MPO were lower while the level of 6-K-PGF1a was higher in cilostazol group than those of aspirin group(P0.05~0.001).Conclusion:Cilostazol is more effective than aspirin to inhibit the aggregation of activated platelet for CHD patients with DM.

With the ageing of the population, heart failure has become a major public health problem. Many medical authorities are focusing on how to regenerate impaired myocardium. A decade of experiments on animals have shown that stem cell transplantation can repopulate injured myocardium. Some clinical experiments have also produced positive results. These studies present a broad base of research into the treatment of refractory heart failure. This article reviews progress in research into cell transplantation with bone marrow stem cell treatment of chronic heart failure.

Objective To study the role of granulocyte colony stimulating factor(G-CSF) in repairing infarcted area of myocardium and improving cardiac function in rats with acute myocardial infarction.Methods Twenty-nine rats were randomizly divided into granulocyte acute myocardium infarction(GAMI) group n = 9,acute myocardium infarction(MI) group n = 10 and sham operation(SO) group n = 10 .The coronary artery was ligated in GAMI and AMI groups,and sham-operation was performed in SO group.Rats in GAMI group were injected with G-CSF 50 μg·kg-1·d-1 for seven days.Saline was given by the same manner in sham-operated rats and AMI groups.After four weeks of infarction,the rats' hemodynamic parameters were measured with catheterization,and the size of infarction area and the density of little vessels in infarction and peri-infarction area were measured under a microscope.Results Three rats in AMI group died on the third,seventh and eighth day respectively after myocardial infarction.No rats died in GAMI and AMI groups.Compared with that in SO group,LVSP(P 0.01),dp/dt max(P 0.01)and dp/dt min(P 0.05) in AMI group were decreased,but LEVDP(P 0.01) was increased.And in GAMI group,dp/dt max(P 0.05) was also decreased,LEVDP(P 0.01) was increased.However,the changes of LVSP(P 0.05) and dp/dt min(P 0.05) were no statistical significant difference in GAMI group.Compared with that of AMI group,LVSP,dp/dt max and dp/dt min were increased LEVDP was decreased in GAMI group P 0.01,P 0.01,P 0.05,P 0.05 respectively .We also found that the size of infarction regions was reduced and the density of little vessels was increased in GAMI group P 0.01,P 0.05 respectively,versus AMI group .Conclusion The G-CSF treatment can reduce the size of infarction zone,increase the number of little vessels and improve the cardiac function in rats with myocardial infarction.

Objective: To investigate T lymphocyte subsets changes affected by treatment of G-CSF in acute myocardial infarction rats. Methods: Twenty-nine rats were randomly divided into there groups, GAMI(n = 9),AMI(n = 10) and SO(n = 10). The left coronary artery was ligated in GAMI and AMI groups result in AMI and sham-operation was performed in SO group. Rats of GAMI group were subcutaneously injected with rhG-CSF(50 μg·kg-1·d-1) for seven days. Saline was given by the same manner in the sham-operated and the AMI group for seven days. After four weeks of infarction, the number of CD3+,CD4+ and CD8+ cells per field of a microscope was detected and CD4+/CD8+ ratio was obtained through the stain of immunohistochemistry. Results: Three rats in the AMI group died on the third,seventh and eighth day after myocardial infarction. No rats died in GAMI and AMI groups. A significant decrease in the number of CD3+ and CD8+ cells per field combined with a significant increase in CD4+/CD8+ ratio were documented in the GAMI group (P 0.01, P 0.01) respectively and there was no statistic significance in CD4+ cells (P 0.05)compared with the AMI group. Conclusion: The treatment of G-CSF can reduce the number of CD3+, and CD8+ per field ,enhance CD4+/CD8+ ratio in rats with myocardial infarction. These findings suggest that G-CSF may play an important role in relieving the immune injury induced by T lymphocyte in acute myocardial infarction rats.

Adriamycin(ADR)play an undisputed key role in the treatment of many neoplastic diseases,but chronic administration of ADR induces irreversible cardiomyopathy and congestive heart failure(CHF)usually refractory to common medications.The mechanisms responsible for the cardiotoxic effect of ADR have been extremely controversial.It is becoming increasingly clear that apoptosis of myocardial cells plays a critical role in the onset of cardiomyopathy induced by ADR.Here we describe the most recent advances about apoptosis of myocardial cells induced by ADR.

objective: To explore the possible causes of chest pain in the early stage after PCI. Methods: One hundred and twelve patients after PCI were divided into chest pain group (12 cases) and non chest pain group (100 cases). The general clinical characteristics, EKGs, cardiac enzymes, and the damages of small coronary artery branches in operation were compared between the two groups. Results: ST-T change, ST depress and T convert proved by EKG were observed in 10 patients of chest pain group. Among them, cardiac enzymes increased combined with small coronary artery branches obstructions in the operation in 6 patients, interlayers in the operation in 4 patients, and coronary thrombi and slow blood flow phenomena in 2 patients. There was a statistical significance compared with non chest pain group (P 0.01). There was no statistical significance between the two groups on the other items (P 0.05), such as age, sex, left ventricle eject fraction (LVEF), smoking, diabetes mellitus, hypertension, hyperlipaenda, and coronary damage degree. Conclusion: Chest pain may correlate with peri-interventional myocardial necrosis, interlayers, coronary thrombi and slow blood flow phenomena.

阿霉素(adriamycin ADR)属于蒽环类抗生素,是一种高效的广谱抗肿瘤抗生素,临床上广泛用于治疗多种恶性肿瘤.

冠心病心绞痛是冠状动脉的严重狭窄或阻塞导致了心肌缺血而产生的.中医诊断为"胸痹心血不足,瘀血痹阻"[1].根据我国中医对心脉瘀阻行活血化瘀、行气止痛的理论,我们对12例严重冠脉病变且经西药常规治疗效果较差,甚至难以进行介入治疗(PCI)或冠状动脉旁路移植术(CABG)的病人增加了血府逐瘀胶囊的治疗,取得了较好的疗效.

SARS患者都有不同程度的呼吸急促或窘迫感,尤其是重症患者轻微体力活动就出现明显气喘和呼吸困难,表现为呼吸频率增加、心率加快、血氧饱和度下降等,酷似心力衰竭(心衰)表现.此时对其心功能作出正确评价对于指导治疗尤为重要.我们对2例重症SARS患者合并低氧血症时的心脏功能进行了评价,报告如下.

综合多数学者的意见,结合对临床所收治SARS患者的观察,我们认为将SARS病程分为4期较为合理.

OBJECTIVE:To summarize the experience of treatment in 32 critical severe acute respiratory syndrome (SARS) patients.METHODS:The age of 32 patients ranged from 19 to 72 years, the average was 43.06 years. Among them, 13 patients were having serious primary diseases, i.e. cardio-cerebral-vascular disease in 9 patients, diabetes in 2 patients, renal dysfunction in 1 patient, and chronic obstructive pulmonary disease (COPD) in 1 patient. The treatment included antiviral agents, glucocorticoid, mechanical ventilation, antibiotics and immunologic enhancement, etc. Cure rate, mortality and complications were analyzed.RESULTS:Among 32 patients, 24 were cured, 2 died of respiratory failure, 6 died of their primary diseases, and the overall mortality was 25.00 percent. Superimposed infection occurred in 12 patients, and among 17 patients who required noninvasive ventilation, 3 patients were complicated by lung injury (mediastinal emphysema, pneumothorax). In addition, hyperglycemia was found in 4 patients, upper intestinal hemorrhage occurred in another 4 patients and cardiac failure occurred in 6 patients.CONCLUSION:The treatment of the pre-existing diseases should be emphasized in the treatment of critical SARS. Glucocorticoid should not be used for a long-term. Vigilance should be paid to avoid lung injury during mechanical ventilation.

SARS患者何时可以出院,虽然有卫生部的部颁标准,但是其中有的内容并不具体,许多医生对其领会也不一致,所以在出院时机的把握上不尽相同.比如:停止发热≥7 d,是指从不发热(退热)开始算起还是指停用糖皮质激素和退热药后7 d以上,对此一直没有统一的意见.现就我们的理解和执行情况作如下介绍.

Objective:To summarize the treatment a experience of32patients with critical severe acute resˉpiratory syndrome(SARS).Methods:The therapy included antiviral agents,glucocorticoid,mechanical ventilaˉtion,antibiotics and immunologic enhancement,etc.The cure rate,fatality rate and complication were analyzed statistically.Results:Among the32patients,24discharged(cure rate:75.0%),2died of respiratory failure(fatality rate:6.25%).Among15cases who received long-term and high dosage glucocorticoid,there were12cases of double infection(80.0%),4cases of hyperglycemia(26.67%)and4cases of upper gastrointestinal hemorrhage(26.67%).Among17cases who required noninvasive ventilation,there were3cases of lung injury(17.65%),such as mediastinal emphysema,pneumothorax,etc.In addition,there were6cases of left cardiac failure.Conclusion:The treatment of primary diseases should be strengthened in the therapy of critical SARS.Glucocorticoid should not be used over a long period of time.During the period of mechanical ventilation,the lung injury should be avoided.

严重急性呼吸综合征(severe acute respiratory syndrome , SARS)患者不同程度的呼吸急促或呼吸窘迫感,尤其是重症患者轻微体力活动就出现明显气喘、胸闷,甚至呼吸困难,不能平卧,同时伴有心率加快,血氧饱和度下降,酷似心力衰竭.此时,对其心脏功能做出正确评价是指导进一步治疗的关键.我们对10例重症SARS患者合并低氧血症时心功能与10例轻型患者的心功能进行了评价和比较.

目的为评价室性心律失常与心肌梗塞后左室重建等诸因素的关系.方法本研究对63名急性心肌梗塞(AMI)病人进行二维切面超声心动图(VCG)检查,了解梗塞后左室缩末容积指数(ESVi)和舒末容积指数(EDVi),左室射血分数(LVEF),通过心电监护和Holter捕捉室性心律失常.结果发生室性心律失常(Lown 3～5级)者12例,占18%;左室容积明显增加,多元逐步回归分析,以复杂室性心律失常为因变量,选入方程的自变量按贡献率大小依次为:ESVi(0.372)、EDVi(0.334)、肌酸磷酸激酶(CK 0.295),溶栓治疗(-0.282)、LVEF(-0.260)和Killip分级(0.244).结论 AMI后发生复杂室性心律失常与左室容积增加密切相关,可能是AMI发生左室重建死亡率高的直接原因.

目的:了解小剂量苯那普利治疗扩张型心肌病的疗效.方法:扩张型心肌病46例,分为常规治疗组和苯那普利加常规治疗组(24例),4周后比较两组病人心功能分级(NYHA分级)的变化、心功能综合评分和左室内径变化.结果:常规治疗加小剂量苯那普利组心功能分级和心功能综合评分优于常规治疗组(2.67±0.95比 3.01±0.72,P<0.05和3.35±2.38比2,78±2.33,P<0.01);左室舒、缩末径回缩及射血分数前者亦大于后者.结论:小剂量苯那普利加常规治疗对扩张型心肌病疗效优于单纯的常规治疗方法.