DES时代经桡动脉冠状动脉旋磨术治疗严重钙化病变的安全性、有效性及对分支血管的影响

目的探讨药物洗脱支架(DES)时代经桡动脉冠状动脉旋磨术治疗严重钙化病变的安全性、有效性及对分支血管的影响。方法回顾性分析2012年1月1日至2014年6月30日在本院行冠状动脉旋磨术的24例患者的冠状动脉病变特征、介入治疗情况、手术并发症、旋磨对病变处及远端分支血管的影响及出院后主要不良心血管事件的发生率。结果 24例患者共26处冠状动脉严重钙化病变,均经桡动脉成功行冠状动脉旋磨术,旋磨后病变处狭窄程度由(89.5±7.3)%降至(37.6±5.6)%,差异具有显著性(P=0.000)。所有病变均成功置入DES,术中、术后无并发症发生。26处钙化病变共20条分支血管,旋磨后所有分支血管均未发生栓塞、夹层,开口直径无显著变化。24例患者平均随访(11.0±6.1)个月,2例分别于术后4个月和15个月因重症肺炎死亡,其余患者在随访期间未发生主要不良心血管事件,6例术后复查冠状动脉造影,无支架内血栓形成、再狭窄及晚期支架贴壁不良。结论 DES时代经桡动脉冠状动脉旋磨术治疗严重钙化病变具有较好的安全性和有效性,且对病变处及远端分支血管无明显影响。     

青年急性心肌梗死患者介入手术治疗效果观察

目的分析青年急性心肌梗死患者接受介入手术治疗的效果,为青年急性心肌梗死患者的临床治疗提供参考。方法选入本院于2013年8月—2018年8月期间确诊并收治的急性心肌梗死患者(年龄<41岁)的所有数据,所有患者经过冠脉造影证实病变出现,依据造影检查结果对梗死血管(IRA)予以急诊经皮冠状动脉成形术以及支架置入手术。结果(1)150例青年急性心肌梗死患者靶血管和PCI情况分析中,前降支占72.7%、回旋支占1.3%、右冠状动脉21.3%、左主干4.7%、完全闭塞88.0%、次全闭塞12.0%、预扩张后支架植入94.7%、直接支架5.3%。(2)病变直径狭窄度由(89.4%±8.5%)降低到(59.6%±7.5%),组间对比差异有统计学意义(P<0.05);150例ST段抬高AMI患者ST段归到等电位线或者降低>50%。2例3度AVB患者临时起搏进行PCI救治,术后窦性心律恢复,2例手术中出现室颤,经过电击恢复。(3)150例患者成功率100%;152处靶病变,150处治疗成功,成功率为99%。结论青年急性心肌梗死患者实行介入手术治疗的效果较好,治疗成功率较高。     

后扩张在老年患者钙化病变PCI术中应用的临床研究

目的观察后扩张在老年患者冠状动脉钙化病变经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中应用的疗效和安全性。方法选择PCI血管造影成功的老年钙化血管造影病变患者124例,随机分为后扩张组(62例)和对照组(常规置入组;62例),观察两组患者PCI术中并发症发生率及住院期间及术后1年支架内血栓、再狭窄和主要不良心脏事件(major adverse cardiac events,MACE)发生率。结果后扩张组和常规置入组患者PCI术中并发症发生率两组间比较差异无显著性(6.5%︰4.8%,P>0.05);1年时的随访结果显示,后扩张组的MACE发生率较对照组降低(4.8%︰12.9%,P<0.05);支架内血栓和支架内再狭窄发生率较常规置入组均明显减少(1.6%︰4.8%;4.4%︰14.3%,P<0.05),差异有显著性。结论在老年钙化病变患者PCI术中应用后扩张治疗安全、有效,能够降低支架内血栓、再狭窄和MACE发生率。     

校正的TIMI帧数评估血栓抽吸在急性ST段抬高型心肌梗死中的疗效

目的探讨校正的心肌梗死溶栓试验(TIMI)帧数(CTFC)评估血栓抽吸在急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)中的临床疗效及短期预后。方法选取行急诊PCI治疗且再灌注成功TIMI血流分级恢复Ⅲ级的STEMI患者75例,根据是否行血栓抽吸分为血栓抽吸+PCI组(n=32)和常规PCI组(n=43)利用CTFC测定梗死相关动脉(IRA)血流,观察两组患者住院期间心功能参数及术后30天内心血管事件发生率。结果血栓抽吸+PCI组患者左前降支(LAD)及右冠状动脉(RCA)中的CTFC明显少于常规PCI组,差异具有显著性(P<0.05);两组患者左回旋支(LCX)中的CTFC比较差异无显著性。两组患者IRA再灌注成功后,在TIMI血流分级Ⅲ级的情况下,血栓抽吸+PCI组患者术后左室射血分数(LVEF)、肌酸激酶同工酶(CK-MB)峰值时间及30天内心血管事件发生率与常规PCI组比较差异均具有显著性(P<0.05),其中血栓抽吸+PCI组患者住院期间发生心源性死亡1例,因心肌梗死后心绞痛发作再次入院1例,常规PCI组患者住院期间发生心源性死亡4例,住院期间发生室性心动过速1例,因心绞痛发作再次入院1例,因严重心力衰竭入院1例,因非靶血管介入入院1例。两组患者住院天数比较差异无显著性。结论 CTFC可有效评价STEMI患者IRA再灌注情况及患者近期预后,有助于对患者进行危险分层和指导治疗。     

尼可地尔对冠状动脉支架植入术后患者IL-10、IL-17和CRP水平及术后再狭窄的影响分析

目的分析尼可地尔对冠状动脉支架植入术后患者白细胞介素(IL)-10、IL-17和C反应蛋白(CRP)水平及术后再狭窄的影响。方法将本院2013年1月至2014年12月收治的64例行冠状动脉支架植入术患者随机分为治疗组和对照组,每组各32例。两组患者均给予调脂、抗血小板等对症治疗,治疗组患者在上述治疗基础上给予尼可地尔。比较两组患者术后再狭窄发生率,IL-10、IL-17、CRP水平变化及心血管事件发生情况。结果治疗组患者术后3、6、12个月再狭窄发生率均显著低于对照组(P<0.05)。术后12个月治疗组患者IL-10、IL-17、CRP水平改善显著优于对照组(P<0.05)。治疗组患者心绞痛、心律失常发生率显著低于对照组(P<0.05),两组患者传导阻滞、心源性休克发生率及死亡率比较差异均无显著性(P>0.05)。结论尼可地尔能够改善冠状动脉支架植入术后再狭窄,减轻炎性反应,降低术后冠状动脉再狭窄及不良心血管事件的发生率。     

药物洗脱支架的安全性

<正>2006年欧洲心脏病学会(the European Society of Cardiology,ESC)年会有关置入药物洗脱支架(drug eluting stent,DES)使患者非心源性死亡和心肌梗死(myocardial infarction,MI)风险增加的报道引起介入心脏病学界对DES安全性的广泛关     

3500例冠脉造影临床总结

目的:分析不同类型冠心病的冠脉病变情况,探讨冠脉造影在冠心病诊断中的临床应用价值。方法:选择3500例冠心病患者,按照临床表现分为心肌梗死组(A组)、典型心绞痛组(B组)、不典型心绞痛组(C组)和其他组(D组),均行冠脉造影检查,比较分析结果。结果:阳性率72.51%,其中心肌梗死组82.83%,典型心绞痛组81.75%,不典型心绞痛组36.50%,其他组50.98%。冠脉病变分布情况:左前降支49.01%,右冠状动脉25.65%,左回旋支21.28%,左主干4.06%。其中78例冠状动脉开口畸形,63例冠状动脉瘘,15例冠状动脉心肌桥,21例爆发性心肌炎,15例心肌病,12例冠状动脉慢血流。结论:冠脉造影可作为诊断冠心病的重要依据,不能单纯依靠心电图和临床表现诊断冠心病。     

离死亡最近的血管堵塞——左主干病变引起急性心肌梗死、心源性休克的抢救

急性心肌梗死合并心源性休克,治疗难度大、死亡率高,是心血管医生需要面对的最严重的挑战之一.其临床证据又十分有限,最优临床策略依然存在争议.本文介绍1例由左主干病变引起急性心肌梗死、心源性休克的病例抢救成功的过程,并总结了其中的关键经验:尽早实行经皮冠状动脉(冠脉)介入(percutaneous coronary int...     

冠状动脉旋磨术的应用与护理

<正>目前,治疗冠心病的主要方法是经皮冠状动脉内球囊成形术(PTCA)。但此方法对于冠状动脉内硬化斑块不能完全消除,对于较为严重的、复杂多变的病变的治疗不是很有效果,容易导致并发症的发生。使临床应用受到了限制。冠状动脉旋磨术(CRA)系的主要运行程序是使管腔扩,但是它对正常组织的运行无明显变化,其主要是将已经钙化和纤维化的病变斑块组织利用高速转动(15~18万(r/min)的旋磨头研磨及消融为5微米大小的微粒。2012年以来,我院为     

经桡动脉血栓抽吸治疗老年非ST段抬高型心肌梗死的临床效果及预后评价

目的评价经桡动脉血栓抽吸治疗老年非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)的临床效果及预后。方法选取2014年3月至2015年2月本院收治的84例老年NSTEMI患者为研究对象,根据随机数表法将入选患者分为观察组与对照组,每组各42例。对照组患者行常规经皮冠状动脉介入治疗(PCI),观察组患者于PCI术前用血栓抽吸导管抽吸血栓。比较两组患者术中冠状动脉造影结果、术后血流恢复情况、住院时间及随访情况。结果观察组患者血栓抽吸后无复流、冠状动脉慢血流患者的比例显著低于对照组(P<0.05),但两组采取主动脉内球囊反搏的患者例数及使用支架数量的构成比、病变血管支数的构成比比较差异均无显著性(P>0.05)。观察组心肌梗死溶栓试验3级血流的患者明显多于对照组(P<0.05);观察组患者肌酸激酶同工酶和肌酸激酶的峰值均显著低于对照组(P<0.05);两组患者术后即刻和术后7天的左室射血分数、左室舒张末期内径、住院时间、住院期间总死亡率比较均无显著差异(P>0.05)。观察组患者术后1、6、12个月的不良心脏事件、死亡、再次心肌梗死、再入院、靶血管重建发生率与对照组比较无显著差异(P>0.05)。结论老年NSTEMI患者于PCI术前采用经桡动脉血栓抽吸可明显降低患者肌酸激酶同工酶和肌酸激酶的峰值,有效缓解病情,显著改善微小血管阻塞及预后,临床疗效良好。     

动脉支架置入术治疗颅外颈动脉狭窄的疗效评价

目的探究将动脉支架植入术应用于治疗颅外颈动脉狭窄的近期疗效。方法在本院数据库中调取时间段2017年5月-2019年2月间收入的16例动脉支架植入术治疗颅外颈动脉狭窄患者作为研究对象。对手术成功率进行记录,分析各项手术指标。结果治疗完成后,成功率为100%。而在治疗后,患者术后的凝血酶原时间以及活化部分凝血酶时间有明显缩短,患者体内的各项炎症指标升高(P <0.05)。结论采用动脉支架植入术对颅外颈动脉狭窄进行治疗,能够获得较为确切的治疗效果。但这种手术方案会引起患者手术后早期出现高凝状态和炎症反应。     

冠心病患者冠脉支架介入治疗的疗效观察

目的探讨冠心病患者行冠脉支架介入治疗的疗效、近远期不良心脏事件发生情况及影响因素。方法研究选择本院于2017年1月—2018年1月期间收治的冠心病患者94例,均行冠脉支架介入术治疗,评价治疗患者血脂、心功能相关指标变化、手术疗效及近远期不良心脏事件发生情况,并依据年龄、靶病变数、靶病变血管、病变支数作为因素评价预后。结果治疗后患者TC、TG、LDL-C等指标降低,HDL-C、EF、E/A等指标升高,与治疗前比较有统计学意义(P<0.05);术后18个月不良心脏事件发生率13.83%高于术后1个月4.26%,比较有统计学意义(P<0.05);年龄越高(≥75岁)、复杂病变、多支血管病变等因素不良心脏事件发生率35.00%、15.39%、23.91%高于其他因素,比较差异有统计学意义(P<0.05)。结论针对冠心病患者采用冠脉支架介入术治疗可获得良好的近期疗效,不良心脏事件发生少,促使血脂及心功能改善,但患者可能受到年龄、靶病变数等影响预后,仍需加强监护,必要时辅助综合治疗改善长期预后,研究价值较高。     

Polymer-free versus permanent polymer drug eluting stents in coronary artery disease: A meta-analysis of 10 RCTs with 6575 patients

BackgroundPermanent polymer drug eluting stents (PP-DES) may induce inflammation of the vessel wall due to the existence of the polymer, which may delay intimal healing. Polymer-free DES (PF-DES) that eliminate the polymeric carrier may potentially lead to safer DES. However, the safety and efficacy of PF-DES remains controversial.MethodsRandomized controlled trials comparing PF-DES with PP-DES were searched in online database including MEDLINE, Excerpta Medica Database (EMBASE) and Cochrane Library. Studies reporting late lumen loss (LLL), all-cause death, myocardial infarction (MI), target lesion revascularization (TLR) and late stent thrombosis (LST) were enrolled and quantitatively analyzed.ResultsTen studies enrolling 6575 patients were included in this meta-analysis. The PF-DES showed a benefit in reducing all-cause death (OR = 0.77, 95% CI: 0.61 to 0.98, P = 0.03) and long-term LLL (weighted mean difference (WMD) −0.16 mm, 95% CI: −0.22 to −0.11 mm, P < 0.001), while no superiority was found in reducing short-term LLL (WMD 0.03 mm, 95% CI: −0.07–0.13 mm, P = 0.57), MI (OR = 1.12, 95% CI: 0.19 to 23.18, P = 0.39), TLR (OR = 1.19, 95% CI: 0.42 to 3.38, P = 0.83) and LST (OR = 0.92, 95% CI: 0.05 to 5.71, P = 0.74).ConclusionPF-DES showed benefits in reducing long-term LLL and mortality compared with PP-DES, but no superiority was found in short-term LLL, MI, TLR and LST. These findings provide a sound basis for the wide application of PF-DES in the future.     

老年STEMI血尿酸对冠脉病变严重程度及预后分析

目的探讨血尿酸与老年急性ST段抬高型心肌梗死(STEMI)患者的冠状动脉病变严重程度及预后的关系。方法回顾性分析2年内(2017年1月—2018年12月)于中国医科大学附属第四医院住院首次行冠状动脉造影的171例老年(年龄≥60岁)STEMI患者。根据血尿酸水平分为高尿酸血症组(25例)及正常组(146例),根据冠脉病变支数分为单支病变组(85例)、两支病变组(59例)及三支病变组(27例)。比较入院临床资料;分析两组中冠脉病变程度;分析两组心脏彩超检查。结果(1)高尿酸血症组SYNTAX评分[(19.98±2.01)分]显著高于正常组[(13.45±2.03)分],两组比较差异有统计学意义(P<0.05);在亚组冠脉病变支数两支及三支病变中,SYNTAX评分在高尿酸血症组均高于正常组,均有统计学意义(P<0.05);(2)两组比较,左室射血分数(LVEF)有明显差异(P<0.05)。结论在老年STEMI患者中,血尿酸水平与冠状动脉病变严重程度及其预后有重要意义。     

分析人文关怀护理对冠心病支架植入术后的临床效果

目的针对冠心病行支架植入手术的患者探究以心人文关怀护理对术后临床效果的影响。方法随机非盲法选择2018年2月-2019年2月120例我院收治冠心病需要行支架植入手术的患者作为研究对象,40例为对比组以常规护理展开,80例为观察组在对照组基础上行人文关怀护理措施,对比两组术后临床治疗效果。结果观察组护理满意度和治疗有效率、焦虑抑郁评分明显优于对比组,差异有统计学意义(P<0.05)。结论冠心病行支架植入手术后行人文关怀护理可获得更好的护理满意度,更高的治疗有效率,使患者的病情得到有效控制,同时提高患者对治疗的依从度,提高患者对治疗的信心。     

Comparative outcomes of endoscopic ultrasound-guided lumen-apposing mental stents drainage for pancreatic pseudocysts and walled-off necrosis: Case series and meta-analysis

BackgroundEndoscopic ultrasound (EUS)-guided transmural drainage for pancreatic fluid collections (PFCs) has become the first-line treatment with quicker recovery and more minor injury compared with surgery and percutaneous drainage. The efficacy of stents implantation and drainage for different PFCs remains controversial, especially lumen-apposing metal stents (LAMS). This study aimed to compare the efficacy and safety of LAMS drainage for pancreatic pseudocysts (PPC) and walled-off necrosis (WON).MethodsA meta-analysis was performed for LAMS drainage for WON and PPC by systematically searching PubMed, Cochrane, and Embase databases from January 2010 to January 2020. From 2017 to 2019, 12 patients who were treated with LAMS drainage for PFCs in our medical center were also reviewed and included in this study.ResultsCombining 11 copies of documents with the data from our medical center, a total of 585 patients with PFCs were enrolled in this meta-analysis, including 343 patients with WON and 242 with PPC. The technical success rate in WON is not significantly different from that of PPC (P = 0.08 > 0.05). The clinical success of LAMS placement was achieved in 99% vs 89% in PPC and WON, respectively (RR = 0.92, 95% CI: 0.86–0.98, P = 0.01 < 0.05). The further intervention of direct endoscopic necrosectomy was required by 60% of patients in WON group. There was no significant difference in the incidence of adverse events, including infection, bleeding, stent migration and stent occlusion, after LAMS placement between WON and PPC.ConclusionsEndoscopic ultrasound-guided LAMS for PFCs are feasible, effective with preferable technical and clinical success rates. The clinical effect of LAMS on PPC is slightly better than that of WON, but its adverse reactions still need to be verified in a large-sample prospective study.     

Influence of Tirofiban maintenance duration on patients with acute myocardial infarction treated by percutaneous coronary intervention

ObjectiveTo evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) combined with intracoronary injection.MethodsA total of 125 patients with acute STEMI were enrolled in this study. They were randomly divided into two groups: control group (n = 61) and Tirofiban group (n = 64). The Tirofiban was used by intracoronary and intravenous administration in Tirofiban group which was randomly divided into three sub-groups according to the duration of Tirofiban by persistent intravenous injection for 12 hours, 24 hours or 36 hours. Thrombolysis in myocardial infarction flow and myocardial perfusion grades were recorded immediately after PCI. The adverse cardiac events and cardiac death within 180 days of PCI, and the adverse effects (hemorrhage and thrombocytopenia) were compared between the two groups and within Tirofiban sub-groups.ResultsGrade 3 in myocardial perfusion was significantly better in Tirofiban group than control group (85.94% vs. 72.13%, P = 0.03) after PCI. There was one cardiac death in control group in 180 days after PCI. The adverse cardiac event rates between two groups was significant difference (16 patients in control group and only 8 in Tirofiban group, P = 0.047). There was no significant difference in incidence of hemorrhage complications and platelet counts between two groups. Nevertheless, hemorrhage complications in the 12- and 24-hour subgroups were less than 36-hour subgroup (P = 0.01).ConclusionsIntravenous Tirofiban treatment reduced the adverse cardiac events and improved short term prognosis without increasing the adverse reactions of the drugs in patients undergoing PCI. The less rate of hemorrhage complication can be achieved in short-duration of Tirofiban by intravenous injection after PCI.     

颈动脉内膜剥脱术防治缺血性脑卒中的临床研究

目的总结颈动脉内膜剥脱术防治颈动脉硬化性狭窄引起的缺血性脑卒中的临床应用。方法回顾性分析2001年11月～2012年1月间对147侧(139例)颈动脉狭窄病变实施内膜剥脱术治疗的临床资料。结果本组中,87%的患者采用颈丛麻醉,92%的患者颈动脉内膜剥脱后应用补片血管成形,11例患者术中放置临时性转流管,2例患者为颈动脉支架失败后改行颈动脉内膜剥脱术(CEA)。术后轻度神经损伤7例,占4.8%;1例于术后3天出现偏瘫,占0.7%;全组无围术期死亡病例。临床随访123例,随访率为88.5%,平均随访39±4个月。术后患者脑缺血症状消失或明显改善97例,占66%;症状改善、好转者19例,占12.9%;术后颈动脉再狭窄发生24例(均<50%),占16.3%。结论颈动脉内膜剥脱术疗效肯定,值得推广应用。