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.