不同剂量舒芬太尼对心脏瓣膜置换术患者应激反应、炎性因子及心肌损伤的影响

目的:探讨不同剂量舒芬太尼对心脏瓣膜置换术患者应激反应、炎性因子及心肌损伤的影响。方法:根据随机数字表法将100例行心脏瓣膜置换术的患者分为低剂量组(n=33,舒芬太尼剂量为1.0μg/kg)、中剂量组(n=33,舒芬太尼剂量为1.5μg/kg)以及高剂量组(n=34,舒芬太尼剂量为2.0μg/kg),比较三组患者应激反应、炎性因子、心肌损伤等指标的变化以及围术期指标情况。结果:中剂量组、高剂量组麻醉诱导后(T1)、插管后1 min(T2)、插管后5 min(T3)、插管后10 min(T4)时间点心率(HR)、平均动脉压(MAP)均低于低剂量组同时间点,且高剂量组低于中剂量组(P<0.05)。与低剂量组比较,中剂量组、高剂量组阻断后30 min(T6)、开主动脉后2h(T7)以及术后1d(T8)时间点白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均降低(P<0.05)。与低剂量组比较,中剂量组、高剂量组体外循环停机2h(T9)、体外循环停机8h(T10)、体外循环停机24h(T11)、体外循环停机48h(T12)时间点心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶(CK-MB)均降低(P<0.05)。低剂量组、中剂量组重症监护室(ICU)滞留时间、拔管时间显著短于高剂量组(P<0.05),而三组心血管不良事件发生率比较差异无统计学意义(P>0.05)。结论:给予1.0μg/kg舒芬太尼麻醉的患者应激反应小,1.5μg/kg、2.0μg/kg舒芬太尼可更好地控制心脏瓣膜置换术患者炎性反应,同时对患者心肌损伤有一定的保护作用,但2.0μg/kg舒芬太尼会延长患者ICU滞留时间、拔管时间。     

压力-应激对大鼠心肌细胞Cx43蛋白表达及心肌纤维化的影响

目的:探讨压力-应激对大鼠心肌细胞间隙连接蛋白-43(Cx43)蛋白表达及心肌纤维化的影响。方法:将20只雄性SD大鼠随机分为正常对照组(n=10)和模型组(n=10),对照组正常饲养,模型组给予不可预测性复合应激结合孤养建立压力-应激大鼠模型。监测两组大鼠的体重变化,并通过组织形态学方法,探讨压力-应激对大鼠心肌细胞Cx43蛋白表达及心肌纤维化的影响。结果:在为期42天的造模过程中,从应激第7天开始,模型组大鼠体重明显低于对照组,差异有统计学意义(P<0.001)。且模型组体重增长缓慢,体重增长百分比明显低于对照组,差异有统计学意义(P<0.001)。与对照组相比,模型组大鼠组织HE染色可见心肌细胞排列紊乱,横纹消失,细胞间隙增大,部分肌纤维断裂、溶解,Masson染色可见心肌间质纤维化,胶原纤维增生、排列紊乱。心肌细胞免疫组化染色可见模型组Cx43蛋白表达明显下降(平均光密度值为0.0110±0.0028),与对照组相比(平均光密度值为0.0268±0.0025),差异具有统计学意义(t=-13.081,P<0.001)。结论:过度疲劳导致猝死的发生可能与Cx43蛋白表达水平的下降引起的恶性心律失常有关。     

Mechanism of salidroside relieving the acute hypoxia-induced myocardial injury through the PI3K/Akt pathway

ObjectiveThe objective was to investigate the anti-inflammatory effects of salidroside through the PI3K/Akt signaling pathway and its protective effects on acute hypoxia-induced myocardial injury in rats.MethodsA total of 24 healthy Sprague-Dawley male rats were selected as the experimental subjects. All rats were divided into 4 groups by using the random number table method, with 6 rats in each group. The groups included the normal control group, the salidroside group, the hypobaric hypoxia group, and the hypobaric hypoxia + salidroside group. Rats in the salidroside group were fed in the original animal laboratory and were intragastrically administered with salidroside every morning at a dosage of 35 mg/kg. Rats in the normal control group were intragastrically administered with an equal dosage of saline. Rats in the hypobaric hypoxia + salidroside group were intragastrically administered with salidroside every morning at a dosage of 35 mg/kg, who were fed in the hypoxic experiment module for animals. The altitude was increased to 4000 m, and the rats were kept in the module for 24 h. Rats in the hypobaric hypoxia group were intragastrically administered with an equal dosage of saline in the same environment, and the altitude was increased to 4000 m after administration. Parameters of blood gas analysis, histopathological changes in cardiac tissues, cardiac indexes, and inflammatory factors IL-6 and TNF-α levels of rats in groups were compared.Results1. The cardiac indexes of rats in groups were compared. The differences between the hypobaric hypoxia group and the hypobaric hypoxia + salidroside group were statistically significant (P < 0.05). 2. The results of blood gas analysis of rats in groups were compared. The differences between the hypobaric hypoxia group and the hypobaric hypoxia + salidroside group were significantly different (P < 0.05). 3. In the hypobaric hypoxia group, the myocardial cells of rats were arranged disorderly and shaped differently, with cases such as edema, degeneration, necrosis, nucleus pyknosis, and massive infiltration of inflammatory cells. In the hypobaric hypoxia + salidroside group, the above-mentioned pathological changes in myocardial cells were relieved. 4. Compared with the hypobaric hypoxia group, in the hypobaric hypoxia + salidroside group, the concentrations of IL-6 and TNF-α in rats decreased apparently, and the differences were statistically significant (P < 0.05).ConclusionSalidroside had the repairing and protective effects on the hypobaric hypoxia-induced myocardial injuries in rats. The application of salidroside could reduce the inflammatory responses of rats with hypobaric hypoxia-induced myocardial injuries through PI3K/Akt signaling pathway, thereby protecting the myocardial cells.     

大鼠脑缺血/再灌注过程中血流量和脑组织含水量的变化趋势*

目的:研究大鼠脑缺血/再灌注过程中血流量及与脑组织水含量变化的趋势。方法:选取5只成年SD雄性大鼠(n=5),参照改良Zea-Longa线栓法制备大鼠大脑中动脉缺血/再灌注模型,2 h后拔出线栓。利用PeriCam PSI血流灌注成像系统实时监测大鼠在缺血前及缺血5 min、30 min、1 h、2 h、再灌注5 min、30 min、1 h、2 h、4 h、6 h及24 h的血流灌注量,记录在ROI(感兴趣区)测量的数值。再选取15只成年SD雄性大鼠,分为Control组、缺血2 h、再灌注30 min、4 h及24 h组(n=3)。正常组不做任何处理,实验组按上述线栓法制备MCAO模型。取新鲜脑组织用干湿重法测定其左、右半球的水含量。结果:栓塞时缺血侧血流量逐渐下降,缺血2 h下降最低(P＜0.05);再灌注早期血流量恢复较大(P＜0.05),30 min时显著下降(P＜0.05),4 h明显上升(P＜0.05),24 h再次上升(P＜0.05)但低于缺血前血流量(P＞0.05)。脑组织水含量测量,缺血2 h组和再灌注30 min组与正常组无明显差异(P＞0.05);再灌4 h组和再灌24 h组明显增高(P＜0.05),且再灌24 h组明显高于再灌4 h组(P＜0.05)。结论:大鼠脑缺血/再灌注过程中血流量和脑组织中水含量的变化存在一定的规律,且脑组织中水含量与再灌注过程中血流量的变化有一定关系。     

Myocardial Infarction Detection and Localization Using Optimal Features Based Lead Specific Approach

ObjectivesObjective of this paper is to present a reliable and accurate technique for Myocardial Infarction (MI) detection and localization.Material and methodsStationary wavelet transform has been used to decompose the ECG signal. Energy, entropy and slope based features were extracted at specific wavelet bands from selected lead of ECG. k-Nearest Neighbors (kNN) with Mahalanobis distance function has been used for classification. Sensitivity (Se), specificity (Sp), positive predictivity (+P), accuracy (Acc), and area under the receiver operating characteristics curve (AUC) analyzed over 200 subjects (52 health control, 148 with MI) from Physikalisch-Technische Bundesanstalt (PTB) database has been used for performance analysis. To handle the imbalanced data adaptive synthetic (ADASYN) sampling approach has been adopted.ResultsFor detection of MI, the proposed technique has shown an AUC = 0.99, Se = 98.62%, Sp = 99.40%, PPR = 99.41% and Acc = 99.00% using 12 top ranked features, extracted from multiple leads of ECG and AUC = 0.99, Se = 98.34%, Sp = 99.77%, PPR = 99.77% and Acc = 99.05% using 12 features extracted from a single ECG lead (i.e. lead V5). For localization of MI, the proposed technique has an AUC = 0.99, Se = 98.78%, Sp = 99.86%, PPR = 98.80%, and Acc = 99.76% using 5 top ranked features from multiple leads of ECG and AUC = 0.98, Se = 96.47%, Sp = 99.60%, PPR = 96.49% and Acc = 99.28% using 8 features extracted from a single ECG lead (i.e. lead V3).ConclusionThus for MI detection and localization, the proposed technique is independent of time-domain ECG fiducial markers and can work using specific leads of ECG.     

Reverse regulation of hepatic ceruloplasmin production in rat model of myocardial ischemia

BackgroundCeruloplasmin (Cp) is a major copper-binding protein produced in the liver and delivers copper to extrahepatic organs. Patients with myocardial infarction are often featured by an elevation of serum copper concentrations due to copper efflux from ischemic hearts. The present study was undertaken to test the hypothesis that serum copper elevation leads to up-regulation of hepatic Cp in myocardial infarction.MethodsAdult male Sprague-Dawley rats were subjected to left anterior descending (LAD) coronary artery ligation to induce myocardial infarction. Serum copper and Cp levels, as well as changes in hepatic Cp and copper-transporting P-type ATPase (Atp7b), were determined from blood and liver samples collected on day 1, 4, or 7 after the operation.ResultsSerum copper concentrations were significantly increased on day 4 after LAD ligation, accompanied by an increase in serum Cp levels and activities. Concomitantly, the protein levels of Cp and copper exporter, Atp7b, were also significantly increased in the liver. Furthermore, inhibiting the increase of serum copper by a copper chelator, triethylenetetramine (TETA), effectively abolished the elevated Cp activity after LAD ligation.ConclusionThese results indicate that serum Cp elevation in response to myocardial ischemia most likely resulted from the increased hepatic Cp production, which in turn was more responsive to serum copper elevation than inflammatory response following myocardial ischemia.     

参麦注射液联合西药对急性心肌梗死患者疗效及机制研究

目的:研究参麦注射液联合西药对急性心肌梗死患者的疗效及机制。方法:选择我院2016年3月~2019年12月收治的101例急性心肌梗死患者,根据随机数字表法分为对照组和观察组。对照组口服替格瑞洛治疗,观察组联用参麦注射液治疗,观察两组治疗的疗效及治疗前后血浆乳酸、脑钠肽(Brain natriuretic peptide,BNP)和血清降钙素原(Procalcitonin,PCT)、超敏C反应蛋白(Hypersensitive C-reactive protein,hs-CRP)水平及心功能指标变化。结果:观察组的有效率明显高于对照组(P<0.05);两组治疗前的血浆乳酸、BNP和PCT、hs-CRP水平无明显差异(P>0.05),治疗后,两组的上述指标明显降低(P<0.05),且观察组低于对照组(P<0.05);两组治疗前的左心室射血分数(Left ventricular ejection fraction,LVEF)、左心室舒张期末内径(End diastolic diameter of left ventricle,LVEDd)、CO和左心室收缩末期直径(leftventricular end systolic diameter,LVESd)无明显差异(P>0.05),治疗后,两组的上述指标明显改善(P<0.05),且观察组优于对照组(P<0.05);观察组的药物不良反应率为14.00%(7/50),与对照组的11.76%(6/51)相比无明显差异(P>0.05)。结论:参麦注射液联合替格瑞洛能减轻急性心肌梗死患者体内的炎症反应,改善心功能,可能与其机制有关。     

复方丹参滴丸联合沙库巴曲缬沙坦对老年心肌梗死患者PCI术后炎性反应、心室重塑和心肌灌注的影响

摘要 目的：探讨复方丹参滴丸联合沙库巴曲缬沙坦对老年心肌梗死患者经皮冠状动脉介入术（percutaneous coronary intervention,PCI）术后炎性反应、心室重塑和心肌灌注的影响。方法：采用随机数字表法将本院2017年3月至2020年2月间收治的行PCI治疗的68例老年心肌梗死为研究对象,分为对照组（34例）和观察组（34例）。两组均行常规药物治疗,在此基础上予以对照组沙库巴曲缬沙坦治疗,予以观察组复方丹参滴丸联合沙库巴曲缬沙坦治疗。比较两组治疗前后血浆中超敏C反应蛋白（high-sensitivity creactive protein,hs-CRP)、肿瘤坏死因子-α（Tumor necrosis factor-α,TNF-α）、白细胞介素-8（interleukin-8,IL-8）、N末端脑钠肽前体（N-terminal-pro-brain-natriuretic-peptide,NT-proBNP）、左室舒张末期前后径（left ventricular end-diastolic diamete,LVEDD）、左室射血分数（left ventricular ejection fraction,LVEF）、左室质量指数（left ventricular mass index,LVMI）以及治疗后TIMI血流分级。结果：两组血浆hs-CRP、TNF-α、IL-8和NT-proBNP水平以及LVEDD和LVMI水平较治疗前明显降低,LVEF水平明显增加（P<0.05）。观察组治疗后血浆hs-CRP、TNF-α、IL-8和NT-proBNP水平以及LVEDD和LVMI水平明显低于对照组,LVEF水平明显高于对照组（P<0.05）。两组术后20 minTIMI血流分级均明显好转,观察组术后20 min时TIMI血流分级明显优于对照组（P<0.05）。两组不良反应总发生率比较无明显差异（P>0.05）。结论：复方丹参滴丸联合沙库巴曲缬沙坦能够明显降低老年心肌梗死患者PCI术后炎性反应,抑制心室重塑,改善心肌灌注,安全性较高。