血液流变学在心肌梗死诊断、治疗和预后判断方面的研究进展

血液流变学是一门研究血液流动与变型的新型学科,其范围包括血液流量、流速、流态、血液凝固性,血液中有形成分及血管变形性与弹性、微循环、微血管血液流变性等。它是心肌梗死发病的一个重要因素之一,其突出表现是红细胞聚集症和高粘滞血症。血液流变学不但在心肌梗死疾病中的诊断,药物、介入等方面作为临床治疗与疗效的评估指标,而且对心肌梗死疾病的预后及对临床观察病情变化及疗效判定等具有重要意义。     

85例心肌梗死患者血液流变学指标的变化

近年来我国心脑血管病逐渐增多 ,其致残率、死亡率也明显上升。我院于 2 0 0 0年 6月至 2 0 0 1年6月对 85例心肌梗死患者进行了血液流变学 5项主要指标的检测 ,发现心肌梗死患者血液流变学指标有明显改变 ,现报告如下。1　资料与方法1 .1　临床资料　对照组 :1 2 0例 ,其中男 6 5例 ,年龄 3 0～ 75岁 ,平均 5 3 .5岁 ;女 5 5例 ,年龄 3 0～82岁 ,平均 5 5 .7岁 ,均是来本院体检 ,排除患有心肌梗死而影响血液流变学指标因素的健康人。心肌梗死组 :85例 ,其中男 49例 ,女 3 6例 ,均来自本院住院病人 ,并经临床和各种检查确诊为心肌梗死的患者…     

青龙肠溶胶囊治疗周围血管病50例的临床与血液流变学观察

青龙肠溶胶囊治疗周围血管病５０例的临床与血液流变学观察三明市第二医院３６６０００刘胜智我们用青龙胶囊治疗周围血管病５０例,对其进行了临床疗效和血液流变学影响的观察,报告如下。１资料和方法治疗对象：所有病例来源于住院及门诊病例。年龄２３～７４岁,其中男...     

降纤酶联合尼莫地平治疗急性脑梗死疗效观察

目的：观察降纤酶联合尼莫地平治疗急性脑梗死的临床疗效及相关生化指标,探讨降纤、抗栓、复流和脑保护在急性脑梗死治疗中的必要性。方法：对符合条件的病例随机分2组,治疗组予降纤酶加尼莫地平治疗,对照组临床疗效及血栓通加胞二磷胆碱治疗,分别对其疗效,血液流变学,凝血酶原时间进行比较。结果：治疗组临床疗效及血液流变学指标改善明显,且无增加副作用。结论：降纤酶有降纤、抗凝、溶栓作用,尼莫地平抑制Ca^2 内流,保护脑细胞,同时有改善血液流变性,两药联合应用治疗急性脑梗死有协同作用,可增加疗效。     

清栓酶对血液流变学的影响（附22例分析）

应用清栓酶对心脑血管病治疗,观察治疗前后血液流变学七项指标变化,经统计学分析,该药对血液流变学的疗效关系,说明该药对预防和治疗心脑血管疾病是一种较为理想的药物之一。     

血液流变学在临床疾病诊断、治疗中的应用

近十多年来,血液流变学在临床医学的各领域得到了广泛而深入的研究,不仅发现了许多疾病可导致血液流变学的异常,而且发现了血液流变学的变化可作为许多疾病诊断、治疗及愈后的重要指标。本文主要介绍血液流变学在这些方面的应用研究。     

慢性肾脏疾病血液流变学测定及其临床意义的探讨

本文对我院1988年至1990年住院40例慢性肾脏疾病病人进行了血液流变学的测定。其中我们发现Ⅱ型肾病综合征病人血液呈高粘状态[P<0.05],慢性肾小球肾炎普通型血液呈低粘状态[P<0.01],其它类型病人血液流变学测定基本正常,并讨论了其原因及临床意义,为临床诊断及治疗提供了依据。     

清栓酶治疗中,重度微循环异常320例疗效观察

本文总结清栓酶治疗中度以上微循环异常的缺血性心脑血管疾病３２０例,观察治疗前、后甲襞微循环的变化。结果表明清栓酶治疗前、后各项分值和总积分值都有显著性差异（Ｐ＜０．０１或Ｐ＜０．０５）,并且与血液流变学的改善以及临床症状、体征的好转呈正相关关系。观察结果表明清栓酶改善微循环疗效确切。甲襞微循环检测有助于预测疾病的危险程度,对指导用药、评估药物疗效等具有重要参考价值。     

丹参酮IIA磺酸钠注射液辅助治疗对突发性耳聋患者血液流变学及临床疗效的影响

目的：探讨丹参酮IIA 磺酸钠注射液辅助治疗对突发性耳聋患者血液流变学及临床疗效的影响。方法：选取我院收治的突发 性耳聋患者78 例,并将其随机分为实验组和对照组,每组39 例。对照组给予三磷酸腺苷二钠、辅酶A、复合维生素、双密达莫片 及高压氧治疗,而实验组在对照组的基础上给予丹参酮IIA 磺酸钠注射液治复合组治疗。观察和比较两组患者治疗后的听力恢复 等级分布以及治疗前后的电测听情况和各项血液流变学指标的变化情况。结果：治疗后,与对照组比较,实验组听力恢复Ⅰ级患 者的比例更高,电听力平均值均显著降低,各项血液流变学指标均明显改善,差异均有统计学意义(P<0.05)。结论：丹参酮IIA 磺酸 钠注射液辅助治疗能够显著提高突发性耳聋的临床疗效,这可能其改善患者的血液流变学有关     

清栓酶治疗急性脑梗塞52例临床疗效与血液流变学分析（摘要）

清栓酶治疗急性脑梗塞５２例临床疗效与血液流变学分析（摘要）抚顺西露天矿医院荆家宏,崔兰英抚顺矿务局医院田敏杰本文观察５２例脑梗塞,在治疗前后的临床疗效及血液流变学常用检测指标的变化,结果表明经两疗程清栓酶治疗后,８项检测指标（血栓长度、湿重、干重、血...     

Protection of ischemic myocardium by exogenous phosphocreatine (neoton): pharmacokinetics of phosphocreatine, reduction of infarct size, stabilization of sarcolemma of ischemic cardiomyocytes, and antithrombotic action

The effect of exogenous phosphocreatine on ischemic myocardium was studied in experimental infarction in rabbits and in total ischemia of pig heart tissue (in vitro). It is shown that single dose administration of phosphocreatine is followed by its rapid clearance from blood plasma (with a half lifetime of 4-6 min), but constantly high plasma concentration of phosphocreatine can be maintained by its intravenous infusion. When administered by this method into rabbits during experimental myocardial infarction, phosphocreatine reduces by 40% the size of the necrotic zone. Morphological electron microscopic studies using a lanthanum tracer method showed significant protection of the sarcolemma of cardiomyocytes in the perinecrotic zone by phosphocreatine. In vitro studies on the model of total ischemia also showed significant protection of cardiac sarcolemma from irreversible ischemic injury and reduction in the rate of high-energy phosphate depletion in the presence of phosphocreatine in the extracellular space. Additionally, it is demonstrated that creatine kinase released during myocardial infarction into the blood flow and exogenous phosphocreatine administered intravenously may significantly inhibit platelet aggregation by rapid removal of ADP, and thus potentially improve microcirculation during myocardial infarction.     

Study of blood and lymph in experimental myocardial ischemia and arterial hypertension]

The peripheral blood and central lymph of rats under experimental myocardial infarction was studied by means of light microscopy and electric conductivity measurement. Both hypertensive rats and animals 3 days after myocardial infarction had similar quantity of neutrophils in peripheral blood. Lymph cells count of hypertensive rats by middle lymphocytes is similar to the animals 1 day after myocardial infarction. The correlation between lymph and blood electric conductivity and its cell composition was noted.     

Myocardial ischaemia following electrical stimulation of the left circumflex coronary artery in sheep: a role for thromboxane A2?

The electrical stimulation model of thrombus formation was tested on rabbit carotid artery and adapted to sheep left circumflex coronary artery (LCCA). LCCA blood flow, mean arterial pressure (MAP), heart rate (HR) and ECG were monitored continuously and arterial and coronary venous blood samples were taken for radioimmunoassay of thromboxane B2. Stimulation of the LCCA mimicked acute myocardial infarction; reduction in LCCA blood flow preceded a fall in MAP and appearance of ECG abnormalities. Thromboxane B2 levels rose by 126% 35 min after stimulation. These findings support the proposal by other authors that thromboxane plays an important role in the pathogenesis of acute myocardial infarction.     

不仅是"益母"草:益母草的心脏保护作用

益母草作为一种传统的妇科中药,近年来的研究表明其作用是多方面的。在心血管方面,益母草能改善心肌缺血、增加冠状动脉血流、提高心功能,其机制主要是在氧化应激状态下通过清除氧自由基、抑制活性氧簇生成发挥抗氧化作用。益母草心脏保护作用的另一机制是促进血管发生。临床试验也表明,益母草能抑制冠心病人的血小板聚集,起抗凝、抗血栓形成作用,从而改善血流变学参数。本文根据目前研究进展,对益母草的心脏保护作用简要综述。     

A comparison of the illness beliefs of people with angina and their peers: a questionnaire study

Background

Systolic compression of a coronary artery by overlying myocardial tissue is termed myocardial bridging. Myocardial bridging usually has a benign prognosis, but some cases resulting in myocardial ischemia, infarction and sudden cardiac death have been reported. We are reporting a case of myocardial bridging which was complicated with acute myocardial infarction associated with inappropriate blood donation.

Case presentation

A 33 year-old-man was admitted to our emergency with acute anteroseptal myocardial infarction after a blood donation. The electrocardiography showed sinus rhythm and was consistent with an acute anteroseptal myocardial infarction. We decided to perform primary percutanous intervention (PCI). Myocardial bridging was observed in the mid segment of the left anterior descending coronary artery on coronary angiogram. PCI was canceled and medical follow up was decided. Blood transfusion was made because he had a deep anemia. A normal hemaglobin level and clinical reperfusion was achieved after ten hours by blood transfusion. At the one year follow up visit, our patient was healthy and had no cardiac complaints.

Conclusions

Myocardial bridging may cause acute myocardial infarction in various clinical conditions. Although the condition in this case caused profound anemia related acute myocardial infarction, its treatment and management was unusual.     

Importance of the TIMI frame count: implications for future trials

Although the TIMI (Thrombolysis In Myocardial Infarction) flow grade classification scheme is widely used to assess angiographic outcomes, it is limited by poor reproducibility and its categoric nature. The corrected TIMI frame count (CTFC) is a simple, more objective continuous variable index of coronary blood flow that can be broadly and inexpensively applied. This measure of the time for dye to traverse a coronary artery is both accurate (highly correlated with Doppler velocity measurements) and precise (reproducible). The method has been prospectively validated as providing independent risk stratification above and beyond the conventional TIMI flow grades. It has been shown to be a predictor of restenosis, and has been of value in elucidating the underlying pathophysiology of acute myocardial infarction. In view of the above and its ease of use, we anticipate that CTFC will become a widely used method to evaluate coronary blood flow.     

Intraventricular vortex flow changes in the infarcted left ventricle: numerical results in an idealised 3D shape

The cardiac diagnostic process is primarily based on the evaluation of myocardial mechanics whereas little is known about blood dynamics that is rarely considered to this purpose. The intraventricular blood flow is analysed here for akinetic and dyskinetic myocardial motion corresponding to the presence of an ischaemic pathology. This study is performed through a 3D numerical model of the left ventricular flow. Results show that the presence of an anterior-inferior wall infarction leads to the shortening and weakening of the diastolic mitral jet. A region of stagnating flow is found near the apex and close to the ischaemic wall. These results are in agreement with previous clinical findings based on echographic imaging. The described phenomena are also noticed for moderate degrees of the ischaemic pathology and suggest a potential value of the study of the intraventricular flow to develop early diagnostic indicators.     

小型猪急性心肌梗死模型的建立及其评价

目的探索结扎小型猪冠状动脉左前降支（LAD）建立急性心肌梗死模型及进行血流评价的方法。方法小型猪20头全麻下开胸暴露心脏,预阻断LAD（第二对角支）15min,后予结扎,术中心电图动态监测,术后进行冠状动脉造影,心肌酶学监测以确定模型建立情况,冠状动脉造影以及^13N-NH3 PET心肌血流测定评价手术后血流改变。结果20头小型猪中有16头存活4周,成活率80％,开胸手术中1头因麻醉意外死亡,3头死于术后呼吸不畅。结扎后心电图呈动态变化,24h后血清心肌酶谱（CK,CK—MB,cTnI）较术前明显增高,差异有统计学意义（P〈0．05）,冠状动脉造影显示LAD血流中断,TIMI分级为0级,^13N—NH3 PET检查显示手术后缺损面积百分比（27．0±5．0）较手术前（4．0±3．2）有显著性差异,证实心梗模型建立成功。结论本实验中开胸手术成功率高,术后血流评价方法可用于手术前后冠脉血流和心肌血流的比较以及对心肌梗死后治疗效果进行评价。     

Targeting autophagy in cardiac ischemia/reperfusion injury: A novel therapeutic strategy

Acute myocardial infarction (AMI) is one of the leading causes of morbidity worldwide. Myocardial reperfusion is known as an effective therapeutic choice against AMI. However, reperfusion of blood flow induces ischemia/reperfusion (I/R) injury through different complex processes including ion accumulation, disruption of mitochondrial membrane potential, the formation of reactive oxygen species, and so forth. One of the processes that gets activated in response to I/R injury is autophagy. Indeed, autophagy acts as a “double-edged sword” in the pathology of myocardial I/R injury and there is a controversy about autophagy being beneficial or detrimental. On the basis of the autophagy effect and regulation on myocardial I/R injury, many studies targeted it as a therapeutic strategy. In this review, we discuss the role of autophagy in I/R injury and its targeting as a therapeutic strategy.