冠脉造影法在冠心病诊断中价值

自1958年Sones通过股动脉切开,逆行插入特制的尖端呈弧形的导管,置入左右冠状动脉开口进行冠状动脉造影,到1967年Judkins和Amplats相继采用经股动脉穿刺途径插入预成形导管进行冠状动脉造影术,使该方法在临床上得到广泛应用,选择性冠状动脉造影术已成为现代诊断冠心病的"金标准".     

64排冠脉CT和冠脉造影对冠心病诊断的对比研究

目的 以冠状动脉造影(CAG)为参照,评价64排冠脉CT (CTCA),即64排多层螺旋CT (MSCT)在冠心病诊断中的价值.方法 选取本院临床46例疑似冠心病的患者分别进行CAG和MSCT检查,以CAG为参照标准,对MSCT诊断价值进行分析.结果 46例患者中CAG发现狭窄92支,其中轻度狭窄6支,中度狭窄38支,重度狭窄34支,闭塞病变14支;MSCT发现狭窄116支,其中轻度狭窄52支,中度狭窄24支,重度狭窄38支,闭塞病变2支.MSCT诊断冠脉狭窄病变的敏感度,特异度,阴性预测值,阳性预测值及准确度分别为82.8％,82.5％,88.7％,74.2％,82.6％,与冠脉造影结果相比较,无明显统计学差异.MSCT检出软斑块32处、混合斑块42处、钙化斑块30处.结论 MSCT诊断冠心病有较高的敏感度和特异度,特别是阴性预测值较高,可作为冠心病高危人群的一种无创筛查手段:同时可以准确显示各种粥样斑块的病理性质,并对斑块的稳定性做出判断,评估急性冠脉事件的发生,具有较高的临床应用价值.     

急性冠脉综合征冠状动脉造影特点

目的了解急性冠脉综合征(ACS)冠脉血管病变情况,为临床分析病情、制定治疗方案提供客观依据.方法对其造影显示的冠脉病变支数、部位、狭窄程度、危险分层及相关因素进行分析.结果 148例确诊ACS患者纳入研究范围,不稳定型心绞痛(UAP)66例,急性心肌梗死(AMI)82例.单支病变94例,占63.5%,双支42例,占28.4%,三支11例,占7.4%;犯罪血管分布中左前降支(LAD)81例,占54.7%,左回旋支(LCX)13例,占8.7%,右冠状动脉(RCA)53例,占35.8%,左主干1例,占0.7%.犯罪血管狭窄程度及危险程度分层中,狭窄在50%～74%者35例,占23.6%,狭窄在75%～99%者82例,占55.4%,完全闭塞者24例(其中AMI 20例,UAP 4例),占16.2%,狭窄<50%者7例,占4.7%.犯罪血管危险程度分层中,低危者27例,占18.2%,中危者54例,占36.5%,高危者53例,占35.8%,极高危者7例,占4.7%;中、高危病变共计107例,占总数的72.3%.结论 ACS患者冠脉造影显示大部分有严重的冠脉病变,部分完全闭塞,应积极考虑急诊PTCA及支架术等介入治疗或外科手术,血运重建,改善预后.     

Assessment of coronary bypass surgery and percutaneous transluminal coronary angioplasty.

Coronary bypass surgery developed as another in a line of surgical procedures dating back more than 60 years. The medical profession at first assessed this procedure with time-honored anecdotal techniques. Gradually, for a variety of reasons, improved methods of comparisons worked their way into assessments of bypass surgery. Randomized controlled trials met resistance but have been very influential. Assessment of percutaneous transluminal coronary angioplasty has benefited from the knowledge generated during the last 25 years, but clinicians have been slower to apply the most advanced techniques.     

急性冠脉综合征直接支架术的疗效观察

目的观察直接支架术在治疗急性冠脉综合征(ACS)的安全性及可行性.方法204例ACS病人分为接支架组(70例)和常规支架组(134例).比较两组成功率及并发症.结果直接支架组成功69例(成功率98.5%),失败1例.69例患者共置入92个支架,病变分型为A型76例,B型16例.常规支架组134例(成功率100%).并发症发生率两组相同,无统计学差异,P＞0.05.结论A型及B1型病变为主的急性冠脉综合征病人,选择直接支架术治疗,操作时间短,且成功率及并发症的发生与常规支架组无明显差异.     

冠心病基因检测与冠心病的关联性

目的观察冠心病基因检测与冠心病是否有关联性,以及关联程度如何。方法选取120例住院患者,其中60例为冠心病人,60例为非冠心病人。年龄40—65岁。冠心病为观察A组,非冠心病为对照B组,记录性别、年龄、冠心病家族史、高血压史、糖尿病史,并均抽血行冠心病基因检测。A组选1人和B组选1人按年龄相近、性别相同配对,共形成60对。开始进行1：1条件Logistic回归分析。结果冠心病家族史、高血压史、糖尿病史、以及冠心病基因检测与冠心病均有关联性。其中冠心病基因检测与冠心病的关联程度低于其他3个因素。结论冠心病基因检测与冠心病有关联性。     

Results of coronary angioplasty in coronary bifurcation. Report of 61 cases

These are the results of 61 bifurcations treated by percutaneous coronary angioplasty in 50 patients (41 males, 9 females) between 1998 and 2003. Bifurcation stenosis, dominated by type I of bifurcation classification. Global restenosis rate was 20% and didn't concern any case of kissing balloon. Restenosis rate in bifunction angioplasty is similar to that of the other sites; besides, it's twice more important when we stent both of the principal and collateral arteries unless we did kissing balloon. Te interventional treatment of bifurcation stenosis is feasible, with restenosis rate similar to the other types of lesions if we proceed systematicaly to kissing balloon.     

冠状动脉非单纯狭窄型病变行支架置入术后的效果

目的对冠状动脉非单纯狭窄型患进行球囊扩张及支架植入术(PCI)随后观察其预后判断.方法对51例非单纯狭窄型病变(NSCAD)患者进行PCI,随访6个月.同时将35例NSCAD未行PCI的患者设为对照组,也随访6个月.结果 PCI组无心脏事件的发生率明显低于对照组(P＜0.01).PCI组和对照组心脏事件(未含心绞痛)的发生率分别为40.12%、 8.6%.结论 NSCAD的冠心病患者PCI后心脏事件发生率升高.     

老年冠心病患者危险因素和冠脉造影分析

目的探讨老年冠心病患者的危险因素，冠状动脉病变特点与中青年的区别。方法对34例住院的老年（年龄≥65岁）、27例中青年（年龄〈65岁）冠心病患者的临床和冠状动脉造影资料进行回顾性的分析和比较。结果老年冠心病患者高血压、糖尿病、空腹血糖明显高于中青年患者（P〈0．05）；冠状动脉造影阳性率明显高于中青年组（P〈0．05）；双支、多支病变明是显高于中青年组（P〈0．05）；中重度病变明显高于中青年组（P〈0、05）；但吸烟、饮酒、甘油三脂（TG）、高密度脂蛋白胆固醇（HDL-C）、体重指数（BMI）显著低于中青年患者（P〈0．05）。结论高血压、糖尿病、空腹血糖异常是老年冠心病患者的危险因素；老年冠心病患者的冠脉病变以双支、多支、中重度病变多见。     

冠状动脉旁路移植术治疗冠心病的临床应用研究

目的报告冠状动脉旁路移植手术（CABG）治疗冠心病的早期结果及分析。方法对270例冠心病患者行冠状动脉旁路移植手术,应用体外循环（ONCABG）63例,非体外循环（OPCABG）207例;不稳定型心绞痛130例,陈旧性心肌梗死96例,室壁瘤15例;多支病变188例,二支病变61,左主干病变21例：合并糖尿病86例,高血压91例,瓣膜病32例,均于术中同期手术处理。结果手术平均每例搭桥3.16支,术后需用IABP支持治疗8例,无围手术期心肌梗死。早期死亡1例;患者术后心绞痛症状消失,生活质量明显提高。结论 CABG手术治疗冠心病临床效果好,充分的术前准备,熟练的手术技术是手术成功的关键：对高龄、多支病变、陈旧心梗并发症及心功能较差的患者仍具有良好的安全性。     

冠心病患者中脂联素在冠状动脉损害中的意义

目的探讨冠心病患者血浆脂联素水平与冠状动脉粥样硬化病变的关系。方法根据选择性冠状动脉造影结果将142例患者分为冠心病组和对照组。冠心病组根据临床诊断分为稳定型心绞痛（SAP）组和急性冠脉综合征（ACS）组；根据冠状动脉病变类型分为A型病变、B型病变和C型病变组；根据冠状动脉病变程度分为轻度病变、中度病变和重度病变组。血浆脂联素浓度通过ELISA方法测定。结果冠心病组脂联素浓度明显低于对照组（（6．09±1．85）μg／ml vs （10．25±1．51）μg/ml，P〈0．001），ACS组脂联素浓度又明显低于SAP组（5．45±1．53）μg／ml vs（7．60±1．67）μg／ml，P〈0．001）。随冠状动脉病变类型和病变程度的加重，脂联素浓度逐渐降低，各组间差异有统计学意义（P〈0．001）。结论脂联素是冠状动脉粥样硬化的负调控因子，低脂联素血症可以做为预测冠状动脉粥样硬化病变情况及斑块稳定性的一个指标。     

Drug-eluting coronary stents

The first method of percutaneously treating a diseased vessel was developed by Dotter and Judkins in 1964. Andreas Grüntzig performed the first coronary angioplasty in 1977. In 1985 Palmaz et al. implanted the first balloon-mounted stent in a peripheral artery. Puel and Sigwart implanted the first human coronary stent in March 1986; it was a self-expanding mesh-like device. Schatz et al. applied some small modifications to the original Palmaz stent, which resulted in the first coronary stent available on the market, called Palmaz-Schatz stent. In 1987 Sigwart was the first to suggest the use of coronary stents in acute vessel occlusions during unsuccessful PTCA. Using the device it became possible to cover the intimal flap and to prevent elastic recoil. Because of the high incidence of subacute stent thromboses and the bleeding complications (aggressive anticoagulation regimens) these times the coronary stents were implanted only in order to avoid emergency CABG surgery. In 1993 BENESTENT and STRESS trials have proved that elective stent implantation can significantly reduce the incidence of restenosis. The dual antiplatelet therapy and the high pressure stent implantation technique dramatically reduced the incidence of subacute stent thrombosis. The treatment of coronary artery disease has undergone revolutionary changes in the past decade but remained the leading cause of mortality in the developed world. The most important limitation of PCI has been in-stent restenosis, which occurs in 20-40% of stent implantations. Clinically it results in recurrent ischemic episodes most often requiring repeat revascularisation (rePCI or CABG). With the use of drug-eluting stents the incidence of in-stent restenosis can be reduced dramatically, based on the currently available clinical trials it remains below 10%.