经皮腔内冠状动脉成形术治疗急性心肌梗死22例临床观察

目的 观察经皮腔内冠状动脉成形术（ＰＴＣＡ）治疗急性心肌梗死的有效性和安全性。方法 对２２例急性心肌梗死患者在发病后１２ｈ内行ＰＴＣＡ术,其中的１８例患者置入冠脉内支架２０枚。梗死相关动脉前降支１２例,右冠脉８例,回旋支２例。结果 ２１例手术成功,成功病例中,术后血流恢复为急性心肌梗死溶栓治疗血流分级（ＴＩＭＩ）３级１７例,ＴＩＭＩ０～１级２例,ＴＩＭＩ２级２例。１例术后死于急性左心衰竭和心源性休     

不同冠脉病变支数患者经皮腔内冠脉成形术前后心率变异性的对比…

通过心率变异性（ＨＲＶ）时域和频域分析法，对经冠造显示不同冠脉焦支数并行经皮腔内冠状动脉成形术（ＰＴＣＡ）扩张成功的６６例患者，分别于ＰＴＣＡ术前术后１周进行ＨＲＶ分析。其中单支为２１例，双支２８例，三支１７例，结果显示：（１）ＰＴＣＡ术后１周心率异性较术前前所改善，但未统计学意义（Ｐ〉０．０５），（２）ＰＴＣＡ术前，术后冠脉单支，双支，三支病变各组间患者ＨＲＶ均无显著差异（Ｐ均〉０．０５）。提示     

PTCA术后心率变异动态演变与再狭窄的关系

目的 观察经皮腔内冠脉成形术（ＰＴＣＡ）后再狭窄与再狭窄患者的心率变异（ＨＲＶ）变化，探讨 ＰＴＣＡ术对心脏处太神经活动的影响及ＨＲＶ变化与再狭窄的关系。方法 对ＰＴＣＡ术患者５１例，其中再狭窄者３４例，无再狭窄者１７例，分别于术前１周、术后１周、术后６个月记录２４ｈ心电信号并进行ＨＲＶ时域法和频域法分析。结果 （１）所有患者ＰＴＣＡ术后１周ＨＲＶ值均较术前降低（Ｐ〈０．０５）；（３）ＰＴＣＡ术后     

不同冠脉病变支数患者经皮腔内冠脉成形术前术后心率变异性的对比分析

通过心率变异性（ＨＲＶ）时域和频域分析法，对经冠造显示不同冠脉病变支数并行经皮腔内冠状动脉成形术（ＰＴＣＡ）扩张成功的６６例患者，分别于ＰＴＣＡ术前术后１周进行ＨＲＶ分析。其中单支病变２１例，双支２８例，三支１７例。结果显示：①ＰＴＣＡ术后１周心率变异性较术前有所改善，但未达统计学意义（Ｐ＞０．０５）。②ＰＴＣＡ术前、术后冠脉单支、双支、三支病变各组间患者ＨＲＶ均无显著差异（Ｐ均＞０．０５）。提示冠心病患者ＨＲＶ的改变可能与神经体液因素对窦房结功能的调控失衡有关。而与冠脉病变支数无关。ＰＴＣＡ术后近期患者ＨＲＶ改善不明显，其机制尚不清楚     

14例冠状动脉腔内成形术及冠脉内支架的初步结果与护理体会

１４例冠状动脉腔内成形术及冠脉内支架的初步结果与护理体会山西省心血管病研究所（０３０００１）王惠仙芦丽芳李保邱宁张冠玲经皮穿刺冠状动脉腔内成形术（Ｐｅｒｃｕｔａｎｅ－ｏｕｓＴｒａｎｓｌｕｍｉｎａｌＣｏｒｏｎａｒｙＡｎｇｉｏｐｌａｓｔｙ，ＰＴＣＡ）和冠...     

32例冠状动脉狭窄或闭塞的介入性治疗

目的 探讨经皮冠状动脉腔内成形术（ＰＴＣＡ）及冠状动脉内支架植入术（ＣＡＳＩ）对这太动脉狭窄及完全闭塞的疗效。方法以地３０例冠状动脉粥样硬化性狭窄或闭塞,１例缺血性心肌病冠状动脉狭窄和１例多发 生结节性动脉为和急性心肌梗塞患者的５０支病变血管实施ＰＴＣＡ或ＣＡＳＩ术。术前、术后和随方腹要太动脉造影图像。结果 手术总成功率９８．９％,１例冠心病争性心肌梗塞患者术后２周因心原性休克死亡,１例冠心病患者     

冠脉造影后直接冠脉内支架植入13例

目的：采用国产ＤＳＡ,通过冠脉造影选择合适病例,观察冠脉造影后直接支架植入术对狭窄病变治疗作用及对冠心病患者生活质量影响。方法：常规Ｊｕｄｋｉｎｓ方法冠脉造影,充分肝素化后,送入引导导管。将ＡＣＳＯ．０１４导丝置于病变远端,部分明显狭窄病变,沿导丝送入２．５ｍｍ～３．０ｍｍ球囊行预扩张（ＰＴＣＡ）,据扩张后血管反应选择合适支架,高压加压扩张球囊,使支架充分打开,术后造影。观察术前、术后冠脉内径变化。记录术中、术后有无心绞痛、急性心肌梗死及住院２８天内病死率。做统计学分析。结果：常规造影后有１３例患者直接冠脉内支架植入,其中２．５ｍｍ球囊预扩张６例次,３．０ｍｍ球囊扩张７例次,植入Ｃｏｒｄｉｓ支架３例,ＡＶＥＧＸ支架１０例。其中３．０ｍｍ支架９例次,３．５ｍｍ支架４例,长度１２～２０ｍｍ不等（平均１５．５ｍｍ）。加压１０～ １４ａｔｍ（平均 １２．６ ± ２．３１ａｔｍ）。术后内径为参比血管 １．０６倍。术后 ＴＩＭＩⅢ级血流。住院期间无心绞痛、急性心肌梗死发生,均获成功。结论：①球囊预扩张可提高冠脉支架成功率;②高压加压球囊使支架充分打开,可减少手术并发症及术后再狭窄。③术后规律抗凝治疗,是防治近期冠脉支架内血栓     

经皮冠状动脉腔内成形术及支架植入在冠心病治疗中的应用

１２例冠心病患者１３支血管病变进行经皮冠状动脉腔内成形术（ＰＴＣＡ）及支架植入。病变血管为前降支６例，左回旋支１例，右冠脉６例。靶血管病变程度为７４％～１００％，长度为１０～３０ｍｍ。ＰＴＣＡ术后残留狭窄为１５５±１２％，术中死亡１例，术后再狭窄１例。７例支架植入全部成功，其中二例为急性心肌梗塞的原发支架植入，植入后无血栓并发症，术后无残留狭窄。     

彩超对急性心肌梗塞与冠脉缺血的对比研究

彩超对急性心肌梗塞与冠脉缺血的对比研究厦门市第一医院李丽月，张世科，张素花为鉴别急性心肌梗塞（ＡＭＩ）与冠脉缺血（ＣＩ）所致室壁节段性运动异常，我们对２０例ＡＭＩ患者、２０例ＣＩ患者及２０例正常人的心脏进行２ＤＥ及ＣＤＦＩ对比分析，现报告如下。一、资...     

平均血小板体积和纤维蛋白原联合对急性冠脉综合征患者冠脉病变程度的预测价值

目的　探讨平均血小板体积（ＭＰＶ）联合纤维蛋白原（Ｆｇ）对ＡＣＳ的预测价值，并在ＡＣＳ患者中分析ＭＰＶ、Ｆｇ与冠 脉病变数的关系。方法　２０１０年１月至２０１３年１２月我院共收治胸痛、胸闷等症状住院患者４３２例，ＡＣＳ患者３１５例（ＡＣＳ组），冠 脉造影阴性患者１１７例（对照组）。入院时检测ＭＰＶ和Ｆｇ，应用ＲＯＣ曲线评估ＭＰＶ和Ｆｇ单独以及两者联合对ＡＣＳ的预测价值， 比较ＭＰＶ、Ｆｇ在不同冠脉病变数间的差异。结果　ＭＰＶ和Ｆｇ均是ＡＣＳ的显著预测因子（ＯＲ＝１３２，Ｐ＝０００；ＯＲ＝２３７，Ｐ＝ ０００），单独用ＭＰＶ和Ｆｇ预测ＡＣＳ曲线下面积（ＡＵＣ）分别为０６３和０７０，当ＭＰＶ与Ｆｇ联合时ＡＵＣ增加到０７３；随着冠脉病变 数增加，ＭＰＶ和Ｆｇ均显著逐渐升高。结论　ＭＰＶ与Ｆｇ联合可以提高对ＡＣＳ的预测价值，ＭＰＶ和Ｆｇ可作为ＡＣＳ冠状动脉病变程 度的预测指标。     

介入性冠状动脉血运重建术的临床应用(附12例报告)

目的 观察介入性冠状动脉血运重建术对冠心病的疗效。方法 冠心病人１２例,Ａ型病变３例,Ｂ型病变６例,Ｃ型病变３例,均作了顷皮冠状动脉腔内成形术,在此基础上共置入１４个冠脉支架。结果病变血管（包括３支完全闭塞血管）现实了再通。经冠状动脉的介入治疗后,所有病人均不复存在缺血性胸痛等症状。结论 冠状动脉血运重建术是治疗冠心病的先进、有效的手段。     

CD36在冠状动脉成形术后再狭窄中的临床意义

目的 探讨CD36与冠脉支架介入治疗术后冠状动脉再狭窄的关系.方法 选择308例行冠脉支架置入术的冠心病患者,分别于术前,术后1个月,6个月,采用ELISA 法检测患者血清CD36、C反应蛋白(CRP)、VCAM-1的表达水平.按照冠状动脉狭窄评分(CSA) 标准,将29例支架术后再狭窄患者分为A、B、C 3组.结果 与术前比较,冠心病患者术后1 个月,6 个月的CD36、CRP、VCAM-1水平均有显著降低;与术后未狭窄组比较,术后再狭窄组上述指标则明显增高;CD36、CRP、VCAM-1水平随CSA评分的升高而升高;CD36、CRP、VCAM-1与术后再狭窄呈正相关性.结论 CD36、CRP、VCAM-1与支架术后冠状动脉再狭窄形成有一定的相关性,对其表达水平的检测有助于冠脉支架术后临床疗效的评价.     

Pharmacoeconomic consequences of amlodipine besylate therapy in patients undergoing PTCA.

In Italy, revascularization interventions increased from 44,600 in 1996 to more than 100,000 in 2001. In particular, the occurrence of percutaneous transluminal coronary angioplasty (PTCA) increased from 239 cases per million population in 1994 to about 1300 cases per million population in 2001. This trend has caused a concomitant increase in revascularization costs, which have doubled in few years, rising from Euro 421 millions in 1996 to Euro 850 millions in 2001. In 2001, PTCA amounted to 55% of total cost of revascularizations. The aim of this study was to assess the pharmacoeconomic consequences of amlodipine besylate therapy administered in patients at high risk of restenosis after PTCA. We conducted a cost-effectiveness analysis comparing therapy with amlodipine besylate added to standard care versus standard care alone. Information on clinical outcomes was drawn from the Coronary Angioplasty Amlodipine Restenosis Study (CAPARES). Medical costs were estimated with reference to drug therapy and hospitalizations for coronary events and revascularization procedures. The study was conducted from the perspective of the Italian third party payer (National Health Service). The analysis was applied to a time horizon of 4 months. Amlodipine besylate resulted less expensive and more effective than standard care. It reduced mortality, morbidity for coronary reasons and the need of revascularization procedures. The cost per 1000 patients was estimated at Euro 1,166,000 in the placebo and Euro 950,000 in the amlodipine besylate group, resulting into a cost saving of Euro 216,000, that is 18.5% of total cost of standard care. Results are sensitive to the cost of amlodipine besylate and the cost of hospitalizations, but therapy with amlodipine besylate resulted dominant even in the most unfavorable hypothesis.     

Revascularization in advanced stable coronary artery disease

Identifying patients with stable coronary artery disease (CAD) who benefit from revascularization is a challenge for the clinician. Based on survival data, we have devised a guide to help the clinician decide which patients with advanced stable CAD should be treated more aggressively with revascularization and which patients may be followed with medical therapy alone. Survival data support the recommendation of coronary artery bypass grafting (CABG) when at least two of the following factors are present: advanced CAD, left ventricular (LV) dysfunction and significant ischemia. For patients with advanced CAD and LV dysfunction, or left main coronary artery disease, CABG remains the treatment of choice. In patients with normal LV function, but advanced CAD and significant ischemia, percutaneous transluminal coronary angioplasty (PTCA) and CABG appear to provide similar survival outcomes. While CABG is more invasive and is associated with a longer recovery period, PTCA is associated with more repeat revascularization procedures on follow-up than CABG. Thus, while the recommendation for revascularization in advanced stable CAD is made based on survival data, in some patients the choice of revascularization procedure may depend on the needs and preferences of the individual patient.     

彩色室壁动力技术低剂量多巴酚丁胺负荷超声心动图估测存活心肌的价值

目的 评估彩色室壁动力分析技术（CK）低剂量多巴酚丁胺负荷超声（LDDSE）识别存活心肌的价值。方法 20例经冠状动脉造影术（CAG）证实为冠心病（HO）的患者,术前全部行CK-LDDSE检查,并与经皮冠状动脉腔内成形术（PTCA）后实际改善的心肌节段进行对比研究。结果 在PTCA术前行CK-LDDSE检查的320个节段中,96段无运动,术后CK检查有收缩功能储备的78个节段中,术前CK能检查出70个节段,CK-LDDSE预测存活心肌的敏感性89.7%,特异性77.8%,准确性87.5%。结论 CK-LDDSE识别存活心肌客观、准确、安全,具有较高的临床应用价值。     

Health-related quality of life in patients with coronary artery disease after coronary revascularization

The aim of this study was to investigate the quality of life (HRQoL) in coronary artery disease(CAD) patients, admitted for rehabilitation within 3 months after an acute coronary event, in relation to treatment strategy [conservative treatment without revascularization (WR), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG)]. Methods: Overall 719 consecutive CAD patients were involved in the study: WR (n=170), PTCA (n=226), CABG (n=323). HRQoL was estimated using the SF-36 questionnaire for total QoL and its two dimensions for physical and mental health [physical and mental component scores (PCS, MCS)]. Sexual dysfunction was assessed using the ASEX scale. Results: Significantly higher PCS, MCS and total SF-36, but lower ASEX score, were found in men compared with women. The ASEX score was significantly affected by age. Significantly higher PCS was found in PTCA group compared with that of CABG group. In multivariate analysis a significant positive association was obtained between PCS/MCS and male sex, between regular exercise, hyperlipoproteinemia, and permanent stress. ASEX was significantly positively associated with the age, CHF and non smoking. Conclusion: The results of this study have demonstrated significantly better HRQoL in men, younger CAD patients, patients who underwent PTCA and in patients without self-reported exposition to stress.     

经皮冠状动脉腔内成形术治疗冠心病200例

200例冠心病患者,63例为心肌梗塞后择期冠脉血管成形术（PTCA）;132例患劳力型心绞痛、5例急性心肌梗塞（AMI）为急诊PTCA。PTCA方法按常规进行,195例成功,成功率97．5％。扩张232处病变,其中左前降支病变147处,右冠病变63处,回族支病变22处。冠脉病变分型：A型病变118支,B1型病变68支,B2型病变21支,C型病变25支。C型中21支为完全闭塞病变,17例手术成功。手术并发症包括急性血管闭塞2例,血管内膜撕裂C型以上15例,死亡1例。4年随访中,5例患者症状复发,其中3例为原扩张部位再狭窄。     

冠脉内成形及支架术前后QT离散度的变化

观察冠脉内成形＋支架术（ＰＴＣＡ＋Ｓｔｅｎｔ）对心绞痛患者ＱＴ离散度（ＱＴｄ）的影响。方法：选择成功行ＰＴＣＡ＋Ｓｔｅｎｔ术的２９例患者,无心肌梗死病史。取术前１ｄ～１０ｄ（３．８３±２．８８）ｄ和术后１ｄ～６ｄ（２．６９＋１．２６）ｄ两份心电图。从导联间最大ＱＴ间期（ＱＴｍａｘ）减去最小ＱＴ间期（ＱＴｍｉｎ）得到ＱＴｄ,同样得到校正的ＱＴｄ（ＱＴｃｄ）。结果：ＱＴｄ、ＱＴｃｄ术前为（５８．９７±１９．１５）ｍｓ、（６２．９±２１．３６）ｍｓ,术后（３２．０７±１０．１４）ｍｓ、（３２．５２±１３．３２）ｍｓ,（Ｐ＜０．００１,Ｐ＜０．００１）。ＱＴｍａｘ术前为（４１２．４±３３．９８）ｍｓ,术后为（３９２．４±２３．９）ｍｓ,有显著差异（Ｐ＜０．００１）,但心率校正后的ＱＴｃｍａｘ术前为（４２９．２±３１．９９）ｍｓ,术后为（４２６．９±２６）ｍｓ,无显著差异（Ｐ＞０．５）。而ＱＴｍｉｎ及心率校正的ＱＴｃｍｉｎ术前（３５３．５±２４．５）ｍｓ、（３６６．３±２２．７）ｍｓ,术后（３６１±２０．７９）ｍｓ、（３９４．３±２４．１）ｍｓ,均有显著差异（Ｐ＜０．０５,Ｐ＜０．００１）,且ＱＴｃｍｉｎ的差异更显著?     

老年急性冠状动脉综合征的急诊介入治疗研究

目的研究与分析老年急性冠状动脉综合征的急诊介入治疗的疗效。方法本文选择了80例老年急性冠状动脉综合征患者进行研究,将这些患者按其意愿分为两组,每组40例,PTCA组患者采用急诊介入的方法进行治疗,对照组则采用常规的药物治疗,之后对比研究这两种治疗方法的疗效及两组患者血凝指标。结果通过对比两组患者的病死率、并发症以及冠状动脉残余狭窄等方面的情况,发现PTCA组患者优于对照组,两组之间存在差异,具有统计学意义(P<0.05)。结论采用急诊介入的治疗方法治疗老年急性冠状动脉综合征的疗效与采用常规治疗方法相比,效果明显,值得在急诊科推广应用。