光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

Objective To compare the characterization of coronary atherosclerotic plaques in patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) by optical coherence tomography (OCT). Methods OCT was performed in 47 patients (23 UAP and 24 SAP) undergoing coronary angiography. Lipid-rich plaque (defined by ≥ 2 quandrants of the cross-section area), thin cap fibroatheroma (TCFA), thickness of fibrous cap, plaque rupture, calcification and thrombus visualized by OCT were compared between UAP and SAP patients. Results OCT imaging was successfully in 44 out of 47 patients (22 UAP, 22 SAP). Proportion of lipid-rich plaques was similar between UAP and SAP groups [91% (20/22) vs, 73% (16/22),P =0. 741]. The minimum thickness of fibrous cap in the UAP group was significantly thinner than that in SAP group [(69.5±34.7) μm vs. (141.1±68.5) μm, P = 0.000] and the rate of fibrous cap erosion in the UAP group was significantly higher than that in the SAP group [59% (13/22) vs. 9% (2/22), P=0.000]. Percents of TCFA [73% (16/22) vs. 14% (3/22) ,P = 0.000] and plaque rupture [50% (11/22) vs.9% (2/22) , P = 0.003] were significantly higher in UAP group compared those in SAP group. Incidence of thrombus and calcification were similar between two groups. Conclusions OCT imaging can clearly define plaque characterization of coronary atherosclerosis. UAP patients have thinner fibrous cap, higher incidences of fibrous cap erosion, plaque rupture and TCFA compared patients with SAP.     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

Objective To compare the characterization of coronary atherosclerotic plaques in patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) by optical coherence tomography (OCT). Methods OCT was performed in 47 patients (23 UAP and 24 SAP) undergoing coronary angiography. Lipid-rich plaque (defined by ≥ 2 quandrants of the cross-section area), thin cap fibroatheroma (TCFA), thickness of fibrous cap, plaque rupture, calcification and thrombus visualized by OCT were compared between UAP and SAP patients. Results OCT imaging was successfully in 44 out of 47 patients (22 UAP, 22 SAP). Proportion of lipid-rich plaques was similar between UAP and SAP groups [91% (20/22) vs, 73% (16/22),P =0. 741]. The minimum thickness of fibrous cap in the UAP group was significantly thinner than that in SAP group [(69.5±34.7) μm vs. (141.1±68.5) μm, P = 0.000] and the rate of fibrous cap erosion in the UAP group was significantly higher than that in the SAP group [59% (13/22) vs. 9% (2/22), P=0.000]. Percents of TCFA [73% (16/22) vs. 14% (3/22) ,P = 0.000] and plaque rupture [50% (11/22) vs.9% (2/22) , P = 0.003] were significantly higher in UAP group compared those in SAP group. Incidence of thrombus and calcification were similar between two groups. Conclusions OCT imaging can clearly define plaque characterization of coronary atherosclerosis. UAP patients have thinner fibrous cap, higher incidences of fibrous cap erosion, plaque rupture and TCFA compared patients with SAP.     

光学相干断层成像评价冠状动脉内支架术后即刻支架周围组织结构改变

目的:应用光学相干断层成像(OCT)评价冠状动脉内支架术后即刻支架周围组织结构改变。方法:对21例临床诊断冠心病准备介入治疗患者,在冠状动脉内置入支架后即刻进行OCT成像检查。21例患者中共有22支冠状动脉置入25个支架,其中前降支11支13个支架,回旋支8支9个支架,右冠状动脉3支3个支架。OCT评价支架贴壁不良、血管夹层及撕裂、组织脱垂等。支架贴壁不良定义为支架支撑杆与血管壁距离大于0.20mm,组织脱垂定义为血管壁组织通过支架网眼突入管腔。结果:21例患者均成功进行OCT检查,22支靶血管25个支架均成功获得清晰OCT图像。通过OCT发现置入的25个支架中有12个支架可以看到部分支架支撑杆未能完全封闭血管壁上的夹层及撕裂;所置入的支架中有50个支架支撑杆贴壁不良,平均支架支撑杆与血管壁的距离为0.39±0.20(0.20~1.16)mm。通过OCT检出置入的25个支架中有20个支架可见到不同程度组织脱垂,共检出85个组织脱垂,平均最大组织脱垂面积为0.55±0.64(0.04~2.81)mm2。结论:OCT成像技术可清晰显示冠心病冠状动脉支架后血管夹层、撕裂组织脱垂及支架贴壁情况,其临床意义有待于进一步研究。     

不同剂量血管紧张素Ⅱ1型受体拮抗剂对急性心肌梗死后左心室重构的远期疗效

目的 :探讨不同剂量的血管紧张素Ⅱ1型 (AT1)受体拮抗剂对急性心肌梗死后左心室重构及心功能保护的远期疗效。　　方法 :选择首次急性心肌梗死患者 12 0例 ,所有病例在常规治疗基础上 (包括硝酸酯类、β受体阻滞剂、阿司匹林、低分子肝素 ) ,随机分为卡托普利组 :12 5～ 2 5mg ,每日 3次 ;缬沙坦 1组 :缬沙坦 80mg ,每日 1次 ;缬沙坦 2组 :缬沙坦 160mg ,每日 1次。所有患者分别于治疗 1、 6、 12、 18个月对心室重构及心功能有关指标进行检测 ,并同时检测血浆血管紧张素Ⅱ (AngⅡ )、醛固酮浓度。　　结果 :治疗 12、 18个月 ,缬沙坦 1、 2组与卡托普利组比较 ,左心室重构各指标 (除外缬沙坦 1组 12个月左心室舒张末期内径指标 )、心功能各指标 (除外缬沙坦 1组 12个月左心室射血分数、每搏输出量指标 )均有显著性差异 (P <0 0 5 ,P <0 0 1) ;用药 18个月不同剂量缬沙坦比较 ,缬沙坦 2组较缬沙坦 1组上述指标亦均有显著性差异 (P <0 0 5 )。血浆AngⅡ水平治疗 6、 12、 18个月缬沙坦 1、 2组和卡托普利组均较治疗前升高 ,其中缬沙坦 1、 2组升高明显 ,且有极显著性差异 (P <0 0 1) ;血浆醛固酮水平与治疗前相比 3组治疗 1、 6个月时开始降低 ,治疗 12、 18个月时卡托普利组逐渐升高 (无显著性差异     

急性心肌梗死后不同剂量血管紧张素Ⅱ1型受体拮抗剂早期干预对心功能和神经激素的影响

目的探讨急性心肌梗死后不同剂量的血管紧张素Ⅱ1型(AT1)受体拮抗剂早期干预对心功能和神经激素的影响。方法选择首次急性心肌梗死患者120例,所有病例在常规治疗基础上(包括硝酸酯类、β受体阻滞剂、阿司匹林、低分子肝素),随机分为卡托普利(C)组40例,口服卡托普利12.5～25mg,每日3次;缬沙坦(D1)组40例,口服缬沙坦80mg,每日1次;缬沙坦(D2)组40例,口服缬沙坦160mg,每日1次。分别于治疗1、6、12、18个月对所有患者的心功能有关指标进行检测,并同时检测血浆血管紧张素Ⅱ、醛固酮浓度。结果治疗12、18个月,缬沙坦D1、D2组与卡托普利组比较,心功能各项指标(除外缬沙坦D1组12个月左心室射血分数、左心室舒张末期容量)差异均有统计学意义(P<0.05,P<0.01);用药18个月缬沙坦不同剂量组间比较,D2组较D1组上述指标差异亦均有统计学意义(P<0.05)。缬沙坦两组和卡托普利组血浆血管紧张素Ⅱ(AngⅡ)水平治疗6、12、18个月均较治疗前升高,其中缬沙坦两组升高明显,差异有统计学意义(P<0.01);3组血浆醛固酮水平与治疗前相比,治疗1、6个月时开始降低,治疗12个月时卡托普利组逐渐升高,缬沙坦两组仍明显减低,差异有统计学意义(P<0.001)。结论AT1受体拮抗剂缬沙坦与血管紧张素转换酶抑制剂卡托普利一样,早期应用能有效改善急性心肌梗死后心室重构,保护心功能,其远期疗效可能优于卡托普利,且随着剂量增加疗效增强。     

Tinman基因及其相关的两种心脏疾病

DNA异常导致婴儿先天性心脏缺陷,进而在成人期引起致命性心律失常,这一现象已引起关注,本文在此作一介绍,以使人们认识.     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

目的 应用光学相干断层成像(OCT)技术比较不稳定性心绞痛(UAP)和稳定性心绞痛(SAP)患者冠状动脉粥样硬化斑块特征.方法 对临床诊断的23例UAP和24例SAP患者,在完成冠状动脉造影并确诊冠心病后进行OCT检查.根据OCT结果 回顾性比较分析UAP和SAP患者冠状动脉粥样硬化斑块特征,包括富含脂质斑块(≥2个象限的脂质斑块)、斑块纤维帽厚度、薄纤维帽粥样斑块(TCFA)、斑块破裂、钙化和血栓等.结果 47例患者中有44例成功进行OCT检查,包括22例UAP和22例SAP患者.UAP患者冠状动脉富含脂质斑块为91%(20/22),多于SAP患者的73%(16/22),但差异无统计学意义(P=0.741).UAP患者冠状动脉脂质斑块表面纤维帽厚度明显小于SAP患者[(69.5±34.7)μm比(141.1±68.5)μm,P=0.000],纤维帽侵蚀比例为59%(13/22),明显多于SAP患者的9%(2/22,P=0.000);TCFA[73%(16/22)比14%(3/22),P=0.000]和斑块破裂[50%(11/22)比9%(2/22),P=0.003]多于SAP患者.UAP患者冠状动脉斑块表而可见血栓形成多于SAP患者,但差异无统计学意义[27%(6/22)比9%(2/22),P=0.761].在斑块钙化方面,UAP与SAP患者之间差异无统计学意义.结论 OCT技术可清晰显示冠状动脉粥样斑块特征.与SAP患者比较,UAP患者冠状动脉粥样硬化斑块表现为纤维帽更薄、更多的纤维帽侵蚀、更多的破裂斑块和TCFA.     

不同资历护士对急诊患者实施健康教育的效果观察

目的观察不同资历护士对急诊患者实施健康教育的效果。方法将急诊就诊的200名患者按就诊单双号分为观察组和对照组各100例,分别由高年资护士和低年资护士实施健康教育,观察实施后两组患者的心理适应情况、配合程度以及健康教育效果。结果观察组的心理适应情况、配合程度以及健康教育效果明显优于对照组（P〈0．01）。结论不同资历护士实施健康教育效果不同。     

光学相干断层扫描比较不稳定性和稳定性心绞痛患者粥样硬化斑块特征

Objective To compare the characterization of coronary atherosclerotic plaques in patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) by optical coherence tomography (OCT). Methods OCT was performed in 47 patients (23 UAP and 24 SAP) undergoing coronary angiography. Lipid-rich plaque (defined by ≥ 2 quandrants of the cross-section area), thin cap fibroatheroma (TCFA), thickness of fibrous cap, plaque rupture, calcification and thrombus visualized by OCT were compared between UAP and SAP patients. Results OCT imaging was successfully in 44 out of 47 patients (22 UAP, 22 SAP). Proportion of lipid-rich plaques was similar between UAP and SAP groups [91% (20/22) vs, 73% (16/22),P =0. 741]. The minimum thickness of fibrous cap in the UAP group was significantly thinner than that in SAP group [(69.5±34.7) μm vs. (141.1±68.5) μm, P = 0.000] and the rate of fibrous cap erosion in the UAP group was significantly higher than that in the SAP group [59% (13/22) vs. 9% (2/22), P=0.000]. Percents of TCFA [73% (16/22) vs. 14% (3/22) ,P = 0.000] and plaque rupture [50% (11/22) vs.9% (2/22) , P = 0.003] were significantly higher in UAP group compared those in SAP group. Incidence of thrombus and calcification were similar between two groups. Conclusions OCT imaging can clearly define plaque characterization of coronary atherosclerosis. UAP patients have thinner fibrous cap, higher incidences of fibrous cap erosion, plaque rupture and TCFA compared patients with SAP.     

以晕厥为首发症状的左房粘液瘤1例报告

患者, 男, 65岁, 主因发作性晕厥2个月, 左侧肢体麻木1个月入院. 患者于2个月前活动时突发晕厥, 持续约1～2分钟缓解, 当时测BP75/50mmHg, 心电图提示窦律, Ⅱ、Ⅴ2、Ⅴ3导联T波低平, 当地诊断为"短暂性脑缺血发作", 予静点"血栓通"好转.