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目的 研究静脉应用重组人脑利钠肽(rhBNP)对急性心肌梗死经皮冠状动脉介入治疗(PCI)术后患者心室重塑和左心功能的影响。方法 选择48例发病12h内的急性前壁心肌梗死PCI术后患者,随机分为rhBNP组25例和常规治疗组23例,分别于发病后1周、4周和24周采用二维超声心动图测定舒张末期容积指数(LVEDVI)、收缩末期容积指数(LVESVI)、左室射血分数(LVEF)、左室质量指数(LVMI),计算梗死区的局部室壁运动指数(RWMI)。结果 两组患者治疗1周时LVEDVI、LVESVI、LVEF、RWMI、LVMI间差异均无显著性意义(P〉0.05);治疗4、24周时LVEDVI、LVESVI、LVEF以及治疗24周时RWMI、LVMI间差异均有显著性意义(P〈0.05)。结论 PCI术后在常规治疗的基础上应用rhBNP可进一步阻抑急性前壁心肌梗死后心室重塑,改善左心功能。  相似文献
2.
Background Many basic and clinical studies have proved that anisodamine can produce significant effect on relieving microvascular spasm, improving and dredging the coronary microcirculation. It may be beneficial to the improvement of slow-reflow phenomenon (SRP) following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). So we investigated the effect of intracoronary administration of anisodamine on SRP of infarct related artery (IRA) following primary PCI in patients with ST segment elevated acute myocardial infarction (STEAMI). Methods Twenty-one patients with SRP from a total of 148 STEAMI patients accepted primary PCI were enrolled into this study from September 2004 to December 2005. When SRP happened, nitroglycerin (200 µg) was “bolus” injected firstly into IRA to exclude the spasm of epicardial artery and identify SRP as well as a baseline and self-control agent following PCI. Ten minutes later, 1000 µg of anisodamine was injected into IRA with SRP at 200 µg/s, while the coronary angiography (CAG) was taken before and at 1st, 3rd and 10th minute after administration of nitroglycerin or anisodamine, respectively. The corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG) and the diameter of IRA were calculated and analyzed by Gibson’s TIMI frame count method using quantitative computer angiography (QCA) system to evaluate the influence of anisodamine on coronary flow and vessel lumen. In the meantime the invasive hemodynamic parameters of intracoronary and systemic artery (systolic, diastolic and mean pressure) and electrocardiogram (ECG) were measured and monitored. The changes of ventricular performance parameters and the adverse reaction were evaluated and followed-up at 1 month post-PCI. Results No significant changes in cTFCs and TMPGs were found at 1st, 3rd and 10th minute after intracoronary administration of nitroglycerin as compared with the baseline control (P>0.05). cTFCs were decreased by 58.3%, 56.2%, and 54.6%, respectively (P<0.001), and TMPGs were increased from 1.13±0.21 grade to 2.03±0.32, 2.65±0.45 and 2.51±0.57 grades (P<0.05) at 1st, 3rd and 10th minute after intracoronary administration of anisodamine as compared with those after intracoronary administration of nitroglycerine, respectively. The average coronary blood flow of TIMI grade was improved from 1.76±0.43 to 2.71±0.46 (P<0.05) while the diameter of middle segment in re-patented coronary artery was slightly increased from (3.20±0.40) mm to (3.40±0.50) mm at the 3rd minute after intracoronary administration of anisodamine (P>0.05) as compared with those of nitroglycerine control. The systolic, diastolic and mean pressures of intracoronary artery after intracoronary administration of anisodamine increased from 115 to 123, 75 to 84, 88 to 95 mmHg (P<0.05), respectively, along with the rise of heart rate from 68 to 84 beats per minute (P<0.05). There were no significant changes in intervals of PR, QT and QRS (P>0.05) and no any severe fast arrhythmia after intracoronary administration of anisodamine. The ventricular performance parameters were significantly improved and no major adverse cardiovascular events (MACE) were found during follow-up at 1 month post-PCI. Conclusions Intracoronary administration of 1000 µg anisodamine is effictive in reversing SRP following PCI in STEAMI patients, especially it is suitable for SRP patients with bradycardia or hypotension.  相似文献
3.
Background Aspirin and clopidogrel can improve myocardial reperfusion and alleviate myocardial injury during percutaneous coronary intervention (PCI). Whether the addition of intravenous tirofiban during this procedure produces further benefit has not been clarified in ST segment elevation myocardial infarction (STEMI) patients. We evaluated this on STEMI patients who underwent primary PCI (p-PCI) via transradial artery approach. Methods Consecutive patients were randomized into tirofiban group (n=-72) or placebo group (n=-78). Angiographic analysis included initial and final thrombolysis in myocardial infarction (TIMI) flow grade (TFG), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the thrombotic vessel. Platelet aggregation rate (PAR), creatine phosphokinase (CPK), CPK isoenzyme MB (CPK-MB) and troponin I levels were measured and TIMI definitions were used to assess bleeding complications. Left ventricular performance parameters were investigated with equilibrium radionuclide ventriculography. Major adverse cardiac events (MACE) were followed up for 6 months. Results The cases of TFG 0 and 1 before PCI, TFG 0 when first crossing of guide wire were less, and the cases of TFG 3 after PCI was more in tirofiban group than those in placebo group. The final CTFC was fewer and the incidence of no reflow phenomenon was lower, as well the percentage of final TFG 3 was higher in tirofiban group than those in placebo group (all P 〈0.05). Mean peak CPK-MB was significantly lower, while the left ventricular performance parameters 1 week after PCI were much more improved in tirofiban group than those in the placebo group. PAR was significantly decreased shortly after tirofiban infusion. The incidence of 6-month MACE in tirofiban group was obviously lower than that in the placebo group. No statistical difference was noted between the two groups with regard to bleeding complications. Conclusions Intravenous tirofiban infusion, in additi  相似文献
4.

Background  Diabetic patients undergoing percutaneous coronary intervention (PCI) have a higher incidence of contrast-induced nephropathy (CIN) than nondiabetic patients, and no pharmacological approach has been demonstrated to offer consistent protection. Therefore, identifying individuals who are at increased risk becomes essential. This study was designed to assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate (CMV/eGFR) in diabetic patients undergoing elective PCI who developed CIN.

Methods  We retrospectively investigated clinical factors associated with the development of CIN in 114 diabetic patients who had undergone elective PCI. The risk factors for CIN included age, gender, body mass index (BMI), left ventricular ejection fraction (LVEF), hemoglobin (Hb), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), volume of contrast medium, basic levels of serum creatinine (Scr), the number of treated vessels and the number of stents used. We conducted a stepwise regression analysis to evaluate the predictive role of these risk factors in the incidence of CIN.

Results  The incidence of CIN was 18.4% (21/114). There were no significant differences in age, gender, BMI, LVEF, Hb, FPG, HbA1c, and incidence of hypertension and number of acute myocardial infarction (AMI) in patients between the CIN (n=21) and the non-CIN (n=93) groups. However, the eGFR was significantly lower ((72.0±12.5) ml∙min-1∙1.73 m-2 vs. (82.0±16.5) ml∙min-1∙1.7 m-2, P=0.010), and the basic serum creatinine level ((1.07±0.12) mg/dl vs. (0.97±0.19) mg/dl P=0.014) was significantly higher in the CIN group. In addition, the volume of contrast medium was significantly larger ((253±75) ml vs. (211±71) ml, P=0.017) and the CMV/eGFR ratio was significantly greater (3.64±1.26 vs. 2.70±1.11, P=0.001) in the CIN group. Stepwise regression analysis showed that the CMV/eGFR ratio was a significant independent predictor for the development of CIN (P=0.001). At a cut-off point of >3.1, the CMV/eGFR ratio exhibited 71% sensitivity and 70% specificity for detecting CIN.

Conclusion  The CMV/eGFR ratio could be a valuable predictor of CIN for diabetic patients after elective PCI. At a cut-off point of >3.1, the CMV/eGFR ratio was an optimal predictor for the incidence of CIN.

  相似文献
5.
Background The incidence of no reflow phenomenon limits the clinical outcomes of percutaneous coronary intervention (PCI). This randomized controlled study was designed to evaluate the immediate protective effects of intensive statin pretreatment on myocardial perfusion and myocardial ischemic injury during PCI.
Methods Altogether 228 patients with acute coronary syndrome (ACS) were randomly assigned to standard statin group (SS group, n=115) and intensive statin group (IS group, n=-113). Patients in the SS group received 20 mg simvastatin and patients in the IS group received 80 mg simvastatin for 7 days before PCI. Thrombolysis in myocardial infarction (TIMI) flow grade (TFG), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the intervened vessel were recorded before and after stent deployment. Creatine kinase (CK) isoenzyme MB, troponin I and plasma level of high sensitive-C reactive protein (hs-CRP), P-selectin and intercellular adhesion molecule (ICAM) were measured before and 24 hours after the procedure.
Results The TFG after stent deployment was significantly improved with less TIMI 0-1 and more TIMI 3 blood flow in the IS group than in the SS group (all P〈0.05). Patients with no reflow phenomenon were less in the IS group (P〈0.001). The CTFC was lower in the IS group than in the SS group (P 〈0.001). TMPG was also improved in the IS group than in the SS group (P=0.001). Although PCI caused a significant increase in CK-MB 24 hours after the procedure, the elevated CK-MB value was lower in the IS group than in the SS group (18.74±8.41 vs 21.78±10.64, P=0.018). Similar changes were also found in troponin I (0.99±1.07 in the IS group vs 1.47±1.54 in the SS group, P=0.006). CK-MB elevation occurred in 27.8% (32/115) of the patients in the SS group vs 15.9% (18/113) in the IS group (P=-0.030). Myocardial necrosis was detected in 4.4% (5/115) of the patients in the SS group, whereas 0.9% (1/113) in the IS group (P=0.341). But no myocardial infarction was found. Similarly, the patients with increased level of troponin I were much more in the SS group (36.5%, 42/115) than in the IS group (19.5%, 22/113) (P=0.04). Among them, myocardial necrosis was detected in 13.0% (15/115) of the patients in the SS group, while 4.4% (5/113) in the IS group (P=-0.021). Myocardial infarction was found in 4.4% (5/115) of the patients in the SS group and 0.9% (1/113) in the IS group (P=0.213).
Conclusions Intensive statin pretreatment for 7 days before PCI can further improve myocardial blood perfusion, protect the myocardium from ischemic injury. These effects are associated with the lowered levels of hs-CRP, P-selectin and ICAM.  相似文献
6.
Fu XH  Liu XK  Gu XS  Fan WZ  Hao GZ  Liu J  Jiang YF  Hu SD  Wei YY  Zhang J  Ma N 《Zhonghua yi xue za zhi》2006,86(16):1129-1132
目的应用选择性冠状动脉前降支(LAD)内微球分次灌注方法造成心肌缺血坏死,探索建立稳定存活的小型猪慢性缺血性心力衰竭(CIHF)动物模型。方法选择15头8~11个月龄的中国五指山小型猪,体重20~30kg,采用4FJudkins导管行冠状动脉造影(CAG)并超选LAD,于LAD内行塑料微球悬液分次注入(1ml/次,约含1·0×105个微球),间隔10min重复注射,直到LAD前向血流减慢,TIMI血流≤2级,LVEDP升高至15mmHg~18mmHg时停止,同时监测心电图、有创血流动力学参数及心肌损伤标志物(CK-MB、cTnI)变化。应用心脏超声分别于制模前、制模后10、20、30、40、50、60d分别测量LVEF。并于制模前和术后2个月应用Swans-Ganz漂浮导管测量mRAP、mRVP,平均右房压(mRAP)、平均右室压(mRVP)、平均肺动脉压(mPAP)及肺毛细血管楔嵌压(PCWP)及CO,并行左室造影测量左室舒张末压(LVEDP)的变化,比较CIHF动物模型成功前后的血流动力学变化。认定和评价模型成功率、稳定性和可重复性。并行心脏剖检测定梗死心肌面积和病理检查。结果制模2个月后共有11头小型猪成活,其中10头达到CIHF动物模型标准(LVEDP>18mmHg和CO下降30%以上),模型成功率为66·7%(10/15),微球注射次数(3·2±0·9)次,总量(3·2±0·9)×105个。制模2个月时与制模前相比,LVEF下降38·5%,LVEDP升高197·8%,CO下降46·8%,(P<0·01)。与模型制作前相比,模型成功后血流动力学检查显示:mRAP、mRVP、mPAP和PCWP均明显升高(P均<0·01)。病理检查显示心肌坏死面积占左心室面积的25·4%~34·9%。光镜显示左心室前壁及心尖部心内膜下心肌血管内散在的半透明微球阻塞,伴灶性凝固性坏死,并呈现缺血性坏死心肌和慢性纤维胶原增生的病理特征。结论超选冠状动脉LAD内微球分次灌注方法制作的小型猪CIHF模型具有闭胸、高成功率、稳定和重复性好等优点,较药物、冠状动脉结扎和起搏诱导的心力衰竭模型更接近临床CIHF病理生理学特点和病程。  相似文献
7.
目的探讨不同胰岛素水平对急性心肌梗死患者经皮冠状动脉介入(PCI)术后心肌微循环灌注及心功能的影响。方法将62例首次急性心肌梗死(AMI)患者根据空腹血清胰岛素(Ins)水平分为:正常胰岛素组(A组)37例、高胰岛素血症(Hyperinsulinemia)组(B组)25例。行冠脉介入治疗,开通梗死相关血管。依据心肌呈色分级(MBG)评价心肌微循环灌注情况。两组患者均于术后1周、6个月行心脏超声心动图(UCG)检查,测定左室射血分数(LVEF),比较两组间差异。结果两组患者据心肌呈色分级(MBG)分析,A、B两组间比较差异有显著性意义(P<0·01)。PCI术后1周超声心动图检查中A组左室射血分数(LVEF)高于B组,有统计学意义(P<0·01)。术后6个月复查超声示A组LVEF较术后1周时明显改善,差异有显著性意义(P<0·01)。B组亦有一定改善,差异无显著性意义(P>0·05);两组6个月时LVEF比较有显著性差异(P<0·01)。结论AMI伴胰岛素水平升高者PCI术后心肌微循环灌注不良,心功能差。  相似文献
8.
目的 评价经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)对慢性闭塞病变伴侧支循环形成的缺血性顽固性心力衰竭患者心功能的改善作用.方法 47例经冠状动脉造影证实为慢性闭塞病变伴侧支循环形成的缺血性顽固性心力衰竭患者,纽约心脏病学会(New York Heart Association,NYHA)分级Ⅳ级.其中男性36例,女性11例,平均年龄(65.37±10.52)岁.行PCI治疗使再血管化.治疗前和治疗后6个月进行临床、6 min步行距离及超声心动图检查,评价PCI对患者心室重构和心功能的影响.结果 与术前相比,患者临床心功能状态、6 min步行距离、左室舒张末容积指数、收缩末容积指数及左室射血分数明显改善[NYHA Ⅳ vs NYHA Ⅱ,(125±36)m vs (385±48)m, (79.4±38.4)mL/m2 vs (67.1±14.3)mL/m2、(34.7±35.6)mL/m2 vs (28.4±12.6)mL/m2、(36.7±6.6)% vs (48.1±7.4)%,P<0.05].结论 PCI可以改善慢性闭塞病变伴侧支循环形成的缺血性顽固性心力衰竭心功能,提高生活质量.  相似文献
9.
Background  Previous studies have proved the renal protective effects of anisodamine in patients with septic shock. The aim of this study was to investigate anisodamine for the prevention of contrast induced nephropathy (CIN) in patients with acute coronary syndrome (ACS).
Methods  Consecutive ACS patients undergoing elective percutaneous coronary intervention (PCI) were randomly assigned to one of two groups: patients in the anisodamine group (ANI group) were assigned to receive intravenous infusions of anisodamine by an adjusted-dose (0.1–0.2 μg∙kg-1∙min-1) from the PCI procedure to 24 hours after PCI, and the control group (CON group) received 0.9% isotonic saline of the same volume. All patients were hydrated for 6 to 12 hours before and 12 hours after PCI. Blood samples were taken on the day of PCI and at 24, 48 and 72 hours after PCI to measure the serum creatinine (SCr).
Results  A total of 177 patients were involved in the study, 88 in the ANI group and 89 in the CON group. In both groups, the SCr concentrations significantly increased after PCI, with the peak value occurring at 48 hours. At 72 hours, the SCr concentration in the ANI group retuned to the baseline level (P >0.05), but the SCr concentration in CON group was still higher than baseline level (P <0.01). The SCr concentrations at 48 and 72 hours after PCI were much lower in the ANI group than those in the CON group (both P <0.01). The estimated glomerular filtration rate (eGFR) significantly decreased after PCI, the lowest value occurred at 48 hours. In the ANI group, the eGFR at 72 hours was similar to the baseline level. In the CON group, the eGFR failed to return to baseline at 72 hours (P <0.01). The eGFR at 24, 48 and 72 hours after PCI were higher in the ANI group (all P <0.05). The incidence of CIN in the ANI group was lower than that in the CON group within 72 hours after PCI (P <0.05). The results of multiple Logistic regression proved that both diabetes and left ventricular ejection fraction (LVEF) were independent predictors of CIN, and treatment with anisodamine was an independent preventive factor of CIN (OR 0.369 and 95% CI 0.171 to 0.794, P=0.011). No serious side effects were found in the ANI group.
Conclusion  Intravenous infusion of anisodamine during and after elective PCI may safely prevent the occurrence of CIN in ACS patients.
  相似文献
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