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130例急性心肌梗死患者院前急救時間延誤分析

目的:分析心肌梗死院前急救時間延誤的原因,為今后更及時、有效地對心肌梗死患者作出相應的處理提供依據。方法:回顧性調查和分析130個心肌梗死患者院前急救基本信息。結果:心肌梗死患者院前急救平均時間延誤為60～120min,其中大部分時間消耗在發病與決定尋求治療這一決策階段。其次是經濟情況、患者職業、學歷、既往史與呼叫120院前急救時間有必然聯系。結論:應盡力減少急性心肌梗死患者院前急救時間的延誤,此對患者預后有重要意義。

兩例主動脈夾層累及冠狀動脈致心肌梗死的基層醫院前期救治體會

Efficacy of Early Use of Heparin for Thrombolytic Therapy on Patients with Acute Myocardial Infarction: A Systematic Review

ObjectiveTo systematically review the efficacy of early use of heparin for thrombolytic therapy in patients with acute myocardial infarction (AMI). MethodsThe Chinese databases involving VIP, CNKI, WanFang Data, CBM and foreign language databases including PubMed and The Cochrane Library (Issue 1, 2013) were electronically searched from inception to January 2013. Randomized controlled trials (RCTs) on early use of heparin in the treatment of AMI were included. Two reviewers assessed the quality of each trial and extracted data independently according to the Cochrane Handbook. RevMan5.2 software was used for statistical analysis. ResultsA total of 23 RCTs involving 2 697 patients were included. The results of meta-analysis showed that the heparin group was superior to the control group in increasing of the rate of coronary artery recanalization, decreasing the time of recanalization, reducing the rate of re-infarction and the death rate, and decreasing the time of ST-T fell for 50%, the time of enzyme peak showed and the time of chest pain relief. There had no significant difference observed in the incidence of adverse reaction between the two groups. ConclusionIt is effective to use heparin before thrombolytic therapy in AMI.

Effects of Bone Marrow Mononuclear Cells Implantation on Morphology, Structure, and Ventricular Function ofInfarct Heart in Dogs

Abstract: 　Objective　To observe the changes in morphology, structure, and ventricular function of infarct heart after bone marrow mononuclear cells (BMMNC) implantation. 　Methods　Twenty-four dogs were divided into four groups with random number table, acute myocardial infarction (AM I) control group , AM I-BMMNC group , old myocardial infarct ion (OMI) control group and OM I-BMMNC group , 6 dogs each group. Autologous BMMNC were injected into infarct and peri-infarct myocardium fo r transplantation in AM I-BMMNC group and OM I-BMMNC group. The same volume of no-cells phosphate buffered solution (PBS) was injected into the myocardium in AM Icontrol group and OM I-control group. Before and at six weeks of cell t ransplantation, ult rasonic cardiography (UCG) were performed to observe the change of heart morphology and function, then the heart was harvested for morphological and histological study. 　Results　U CG showed that left ventricular end diastolic dimension (LV EDD) , left ventricular end diastolic volume (LVEDV ) , the thickness of left ventricular postwall (LVPW ) in AM I-BMMNC group were significantly less than those in AM I-control group (32. 5±5. 1mm vs. 36. 6±3. 4mm , 46. 7±12. 1m l vs. 57. 5±10. 1m l, 6. 2±0. 6mm vs. 6. 9±0. 9mm; P lt; 0. 05). LVEDD, LVEDV , LVPW in OM I-BMMNC group were significantly less than those in OM I-control group (32. 8±4. 2 mm vs. 36. 8±4. 4mm , 48. 2±12. 9m l vs. 60.6±16.5m l, 7. 0±0. 4mm vs. 7. 3±0. 5mm; P lt; 0. 05). The value of eject fraction (EF) in OM I-BMMNC group were significantly higher than that in OM I-control group (53. 3% ±10. 3% vs. 44. 7%±10. 1% ). Compared with their control group in morphological measurement, the increase of infarct region thickness (7. 0 ± 1. 9mm vs. 5. 0 ±2.0mm , 6.0±0. 6mm vs. 4. 0±0. 5mm; P lt; 0. 05) and the reduction of infarct region length (25. 5±5. 2mm vs. 32. 1±612mm , 33. 6±5. 5mm vs. 39. 0±3. 2mm , P lt; 0. 05) were observed after transplantation in AM I-BMMNC group and OM I-BMMNC group, no ventricular aneurysm was found in AM I-BMMNC group, and the ratio between long axis and minor axis circumference of left ventricle increased in OM I-BMMNC group (0. 581±0. 013 vs. 0. 566±0.015; P lt; 0. 05). Both in AM I-BMMNC group and OM I-BMMNC group, fluorescence expressed in transplantation region was observed, the morphology of most nuclei with fluorescencew as irregular, and the differentiated cardiocyte with fluorescence was not found in myocardium after transplantation. The histological examination showed more neovascularization after transp lantation both in AMI and in OM I, and significant lymphocyte infiltration in AM I-BMMNC group. 　Conclusion 　BMMNC implantation into infarct myocardium both in AMI and OMI have a beneficial effect, which can attenuate deleterious ventricular remodeling in morphology and st ructure, and improve neovascularization in histology, and improve the heart function.

Comparison Study of Left Ventricular Function Assessment by 18F-FDG PET, Gated SPECT and 2D-Echocardiography in Patients with Myocardial Infarction

The aim of this study is to analyze the concordance between EDV, ESV and LVEF values derived from 18F-FDG PET, GSPECT and ECHO in patients with myocardial infarction. Sixty-four patients with coronary artery disease (CAD) and myocardial infarction were enrolled in the study.. Each patient underwent at least two of the above mentioned studies within 2 weeks. LVEF、 EDV and ESV values were analyzed with dedicated software. Statistical evaluation of correlation and agreement was carried out EDV was overestimated by 18F-FDG PET compared with GSPECT [(137.98±61.71) mL and (125.35±59.34) mL]; ESV was overestimated by 18F-FDG PET (85.89±55.21) mL and GSPECT (82.39±55.56) mL compared with ECHO (68.22±41.37) mL; EF was overestimated by 18F-FDG PET (41.96%±15.08%) and ECHO (52.18%±13.87%) compared with GSPECT (39.75%±15.64%), and EF was also overestimated by 18F-FDG PET compared with GSPECT. The results of linear regression analysis showed good correlation between EDV, ESV and LVEF values derived from 18F-FDG PET, GSPECT and ECHO (r=0.643-0.873, P=0.000). Bland-Altman analysis indicated that 18F-FDG PET correlated well with ECHO in the Left ventricular function parameters. While GSPECT correlated well with 18F-FDG PET in ESV, GSPECT had good correlation with Echo in respect of EDV and EF; whereas GSPECT had poor correlation with PET/ECHO in the remaining left ventricular function parameters. Therefore, the clinical physicians should decide whether they would use the method according to the patients' situation and diagnostic requirements.

心肌梗死后殘存心肌細胞肥大性改變及其IGF1、IGF1R的表達

目的 觀察心肌梗死后殘存心肌細胞肥大性改變及其胰島素樣生長因子-1(IGF-1)、胰島素樣生長因子-1受體(IGF-1R)的表達，探討梗死心肌心肌細胞肥大的機制。 方法 取急性心肌梗死后2周、4周、8周的梗死心肌，制備單心肌細胞懸液，采用激光共聚焦掃描顯微鏡(Confocal)檢測心肌細胞體積，采用免疫組織化學法檢測心肌細胞IGF-1、IGF-1R的表達。 結果 〖HTSS〗急性心肌梗死8周梗死區域心肌細胞體積較正常區域心肌細胞增大（37 563.93±6 176.79 μm3 vs. 28 638.61±6 890.89 μm3, t=4.840，P=0.020），細胞肥大以寬度和厚度為主；梗死區域心肌細胞可見IGF1染色陽性顆粒，IGF-1表達高于正常區域心肌細胞（79.58±4.57 vs. 64.12±3.91,t=27.564，P=0.002）；IGF-1R主要分布于心肌細胞膜，梗死區域心肌細胞IGF1R表達高于正常區域心肌細胞（67.02±2.56 vs. 66.73±3.49,t=3.845，P=0.042），其中以急性心肌梗死4周IGF-1R表達最高。 結論 心肌梗死后殘存心肌細胞分泌IGF-1和IGF-1R，并可能在促使殘存心肌細胞肥大中起了積極作用。

Emergent Percutaneous Transluminal Coronary Angioplasty in 41 Patients with Acute Myocardial Infarction in Elementary Hospital

摘要:目的:探討基層醫院開展急診經皮冠狀動脈支架植入術(PCI)治療急性心肌梗死(AMI)的可行性、安全性。方法:回顧分析2002年11月~2009年4月我院41例AMI患者的急診PCI資料。結果:41例AMI患者,急診開通梗死相關動脈(IRA)39例(即時成功率95.1%),開通IRA者中術后死亡2例(死亡率4.9%),總成功率90.2％。結論:在有條件的基層醫院開展急診PCI安全有效。Abstract: Objective: To explore the feasibility and safety of primary percutaneous coronary intervention in patients with acute myocardial infarction in elementary hospital. Methods: The clinical data of 41 AMI patients who underwent emergent PCI from November 2002 to April 2009 were retrospectively analyzed. Results: Among the 41 AMI patients referred to PCI, infarctrelated arteries were recanalized in 39 cases. The immediate success rate was 95.1%. 2 cases of them died. The total success rate was 90.2%.Conclusion: Emergent PCI is safe and effective in the hospitals which could carry out PCI.

Surgical Management of Patients with Acute Myocardial Infarction

Objective\ To analyze the experiences of emergent or urgent coronary artery bypass grafting(CABG) for patients with acute myocardial infarction(AMI). Methods\ From May, 1996 through December, 1999, 9 patients with AMI underwent emergent CABG including eight males and one female, with mean age 61 years, and year range 44 70. The localization of the AMI was anterior in 4 and inferior in 5. The interval between the onset of AMI and CABG was within 24 hours in 7 cases, 10 days in 1 case and 14 days in 1 case....

小腸黏膜下層-骨髓間充質干細胞移植-治療陳舊性心肌梗死

摘要: 目的 探討自體骨髓間充質干細胞(MSCs)小腸黏膜下層(SIS)支架復合物移植于陳舊性心肌梗死區域后細胞的存活、支架的降解情況及其對心功能的影響。 方法 將16只黑山羊按隨機數字表法分為兩組，每組8只。實驗組：建立心肌梗死模型，抽取自體骨髓,經體外分離MSCs,進行培養、傳代、BrdU標記、與SIS支架復合，并于心肌梗死6周時將MSCs-SIS復合物補片移植至陳舊性心肌梗死區；對照組：建立心肌梗死模型。于移植后6周行超聲心動圖、HE染色及免疫組織化學檢測。 結果 MSCs-SIS植入心肌梗死區2周時在補片區可見大量炎性細胞浸潤；6周時淋巴細胞浸潤消失，SIS部分降解，移植區見大量移植細胞存活。MSCs-SIS植入體內后6周時，實驗組每搏輸出量(42.81±4.91 ml vs. 37.06±4.75 ml)、射血分數(59.20%±5.41% vs. 44.56%±4.23%)、室壁增厚率（54.51%±8.60% vs. 43.36%±8.91%）、舒張期E峰 (54.85±6.35 cm/s vs. 43.14±4.81 cm/s)顯著高于對照組(Plt;0.05)，左心室收縮期末容積(29.75±5.98 ml vs. 46.25±6.68 ml)、舒張期末容積(72.55±8.13 ml vs. 83.31±8.61 ml)顯著低于對照組(Plt;0.05)。 結論 SIS作為支架移植MSCs有利于移植細胞存活，對陳舊性心肌梗死后心功能有明顯的改善作用。

Progress in Surgical Treatment of Ischemic Mitral Regurgitation

Ischemic mitral regurgitation is the common complication after myocardial infarction. Ischemic mitral regurgitation which can be described as the modification of the ventricle caused by myocardial infarction remarkably increases the risk of developing congestive heart failure and mortality after myocardial infarction. The imbalanced dynamic of tethering and occluding of the leaflets or the annular dilatation can result in ischemic mitral regurgitation. We have to diagnose, evaluate ischemic mitral regurgitation timely and perform surgical treatment effectively. It has significant meaning to improve the prognosis of patients.