埃索美拉唑及泮托拉唑对氯吡格雷抗血小板聚集作用的影响

目的 检测联合应用氯吡格雷与质子泵抑制剂前后的血小板聚集率,通过比较用药前后的的血小板聚集率的差值,探讨埃索美拉唑、泮托拉唑是否会影响氯吡格雷的抗血小板作用.方法 入选200例急性冠状动脉综合征患者,均给予双重抗血小板聚集治疗(阿司匹林肠溶片100 mg/d,氯吡格雷负荷量300 mg后75 mg/d维持),分为埃索美拉唑组(埃索美拉唑20 mg/d)60例,泮托拉唑组(泮托拉唑40 mg/d)60例及不合用质子泵抑制剂的对照组80例.于用药前及用药后7 d应用比浊法测定ADP诱导的血小板最大聚集率及住院期间、1个月内的主要心血管事件,比较三组间血小板聚集率前后差值及主要心血管事件(非致命性心肌梗死,非致命性卒中和死于心血管疾病)发生率差异有无统计学意义.结果 三组间血小板聚集率的差值在对照组(26.7±3.3)%、埃索美拉唑组(26.5±3.6)%、泮托拉唑组(25.6±2.9)%差异无统计学意义(P＞0.05),主要心血管事件发生率差异无统计学意义(P＞0.05).结论 泮托拉唑、埃索美拉唑不影响氯吡格雷的抗血小板聚集作用. Abstract： Objective To determine the platelet aggregation rates before and after the usage of clopidogrel in combination with proton pump inhibitors and compare the differences of the rates of platelet aggregation in order to explore whether esomeprazole, pantoprazole will affect the anti-platelet aggregation effect of clopidogrel. Methods Two hundred patients with acute coronary syndrome were treated with dual antiplatelet aggregation therapy ( aspirin enteric - coated tablets 75 mg/d, clopidogrel after 300 mg loading dose 75 mg/d maintenance), and were divided into three groups: esomeprazole group (Esomeprazole 20 mg/d) 60 cases, pantoprazole group (Pantoprazole 40 mg/d) 60 cases and control group ( without proton pump inhibitors) 80 cases. The ADP - induced maximum platelet aggregation rates were detected by Turbidimetry on the day before and 7 days after the medication. The differences of the rate of platelet aggregation in the three groups before and after the medication and the incidence of major cardiovascular events were recorded. Results There was no significant difference in the platelet aggregation rate of the three groups,which were (26.7 ± 3.3) % in the control group, (26.5 ± 3.6) % in the esomeprazole group and (25.6 ± 2.9 ) % in the pantoprazole group. Conclusions Pantoprazole and esomeprazole do not affect the anti-platelet aggregation effect of clopidogrel.     

射频消融术对右侧旁道显性预激患者心功能的影响

目的 观察射频消融术对右侧旁道显性预激患者心功能的影响.方法 选择32例右侧旁道显性预激且反复发作房室折返性心动过速的患者,通过比较射频消融术术前、术后经胸心脏超声及多普勒检查的参数以判定左心功能.结果 射频消融术后左室舒张期A峰较术前显著增高,E/A比值较术前显著降低,而手术前后心率、左室舒张末期容积、左室内径缩短率、左室射血分数、每搏输出量和舒张期E峰差异均无统计学意义.结论 成功的射频消融术可以改善右侧旁道显性预激并室上性心动过速患者左室充盈和舒张功能,但对左室收缩功能未见明显影响. Abstract： Objective To observe the influence of radiofrequency current ablation (RFCA) on left ventricular (LV) systolic and diastolic function in patients with right - lateral Wolff - Parkinson -White syndrome( W- P- W syndrome). Methods The study group consisted of 32 patients with right -side WPW syndrome and recurrent episodes of AVRT without any concomitant diseases. Transthorasic echocardiography (TTE) and doppler were performed before and after RFCA in order to assess LV systolic and diastolic function. Results Doppler analysis revealed an increase in A wave and a decrease in E/A ratio. No significant differences were found in HR, LVEDV, FS, EF, SV and E wave. Conclusions RFCA of accessory pathway in patients with right - lateral WPW syndrome and AVRT are associated with improvement of LV filling and diastolic function. No significant differences in regard to LV systolic function are found post RFCA.     

ST 段抬高心肌梗死患者溶栓后急诊冠状动脉介入术的疗效

目的：评价急性 ST 段抬高心肌梗死（STEMI）12 h 内静脉尿激酶溶栓治疗后3－6 h 桡动脉入路急诊冠状动脉造影（CAG）并行梗死相关冠状动脉（IRA）补救性冠状动脉介入治疗（PCI）的近期疗效和安全性。方法回顾分析2012年7月至2013年12月21例 STEMI 静脉溶栓后临床及 CAG 检查均符合直接 PCI 指征并行 PCI 患者的临床资料。结果21例静脉尿激酶溶栓失败患者急诊 PCI 后,均获成功,IRA 全部再通,血流均达 TIMI3级血流。出院时心功能 I 级16例,II - III 级5例,LVEF 0.51±0.13。结论 STEMI 患者静脉溶栓后经桡动脉行补救性PCI 是安全、有效的。     

ST段抬高型心肌梗死急诊PCI冠脉无复流综合防治的临床研究

目的探讨82例高血栓负荷急性ST段抬高型心肌梗死（ST elevation myocardial infarction,STEMI）患者急诊冠脉介入治疗（percutaneous coronary intervention,PCI）时采用综合措施防治冠脉无复流（non-reflow）的可行性。方法选取发病在12 h内的174例STEMI患者给予急诊PCI,对其中82例高血栓负荷患者梗死相关动脉（infarction-related artery,IRA）采用综合治疗措施（药物＋血栓抽吸＋介入治疗技术）。结果 82例患者PCI时无复流发生4例,无院内再发心肌梗死、猝死、大出血等。结论高血栓负荷STEMI患者急诊PCI时综合治疗措施可以防治无复流的发生,改善患者的近期预后,提高PCI的成功率和安全性。     

不同剂量瑞舒伐他汀治疗急性冠脉综合征的临床研究

目的比较不同剂量瑞舒伐他汀对急性冠脉综合征（ACS）患者血脂、血清高敏C反应蛋白（hs-CRP）及白介素-18（IL-18）影响。方法将65例ACS患者随机分为瑞舒伐他汀低剂量组（10mg/d）和高剂量组（40mg/d）,每晚给药1次,用药2个月后检测2组患者血脂、hs-CRP及IL-18在血清中的表达。结果给予瑞舒伐他汀2个月后,高、低剂量组血清中TC、LDL-C、hs-CRP和IL-18表达水平均比治疗前降低（P〈0.05）,HDL-C表达水平升高（P〈0.05）,TG含量无显著变化（P〉0.05）,高剂量组比低剂量组降低的更为明显（P〈0.05）。结论瑞舒伐他汀可明显降低ACS患者血清中血脂、hs-CRP及IL-18的含量,高剂量组比低剂量组更为有效。     

边支血管主动球囊保护技术在冠状动脉分叉病变介入治疗中的应用分析

目的 对比Jailed导丝技术与边支血管主动球囊保护技术在冠状动脉分叉病变介入治疗中的临床效果.方法 选取2014年1月至2015年3月期间166例冠状动脉分叉病变行经皮冠状动脉介入(PCI)的患者,随机分为2组(Jailed导丝组82例,主动球囊保护组84例),比较两组患者的对比剂用量、手术时间、PCI术后即刻影像学效果及30天主要不良心血管事件(MACE)发生率等方面差异.结果 主动球囊保护组较Jailed导丝组患者术后的TIMI 3级血流率(96％ vs 85％,P＜0.05)、术后30天MACE发生率(5.95％ vs15.9％,P＜0.05)明显降低,而对比剂用量[(59.20±10.36) ml vs (61.92±9.36) ml),P＞0.05]、手术时间[(34.12±8.94)min vs(31.63±8.81)min,P＞0.05]无明显增加.结论 采用边支血管主动球囊保护技术提高了分叉病变PCI的临床效果,而且不增加手术时间及对比剂用量.     

不同剂量瑞舒伐他汀治疗急性冠脉综合征疗效

急性冠脉综合征(acute coronary syndrome,ACS)系冠状动脉内不稳定的动脉粥样硬化斑块破裂或糜烂引起血栓形成所致的急性心脏缺血综合征,它严重威胁着人类的健康[1]。目前,仍有相当一部分ACS患者治疗效果不是十分理想[2]。他汀类药物除降脂外,还具有稳定斑块、改善内皮功能、抗炎、抗氧化等广泛的生理活性,在ACS治疗中具     

脑钠肽与室性期前收缩的相关性研究

目的 观察不同组别患者血浆脑钠肽(BNP)水平的变化情况,探讨其与室性期前收缩(PVB)的相关性及意义.方法 选取PVB患者68例,按是否存在器质性心脏病(0HDA)分为室性期前收缩(PVB)组38例、室性期前收缩并器质性心脏病(PVB合并OHDA)组30例,均排除心功能不全;另选14例无心血管疾病的其他患者为对照组.用Triage BNP干氏床旁快速检测方法检测患者血浆BNP浓度,心脏多普勒测量患者左室射血分数(LVEF)、左心室舒张末期内径(LVEDD).结果 PVB合并OHDA组的BNP水平为(151±8)ng/L,明显高于PVB组(50±6)ng/L和对照组(46±5)ng/L(P＜0.01),PVB组较对照组轻度增高,但差异无统计学意义(P＞0.05).PVB合并0HDA组与PVB组、对照组相比LVEDD增大(P＜0.01),LVEF降低(P＜0.01).各组血浆BNP水平与年龄、心率、CK-MB无相关性,与LVEDD(r=0.526,P＜0.01)呈正相关,与LVEF(r=-0.479,P＜0.01)呈负相关.结论 PVB合并0HDA患者血浆BNP浓度明显升高,提示其有助于鉴别PVB患者有无合并0HDA,对监测病情发展、指导治疗和预后具有重要意义.     

负荷量替格瑞洛改善急性心肌梗死患者PCI术后心肌灌注的临床研究

目的探讨术前负荷量替格瑞洛对改善急性心肌梗死患者经皮冠脉介入(PCI)术后心肌灌注的作用。方法选取2015年6月—2016年6月焦作市人民医院收治的PCI术后急性心肌梗死患者120例,随机分为对照组(60例)和治疗组(60例)。两组患者于PCI术前30 min嚼服阿司匹林片,0.3 g/次,对照组在此基础上嚼服硫酸氢氯吡格雷片,600 mg/次,治疗组在阿司匹林片基础上嚼服替格瑞洛片,180 mg/次。两组患者均于术中动脉鞘推注低分子肝素钠注射液1 000 U/kg,同时静脉持续泵入盐酸替罗非班注射液10μg/L,持续24~36 h。两组患者PCI术1周后均长期皮下注射低分子肝素钠注射液5 000 U/次,对照组患者在此基础上长期口服阿司匹林片100 mg/d联合硫酸氢氯吡格雷片75 mg/d,治疗组在此基础上长期口服阿司匹林片100 mg/d联合替格瑞洛片90 mg/d。比较PCI前后两组患者心肌血流灌注指标、超声心动图指标、血清单核细胞趋化因子1(MCP-1)和高迁移率族蛋白1(HMGB1)水平以及主要心脏不良事件(MACE)发生率和不良反应率。结果 PCI术后,治疗组TIMI 3级57例、TMPG 3级54例,分别明显多于对照组的42例和40例,且治疗组无复流/慢血流比例显著低于对照组,两组比较差异具有统计学意义(P0.05)。PCI术后,治疗组患者左室后壁厚度(LVPWT)、室间隔厚度(IVST)、左室舒张末内径(LVDd)水平明显降低,左心室射血分数(LVEF)水平升高,同组PCI术前后比较差异具有统计学意义(P0.05);且PCI术后治疗组超声心动图指标明显优于对照组(P0.05)。PCI术后,两组患者血清MCP-1、HMGB1水平均显著降低(P0.05);且治疗组上述血清MCP-1、HMGB1水平明显低于对照组(P0.05)。治疗组随访期间MACE发生率显著低于对照组,且治疗组MACE总发生率和不良反应总发生率明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论术前负荷应用替格瑞洛抗栓治疗能有效改善急性心肌梗死患者PCI术后心肌灌注及心功能,具有一定的临床推广应用价值。     

脂蛋白相关磷脂酶A2与冠状动脉粥样硬化病变程度及斑块稳定性的关系

目的 探讨脂蛋白相关磷脂酶A2(Lp-PLA2)与冠状动脉粥样硬化病变程度及斑块稳定性的关系.方法 对160例可疑冠心病患者行冠状动脉造影,根据冠状动脉造影结果分为冠状动脉造影正常的对照组(34例)和冠心病组(126例),冠心病组根据临床类型分为急性冠状动脉综合征组(86例)和稳定型心绞痛组(40例).以病变支数和Gensini积分评价动脉粥样硬化病变程度,以临床类型评价斑块稳定性.检查所有患者血清Lp-PLA2水平、高敏C-反应蛋白(hs-CRP)等指标,分析Lp-PLA2、hs-CRP等与病变支数、Gensini积分、斑块稳定性的关系.结果 冠心病组Lp-PLA2水平显著高于对照组(P＜0.05),而且随着冠状动脉病变支数的增加和Gensini积分的增加而逐渐升高,在急性冠状动脉综合征组较稳定型心绞痛组升高.Lp-PLA2水平与hs-CRP无明显相关性.结论 冠心病患者血清Lp-PLA2水平与冠状动脉粥样硬化病变程度及斑块稳定性有关. Abstract： Objective To investigate the correlations between serum levels of lipoprotein -associated pospholipase A2 ( Lp - PLA2 ) and the severity and stability of coronary atherosclerosis. Methods Coronary angiography (CAG) was performed in 160 patients who were suspected as having coronary artery disease(CAD). According to the coronary artery chanrges and plaque characters in CAG, all patients were divided into control group( n =34) and CAD group( n = 126). According to the clinical types,the CAD patients were divided into acute coronary syndrome (ACS) group ( n = 86) and stable angina pectoris (SAP) group ( n = 40). The number of diseased coronary branches and Gensini' s score was used for evaluate the severity of atherosclerosis. The clinical types was used for evaluate the stability of plaque. Lp - PLA2 and hs - CRP were measured in all the patients. The correlation between serum LpPLA2 with hs - CRP and the number of diseased coronary branches, Gensini's score, clinical types were analyzed. Results Lp - PLA2 in CAD patients was significantly higher than that in control group ( P＜0.05) and increased with the increasing number of diseased coronary branches and Gensini's score.Lp -PLA2 in ACS group was higher than SAP group. Lp -PLA2 level had no correlated with hs -CRP.Conclusions CAD patients serum Lp - PLA2 level is correlated with the severity of atherosclerosis and the stability of plaque.