硝苯地平控释片治疗无痛性心肌缺血对左心功能的影响

硝苯地平（２０ｍｇ，ｑ１２ｈ×３ｗｋ）治疗无痛性心肌缺血２３例（男１５例，女８例，年龄５５±９．４ａ），对左心功能和ＲＡＡ检测结果显示：治疗后ＨＲ、ＳＢＰ、ＤＢＰ和ＭＡＰ均降低，以ＤＢＰ和ＭＡＰ降低显著（Ｐ＜０．０５）；缺血型ＳＴ段明显改善（Ｐ＜０．０１）；核素心功能ＬＶＥＦ、ＳＶ、ＥＲ和ＲＣＯ均升高（Ｐ＜０．０５～０．０１）；血浆ＰＲＡ和ＡｎｇⅡ降低明显（Ｐ＜０．０５）。表明该药有良好的降压和改善左心功能效应。     

Cardiovascular effects of dose escalating of norepinephrine in healthy dogs anesthetized with isoflurane

ObjectiveTo evaluate the systemic cardiovascular effects of dose escalating administration of norepinephrine in healthy dogs anesthetized with isoflurane.Study designExperimental study.AnimalsA total of six adult laboratory Beagle dogs, 10.5 (9.2–12.0) kg [median (range)].MethodsEach dog was anesthetized with isoflurane at an end-tidal concentration of 1.7%, mechanically ventilated and administered a continuous rate infusion of rocuronium (0.5 mg kg^–1 hour^–1). Each dog was administered incremental dose rates of norepinephrine (0.05, 0.125, 0.25, 0.5, 1.0 and 2.0 μg kg^–1 minute^–1), and each dose was infused for 15 minutes. Cardiovascular variables were recorded before administration and at the end of each infusion period.ResultsNorepinephrine infusion increased mean arterial pressure (MAP), cardiac output (CO) and oxygen delivery in a dose-dependent manner. Systemic vascular resistance did not significantly change during the experiment. Stroke volume increased at the lower dose rates and heart rate increased at the higher dose rates. Oxygen consumption and lactate concentrations did not significantly change during infusions.ConclusionsIn dogs anesthetized with isoflurane, norepinephrine increased MAP by increasing the CO. CO increased with a change in stroke volume at lower dose rates of norepinephrine. At higher dosage, heart rate also contributed to an increase in CO. Norepinephrine did not cause excessive vasoconstriction that interfered with the CO during this study.Clinical relevanceNorepinephrine can be useful for treating hypotension in dogs anesthetized with isoflurane.     

Anatomical features of ossa cordis in the Steller sea lion

Irregular triangular cartilage or bone fragments are sometimes found in the fibrous triangle of the heart. Ossa cordis and/or cartilago cordis has been demonstrated in various terrestrial animal species. Regarding marine mammals, sperm whales lack heart bones, and there have been no studies on bones or cartilage in pinniped hearts. Therefore, we examined the ossa cordis and/or cartilago cordis of the Steller sea lion. Eleven Steller sea lion hearts were examined morphologically and histologically. Before dissection, some hearts were imaged by CT to confirm the presence of ossa cordis or cartilago cordis. As a result, ossa cordis-like fragments were confirmed in four adults and one pup. All of the fragments were found at the right fiber triangle, and one adult had ossified tissue, including adipose tissue in the bone marrow cavity. The ossa cordis probably support the aorta because they surround the aorta as in other terrestrial animals. Steller sea lions can dive to a few hundred meters, but they need to rest on land frequently. Hence, their ossa cordis help maintain heart function during the tachycardia that occurs upon repeated surfacing and movements on land after diving in water.     

乳鼠心肌细胞的体外三维培养

【目的】探讨应用PLGA泡沫支架材料,在体外建造组织工程化心肌组织的可行性。【方法】采用顺序消化及差速贴壁法分离纯化乳鼠心肌细胞,将分离所得的心肌细胞接种于PLGA多孔支架材料上,观测复合体内心肌细胞的生长状况、超微结构、细胞代谢率及细胞组分的变化,并将其与正常心肌和二维培养的心肌细胞进行比较。【结果】复合体内的细胞具有心肌细胞的特殊超微结构,免疫组化显示其中的α-横纹肌肌动蛋白染色呈强阳性,与二维培养的细胞相比,细胞代谢更加旺盛。【结论】采用组织工程技术有可能在体外培育出组织工程化心肌组织。     

牛膝多糖对牛蛙心脏活动的影响

应用斯氏蛙心灌流方法,观察和分析牛膝多糖对离体蛙心的作用及机理。结果发现,10μg/mL的牛膝多糖溶液即可加强心肌的收缩能力,50μg/mL时差异极著(P0.01),以后随用药浓度的增加,振幅进一步增大,二者呈显著的量效关系。牛膝多糖溶液在一定浓度范围内不影响心率,但浓度升高到500μg/mL时可使心率增加,至1000μg/mL时收缩振幅和心率进一步加大,但随后出现心脏功能衰竭。研究时选择100μg/mL的牛膝多糖浓度,其正性肌力作用与β受体有关,与M受体无关。     

门电路心血池显象在病毒性心肌炎诊断中的意义

应用门电路心血池显象的勾边轮廓法及相位分析中的振幅图和心室相角程标准差观察３８例病毒性心肌炎患者（急性期２０例、后遗症期１８例）和１０例正常人。结果：勾边轮廓法显示左舒缩功能紊乱占９２．１％，其中７３．７％同时显示局部收缩下降；振幅图显示灰阶不均匀、局部灰度下降占７６．３％；左室相角程标准差增宽占６０．５％，其参数为１０．２３±２．９３，与正常对照组比较有极显著差异（Ｐ＜０．０１）。对本文结果分析，认为上述门电路心血池显象三种检查，在病毒性心肌炎（包括急性期和后遗症期）诊断中，能较好地反映心肌损害的程度和心功能状态。     

18 例心肺脑复苏成功的体会

目的：探讨心肺脑复苏的成功经验6方法：回顾性分析18例心肺脑复苏成功的患者（其中急性心肌梗死4例，有机磷农药中毒5例)，银环蛇咬伤2例，安定中毒2例，溺水2例，电击伤2例，气管异物1例)，抢救方法除了胸外按压，人工呼吸，肾上腺素，电击除颤，利多卡因、碳酸氢钠、脱水等常规措施外，对4例心跳骤停时间超过5min者加用了硫喷妥钠静滴，对3例中枢性高热者加用4-8℃生理盐水（冰盐水)静摘。结果：肾上腺素所需的剂量为1mg者12例，3mg 5例，5mg 1例，4例加用硫喷妥钠和3例加用冰盐水静滴的患者均取得满意疗效。结论：在心肺脑复苏的救治中，尽快恢复心跳，及时静脉摘注硫喷妥钠和冰盐水可能是保护脑功能的有效措施。