血栓抽吸并经血栓抽吸导管注射尿激酶原对ST段抬高型心肌梗死患者经皮冠状动脉介入治疗效果的影响

目的探讨血栓抽吸并经血栓抽吸导管注射尿激酶原对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)效果的影响。方法选取2015年9月—2017年6月邯郸市第一医院心血管内科收治的STEMI患者102例,采用随机数字表法分为对照组53例和观察组49例。对照组患者仅行PCI;观察组患者于PCI前行血栓抽吸,待造影检查显示无明显血栓影后经血栓抽吸导管注射尿激酶原。比较两组患者PCI前后TIMI血流分级、TIMI心肌灌注分级(TMPG)及校正的TIMI帧数(c TFC),PCI前及PCI后1周心功能指标;随访3个月,观察两组患者主要不良心血管事件发生情况。结果 PCI前两组患者TIMI血流分级、TMPG及c TFC比较,差异无统计学意义(P0.05);PCI后观察组患者TIMI血流分级和TMPG优于对照组,c TFC少于对照组(P0.05)。PCI前两组患者左心室射血分数(LVEF)及血清脑钠肽(BNP)、肌钙蛋白I(Tn I)水平比较,差异无统计学意义(P0.05);PCI后1周观察组患者LVEF高于对照组,血清BNP、Tn I水平低于对照组(P0.05)。随访3个月,观察组患者主要不良心血管事件发生率低于对照组(P0.05)。结论血栓抽吸并经血栓抽吸导管注射尿激酶原能有效改善STEMI患者PCI后心肌血流灌注及心功能,降低主要不良心血管事件发生风险。     

血栓抽吸术联合冠状动脉内注射尼可地尔治疗NSTEMI患者PCI术中慢血流/无复流的效果及对心肌微灌注、近期预后的影响

目的 分析血栓抽吸术联合冠状动脉内注射尼可地尔治疗非ST段抬高型心肌梗死(NSTEMI)患者经皮冠状动脉介入(PCI)中慢血流/无复流的效果及对心肌微灌注、近期预后的影响。方法 回顾性选取120例NSTEMI患者,均于PCI术中予以血栓抽吸术,依据在PCI术前冠状动脉内注射药物不同分为研究组(术前应用尼可地尔,n=58)、对照组(术前应用硝酸甘油,n=62),对比两组慢血流/无复流发生率、心肌损伤相关指标及心肌微灌注、心肌梗死溶栓血流帧数(cTFC)、心功能[左室舒张末期内径(LVEDD)、室壁运动记分指数(WMSI)、左室射血分数(LVEF)]、近期预后。结果 研究组慢血流/无复流发生率明显低于对照组(P<0.05);术后1 w,研究组心肌肌钙蛋白(cTn)I、肌酸激酶同工酶(CK-MB)、N端脑钠肽前体(NT-proBNP)水平明显低于对照组(P<0.05);术后1 w,研究组LVEDD明显低于对照组,LVEF明显高于对照组(P<0.05),两组WMSI无明显差异(P>0.05);术后2、3个月,研究组心肌灌注缺损评分明显低于对照组,冠状动脉给药后及PCI结...     

冠脉内注射尿激酶原对AMI患者急诊PCI术后心肌微循环的影响

目的:探讨冠脉内注射重组人尿激酶原(rhPro-UK)对急性心肌梗死(AMI)患者急诊经皮冠脉介入治疗(PCI)术后心肌微循环的影响。方法:2016年7月~2017年12月我院的90例行PCI治疗的AMI患者被随机均分为PCI对照组(单纯急诊PCI)和联合治疗组(先冠脉内注射rhPro-UK,再行急诊PCI)。比较两组PCI术后即刻TIMI血流分级、校正的TIMI血流帧数(CTFC)、TIMI心肌灌注分级(TMPG),及PCI术前、24h后外周血肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平,并记录两组30d内主要不良心血管事件(MACE)及出血事件发生情况。结果:术后即刻,与PCI对照组比较,联合治疗组TIMI 3级比例(75.56%比91.11%)、TMPG 3级比例(71.11%比93.33%)均显著升高,CTFC[(30.62±4.94)帧比(24.84±5.29)帧]显著降低,P<0.05或<0.01。两组术后24h外周血CK-MB、cTnI水平均显著升高;与PCI对照组比较,联合治疗组术后24h CK-MB[(34.26±5.64)ng/ml比(29.68±4.49)ng/ml]、cTnI[(9.85±2.36)ng/ml比(8.25±2.13)ng/ml]水平显著降低,P均=0.001。联合治疗组30d内MACE发生率显著低于PCI对照组(15.56%比35.56%),P=0.030;两组30d内出血事件发生率无显著差异,P=0.535。结论:冠脉内注射尿激酶原能够显著改善AMI患者急诊PCI术后心肌微循环灌注,减轻心肌损伤,降低30d内MACE发生率,且不显著增加出血风险。     

黄蛭口服液对急性心肌梗死病人经皮冠状动脉介入术后心肌血流灌注及心功能的影响

目的探讨急性心肌梗死(AMI)经皮冠状动脉介入(PCI)术前、术后使用黄蛭口服液治疗对心肌血流灌注及心功能的影响。方法选取2017年1月—2019年1月中山市中医院收治的行急诊PCI术的急性心肌梗死病人100例,随机分为治疗组和对照组,每组50例。所有病人在急诊PCI术前均口服肠溶阿司匹林300 mg、替格瑞洛180 mg及他汀类药物。治疗组在此基础上术前30 min以及术后加用黄蛭口服液,疗程为1个月。比较两组病人术前与术后心肌梗死溶栓试验(TIMI)血流分级,TIMI心肌灌注分级(TMPG)3级占比,术后ST段回落率(STR)≥50%占比,术前与术后1周室壁运动积分指数(WMSI)和左心室射血分数(LVEF),术中无复流现象(NRP)发生率以及术后30 d内主要心脏不良事件(MACE)发生率。结果两组术前TIMI血流分级、TMPG 3级占比、WMSI及LVEF比较,差异均无统计学意义(P0.05)。两组术后TIMI血流分级、TMPG 3级占比及STR≥50%占比比较差异均有统计学意义(P0.05)。两组术后WMSI、LVEF比较,差异均有统计学意义(P0.05)。治疗组和对照组PCI术后30 d MACE发生率分别为24.0%、38.0%,两组比较差异有统计学意义(P0.05)。治疗组和对照组术中NRP发生率分别为10.0%、16.0%,治疗组术中NRP发生率低于对照组,但差异无统计学意义(P0.05)。结论 PCI术前、术后使用黄蛭口服液治疗可改善急性心肌梗死病人TIMI血流分级及心功能,降低术后无复流现象发生率。     

术前冠状动脉内注射尼可地尔对急性心肌梗死患者术后心肌血流灌注水平及心功能的影响

目的 探讨经皮冠状动脉介入治疗(PCI)术前冠状动脉内注射尼可地尔对急性心肌梗死(AMI)患者术后心肌血流灌注水平及心功能的影响.?方法 选取2017年2月至2019年12月冀中能源峰峰集团有限公司总医院收治的100例行PCI术的AMI患者,使用随机数字表法分为两组,各50例,对照组在PCI术前应用硝酸甘油,观察组在术...     

曲美他嗪或尼可地尔对PCI相关心肌损伤的保护作用研究

目的探讨曲美他嗪或尼可地尔对PCI相关心肌损伤的保护作用。方法选取行PCI的冠心病患者126例,在术前48h随机分为曲美他嗪组、联合用药(曲美他嗪+尼可地尔)组、尼可地尔组和对照组,对照组接受他汀类药物、氯吡格雷、β受体阻滞剂等常规治疗,并行PCI治疗。联合用药组在对照组方案的基础上,于PCI术前48h开始口服曲美他嗪20mg,3次/日及尼可地尔5mg,3次/日。曲美他嗪组患者于术前48h口服曲美他嗪20mg,3次/日。尼可地尔组患者于术前48h口服尼可地尔5mg,3次/日。四组均服药至术后24h。检测各组PCI术前及术后12h、18h、24h的肌酸激酶同工酶(CK-MB)、肌钙蛋白I(c Tn I)。结果对照组术后18h的CK-MB水平明显高于术前(P0.05)。联合用药组、曲美他嗪组和尼可地尔组PCI术后12h、18h、24h的c Tn I水平均低于对照组,差异均有统计学意义(均P0.05);术后12h、18h及24h联合用药组与曲美他嗪组及尼可地尔组c Tn I水平比较,差异均无统计学意义(均P0.05)。结论曲美他嗪或尼可地尔对PCI心肌损伤都有一定的心肌保护作用,但联用曲美他嗪和尼可地尔的效果与单独使用曲美他嗪或尼可地尔时没有显著差异。     

尼可地尔联合国产重组人脑利钠肽对AMI急诊PCI术后慢血流患者红细胞渗透脆性及氧化应激损伤的影响

目的:探讨尼可地尔联合国产重组人脑利钠肽对急性心肌梗死(AMI)急诊PCI术后慢血流患者红细胞渗透脆性及氧化应激损伤的影响。方法:将2016-06-2017-06我院收治的急诊PCI术后发生慢血流的患者90例随机分为观察组与对照组,每组各45例。其中对照组在常规治疗基础上加用尼可地尔,观察组则在常规治疗基础上加用尼可地尔联合国产重组人脑利钠肽。对比两组患者心肌灌注情况、心功能、红细胞渗透性及氧化应激指标水平差异。结果:术后第7天,观察组室壁运动积分指数(WMSI)与左心室收缩末期容积指数(LVESVI)明显低于对照组,左室射血分数(LVEF)明显高于对照组(均P0.05)。观察组髓过氧化物酶(MPO)、丙二醛(MDA)、红细胞渗透脆性最大抵抗值(OFmax)、红细胞渗透脆性最小抵抗值(OFmix)、红细胞平均体积(MCV)、溶血率(0.45/0)及溶血率(0.45/0.15)水平明显低于对照组(均P0.05);超氧化物歧化酶Orgotein(SOD)及NQO-1水平均高于对照组(均P0.05)。结论:尼可地尔联合国产重组人脑利钠肽可明显降低AMI急诊PCI术后慢血流患者氧化应激损伤,提高红细胞渗透脆性,改善心功能及血流灌注能力。     

替罗非班在老年人急诊经皮冠状动脉介入治疗中预防无复流的临床观察

目的观察老年人急诊PCI术中冠状动脉内注射替罗非班对术后无复流的影响。方法选择急性心肌梗死行急诊PCI患者163例,随机分为替罗非班组(83例)和对照组(80例)。替罗非班组在导丝通过病变后经导管冠状动脉内注射替罗非班10μg/kg,之后予替罗非班0.15μg/(kg·min)持续静脉滴注24 h。对照组给予常规治疗。观察2组患者TIMI、心肌灌注分级(TMPG),入院后30 d LVEF和左心室舒张末内径,心血管事件及出血并发症。结果替罗非班组TIMI血流3级和TMPG 2～3级比例较对照组明显升高,TIMI血流0～2级和TMPG 0～1级比例较对照组明显降低,差异有统计学意义(P<0.05)。替罗非班组LVEF较对照组明显改善,主要心血管事件较对照组明显降低,差异有统计学意义(P<0.05)。结论急诊PCI术中冠状动脉内注射替罗非班减少无复流,改善心肌灌注和心功能,且不增加心血管事件和并发症。     

冠状动脉内注射乌拉地尔对急性心肌梗死心肌灌注和心功能的影响

目的:探讨乌拉地尔对急性心肌梗死(AMI)急诊经皮冠状动脉介入治疗(PCI)患者心肌灌注和心功能的影响。方法:对经急诊PCI治疗的AMI患者54例,随机分为乌拉地尔组、硝酸甘油组和对照组。分别于经皮腔内冠状动脉成形术前冠状动脉内注射乌拉地尔、硝酸甘油、生理盐水。观察PCI术前、术后心肌梗死溶栓试验(TIMI)血流、校正的TIMI帧计数(cTFC)、心肌充血分级(MBG)、ST段回落、心肌坏死指标、左心室射血分数(LVEF)及住院期间主要心血管不良事件(MACE)。结果:乌拉地尔组与硝酸甘油组和对照组相比,PCI后cTFC降低、MBG增加、ST段回落增加、LVEF增加、CK和TnT峰值降低(P均<0.01)。结论:乌拉地尔可改善AMI急诊PCI患者冠状动脉血流、心肌灌注和左心室收缩功能,减少梗死面积,不增加住院期间MACE。     

老年急性心肌梗死患者血清miR-18a水平及意义

目的探讨老年急性心肌梗死(AMI)患者血清miR-18a水平及临床意义。方法选择老年AMI患者90例作为AMI组,老年健康体检者90例作为对照组。采用逆转录-聚合酶链反应(RT-PCR)测定血清miR-18a水平,采用酶联免疫吸附试验(ELISA)测定血清心肌肌钙蛋白(c Tn T)、肌酸激酶同工酶(CK-MB)、生长分化因子(GDF)-15、转化生长因子(TGF)-β1水平。采用心脏超声心动图测定心功能。结果 AMI组血清miR-18a、c Tn T、CK-MB、GDF-15、TGF-β1水平显著高于对照组,差异有统计学意义(P<0. 05)。AMI组左心室射血分数(LVEF)显著低于对照组,差异有统计学意义(P<0. 05),左心室舒张末容积(LVEDV)、左心室舒张末内径(LVEDD)显著高于对照组,差异有统计学意义(P<0. 05)。双支血管病变和3支血管病变AMI患者血清miR-18a水平显著高于单支血管病变者,差异有统计学意义(P<0. 05),3支血管病变AMI者血清miR-18a水平高于双支血管病变者,差异有统计学意义(P<0. 05)。PCI治疗治疗后血清miR-18a水平显著低于治疗前(P<0. 05)。AMI患者血清miR-18a水平与血清c Tn T、CK-MB、GDF-15、TGF-β1水平呈正相关(P <0. 05)。AMI患者血清miR-18a水平与LVEF呈负相关(P<0. 05),与LVEDV和LVEDD呈正相关(P<0. 05)。结论老年AMI患者血清miR-18a水平升高,参与心肌损伤和心肌重构,在老年AMI的诊断、病情评估及疗效评估中具有一定价值。     

Pseudoaneurysm of coronary artery following rupture of coronary artery during coronary angioplasty.

Rupture of the coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We describe a case of coronary artery rupture during PTCA resulting in the formation of a coronary artery pseudoaneurysm. The pseudoaneurysm was successfully treated by percutaneous spring-coil embolization of the coronary artery.     

Percutaneous coronary intervention of bifurcation coronary disease

Bifurcation coronary artery disease is a frequent problem faced by interventional cardiologists and it affects approximately 15-20% of patients undergoing percutaneous coronary intervention (PCI). The application of drug-eluting stents (DES) technology to prevent restenosis after PCI represents one of the success stories in cardiology, but DES have not resolved the bifurcation PCI challenge. Bifurcation PCI remains associated with higher procedural failure and worse outcomes compared with PCI of non-bifurcated lesions even in DES era. A dependable strategy for PCI of bifurcation lesions has yet to be established, which is likely due to the paucity of studies evaluating the anatomical intricacies of the bifurcation as well as the lack of large scale randomized therapeutic trials. Further, bifurcation has many anatomical variants and it is unlike that one technique will fit all. Currently, we are left with the option of a tailor-made strategy for each patient and bifurcation anatomy and make the most of the limited evidence available to support our therapeutic decisions. In this review, we attempted to describe the current understanding of bifurcation anatomy and corresponding PCI strategies.     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

Clinical trials of coronary revascularization: coronary angioplasty vs. coronary bypass grafting

In the absence of diabetes mellitus, rates of survival and of survival free of myocardial infarction (MI) are almost identical among patients with multivessel disease assigned to percutaneous transluminal coronary angioplasty (PTCA) versus those assigned to coronary artery bypass grafting (CABG) after 6.5 to 8 year follow-up period. Additional revascularization occurs 2.5 to 4.5 times more frequently in PTCA-treated than in CABG-treated patients and prevalence of angina is no longer statistically different between the two treatment groups. The excess health care costs of bypass surgery, which are important early after revascularization, almost disappear 5 to 8 years later. In patients with single vessel disease, survival free of MI is also comparable in both treatment groups at 5 years. Additional revasculariztion occurs two to four times more often in PTCA-treated than in CABG-treated patients and prevalence of angina does not differ between the two treatment groups. Thus, in nondiabetic patients with multivessel disease, the choice of a revascularization strategy rests on the patient's and treating physician's preference between the invasive nature of bypass surgery and the risk of recurrent procedures. In patients with single vessel disease, these long-term data suggest that bypass surgery is at least as safe and effective as coronary angioplasty and therefore may be a treatment option in selected cases.     

冠状动脉256排CT与冠状动脉造影对冠心病的诊断比较

目的冠状动脉256排CT成像技术与冠状动脉造影检查对冠状动脉粥样硬化性心脏病的诊断比较。方法选取2013年5月至2014年5月内蒙古兴安盟人民医院心血管内科疑似冠心病患者50例,其中男性29例,女性21例,年龄37~68岁。先行冠状动脉256排CT扫描及图像后处理,后行冠状动脉造影检查,将两结果进行对比分析。结果以冠状动脉狭窄≥50%者为阳性。冠状动脉256排CT诊断冠心病灵敏度为40.00%,特异度98.18%,阳性预测值88.89%,阴性预测值81.82%,正确指数38.18%,符合率82.67%,KAPPA值46.28%。结论冠状动脉造影诊断冠心病准确性优于冠状动脉CT。冠状动脉CT可对冠心病患者进行初筛诊断。     

冠脉微循环与冠心病

冠心病急性心肌梗死的再灌注治疗是现代医学发展的里程碑,它使被动、保守治疗转为积极、主动的血运重建,随着包括静脉溶栓、冠状动脉内溶栓、经皮冠状动脉腔内成形术(PTCA)、冠状动脉内支架置入术以及冠状动脉搭桥术等再灌注治疗技术的成熟、普及,挽救了无数患者的生命.     

Right coronary artery coronary sinus fistula with coronary sinus ostium stenosis

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. The draining site of a right coronary artery (RCA) fistula may usually be the right ventricle, right atrium, or pulmonary artery. Here, we present a patient with right coronary artery to coronary sinus fistula (RCACSF) complicated by aneurysmal dilatation of the coronary sinus (CS) and stenosis of CS ostium.     

Percutaneous transluminal coronary angioplasty of coronary artery embolism

A 35-yr-old woman with known valvular heart disease presented with acute myocardial infarction. Angiography demonstrated a totally occluded distal left anterior descending coronary artery. Though initially successful, angioplasty ultimately failed to maintain arterial patency, leaving a more distal total occlusion after several balloon inflations. In spite of this, PTCA possibly provided a more localized infarction via a peripheral mobilization of the embolus.     

Detecting of coronary dissection by coronary magnetic resonance

A 75-year-old man, who had a history of coronary dissection after percutaneous coronary intervention in left anterior descending coronary artery, underwent coronary magnetic resonance. Magnetic resonance demonstrated coronary dissection in the distal portion of the left anterior descending artery. Both the true lumen with thick vessel wall and the false lumen with thin vessel wall were demonstrated in the cross-sectional images using T1-weighed black blood technique and T2-weighed black blood technique. Soft plaque was located at the twelve o'clock in the true lumen. Invasive coronary angiogram showed long coronary dissection from middle to distal portion of left anterior descending coronary artery. Magnetic resonance was thought to be useful to detect and follow up the coronary dissection noninvasively.