冠状动脉侧支循环与心肌缺血时间的相关性

目的:研究冠状动脉侧支循环形成与心肌缺血、心肌梗死发生的时间关系。方法:回顾分析412例经冠状动脉造影证实的冠状动脉完全或次全闭塞患者,先将有心肌梗死病史的患者分为3组:A组(心肌梗死后1个月内)、B组(1个月～1年)、C组(1年以上)。仅有心肌缺血者同样根据缺血时间(上述3个时间段)分为A、B、C组。分别观察侧支循环形成良好率,进行对比分析。再根据闭塞血管将所有患者分为前降支、回旋支、右冠状动脉3组观察其侧支循环形成情况。结果:有心肌梗死及心肌缺血病史者A、B、C组患者侧支循环形成的良好率两两比较均差异无统计学意义(P>0.05)。右冠状动脉完全或次全闭塞时侧支循环形成良好率明显高于左冠状动脉;前降支与右冠状动脉比较、回旋支与右冠状动脉比较均差异有统计学意义(P<0.05)。结论:心肌梗死和心肌缺血随着时间的延长侧支循环良好情况无显著改变。     

尼可地尔联合比索洛尔治疗急性心肌梗死后心绞痛疗效观察

目的观察尼可地尔联合比索洛尔治疗急性心肌梗死后心绞痛的疗效。方法将急性心肌梗死后出现心绞痛患者60例随机分为两组,各30例。对照组给予标准抗心绞痛基础上加美托洛尔及单硝酸异山梨酯,治疗组在标准抗心绞痛基础上给予尼可地尔联合比索洛尔,疗程均为2周。结果治疗组总有效率达90.0%显著高于对照组的73.3%,差异有统计学意义(P0.05);治疗组心电图缺血改善情况优于对照组,差异有统计学意义(P0.05)。结论尼可地尔联合比索洛尔治疗急性心肌梗死后心绞痛效果较好,对心肌供血改善有一定疗效。     

参龙宁心胶囊对冠心病心绞痛患者肿瘤坏死因子-α及白细胞介素-6影响

目的观察参龙宁心胶囊治疗冠心病心绞痛的疗效。方法将98例患者随机分为治疗组(48例)与对照组(48例)。治疗组给予西医常规治疗加参龙宁心胶囊;对照组给予西医常规治疗。观察两组患者治疗前后心绞痛疗效、心电图疗效及血清肿瘤坏死因子-a(TNF-α)、白细胞介素-6(IL-6)的水平。结果治疗后治疗组心绞痛疗效、心电图疗效均优于对照组,差异有统计学意义(P0.05);治疗组TNF-α、IL-6水平均显著降低,与对照组比较,差异有统计学意义(P0.05)。结论参龙宁心胶囊治疗冠心病心绞痛疗效确切,其机制可能与抑制炎症反应有关。     

丹红注射液治疗心肌梗死后早期心绞痛102例

目的 观察丹红注射液治疗心肌梗死后心绞痛的临床疗效及对心电图、血脂的影响.方法 将98例心肌梗死后心绞痛患者随机分为治疗组及对照组,对照组采用常规治疗,治疗组加用丹红注射液,观察患者心绞痛症状变化及血脂、心电图变化.结果 治疗组心绞痛总有效率为82.3%,高于对照组的62.2%(P<0.05).结论 丹红注射液治疗心肌梗死后早期心绞痛优于常规治疗.     

心理护理对急性心肌梗死介入术患者的影响

目的观察心理护理对急性心肌梗死介入术患者的临床疗效。方法纳入70例急性心肌梗死介入术患者,随机分为治疗组及对照组,对照组给予常规治疗及护理,治疗组在常规基础上给予心理护理。观察比较两组治疗前后心绞痛评分、护理满意度及卧床时间、住院天数和住院费用。结果经过心理护理干预1个月后心绞痛评分、护理服务满意度评价,治疗组与对照组比较差异有统计学意义(P<0.05或P<0.01);治疗组的卧床时间、住院天数、住院费用均低于对照组(P<0.05)。结论心理护理能改善急性心肌梗死介入术患者的心绞痛情况,提高生活质量,减少了卧床时间、住院天数、住院费用等。     

急性心肌梗死患者侧支循环形成的相关因素分析

目的探讨急性心肌梗死患者侧支循环形成的相关因素,以期为临床提供科学依据及治疗指导。方法选取南方医科大学附属珠江医院2015年1月至2017年9月156例急性心肌梗死患者为研究对象,所有患者均行经皮冠状动脉介入治疗,按Rentrop分级分为侧支循环良好组(n=53)和侧支循环不良组(n=103),比较两组患者的临床资料及冠状动脉病变特点等与侧支循环形成的相关性。结果两组年龄、性别、心肌梗死类型、原发性高血压史、吸烟史、糖尿病史、肾功能不全史、低密度脂蛋白胆固醇浓度、糖化血红蛋白等比较,差异无统计学意义(P0.05)。侧支循环良好组的心率稍低于侧支循环不良组,而舒张压稍高于侧支循环不良组,差异有统计学意义。右冠状动脉、完全闭塞、近端病变、弥漫性病变及血管病变数对良好侧支循环形成有统计学意义。多因素回归分析提示,心率、舒张压水平及梗死后心肌缺血可能是心肌梗死后冠状动脉侧支循环形成的独立危险因素。结论梗死后心肌缺血控制心率可能有利于心肌梗死后冠状动脉侧支循环形成,为提前干预心肌梗死高危患者提供理论依据。     

参龙宁心胶囊治疗心绞痛并抑郁症的临床研究

目的观察参龙宁心胶囊治疗心绞痛并抑郁症的疗效。方法将76例患者随机分为两组,治疗组38例给予西医常规治疗加参龙宁心胶囊,对照组38例给予西医常规治疗。观察症状改变、心电图疗效及抑郁评分的变化。结果两组患者心绞痛症状改变、心电图疗效及抑郁评分比较,治疗组明显优于对照组,组间比较差异有统计学意义(P0.05)。结论参龙宁心胶囊可有效改善心绞痛并抑郁症患者症状,疗效确切。     

四妙丹蒌颗粒治疗非ST段抬高型心肌梗死的临床疗效

目的探讨四妙丹蒌颗粒治疗非ST段抬高型心肌梗死(NSTEAMI)的临床疗效。方法将100例符合条件的NSTEAMI患者随机分为治疗组和对照组各50例,对照组给予西医规范化治疗,治疗组在对照组基础上加服四妙丹蒌颗粒,疗程2 w。观察两组患者试验前后的心绞痛疗效、中医证候疗效、心电图疗效、生活质量改善情况、安全性及转归,并进行统计分析。结果治疗组在心绞痛疗效、中医证候疗效及心绞痛稳定状态、心绞痛发作情况、治疗满意度等方面均优于对照组(P0.05,P0.01),并可降低经皮冠状动脉介入治疗(PCI)治疗率(P0.05)。结论四妙丹蒌颗粒对NSTEAMI具有良好疗效。     

尼可地尔在冠脉痉挛患者中的疗效和安全性

目的 探讨尼可地尔在治疗冠脉痉挛患者中的疗效及安全性。 方法 通过冠脉造影筛选出符合冠脉痉挛的患者50例,随机分为对照组和试药组,对照组给予抗血小板、调脂等常规治疗,试药组在常规治疗的基础上加用尼可地尔5 mg（3次/d）,观察两组临床疗效以及治疗前后内皮功能变化[NO含量与内皮素（ET）-1水平]及药物安全性。 结果 试药组的治疗效果明显优于对照组（P<0.05）,与治疗前相比,对照组治疗后NO含量增高（P<0.05）,ET-1含量减低（P<0.05）;尼可地尔组治疗3个月后,NO含量显著增加（P<0.01）,ET-1含量显著减低（P<0.01）。治疗3个月后,与对照组相比,试药组NO含量显著增高（P<0.01）,试药组ET-1含量显著减低（P<0.01）,试药组仅发生1例轻微头痛,可耐受。 结论 尼可地尔在治疗冠脉痉挛患者中具有良好的疗效和安全性。     

中西医结合治疗冠心病心绞痛疗效观察

目的分析中西医结合治疗冠心病心绞痛患者的疗效观察。方法选取我院2014年2月~2015年12月收治的冠心病心绞痛患者120例为研究对象,按照入院顺序分为两组观察组与对照组,各60例。对照组给予常规西医治疗,观察组6在常规西医治疗的基础上给予补阳还五汤加减治疗。对比两组患者治疗之后的心电图疗效、心绞痛发作频率及持续时间,血脂指标。结果观察组的心电图疗效、中医症候疗效、心绞痛发作频率与持续时间、血脂指标均优于对照组,差异有统计学意义(P0.05)。结论中西医结合治疗冠心病心绞痛患者的疗效十分显著,值得在临床中推广应用。     

Role of previous angina pectoris and collateral flow to preserve left ventricular function in the presence or absence of myocardial infarction in isolated total occlusion of the left anterior descending coronary artery

The aim of this study was to determine whether previous angina pectoris and collateral circulation influenced myocardial function after isolated coronary occlusion. In 58 consecutive patients, coronary angiography showed a complete isolated occlusion of the left anterior descending coronary artery; 43 patients (74%) had previous myocardial infarction. Duration of previous angina pectoris was defined as the time from the first ischemic symptom to the date of myocardial infarction or of coronary angiography in the absence of myocardial infarction. Left ventricular ejection fraction was measured on the 30 degrees right anterior oblique projection of the left ventricular angiogram. Collateral circulation was graded as follows: none or filling limited to side branches (group 1) and partial or complete filling of the epicardial arterial segment (group 2). Group 2 (40 patients) had higher ejection fraction (57 vs 38%; p less than 0.0001) and longer duration of previous angina pectoris (11 vs 0.1 months; p less than 0.002) than group 1 (18 patients). A longer duration of previous angina pectoris probably allows collateral development before coronary occlusion in 1-vessel coronary artery disease, thereby limiting myocardial damage.     

Relations of the duration of pre-existing angina pectoris, collateral circulation and left ventricular function after isolated coronary occlusion with or without myocardial infarction

The aim of this retrospective study was to determine the relationship between the duration of preceding angina pectoris, collateral circulation and left ventricular function after isolated coronary occlusion with or without myocardial infarction. Coronary angiography of 138 consecutive patients showed isolated and complete occlusions of the left anterior descending (58 patients) or right coronary artery (80 patients). One hundred and four patients had myocardial infarction with (Group A, n = 21) or without (Group B, n = 83) preceding angina pectoris and 34 had angina without myocardial infarction (Group C). The left ventricular ejection fraction was measured by ventriculography in the 30 degrees right anterior oblique projection. The collateral circulation was assessed by coronary angiography and evaluated as follows: no flow or flow limited to collateral branches (subgroup 1) and partial or complete filling of the epicardial arterial segment (subgroup 2). In the global population the left ventricular ejection fraction was higher and the duration of preceding angina pectoris was longer in the subgroups with a well developed collateral circulation. There was no difference in ejection fraction between Groups A and B (presence of myocardial infarction), on the other hand, within each of the groups, a good collateral circulation (subgroup 2) was associated with a significantly higher ejection fraction. Group C (without infarction) patients had better ejection fractions than Groups A or B, especially when the collateral circulation was poorly developed. Within Group C, the quality of the collateral circulation did not seem to affect the ejection fraction. The left ventricular ejection fraction is lower in patients with isolated coronary occlusion and myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)     

冠脉宁口服液治疗冠心病心绞痛186例临床研究

目的 :探讨冠脉宁口服液治疗冠心病心绞痛的临床疗效。方法 :应用自研冠脉宁口服液为主 ,中西医结合治疗冠心病心绞痛 186例 (治疗组 ) ,与常规西药治疗 10 0例 (对照组 )作比较。结果 :两组均能缓解冠心病心绞痛症状 ,治疗组疗效显著 ,两组显效率、有效率分别为 47.3 %、93 .5 %与3 4.0 %、87.0 % (P <0 .0 5 ) ;与对照组比较 ,治疗组能明显改善心电图 (P <0 .0 5 ) ,减少硝酸甘油的消耗量 (P <0 .0 5 ) ,改善血液流变学的异常 (P <0 .0 1) ,降低血脂 (P <0 .0 0 1)。结论 :治疗组主要适合于心气不足型、气滞血瘀型 ,能明显缓解稳定型心绞痛 (P <0 .0 5 )。说明冠脉宁口服液是治疗冠心病心绞痛有效药物之一。     

心肌缺血预适应对急性心肌梗塞面积及近期预后的影响

目的　观察急性心肌梗塞心绞痛发作 ,与梗塞范围及近期预后的关系。方法　 2 1 9例急性心肌梗塞患者分为梗塞前 72小时有心绞痛组 ( A组 ) 93例 ,无心绞痛组 ( B组 ) 1 2 6例。对两组的梗塞面积 ,并发症和病死率进行比较分析。结果　有心绞痛组的心肌梗塞范围小 (两组间有显著差异 ,P<0 .0 5 ) ,住院期间严重心律失常、心力衰竭、心源性休克发生率及病死率均低于梗塞前无心绞痛组 (两组间有显著差异 ,P<0 .0 5 )。结论　急性心肌梗塞发病 72小时以前有心绞痛病史对心肌具有明显的保护作用。     

Comparison of the cardioprotective effect of prodromal angina pectoris and collateral circulation in patients with a first anterior wall acute myocardial infarction

To compare the cardioprotective effect of prodromal angina pectoris and collateral circulation, 245 patients with first anterior acute myocardial infarction who underwent coronary angioplasty within 12 hours of symptoms were studied. Prodromal angina pectoris and collateral circulation were independently associated with higher predischarge left ventricular ejection fraction (LVEF), and a combination of prodromal angina pectoris and collateral circulation afforded cumulative improvement in LVEF in patients without diabetes mellitus. In patients with diabetes mellitus, collateral circulation, but not prodromal angina pectoris, was associated with higher predischarge LVEF.     

C反应蛋白水平与冠心病的相关性研究

目的 探讨冠状动脉粥样硬化心脏病(CHD)与C反应蛋白(CRP)之间的关系.方法 测定50例正常对照人群和80例经冠状动脉造影证实为CHD患者血浆的CRP水平,其中单支病变30例、双支病变25例、三支病变25例;稳定型心绞痛31例、不稳定型心绞痛25例,急性心肌梗死24例.结果 CRP 水平在稳定型心绞痛组、不稳定型心绞痛组、急性心肌梗死组依次增高;稳定型心绞痛组(F=1.826,P＜0.05)、不稳定型心绞痛组(F=4.232,P＜0.01)及急性心肌梗死组(F=6.745,P＜0.01)的CRP水平均明显高于对照组,在冠心病组中,双支病变组(F=7.925,P＜0.01)以及三支病变组(F=9.467,P＜0.01)中CRP 水平也明显高于对照组.结论 CRP水平与冠心病和冠脉病变程度相关.     

Development of collateral circulation after acute myocardial infarction: its role in preserving left ventricular function

The present study evaluated the effects of coronary collateral circulation developing after acute myocardial infarction on global and regional left ventricular function during the chronic stage. The study group consisted of 16 patients with initial myocardial infarction having total occlusion of the proximal left anterior descending coronary artery. To eliminate the effects of collateral circulation existing at the onset of infarction, patients with pre-infarction angina were excluded from this study. The patients were categorized in two groups depending on the extent of their collateral circulation (collateral index: CI 0-3): group A--patients with significant collateral circulation (CI = 2 or 3) to the infarct-related coronary artery; group B--patients without significant collateral circulation (CI = 0 or 1). Their heart rate, left ventricular peak systolic and end-diastolic pressures and cardiac index were similar in the two groups. The left ventricular end-systolic volume index in the group B was significantly greater than that in the group A (60 +/- 21 ml/m2 vs 34 +/- 9 ml/m2, p less than 0.05). Left ventricular ejection fraction in the group A was significantly greater than that of the group B (55 +/- 9% vs 39 +/- 15%, p less than 0.05), and a significant difference was observed in the percentage of segment shortening in the infarct area between the groups A and B (10.8 +/- 9.2% vs -0.2 +/- 5.4%, p less than 0.01). It was concluded that coronary collateral circulation which develops after acute myocardial infarction exerts beneficial effects on global and regional left ventricular function during the chronic stage.     

闭塞性冠状动脉病变侧支循环形成对急性心肌梗死患者近期预后的影响

目的探讨闭塞性冠状动脉病变侧支循环形成对急性心肌梗死(AMI)患者近期预后的影响。方法入选1996年以来行冠状动脉造影的AMI患者126例,根据有无侧支循环形成分为A组(无侧支循环组)n=69例、B组(有侧支循环组)n=57例。比较两组间院内病死率、死亡原因及存活患者心功能的差异。结果(1)B组院内病死率明显低于A组,有显著性差异(P<0.05)。(2)B组患者因心源性休克或心力衰竭而死亡的比例略低于A组,有显著性差异(P<0.05);因心脏破裂而死亡的比例明显低于A组,有显著性差异(P<0.01)。(3)存活患者出院时,B组左心室射血分数均明显高于A组,有显著性差异(P<0.05)。结论闭塞性冠状动脉病变侧支循环形成对AMI患者近期预后相对较好。     

缺血预处理对急性心肌梗死溶栓治疗冠脉再通及预后的影响

目的缺血预适应对急性心肌梗死（AMI）溶栓治疗后冠脉血管再通率及近期预后的影响。方法对86例AMI并进行尿激酶溶栓患者的临床资料进行分析,按梗死前有无心绞痛分为心绞痛组（IP）与非心绞痛组（对照组）,比较两组患者对心肌酶浓度、冠脉再通率、左室功能及心脏事件发生率的影响。结果（1）IP组尿激酶溶栓血管再通率及再通速率高于对照组（P〈0．05）;（2）IP组AMI后血清心肌酶峰值、梗死面积及心脏主要并发症及住院病死率明显降低对照组（P〈0．05）;（3）IP组AMI后EF恢复优于对照组（P〈0．05）。结论梗死前心绞痛对缺血心肌起明显的保护作用;对提高AMI溶栓后血管再通率、从而减少梗死面积和心肌的损害程度,降低病死率。     

90例选择性冠状动脉造影分析

目的：探讨选择性冠状动脉造影在冠心病诊断及治疗中的价值。方法：对心肌梗塞、典型心绞痛、不典型心绞痛患者共90例进行选择性冠状动脉造影，并对结果进行分析。结果：冠脉造影阳性率：心肌梗塞组占100％，典型心绞痛组占79．2％，不典型心绞痛组占37．5％。心肌梗塞组及典型心绞痛组与不典型心绞痛组比较，冠脉造影阳性率差异非常显著（P〈0．01），心肌梗塞组与典型心绞痛组比较阳性率无显著差异（P〉0．05）。结论：冠状动脉造影不仅是诊断冠心病的“金标准”，而且有益于冠心病的分型和指导治疗。