低通气量呼吸对犬左空心肌收缩性的影响

大量的研究表明,急性呼吸衰竭时多伴有心血管功能的损害,但有关急性呼吸衰竭对于左室心肌收缩性的影响所知甚少。本文对开胸麻醉犬在低通气引起呼吸衰竭时,左室心肌收缩性的变化进行了观测和分析。结果表明,在实验组(n=9)低通气呼吸(通气量小于160ml/min/kg,PaO_2小于60mmHg)时,心率(HR)、主动脉平均压(MOP)、左室收缩峰压(LV-SP)、左室内压最大上升速率(dP/dt_(max))、节段心肌发展张力(DT)及其最大发展速率(dT/dt_(max))均显著降低,心肌开始收缩至dp/dt_(max)的时间(t-dp/dt_(max))和至dT/dt_(max)的时间(t-dT/dt_(max))则显著增加,与低通气呼吸前比较均有统计学差异。而在对照组(n=5)保持正常通气(通气量大于450ml/min/kg,PaO_2大于70mmHg),观察45min,未见上述指标有明显改变。本研究表明,急性呼吸衰竭时左室心肌收缩性严重受损。     

氟碳乳剂与右旋糖酐对犬缺血心肌侧支循环供氧的影响

本实验在14只麻醉开胸狗心脏上观察了氟碳乳剂与右旋糖酐稀释血液对心肌耗氧量与供应缺血心肌氧量关系的影响。以左室压力-时间指数(SPTI)作为心肌耗氧量的指标,根据冠脉有效侧支血流量(ECF)、PaO_2和 Hb 浓度计算供应缺血心肌的氧量。实验结果表明,低分子右旋糖酐稀释血液后,SPTI 暂时性轻度增加(稀释后30min 时较对照增加7.1±2.7%,P<0.05,稀释后60min 时增加2.8±1.2%,P>0.05),ECF 明显增多(稀释后30min 时较对照增加58.5±6.1%,P<0.01),缺血区边缘心肌氧供需关系未发生明显变化。氟碳乳剂稀释血液后,SPTI 的变化规律与右旋糖酐稀释后相同(稀释后30min 和60min 时分别较对照增加2.5±0.7%和1.9±0.8%)ECF 和 PaO_2升高(稀释后30min 时分别较对照增加53.9±6.7%和93±8.9%),供应缺血心肌的氧量显著增加,缺血区边缘心肌氧供需矛盾明显改善。     

急性心肌缺血对血液流变学和心脏收缩功能改变的影响

在麻醉开胸狗观察了急性心肌缺血对血液流变学和心脏收缩功能改变的影响。在阻断狗前降支冠脉1h内,血液流变学各参数发生异常变化,表现为高、低切变率下全血粘度(ηbh、ηb1)、血浆粘度、血细胞压积和纤维蛋白原升高,红细胞电泳时间缩短。同步描记心电、心音和颈动脉搏动图而记录的心脏收缩时间间期,表现为射血前期(PEP)延长、左室射血时间(LVET)缩短和PEP/LVET比值增大。此外,动脉舒张压(DAP)升高,心输出量(CO)减少。上述各参数均与对照值有明显差异,P<0.05。缺血40min时,对ηb1和PEP/LVET或DAP进行相关分析,呈明显正相关,P<0.05;ηb1和CO呈明显负相关,P<0.01。结果提示,心肌缺血后发生的血液流变学异常变化,具有增加射血阻力和减少心输出量的作用。     

Beta-adrenergic receptor characteristics of postnatal rat myocardial cell preparations

Summary Primary mycolardial cell cultures and freshly isolated cardiac cells in suspension resprensent two isolated, whole cell models for investigating cellular transsarcolemmal⁴⁵Ca⁺⁺ exchange in response to a receptor-coupled stimulus. Studies were performed to characterize beta-adrenergic receptor binding, beta-adrenergic receptor mediated cellular calcium (⁴⁵Ca⁺⁺) exchange, and viability in purified primary myocardial cell cultures and freshly isolated cardiac cells in suspension obtained from 3-to 3-d-old Sprague-Dawley rats. In addition, beta-adrenergic receptor binding was characterized in whole-heart crude membrane preparations. All three preparations had saturable beta-adrenergic binding sites with the antagonist [¹²⁵I]iodopindolol ([¹²⁵I]IPIN). The suspensions had a significantly lower B _max (42±6 fmol/mg protein) than the membranes and cultures (77±8 and 95±10 fmol/mg protein, respectively). The K _D of the cultures (218±2.0 pM) was significantly higher than that for the suspensions (107 ±1.3 pM) and membranes (93±1.3 pM). Viability was significantly lower in the suspensions (57%) when compared to 94% viability in myocardial cell cultures after 3 h of incubation in Kreb's Henseleit buffer. Incubation of the cultures with 5.0×10⁻⁷ M isoproterenol resulted in a significant increase in⁴⁵Ca⁺⁺ exchange as early as 15 s. In contrast,⁴⁵Ca⁺⁺ exchange into the suspensions was not increased. Although both primary cell cultures and cardiac cells in suspension possess saturable beta-adrenergic receptors, only the monolayer cultures exhibited functional beta-adrenergic receptor-mediated⁴⁵Ca⁺⁺ exchange. Of the two intact cell models investigated, these data suggest that primary myocardial cell cultures are more suitable than cell suspensions for investigating beta-adrenergic receptor binding and functions in the postnatal rat heart. This research was supported by The University of Texas Research Institute, a grant from the Texas Advanced Research Technology Program awarded to S. W. Leslie and R. E. Wilcox, and contract 223-86-2109 from the Food and Drug Administration.     

Disturbed lipid metabolism in diabetic coronary vessels

The aim of this study was to clarify whether or not arachidonic acid metabolic disorders are caused by a substrate inavailability and whether such disorders might contribute to circulatory disturbances in the diabetic myocardium. Norepinephrine induced a decrease in the conductivity of both coronary arterial bed and myocardial microcirculation in alloxan-diabetic dogs. It was markedly (p < 0.05) attenuated both by indomethacin and acetylsalicylic acid pretreatments indicating an imbalance among the vasoactive prostanoids in diabetes. TXA₂ release from the diabetic coronary rings was found to be elevated and could be normalized after the blockade of vascular adrenoceptors by phentolamine (p < 0.05). PGIZ synthesis was also enhanced by adrenergic blockade in the diabetic arterial rings. After pretreatment with ^l4C arachidonic acid, in order to measure substrate availability, the arachidonic acid metabolic rate was less in the diabetic coronary arteries than in healthy vessels (p < 0.05). Ten µmol/1 norepinephrine decreased arachidonic acid metabolism in the presence of prelabelled substrate in the diabetic animals, compared to an increase observed in metabolically healthy dogs. Therefore diabetes appears to diminish arachidonic acid metabolism and uptake independent of adrenoceptors and to induce an imbalance between vasoconstrictor and vasodilator cyclooxygenase products, resulting in elevated TXA₂ release controlled by adrenergic mechanisms which may contribute to an impairment in myocardial microcirculation.Abbreviations 6-oxo-PGF₁ 6-oxo prostaglandin F₁ - HPLC High Pressure Liquid Chromatograph - LAD Left Anterior Descending (coronary artery) - PGI₂ Prostacyclin - TXA₂ Thromboxane     

肾性高血压大鼠左室等容峰压一容积关系及其对异丙肾上腺素的反应

本研究观察了肾血管性高血压大鼠(RHR)肥大左室的等容峰压-容积关系(PIPVR)和左室压力最大上升速率-容积关系(PRPVR)的曲线特征,并用两曲线的升支斜率E_(max)和dE/dt_(max)及曲线的特征参数评价了RHR(8周)左室的收缩能力及其对异丙肾上腺素的反应性。结果显示,大鼠高血压8周后左室发生明显肥大;与同龄假手术对照大鼠(SOR)相似,RHR的PIPVR和PRPVR也呈指数曲线形式;与SOR比较,RHR左室的PIPVR和PRPVR左上移位,E_(max)、dE/dt_(max)显著增大(P均<0.01),分别增加78％和97％,曲线的特征参数K_1、K_2、B_1和B_2也明显高于SOR(P均<0.05),分别增加37％、32％、25％和57％;灌注异丙肾上腺素(0.94μg/min)后,上述指标的增加幅度均较SOR低(P均<0.05)。结果提示,压力超负荷心肌肥大并不影响PIPVR的非线性特征,基础状态下,RHR肥大左室的收缩能力增强,但对异丙肾上腺素的反应性降低。     

躯体传入冲动抑制中枢性心肌缺血的脊髓机制

本工作在58只尿酯-氯醛糖麻醉,三碘季铵酚制动,人工呼吸,切断迷走神经的兔上进行。结果显示:电刺激正中神经(MN)和腓深神经(DPN)均能抑制或部分抑制下丘脑背内侧核(DMH)诱发的缺血性心电 ST 段偏移,以刺激 MN 的抑制作用更为明显。蛛网膜下腔注射(ith)吗啡(40μg)也能抑制这种缺血性心电变化。ith 纳洛酮(20μg)则可阻断刺激 MN 对中枢性心肌缺血的抑制作用。完整兔在刺激左侧 MN 或 DPN 后,用放射免疫技术测得胸 2—5(T_2-5)节段两侧中间外侧柱(IML)中亮氨酸脑啡肽(LENK)含量明显增加。在颈1(C_1)水平横断脊髓,以同样参数刺激左侧 MN,同侧胸髓 IML 中 LENK 含量明显增加,而对侧胸髓 IML 中 LENK 含量无明显改变;刺激一侧 DPN,T_(2-5)的两侧 IML 中 LENK 含量均无明显变化。上述结果表明,刺激 MN 与 DPN 均能抑制 DMH 诱发的中枢性心肌缺血,但以MN 作用较明显。我们推测这种抑制作用可能与通过脊上机制双侧性增加 IML 中 LENK 含量有关,MN 的抑制作用可能尚包括直接激活胸髓内的脑啡肽系统,增加同侧 IML 中 LENK含量,加强了对交感输出活动的抑制作用。     

Carbohydrates,lipids and lipoproteins and islet changes in diabetes with superimposed myocardial infarction

Short-term metabolic and concomitant morphologic effects of streptozotocin diabetes on isoproterenol-induced myocardial infarction was studied in Wistar rats, Of particular significance was the observation that myocardial infarction in concert with diabetes brought about a distinctive exacerbation of the severity and complexity of the histopathological lesions. Of all the biochemical parameters, serum glucose and free fatty acids registered maximum elevation and serum lactate and cardiac glycogen levels a maximum reduction. Among the lipoproteins, an inverse relationship was found between high density lipoproteins and low density and very low density lipoproteins; while high density lipoproteins, ratio of high density lipoprotein to low density lipoprotein and the percentage of high density lipoprotein were decreased, there was a significant increase in low density lipoprotein concentration and percentage values of low density and very low density lipoproteins. In diabetes, the B cell of the endocrine pancreas depicted selective necrosis. Loss of insulin granules and wide-spread necrobiosis of cellular elements of the pancreatic islets were observed, respectively, in myocardial infarction and in diabetes plus myocardial infarction combinations. Pathological evidence of chemical-induced mild toxicity was present in the exocrine parenchyma. Mitotic features and the presence of centroacinar cells in the damaged Langerhans’ islets supposedly formed the basis of regeneration of the tissue in diabetes, with or without vascular complications     

Cardiac copper,magnesium, and zinc in recent and old myocardial infarction

X-ray fluorescence spectrometry and atomic absorption spectrometry were used in a quantitative study of zinc, copper, and magnesium in 71 postmortal human hearts. Samples were obtained from individuals who had demonstrated no previous clinical or subsequent pathological findings of myocardial infarction and from victims of a recent or an old infarction. A significant difference (p<0.001) in the elemental levels was observed between the noninfarct and the recent infarct groups. The noninfarct group had higher cardiac levels of all three elements. However, the difference in elemental concentrations between the noninfarct and the old-infarct groups was not significant. Cardiac levels of zinc (p<0.001) and copper (p<0.01) were significantly greater in the old-infarct group than in the recent-infarct group. Magnesium levels were higher in the recent-and-old-infarct group than in the recent infarct group (p<0.01). It is possible that the elements are redistributed during myocardial infarction, and that uptake of these elements (from the serum pool) by the heart may be important in maintaining myocardial integrity and function.     

Meteorological factors and the time of onset of chest pain in acute myocardial infarction

Analysis of the time of onset of chest pain in 2254 patients with a myocardial infarction admitted to a coronary care unit in Leicester during a 10-year period shows an association with temperature and humidity. During both the most cold and humid times of the year, the relationship is a strong one. A generalized linear model with a log link was used to fit the data and the backward elimination selection procedure suggested a humid, cold day might help to trigger the occurrence of myocardial infarction. In addition, cold weather was found to have a stronger effect on the male population while those men aged between 50 and 70 years were more sensitive to the effect of high humidity.