目的   探讨基于思维导图的绿色通道急救干预对急性心肌梗死患者介入治疗的效果。方法   对天津市人民医院2022年1月—2024年12月收治的80例AMI患者进行研究，依照收治时间进行分组，将2022年1月—2023年6月采取常规急救流程干预的40例患者分为常规组，将2023年7月—2024年12月的采取基于思维导图的绿色通道急救干预的40例患者分为思维导图组。比较两组患者急救效率、急救前后生命体征（心率、舒张压、收缩压）、心肌损伤指标［磷酸肌酸激酶（CK-MB）及肌钙蛋白Ⅰ（cTnI）］，最后比较两组患者干预满意度。结果   对比急救效率发现，思维导图组的预检时间、会诊时间、导管室激活时间、急诊送至PCI手术时间均短于常规组（P＜0.05）；对比急救前后生命体征发现，与急救前对比，急救后两组的心率、舒张压、收缩压均降低（P＜0.05），急救前后两组心率、舒张压、收缩压比较差异无统计学意义（P＞0.05）；对比急救前后心肌损伤指标发现，急救前两组CK-MB、cTnI比较差异无统计学意义（P＞0.05），急救后，思维导图组CK-MB、cTnI低于常规组与急救前（P＜0.05）；对比干预满意度发现，思维导图组干预满意度为100.00%，高于常规组的85.00%（P＜0.05）。结论  基于思维导图的绿色通道急救干预可提升AMI患者的急救效率，稳定患者生命体征，减轻心肌损伤的同时，提升患者干预满意度。

       Objective  To explore the effect of green channel emergency nursing based on mind mapping on percutaneous coronary intervention（PCI） of patients with acute myocardial infarction（AMI）．Methods  A study was conducted on 80 AMI patients admitted to Tianjin People’s Hospital from January 2022 to December 2024．The patients were divided into two groups based on their admission time．The 40 patients who received routine emergency nursing interventions from January 2021 to June 2023 were assigned to the conventional group，while the 40 patients who  received green channel emergency nursing based on mind mapping from July 2023 to November 2024 were assigned to the mind mapping group．The emergency treatment efficacy，vital signs（heart rate，diastolic blood pressure，systolic bloodpressure），myocardial injury indicators（phosphocreatine kinase［CK-MB］，and troponin I［cTn1］）between two groups of patients before and after emergency treatment were compared．Results  The pre-examination time，consultation time，catheterization room activation time and emergency room to PCI operation time of mind mapping group were all shorter than those of conventional group（P＜0.05）．Compared with the vital signs before and after emergency treatment，we found that the heart rate，diastolic pressure and systolic blood pressure of the two groups decreased after emergency treatment（P＜0.05），and there was no significant difference between the heart rate，diastolic pressure and systolic blood pressure of the two groups before and after emergency treatment（P＞0.05）．Comparing the myocardial injury indicators before and after emergency treatment，there was no significant difference in CK-MB and cTn1 between the two groups before emergency treatment（P＞0.05）．After emergency treatment，CK-MB and cTn1 in the mind map group were lower than those in the conventional group and before emergency treatment（P＜0.05）．Comparing the intervention satisfaction，it was found that the mind mapping group of 100.00% was higher than the conventional group of 85.00%（P＜0.05）．Conclusions  Green channel emergency nursing based on mind mapping can improve the efficiency of emergency treatment for AMI patients，stabilize their vital signs，reduce myocardial injury，improve patient intervention satisfaction．

目的 探讨急性心肌梗死患者细胞色素P450酶基因(cytochrome P450,family 2,subfamily C,polypeptide 19,CYP2C19)多态性与高敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞介素-6(interleukin- 6,IL-6)及临床预后的相关性。方法 选取2019年5月—2020年5月入住我院心血管内科的急性心肌梗死患者182例作为研究对象,研究对象均接受经皮冠脉介入术,采取RT-PCR方法进行外周全血CYP2C19基因多态性的检测,并进行分组。口服阿司匹林300 mg和氯吡格雷300 mg后次日,测定血中hs-CRP和IL-6含量,治疗后12个月内,随访主要心血管不良事件。结果 182例急性心肌梗死患者中,快代谢组(CYP2C19*1/*1)患者最多,为78例(42.8%);中等代谢组(CYP2C19*1/*2、CYP2C19*1/*3),为65例(35.7%);慢代谢型组(CYP2C19*2/*2、CYP2C19*2/*3、CYP2C19*3/*3)最少,为39例(21.5%)。与快代谢组比较,中代谢组及慢代谢组hs-CRP、IL-6水平均升高,差异有统计学意义(P<0.05);与中代谢组比较,慢代谢组患者hs-CRP、IL-6水平均升高,差异有统计学意义(P<0.05)。CYP2C19基因型与hs-CRP及IL-6呈正相关(r=0.163、0.175,P<0.05)。中代谢组、慢代谢组患者1年内主要心血管不良事件发生率高于快代谢组患者(P<0.05)。结论 CYP2C19基因型与hs-CRP及IL-6具有相关性,CYP2C19基因型为中代谢型和慢代谢型能够激活机体炎症反应,影响急性心肌梗死患者的临床预后。

Objective To explore the correlation of cytochrome P450 gene (CYP2C19) polymorphism with hypersensitive C-reaction protein (hs-CRP), interleukin-6 (IL-6) and prognosis in patients with acute myocardial infarction (AMI). Methods A total of 182 patients with AMI admitted to cardiology department from May 2019 to May 2020 were selected as the research objects, all subjects underwent percutaneous coronary intervention (PCI), and CYP2C19 gene polymorphism in peripheral blood was detected by RT-PCR, which was grouping basis. One day after taking aspirin 300 mg and clopidogrel 300 mg orally, the levels of hs-CRP and IL-6 in patients' plasma were measured. The major adverse cardiovascular events (MACE) were followed up for 12 months after treatment. Results Among 182 patients with AMI, 78 patients (42.8%) were in the fast metabolism group (CYP2C19*1/*1), 65 patients (35.7%) in medium metabolism group (CYP2C19*1/*2, CYP2C19*1/*3), 39 patients (21.5%) in the slow metabolism group (CYP2C19*2/*2, CYP2C19*2/*3, CYP2C19*3/*3).Compared with the fast metabolism group, hs-CRP and IL-6 levels in the medium and slow metabolism group were significantly higher (P<0.05); compared with the medium metabolism group, hs-CRP and IL-6 levels in the slow metabolism group were significantly increased (P<0.05). CYP2C19 genotype was positively correlated with hs-CRP and IL-6 levels (r=0.163, 0.175,P<0.05). The incidences of MACE in the medium and slow metabolism groups were higher than that in the fast metabolism group (P<0.05). Conclusion CYP2C19 genotypes were associated with hs-CRP and IL-6 levels. Medium and slow metabolism types of CYP2C19 gene can activate the inflammatory response and affect the clinical prognosis of patients with AMI.

目的 研究氯吡格雷联合低分子肝素对老年急性心肌梗死(acute myocardial infarction, AMI)患者血清中血脂及炎性因子的影响,为临床AMI的治疗提供参考依据。方法 选取新乡医学院第一附属医院于2016年10月—2019年11月期间收治的老年AMI患者112例,按照随机分配的原则分成两组,即对照组和观察组,每组病例各56例,治疗方式为对照组单给予口服氯吡格雷进行治疗,观察组给予口服氯吡格雷与皮下注射低分子肝素联合治疗,比较治疗前后两组患者血清中甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)及低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDH-C),炎性因子的水平变化及心功能的改变情况。结果 与治疗前相比较,治疗后对照组和观察组患者血清TG、TC及LDH-C水平均降低,炎性因子TNF-α,IL-1β,CRP,IL-6的水平均降低,患者的左心室后壁厚度、左心室舒张末期内径均有降低,射血分数升高;而与对照组治疗后相比较,治疗后观察组患者血清TG、TC及LDH-C水平进一步降低,炎性因子TNF-α,IL-1β,CRP,IL-6的水平进一步降低,患者的左心室后壁厚度、左心室舒张末期内径均降低,而射血分数升高,差异有统计学意义。结论 氯吡格雷联合低分子量肝素可通过降低血清中血脂的水平,抑制AMI过程中的炎症反应,减少炎性因子的释放,提高患者的心功能,改善患者的病情。

Objective To explore the effects of clopidogrel combined with low molecular weight heparin on serum lipids and inflammatory factors in elderly patients with acute myocardial infarction, and provide reference for clinical treatment of AMI. Methods 112 elderly patients with AMI admitted to the First Affiliated Hospital of Xinxiang Medical University from October 2016 to November 2019 were randomly divided into control group and observation group,56 cases in each group.The control group was treated with clopidogrel alone, and the observation group was treated with clopidogrel combined with low molecular weight heparin. The levels of serum TG, TC and LDH-C, inflammatory factors and cardiac function were compared between the two groups before and after treatment. Results Compared with before treatment, the levels of serum TG, TC and LDH-C decreased, and the levels of inflammatory factors TNF-α, IL-1β, CRP and IL-6 decreased in the observation group and the control group after treatment. The left ventricular posterior wall thickness and LVEDD decreased, but LVEF increased in the observation group and control group after treatment. Compared with control group after treatment, the levels of serum TG, TC and LDH-C decreased, and the levels of inflammatory factors TNF-α, IL-1β, CRP and IL-6 decreased, the left ventricular posterior wall thickness and LVEDD decreased, but LVEF increased further in observation group after treatment. Conclusion Clopidogrel combined with low molecular weight heparin may improve the patient's cardiac function, then improve the patient's condition through reducing the level of serum lipids, inhibit the inflammatory reaction in AMI, reduce the release of inflammatory factors.

尼可地尔是一种ATP敏感型钾离子通道开放剂,同时兼有类硝酸酯作用,具有舒张冠脉和外周血管及通过缺血预适应对心脏起保护作用等双重功效,主要用于抗心绞痛的治疗。介于尼可地尔这种特殊结构及其作用机制能否降低急性心肌梗死患者PCI术后无复流的发生率及改善临床预后,目前临床研究仍在探索中。现就尼可地尔的作用机制、模拟的药物预适应作用、及综合作用与急性心肌梗死的关系做一综述,评估尼可地尔作为辅助药物在AMI行介入治疗中的作用及临床预后,指导临床用药。

Nicorandil is an ATP-sensitive potassium (K-ATP) channel opener, meanwhile has an effect like nitrate, has dual actions including coronary and peripheral vasodilatation and cardioprotective effects through ischemic preconditioning, mainly for the treatment of anti-angina. Whether the specific structure of nicorandil and its mechanism can reduce the incidence of no-reflow in patients with acute myocardial infarction (AMI) after PCI and improve the clinical prognosis, the current clinical research is still under investigation. We will expound mechanisms of nicorandil, drug preconditioning and its comprehensive effect. The role of nicorandil in the interventional therapy of AMI was reviewed to guide clinical medication.

目的 分析与比较不同血运重建策略对急性心肌梗死合并多支血管病变患者的疗效,以探讨其临床价值。方法 选取本院在2012年8月—2015年8月期间收治的急性心肌梗死合并多支血管病变患者,对每个患者均成功行PCI后,按随机数字表法分为实验组与对照组,实验组于发病后7～10天行预防性急诊PCI,并对非梗死相关血管病变进行干预;对照组则根据患者的缺血情况对非梗死相关血管病变行急诊PCI。随访2年,并记录2组患者主要心脏不良事件、其它心血管事件以及再次急诊PCI情况。结果 共有450例患者完成2年的随访,实验组患者有226例,对照组患者有224例。2组患者的全因病死率(χ²=7.040,P=0.008)、心脏不良事件(P均>0.05)以及心力衰竭发生率(χ²=1. 527,P=0.217)均无统计学差异。与对照组相比,实验组再发心绞痛(χ²=21.092,P<0.001)、心因性再住院(χ²=22.893,P<0.001)和再次支架治疗(χ²=17.835,P<0.001)的发生率均明显较低,而其相关血管血运重建率较高。且实验组随访2年时,β受体阻滞剂(χ²=7.040,P=0.008)和硝酸酯类药物(χ²=63.889,P<0.001)服用率均明显较高。结论 急性心肌梗死合并多支血管病变患者在成功行急诊干预梗死相关血管后,且预防性干预非梗死相关血管,可使再发心绞痛、再次支架治疗以及心因性再住院的发生率显著降低。

Objective By analyzing and comparing the effects of different revascularization strategies on patients with acute myocardial infarction complicated with multi-vessel disease, to explore its clinical value.Methods Selecting the patients with acute myocardial infarction complicated with multi-vessel disease from August, 2012 to August, 2015 in our hospital (Zhaoqing No.2 People's Hospital), after each patient was successfully treated with PCI, divided them into experimental group and control group by random number table method, the experimental groups were treated with preventive emergency PCI after the onset 7-10 days, and the intervention of non-infarct-related vascular diseases were done;the control groups were treated with emergency PCI for the non-infarct-related vascular diseases according to the patient's lack of blood. Visiting them randomly for 2 years, the main cardiac adverse events, other cardiovascular events and one more emergency PCI situation in the two groups were recorded.Results A total of 450 patients completed two years of follow-up, with 226 patients in the experimental group and 224 patients in the control group. All-cause mortality (χ2=7.040,P=0.008), cardiac adverse events (P> 0.05)and incidence of heart failure (χ2=1. 527,P=0.217) were no statistically significant difference between the two groups. Compared with the control group, the incidence of angina pectoris (χ2=21.092,P<0.001), cardiologic rehospitalization (χ2=22.893,P<0.001)and one more stent treatment (χ2=17.835,P<0.001) of the experimental group was significantly lower, but the revascularization rate was higher of their related blood vessels. And when the experimental group was followed up for 2 years, the taking rate of β-blockers (χ2=7.040,P=0.008) and nitrates (χ2=63.889,P<0.001) was significantly higher.Conclusion After the patients with acute myocardial infarction complicated with multi-vessel disease were successfully treated with emergency PCI to intervene the infarct-related blood vessels, and at the same time the intervention of the non-infarct-related blood vessels were done, the recurrence of angina pectoris, stent treatment and cardiopulmonary rehospitalization was significantly reduced.

目的 探讨血清胱抑素C、尿酸及降钙素原对诊断急性心肌梗死的临床价值。方法 回顾性分析我院134例心肌梗死患者及89名健康人血清胱抑素C、尿酸及降钙素原水平。结果 与健康对照组相比,实验组患者血清Cys-C、UA和PCT均有不同程度的升高,且差异有统计学意义。此外,血清Cys-C和PCT升高的水平与心肌梗死程度有关。结论 血清Cys-C、UA和PCT水平均可以作为AMI的临床指标,并且血清Cys-C和PCT在一定程度反映心肌梗死的严重程度。

目的 评价急性心肌梗塞患者转往有条件医院行PCI治疗前应用替罗非班(血小板Ⅱb/Ⅲa受体拮抗剂)的临床疗效与安全性。方法 选取从2013年1月—2014年9月诊断为急性心肌梗塞行PCI治疗的患者共66例。随机分为观察组(确定转院行PCI治疗前在我院应用替罗非班) 34例、对照组(转运到花都区人民医院心内科行PCI治疗后应用替罗非班) 32例。观察比较两组患者首次造影的冠脉血流情况与术后的冠脉血流情况、PCI时心电图抬高的ST回落情况与心肌标志物峰值前移情况、住院期间与随访30天期间不良心血管事件(MAGC)的发生情况(支架内血栓与二次血运重建发生率、再梗塞率、心绞痛、死亡率)以及两组的不良反应。结果 观察组首次造影的冠脉血流优于对照组;术后的冠脉血流观察组优于对照组(P<0.05);PCI时心电图ST回落≥1/2的情况与TNI、CK-MB峰值前移情况优于对照组(P<0.05);不良心血管事件发生率较对照组少(P<0.05);不良反应发生率差异无统计学意义(P>0.05)。结论 急性心梗转院PCI患者,转院前应用替罗非班比转院后应用获益更大,安全性尚可。这类病人,在确定转院之时即时应用替罗非班是合理时机。

目的 建立大鼠急性心肌梗死缺血再灌注后无复流模型,并初步验证细胞焦亡在其中的发生情况。方法 选用20只标准成年雄性Sprague Dawley大鼠（体质量260~320 g）,随机分为对照组（n=5）和手术组（n=15）。对照组仅穿线冠状动脉,未行结扎;手术组结扎左前降支0.5 h后解除,进行再灌注4 h,以建立无复流模型。通过Evens blue和硫磺素S染色,评估心肌的正常供血区、再灌注区及无复流区,并对两组大鼠心肌组织进行病理分析。结果 对照组大鼠全部存活,未出现无复流现象,心肌组织中未见细胞焦亡。手术组存活13只,形成明确的正常供血区（n=13）、再灌注区（n=13）和无复流区（n=10）。在无复流区的心肌细胞中均观察到细胞焦亡（n=10）,而正常供血区未见（n=0）,再灌注区部分出现（n=4）,差异具有统计学意义（P<0.05）。结论 细胞焦亡现象主要存在于大鼠急性心肌梗死缺血再灌注后无复流区域中,细胞焦亡可能作为一种区域特异性程序性死亡方式,在心肌无复流的发生与发展中发挥重要作用。

Objective To establish a rat model of myocardial no-reflow after acute myocardial infarction with ischemia-reperfusion injury and to preliminarily explore the occurrence of pyroptosis in the affected myocardium. Methods Twenty adult male Sprague-Dawley rats（260-320 g）were randomly divided into a control group（n=5）and a surgical group（n=15）. In the control group,the coronary artery was encircled with suture but not ligated. In the surgical group,the left anterior descending artery was ligated for 30 minutes, followed by 4 hours of reperfusion to induce the no-reflow model. Evans blue and thioflavin S staining were used to evaluate the normal perfusion area,reperfusion area,and no-reflow area of the myocardium. Histopathological analysis was conducted on myocardial tissues from both groups. Results All rats in the control group survived without evidence of no-reflow or pyroptosis in myocardial tissue. In the surgical group, 13 rats survived and showed distinct regions of normal perfusion, 13 with reperfusion, and 10 with no-reflow. Pyroptosis was observed in all no-reflow areas（n=10）, absent in the normal perfusion zones（n=0）, and partially present in the reperfusion zones（n=4）. The differences were statistically significant（P<0. 05）. Conclusions Pyroptosis predominantly occurs in the no-reflow zones following acute myocardial infarction and ischemia-reperfusion injury in rats. As a region-specific form of programmed cell death, pyroptosis may play an important role in the development of myocardial no-reflow.