随着临床上血管溶栓、心脏介入等治疗的普及，心脏缺血再灌注损伤的问题越发多见。为了让本科医学生尽早进入临床，以临床需求为指导学习基础知识，本项目设计了关于心肌缺血再灌注损伤的综合实验项目。第一部分是一个心肌缺血病例抢救视频，由教师引导学生进行线上或线下病例讨论，认识临床患者心肌缺血和再灌注损伤后的临床表现。第二部分是虚拟实验，选用和人的心脏解剖相似的小型猪做实验动物，采用3D建模、人机交互等技术，模拟操作实验猪心肌缺血再灌注损伤的过程，并根据预设的数学公式得到缺血和再灌注后的生理、生化指标变化的实时数据，让学生充分理解心肌缺血后及时抢救的重要性，以及再灌注损伤发生的相关机制。第三部分是学生自主设计本模型的防治研究，进一步培养学生的创新思维能力。教师通过线上、线下引导和管理，对学生进行过程性评价。本实验不仅可以让学生尽早了解临床患者的发病状态，还能通过虚拟实验深入学习发病时机体的机能代谢变化以及变化的机制，通过防治方式的设计研究相关的防治措施。
Mr.Zhang , male, 48 years old, height 172cm, weight 85kg, occupation: chef, favors salty or greasy food. Smoking and drinking history: smoking for more than 20 years, occasional drinking.
He has hypertension for 3 years and hyperlipidemia for 2 years. The control of Blood pressure is poor by using valsartan irregularly. His hyperlipidemia never received any treatments. No history of diabetes.
His father died because of "acute myocardial infarction" 5 years ago. His mother is alive and suffers from hypertension.
One day, Mr. Zhang felt uncomfortable while cooking in restaurant. He suffered from pain in the anterior cardiac region and sweated a lot. So Mr. Zhang sat down and rested for a while. After drinking water and taking antihypertensive drugs, he felt better. Because the restaurant is very busy, Mr. Zhang continued working even though there were still some discomforts. Two hours later, the pain became worse, accompanied by sweating and nausea. His wife immediately called their son studying in medical school and asked if they should go to the hospital. After listening to the description, the son realized that his father might have suffered from acute myocardial infarction. He told his mother to call 120 and not to go to the hospital by themselves. From the incidence of chest pain to ambulance arrival, it has been nearly three hours.
When first aiders came, Mr. Zhang was extremely restless, dullness, sweating and unable to reply. He was given 300 mg aspirin and 180 mg Brilinta orally administration for anticoagulation, 40 mg Lipitor orally administration and 12-lead electrocardiogram examination. The ECG showed that ST segment elevation in lead V1-V6 and Mr. Zhang was initially diagnosed as acute anterior myocardial infarction. Simply asking his wife about the present history, first aiders immediately lifted him to the ambulance with stretcher. Oxygen inhalation was given through nasal catheter and vital signs were monitored. It was showed that the respiratory and heart rate accelerated, blood pressure and oxygen saturation were normal. On arrival at the hospital, the doctor simply inquired about the medical history, reexamined the 18-lead ECG, and monitored ECG. Blood routine, myocardial enzymes, cardiac troponin, proBNP, electrolyte, coagulation function, renal function and other indexes were examined in emergency. 3 mg? for sedation and analgesia, and low molecular heparin for anticoagulation were subcutaneously injected. Nurses established venous access and oxygen inhalation was given. The patient underwent coronary angiography in catheter room. He had 100% stenosis in the proximal anterior descending artery. There was no collateral circulation. Looking by contrast agent, only small blood flow passed through. A balloon was placed into the lesion and recanalized at low pressure (4-6 atm). After blood reperfusion, ventricular tachycardia occured and blood pressure dropped to 70/45 mmHg. 200 J synchronous direct current was immediately used to rehabilitate and then sinus rhythm was restored. Blood pressure rose to 90/65 mmHg and the vessel stent was then placed.
The angiogram showed that the infarction of anterior descending branch was completely opened, but the blood flowed slowly after reperfusion. Nicorandil was given to dilate the coronary artery and increased the blood supply to the heart. At the end, the patient's condition was basically stable. The doctor told him to ingest less salty or greasy food and insist on taking antihypertensive and lipid-lowering drugs regularly. One week later, he was discharged from hospital.