Objective: To evaluate the myocardial protecting effect of Shenmai injection (SMI) against ischemia/reperfusion injury in thrombolytic therapy with urokinase (UK) for acute myocardial infarction patients by 99mTc-MIBI myocardial imaging (SPECT). Methods: Five hundred and thirty-seven patients were divided into two groups randomly. The SMI group (n=292) was treated with thrombolytictreatment plus SMI and the control group (n=245) with thrombolytic treatment solely. Single photon emission computed tomography (SPECT) was carried out on the 7th day after thrombolysis to determine the ischemic myocardial area (IMA) and ejection fraction (EF) in both groups and compared. Results: The infarction related area (IRA) of reperfusion rate in the two groups was not different significantly (72.26% vs 72.65%, P >0.05). The IMA in patients of the SMI group, no matter with or without reperfused IRA (211 cases and 81 cases) respectively, was significantly lower than that in the control group (178 cases and 67 cases) respectively, P<0.01 and P<0.05 respectively. The EF value in the SMI group was significantly higher than that in the control group (P<0.01). Conclusion:Using SMI in early stage of thrombolytic treatment in acute myocardial infarction could significantly reduce IMA and increase EF. SMI showed good protective effect against myocardial ischemia/reperfusion injury in thrombolytic treatment.

Objective: To evaluate the myocardial protecting effect of Shenmai injection (SMI) against ischemia/reperfusion injury in thrombolytic therapy with urokinase (UK) for acute myocardial infarction patients by 99mTc-MIBI myocardial imaging (SPECT). Methods: Five hundred and thirty-seven patients were divided into two groups randomly. The SMI group (n=292) was treated with thrombolytictreatment plus SMI and the control group (n=245) with thrombolytic treatment solely. Single photon emission computed tomography (SPECT) was carried out on the 7th day after thrombolysis to determine the ischemic myocardial area (IMA) and ejection fraction (EF) in both groups and compared. Results: The infarction related area (IRA) of reperfusion rate in the two groups was not different significantly (72.26% vs 72.65%, P >0.05). The IMA in patients of the SMI group, no matter with or without reperfused IRA (211 cases and 81 cases) respectively, was significantly lower than that in the control group (178 cases and 67 cases) respectively, P<0.01 and P<0.05 respectively. The EF value in the SMI group was significantly higher than that in the control group (P<0.01). Conclusion:Using SMI in early stage of thrombolytic treatment in acute myocardial infarction could significantly reduce IMA and increase EF. SMI showed good protective effect against myocardial ischemia/reperfusion injury in thrombolytic treatment.

急性心肌梗死冠脉介入治疗前后中医辨证治疗思路与方法--附70例患者治疗分析

在对急性心肌梗死(AMI)的救治中,冠脉介入治疗有着不可替代的作用,在应用冠脉介入治疗手段干预的情况下,如何进行中医的辨证治疗是一个值得探讨的论题.作为率先在全国开展冠脉介入治疗的中医院,我们将近3年来在我院成功接受冠脉介入治疗和中医治疗的AMI患者的思路与方法总结于下.

缺血预适应对合并糖尿病的急性心肌梗死患者左室功能的近期影响

预先短暂缺血可以提高心肌组织对随后较长时间缺血的耐受性,称为缺血预适应(ischemic preconditioning,IP).有研究证实,梗死前心绞痛可以通过IP机制减少急性心肌梗死(acute myocardial infarction,AMI)患者梗死面积,保护其心脏功能.

急性心肌梗死介入治疗进展

血栓形成确认为急性心肌梗死的病理基础后，80年代起再灌注治疗开创了急性心肌梗死（AMI）治疗的里程脾。多项临床试验证实静脉溶栓治疗显著降低了心肌梗死（MI）的死亡率，大大改善了心肌梗死患者的预后。然而，静脉溶栓治疗仍有不足之处，如能接受溶栓治疗的患者仅1/3，血管再通率只有60％～80％，而实际上溶栓后梗死相关血管冠状动脉造影达TIMI 3级血流（即完全再灌注）的仅50％～55％，TIMI 2级血流（即部分再灌注）虽达再灌注标准，但并不降低死亡率，Anderson等报告90min梗死相关血管达TIMI 3级血流者30d死亡率才降低（3.7%），而部分再灌注TIMI 2级的死亡率和血管未灌注者一样（TIMI 2级和TIMI 0/l级的死亡率分别为7％和8％）［1］。溶栓治疗患者还要冒出血，特别是颅内出血的风险。 80年代初，Hartzler等首先报道直接经皮冠状动脉腔内成型术（PTCA）的机械再灌注代替药物溶栓治疗急性心肌梗死取得了良好效果［2］，然而，对急性心肌梗死急诊PTCA治疗长期以来一直存在争议，但经过大量随机临床对比研究，与药物静脉溶栓比较，直接PTCA在增加血管再通率，降低死亡率，减少再梗死及出血并发症方面确实优于溶栓治疗。AMI急诊PTCA近年来已逐渐广泛应用于临床。AMI时机械再灌注方法按其目的和进行时间分为直接、补救性、立即和延迟PTCA。1 直接PTCA 直接PTCA指急性心肌梗死不采用药物溶栓而直接进行PTCA。直接PTCA登记(The Primary Angioplasty registry，PAR)［3］包括6个中心，271例AMI，发病12h内行直接PTCA，成功率(达TIMI 3级血流及残余狭窄＜50％)高达92％，死亡率4％，再梗死3％及卒中1%，效果相当满意。Weaver等［4］综合分析13项临床试验比较AMI溶栓和直接PTCA结果，出院时或30d直接PTCA降低死亡相对危险性34％，死亡+非致命性再梗42％以及非致命性再梗47%，绝对危险性分别降低21％，4.6％和24％。GUSTO-IIb［5］比较t-PA溶栓与直接PTCA治疗AMI的效果，AMI发病时间分别为18和19h，但开始治疗时间PTCA比溶栓延迟了50min。直接PTCA组TIMI 3级血流达80％，并显著降低了30d死亡率、再梗或非致命性卒中的发生率。但PTCA的益处随时间的延长而减少，6个月的死亡率两者无显著差异（PTCA为14.1％，t-PA为16.1％），非致命性再梗也无减少。 急性心肌梗死合并心源性休克常规治疗死亡率高，平均为70％［6］。溶栓治疗未能明显降低死亡率［7］。近年报道机械性再灌注治疗降低心源性休克死亡率。1995年公布的一组251例心源性休克的前瞻性登记资料，急诊血管重建组和保守组死亡率分别为51％和85％［8］。1999年公布多中心随机研究休克结果，302例AMI伴心源性休克患者随机分为6h内血管重建（PTCA或冠状动脉搭桥术）和药物溶栓组，两组均应用主动脉内球囊反搏（IABP）。结果显示30d死亡率两组无差别，但6个月死亡率在早期血管重建组（50.3％）显著低于药物治疗组（63.1％,P＜0.05）。30d早期直接PTCA成功者的死亡率（33％）显著低于不成功者（79％，P＜0.01）。故对AMI合并心源性休克者提倡早期血管重建治疗。 直接PTCA也存在一些问题，如延长了再灌注时间，梗死相关血管病变复杂（夹层、痉挛或血栓），技术设备条件要求高，还需要一组能行直接PTCA的高技术。随时应召的队伍以及价格昂贵等。即使在美国，能实施每天24h行急诊PTCA的医院不到10％。目前推荐AMI首选直接PTCA的适应症是：①溶栓禁忌；②高龄（＞70岁）；③心功能Killip 3级及心源性休克；④既往MI史或冠状动脉搭桥术（CABG）史；⑤梗死部位在左前降支（LAD）近端。

静脉溶栓治疗急性心肌梗塞的疗效分析

80年代以来,急性心肌梗塞(acute myocardial infarction, AMI)临床治疗显著的进展之一是静脉溶栓治疗.溶栓药物较多,我国常用尿激酶(UR)、链激酶(SK)和重组链激酶(r-SK).现将铁道部第四工程局三处医院、北京中日友好医院、山东省沂水县人民医院1986年7月至1997年7月AMI静脉溶栓治疗病例151例做回顾性分析,旨在探讨上述三种药物静脉溶栓治疗AMI的有效性和安全性.

Objective To investigate the clinical outcomes of an invasive strategy for elderly (aged≥75 years) patients with acute ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Methods Data on 366 of 409 elderly CS patients from a total of 6,132 acute STEMI cases enrolled in the Korea Acute Myocardial Infarction Registry between January 2008 and June 2011, were collected and analyzed. In-hospital deaths and the 1-month and 1-year survival rates free from major adverse cardiac events (MACE;defined as all cause death, myocardial infarction, and target vessel revascularization) were reported for the patients who had undergone invasive (n=310) and conservative (n=56) treatment strategies. Results The baseline clinical characteristics were not significantly different between the two groups. There were fewer in-hospital deaths in the invasive treatment strategy group (23.5%vs. 46.4%, P<0.001). In addition, the 1-year MACE-free survival rate after invasive treatment was significantly lower compared with the conservative treatment (51%vs. 66%, P=0.001). Conclusions In elderly patients with acute STEMI complicated by CS, the outcomes of invasive strategy are similar to those in younger patients at the 1-year follow-up.

PRAMI研究结果能够改变将来的临床实践吗

新近发表的PRAMI(Preventive Angioplasty in Acute Myocardial Infarction)研究[1]是一项计划入选600例ST段抬高急性心肌梗死(STEMI)合并多支血管病变的患者,对其进行随机比较一次性经皮冠状动脉介入治疗(PCI)策略与分次PCI策略的研究,由于在前465例患者的中期结果显示一次性策略明显获益而中止研究.这项研究结果的发表给我们带来了诸多思考.

延迟介入治疗对心肌梗死后左心室重构和左心室功能的影响

急性心肌梗死梗死前心绞痛独立于侧支循环的心脏保护作用

再灌注治疗急性心肌梗塞的临床评价(摘要)

直接经皮冠状动脉腔内成形术对急性心肌梗塞早期24小时心电稳定性的干预(摘要)

急性心肌梗塞经皮冠状动脉腔内支架术(摘要)

急性心肌梗塞延迟经皮冠状动脉腔内成形术对改善左心室功能的近期及远期疗效观察(摘要)

经桡动脉与股动脉入径直接经皮冠状动脉介入治疗急性心肌梗死的对比研究

基质金属蛋白酶-9和金属蛋白酶组织抑制因子-1与急性心梗后左室重构关系的临床研究

冠状动脉内支架术治疗急性心肌梗塞(摘要)

延迟经皮冠状动脉介入治疗对急性心梗死患者近期左心室重构及功能的影响

急性心肌梗塞合并泵衰竭的介入治疗(摘要)

主动脉瓣关闭不全致急性心肌梗死七例分析