使用替罗非班时泮托拉唑对非ST段抬高型急性冠脉综合征患者消化道保护作用的评

目的:盐酸替罗非班、阿司匹林、氯吡格雷、低分子肝素（四联）联合使用治疗急性冠脉综合征(ACS)患者时,评价静脉注射泮托拉唑对消化道保护的疗效和安全性。方法: 选择住院ACS患者296例,随机分为试药组184例,对照组112例,所有患者均服用阿司匹林、氯吡格雷、低分子肝素和使用2～3 d盐酸替罗非班。在此基础上试药组患者静脉输注泮托拉唑40 mg/d,4~5 d,再服用泮托拉唑片剂40 mg/次,2次/d,连服8 d。结果: 试药组8 d内全因死亡、顽固性心绞痛、再次心肌梗死、急诊经皮冠状动脉介入治疗(PCI)数较对照组显著减少（P<0.05）;试药组与对照组比较消化道出血发生率（2.2% vs. 12.5%）、TIMI小出血发生率(1.6% vs. 6.2%)和TIMI较小出血发生率(0.5% vs. 5.4%)明显降低（P<0.05）。结论: 在四联抗栓治疗ACS患者时,静脉注射和口服泮托拉唑可以减少8 d内消化道出血发生率,从而减少了8 d内患者死亡、顽固性心绞痛、再次心肌梗死、急诊PCI数,具有良好的消化道保护作用和安全性。     

替罗非班在急性心肌梗死支架置入术中的应用

目的观察急性心肌梗死支架置入术中冠脉内应用血小板糖蛋白（GP）Ⅱb／Ⅲa受体拮抗剂盐酸替罗非班的疗效和安全性。方法64例急性心肌梗死患者随机分为2组,冠状动脉内置入支架加替罗非班组34例,冠状动脉内置入支架加用普通肝素组30例,均于发病12h内行急诊PCI术。观察两组患者用药后对冠状动脉再灌注的影响,并随访主要心脑血管事件和出血并发症。结果替罗非班组PCI术后慢复流发生率及主要不良心脏事件的发生率均低于普通肝素组,差异有统计学意义（P〈0．05）,出血并发症的发生与普通肝素组差异无统计学意义（P〈0．05）。结论冠状动脉内应用替罗非班能改善急性心肌梗死患者支架置入术后梗死相关血管的TIMI血流,减少PCI术后主要不良心脏事件的发生率,临床应用安全有效。     

替罗非班在急性ST段抬高型心肌梗死急诊PCI治疗中的作用

目的探讨在冠状动脉介入术（PCI）前开始使用盐酸替罗非班对急性ST段抬高型心肌梗死（STEMI）患者心肌再灌注的疗效。方法入选84例STEMI患者,根据是否有胸痛症状分为替罗非班组（n=61）和对照组（n=23）。对照组给予阿司匹林、氯吡格雷常规药物治疗,替罗非班组在常规治疗基础上加用盐酸替罗非班治疗,观察替罗非班对患者冠状动脉血流、PCI术后1hST段回落、CK-MB峰值及出血副作用的影响。结果支架置入术前替罗非班组TIMI1级血流发生率及支架置入术后TIMI3级、2级血流发生率均优于对照组（P均〈0.05）。两组CK-MB峰值、PCI术后1hST段完全回落率比较,均有统计学差异（P均〈0.05）。替罗非班组和对照组发生轻微出血的比率分别为29.51%、8.70%,差异有统计学意义（P〈0.05）。结论替罗非班能改善支架置入前后的TIMI血流,有利于缺血心肌的再灌注,但同时增加轻微出血的风险。     

冠状动脉介入治疗术后应用盐酸替罗非班替代肝素化临床观察

目的:探讨急性心肌梗死(AMI)急诊冠状动脉介入治疗(PCI)、复杂冠状动脉病变PCI术后应用盐酸替罗非班替代术后肝素化的临床疗效及安全性。方法:选AMI、冠状动脉造影示复杂病变及伴发糖尿病行PCI者共64例,分为术后肝素化组(34例)和盐酸替罗非班组(30例),分别给予术后肝素化(肝素600～800U/h,持续18h)及盐酸替罗非班(术后即刻静脉注射盐酸替罗非班10μg·kg-1,继以0.15μg·kg-1·min-1持续静脉泵入,维持36h后停用),使用替罗非班期间低分子肝素钙用量减半。结果:住院期间及出院后随访1个月,2组患者均无支架内急性或亚急性血栓形成、无新近心肌梗死及再次急诊PCI,盐酸替罗非班组严重出血并发症明显低于肝素组。结论:盐酸替罗非班用于AMI急诊PCI、复杂冠状动脉病变PCI后预防急性及亚急性血栓形成的疗效与术后肝素化接近,严重出血并发症低于肝素组。     

盐酸替罗非班在老年急性ST段抬高型心肌梗死急诊冠脉介入治疗的疗效观察

目的探讨盐酸替罗非班在老年急性ST段抬高型心肌梗死（STEMI）急诊冠脉介入治疗（PCI）的疗效及安全性。方法选择老年急性STEMI患者70例,按就诊顺序分为盐酸替罗非班组、对照组各35例。盐酸替罗非班组行PCI术前应用盐酸替罗非班[0.15μg/（kg.min）],持续泵入至术后36 h,对照组行常规PCI术。分别观察两组患者冠脉复流、出血事件及术后30 d内主要不良心脏事件（MACE）的发生情况。结果盐酸替罗非班组急诊PCI术后TIMI 3级血流发生率100%;对照组TIMI 3级血流发生率82.9%,两组比较P〈0.05;术后30 d两组MACE发生情况无明显差异;盐酸替罗非班不增加出血事件。结论老年急性STEMI急诊PCI联合应用盐酸替罗非班安全有效。     

国产替罗非班在急性冠状动脉综合征介入治疗中的安全性及有效性

目的:评估国产替罗非班用于急性冠状动脉综合征(ACS)冠状动脉介入治疗(PCI)时的安全性及有效性。方法:已确诊的ACS患者PCI术前随机分为替罗非班组和对照组,替罗非班组PCI术前静脉应用替罗非班。观察2组30d发生的复合终点事件、术后出血事件及血小板情况。结果:给药后30d内心肌梗死、急性冠状动脉血运再重建等复合终点事件的发生率2组之间差异无统计学意义(P>0.05),但病死率替罗非班组有下降趋势(3.85%∶11.54%)。血小板减少、出血事件发生率2组差异无统计学意义(P>0.05),无严重出血。结论:国产替罗非班可安全用于ACS的介入治疗中,且可能降低30d病死率。     

替罗非班应用于急性冠状动脉综合征患者不同时机的安全性和有效性

目的:探讨急性冠状动脉综合征(ACS)患者择期经皮冠状动脉支架置入术前、术中、术后应用国产盐酸替罗非班的疗效和安全性.方法:ACS患者280例,随机分为替罗非班组和对照组,其中替罗非班组分为术前组(68例)、术中组(70例)、术后组(72例).用比浊法测定ADP诱导的血小板聚集率,观察4组术后30 d内主要不良心血管事件(MACE)的发生率;出血并发症及拔管后压迫止血15 min后出血率;术后3 d血小板计数.结果:与对照组比较,替罗非班组30 d内MACE(包括顽固性心绞痛、新发心肌梗死、心源性死亡、再次血运重建)发生率显著降低, 血小板聚集率明显降低(P＜0.05).拔管后压迫止血15 min后出血率术前、术中组较术后、对照组明显增高(P＜0.05).替罗非班组间血小板聚集率差异无统计学意义(P＞0.05).4组出血并发症、术后血小板计数差异无统计学意义(P＞0.05).结论:替罗非班术后应用也能降低血小板聚集率和术后MACE发生率,拔管后压迫止血15 min后出血率下降.     

质子泵抑制剂对老年急性心肌梗死患者抗栓治疗中消化道出血的预防作用

目的:观察质子泵抑制剂泮托拉唑(PPI)对老年人急性心肌梗死抗栓治疗中消化道出血的预防作用。方法:选择急性心肌梗死(包括急性ST段抬高型和非ST段抬高型)老年患者80例,年龄70~86岁,随机分为单纯抗栓治疗组43例,抗栓加PPI组37例,平均年龄分别为(72±12)岁和(74±11)岁。单纯抗栓组:口服拜阿司匹林100mg/d,氯吡格雷75mg/d双重抗血小板,(必要时加用替罗非班),每12h腹部皮下注射低分子肝素(依诺肝素)0.4mg,疗程7d。PPI组:在抗栓治疗基础上,静注泮托拉唑60mg/d。结果单纯抗栓组6例发生消化道出血,出血发生率13.9%。PPI组2例发生消化道出血,出血发生     

泮托拉唑在预防心肌梗死患者行经皮冠状动脉支架植入术后消化道出血中的应用

目的探讨泮托拉唑在急性心肌梗死患者行经皮冠状动脉支架植入术后消化道出血中的预防作用。方法将襄阳市第一人民医院内科2011年4月至2016年3月收治的389例急性心肌梗死患者作为研究对象。将其采用随机数字表法分为观察组(195例)与对照组(194例),对照组行常规经皮冠状动脉支架植入术,观察组在此基础上加用泮托拉唑。观察两组的手术成功率、并发症发生率及6周内的消化道出血情况。结果两组手术成功率均为100%(P0.05)。观察组并发症发生率为4.62%,低于对照组的19.07%(P0.05);观察组术后6周内消化道出血情况显著优于对照组(P0.05)。结论泮托拉唑应用于急性心肌梗死患者行经皮冠状动脉支架植入术能够显著减少术后消化道出血,且并发症发生率较低,具有较高的临床应用价值。     

急诊经桡动脉冠脉介入治疗急性冠脉综合征中应用替罗非班的有效性和安全性

目的评估盐酸替罗非班对急性冠脉综合征(ACS)患者急诊经皮冠状动脉介入治疗(PCI)时防治无复流现象的作用以及安全性。方法 116例ACS患者随机分为盐酸替罗非班组和对照组,观察两组PCI术后TIMI血流级别、24 h肌钙蛋白T(CTnT)水平、24 h及30 d复合心血管终点事件发生率及出血情况。结果替罗非班组和对照组PCI术后TIMI 3级血流发生率分别为96.8%和88.9%,TIMI 0～2级血流发生率分别为3.2%和11.1%,P均<0.05。替罗非班组24 h CTnT水平较对照组降低(P<0.05),主要复合终点心血管事件发生率较对照组降低(P<0.05)。两组均无严重出血事件发生。结论盐酸替罗非班能明显降低ACS患者PCI术后无复流现象的发生,并改善无复流现象程度。     

Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

Background

The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden.

Coronary Sarcoidosis Presenting as Acute Coronary Syndrome

Sarcoidosis is a systemic disorder of uncertain etiology characterized by noncaseating granulomatous inflammation. The disease often involves the heart on autopsy, but the antemortem diagnosis of cardiac sarcoidosis is frequently missed. Cardiac involvement usually includes granulomatous inflammation or fibrosis of the myocardium, conduction system, or pericardium. We now describe a case of epicardial coronary involvement by sarcoidosis, where the diagnosis was made by surgical biopsy of the coronary artery in an African American man presenting with acute coronary syndrome and recurrent symptomatic restenosis following coronary intervention. The case extends the spectrum of common cardiac syndromes that cardiac sarcoidosis can masquerade as and highlights the importance of maintaining a high index of suspicion for early recognition and instituting specific treatment that might improve prognosis. A review of the literature also suggests the need for improvement in diagnostic approaches and prospective clinical trials to establish the best management strategy for this disease. Copyright © 2009 Wiley Periodicals, Inc.     

Coronary Thromboembolism with Fatal Outcome Following Coronary Angiography

ABSTRACT A case of fatal thromboembolic occlusion of the left coronary artery at selective coronary arteriography is described. The course of events and the findings at autopsy suggest that thrombotic material was deposited on one intravascular catheter and transferred to a second catheter inserted over the same guide wire. Contrast injection through the second catheter into the left coronary ostium resulted in immediate and fatal occlusion of the two major branches of the left coronary artery.     

Percutaneous Transluminal Coronary Angioplasty of Single Coronary Artery

The presence of single coronary artery is a very rare finding on coronary arteriography. This type of coronary artery anomaly was revealed in a 54-year-old patient with exertional angina refractory to full medical treatment and positive exercise test. The unique coronary vessel presented significant stenosis in the distal segment of circumflex artery—which continued as right coronary artery—and was successfully dilated with conventional balloon angioplasty.     

Coronary microembolization

Atherosclerotic plaque rupture is a key event in the pathogenesis of acute coronary syndromes and during coronary interventions. Atherosclerotic plaque rupture does not always result in complete thrombotic occlusion of the entire epicardial coronary artery with subsequent acute myocardial infarction; however, in milder forms it may result in the embolization of atherosclerotic and thrombotic debris into the coronary microcirculation. The present report summarizes the available morphologic evidence for coronary microembolization in patients who died of coronary artery disease, especially sudden death. The report then goes on to address the experimental pathophysiology of coronary microembolization in animal models of acute coronary syndromes and heart failure. Finally, the report presents the available clinical evidence for coronary microembolization, highlights its key features--arrhythmias, contractile dysfunction, infarctlets and reduced coronary reserve--and addresses prevention by mechanical protection devices and glycoprotein IIb/IIIa antagonism.