急诊经皮冠状动脉介入治疗术后中性粒细胞水平与ST段回落及血浆N末端利钠肽原相关研究

目的 评价急性ST段抬高心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后中性粒细胞水平与ST段下降幅度(STR)及血浆N末端利钠肤原(NT-proBNP)相关性.方法 入选发病12小时内成功接受PCI的STEMI患者195例.PCI术前、术后2小时分别记录18导联心电图,PCI术后12小时进行中性粒细胞计数和NT-proBNP水平检测,随访6个月,记录主要心脏不良事件(MACE).根据其中性粒细胞水平分为3组:A组(中性粒细胞<4.78×109/L)32例;B组[中性粒细胞(4.78～8.79)×109/L]118例;C组(中性粒细胞>8.79×109/L)45例.结果 C组PCI术后2小时STR>70%所占比率较A组明显减少(17.8%vs 43.8%,P<0.05);STR<30%组高中性粒细胞(>8.79×109/L)血症、高血浆NT-proBNP(>600 pmo/L)比率均明显高于STR>70%组(33.3%vs 13.8%、34.9%vs 12.3%,P<0.05或<0.01);直线相关分析显示,C组中性粒细胞与NT-proBNP水平呈正相关(r=0.401,P<0.01);随访6个月,3组MACE发生率差异无统计学意义(P>0.05).结论 PCI后中性粒细胞水平与STR和NT-proBNP水平密切相关,PCI后中性粒细胞数早期监测有利于急性心肌梗死患者PCI后心肌组织灌注水平和临床预后的评价.     

急性冠状动脉综合征患者经皮冠状动脉介入治疗围术期死亡原因分析

目的：探讨急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）围术期死亡原因。方法：2002年1月—2006年3月在复旦大学附属中山医院接受PCI的3 806例冠心病患者中36例ACS患者发生围术期死亡。其中男性23例,女性13例;年龄24~85岁（平均年龄69±23岁）,包括急性心肌梗死（AMI）29例、不稳定心绞痛7例,其中既往有陈旧性心肌梗死史者7例、PCI治疗史者4例、冠状动脉旁路移植术（CABG）史者1例、脑卒中史者4例,合并有高血压病者20例、脂代谢紊乱者11例、糖尿病者6例、慢性阻塞性肺病者4例。结果：36例ACS患者中,因AMI行急诊PCI者24例,ACS行择期PCI者12例（包括AMI5例、不稳定心绞痛7例）。冠状动脉造影显示,26例有2支及以上多支血管病变,10例为单支血管病变。36例ACS患者PCI围术期死亡原因为心力衰竭或（和）心源性休克16例（44.4%）,室颤和（或）心脏骤停8例（22.2%）,多脏器功能衰竭4例（11.1%）,心脏破裂4例（11.1%）,急性或亚急性支架内血栓形成3例（8.3%）,消化道大出血1例（2.8%）。急诊PCI因泵衰竭死亡的12例患者中,广泛前壁AMI7例、下壁＋后壁AMI3例,下壁＋右室AMI2例。结论：ACS患者PCI围术期死亡的主要原因为泵衰竭、室颤和（或）心脏骤停、多脏器功能衰竭、心脏破裂及支架内血栓形成。     

急性冠状动脉综合征介入治疗联合应用盐酸替罗非班对围手术期转归的影响

目的:探讨在急性冠脉综合征(ACS)患者病程中常规治疗联合应用盐酸替罗非班对心肌组织水平再灌注与围PCI术期严重心脏不良事件(MACE)的影响。方法:2005—2006年间15例在急诊或择期PCI术前具有形成血栓的高危因素或PCI术时发现慢血流现象或血栓的ACS患者,在术前、术中或术后应用盐酸替罗非班,按推荐剂量经外周静脉或冠脉内直接注入药物,观察15～20min后相关血管的血栓征象、血栓负荷、TIMI分级情况、术后MACE及出血并发症等。结果:15例ACS患者,男性13例,女性2例,年龄44～75岁,起病时间在数小时至数天。全部患者术中即刻造影均未见有明显的新发血栓形成,原有新鲜血栓消失,肇事血管前向血流由TIMI0～2级恢复至TIMI3级。术后14例患者术后一般情况稳定,症状明显改善或消失,住院期间未发生MACE与出血并发症,但有1例患者在住院期间因心源性休克、多器官功能衰竭死亡。结论:对ACS介入治疗围手术期存有靶血管高危因素存在(如慢血流、血栓等征象)的患者,经冠脉或外周静脉应用盐酸替罗非班有助于改善心肌组织再灌注水平,减少围手术期血栓并发症所致的MACE发生。     

冠心病PTCA＋支架术及药物再干预对左心重构和左室功能的影响

目的研究PTCA＋支架术对左心重构和左室功能的影响及药物再干预的效果。方法对98例冠心病患者经皮冠状动脉介入治疗（PCI）术后1年内4组与术前左心重构、左室功能的临床与超声指标对比研究，对不同PCI策略和不同药物干预效应与左心重构和左室功能的关系进行分析。结果PCI术后1年内4组比术前NYHA心功能分级、6min步行、左房容量指数（LAVI）、左室舒张末容量指数（LVEDVI）、室壁运动缺失分数（WMLF）、射血分数（EF）有极显著的改善（均P〈0．001）；PCI6个月组和12个月组比PCI 1周组上述6项指标有显著的改善（均P〈0．01）；不同PCI策略之间LAVI、LVEDVI、WMLF、EF有显著差别；PCI术后辛伐他丁组、厄贝沙坦组比常规药物组LAVI、LVEDVI、WMLF、EF有显著的改善，而替罗非班组与常规药物组比较4项指标差异不显著。结论冠心病PCI术后1年左心重构和左室功能有显著的改善，恰当的PCI策略和药物再干预对左心重构和左室功能的改善产生更有利的影响。     

Complications related to procedures for acute coronary syndrome

Recent advances in thrombolytic therapy and percutaneous coronary intervention (PCI) have resulted in dramatic improvements in the outcome of patients with acute coronary syndromes (ACS). Unfortunately, the reduced risk of cardiac and non-cardiac complications associated with advancements in technology has also been paralleled by an increase in the incidence of some complications. The most important complications relate to abrupt vessel closure with PCI, which may result in myocardial infarction or cardiac death. Major bleeding is also a relatively frequent non-cardiac complication of thrombolytic therapy and it is associated with a poor hospital prognosis. Most complication can be prevented or at least minimized with proper strategy, execution, and patient selection.     

氯吡格雷双倍剂量对冠脉介入术后氯吡格雷抵抗患者缺血及出血事件的影响

目的 评价经皮冠状动脉介入治疗(PCI)后,氯吡格雷抵抗患者服用双倍剂量氯吡格雷的有效性及安全性.方法 依据血栓弹力图(TEG)的测定结果,将入选的134例氯吡格雷抵抗患者分为常规剂量组67例与双倍剂量组67例,随访观察两组患者PCI术后6个月时临床缺血及出血事件的发生率.结果 双倍剂量组与常规剂量组患者相比较,主要不良心血管事件的发生率明显降低,而出血事件发生率在两组患者间比较,差异无统计学意义.结论 增加氯吡格雷的维持剂量,可以减少冠心病患者PCI术后缺血事件的发生,且不增加患者的出血风险.     

Patient recovery and transitions after hospitalization for acute cardiac events: an integrative review

Despite increased attention to providing seamless transitions after hospitalization, patients often feel unprepared, lack knowledge, and may be confused by what to expect during recovery at home after a cardiac event. Care transition after hospital discharge could be improved by informing and counseling patients more specifically about expected recovery after a cardiac event. Therefore, an integrative review of research was conducted to evaluate cardiac patients' trajectory of recovery after hospitalization. A total of 61 studies were included in this review. Studies included were those of cardiac patients who had been hospitalized for significant cardiac events and those focused on acute coronary syndrome (n = 18), percutaneous coronary intervention (PCI) (n = 12), cardiac surgery (coronary artery bypass surgery and valve surgery; n = 25), and heart failure (n = 6). Studies included quantitative, mixed-methods, and qualitative designs, with sample sizes ranging from 4 to 2121 participants. Notwithstanding the limitations of this review, findings demonstrated that patients' perceptions of their cardiac event evolved over time from uncertainty, fears, anxiety, and depression, which were often associated with a lack of knowledge of their cardiac condition, to a phase of self-management of their cardiac condition. Furthermore, patterns of commonly occurring symptoms and changes in functioning abilities during recovery after hospitalization were apparent among the different cardiac groups. These findings may be useful to both patients and clinicians to inform them about the recovery trajectory after a cardiac event to improve preparation for the transition from hospital to home.     

Thrombolytic therapy vs primary percutaneous intervention after ventricular fibrillation cardiac arrest due to acute ST-segment elevation myocardial infarction and its effect on outcome

The aim of this study was to evaluate the effect of thrombolytic therapy on neurologic outcome and mortality in patients after cardiac arrest due to acute ST-elevation myocardial infarction and to compare this with those in patients treated with primary percutaneous coronary intervention (PCI). We retrospectively examined patients after they had ventricular fibrillation cardiac arrests. To assess the effect of thrombolysis and PCI on outcome, we used odds ratios and their 95% confidence intervals and logistic regression modeling. Thrombolysis was applied in 101 patients (69%) and PCI in 46 patients (31%). More patients who received thrombolysis had favorable functional neurologic recovery (cerebral performance category 1 and 2) and survived to 6 months compared with patients with primary PCI (P = .38 and P = .13, respectively). In patients with cardiac arrest due to ST-elevation myocardial infarction, it may be acceptable to use thrombolysis as a reperfusion strategy. This applies especially in hospitals where immediate PCI is not available.     

不同性别高龄急性冠脉综合征患者介入治疗的预后分析

目的探讨性别差异对高龄急性冠脉综合征患者经皮冠状动脉介入治疗预后的影响。方法回顾性分析80例85岁以上急性冠脉综合征患者,观察性别差异对住院期间和长期预后的影响。结果女性组高血压病、单支病变及DES植入比例略高;而既往心肌梗死史、既往冠脉介入治疗史、血脂异常、三支病变比例低于男性组。住院期间主要心血管不良事件(MACE)发生率要高于男性组(10.8%vs 7.0%;P>0.05)。随访1年时MACE发生率两组相似(5.7%vs 4.9%;P=0.10)。尽管80%患者仅植入1个支架,但1年生存率较高。结论高龄女性ACS接受PCI住院期间MACE发生率要高于男性,不完全血运重建策略仍可使这一特殊人群长期获益。     

A Case of Neurologically Intact Survival after 2 hours and 50 minutes of Euthermic Cardiac Arrest Treated with Mechanical CPR and Intra-arrest Percutaneous Coronary Intervention

We report a case of a 56 year old male in ventricular fibrillation (VF) cardiac arrest for a total of 2?hours and 50?minutes who was diagnosed with ST elevation myocardial infarction (STEMI) during a brief 10?min period of return of spontaneous circulation (ROSC). The patient underwent successful percutaneous coronary intervention (PCI) while receiving mechanical chest compressions for ongoing VF. Our case demonstrates the potential for neurologically intact survival in VF cardiac arrest patients despite prolonged periods of VF who are treated with mechanical CPR and intra-arrest PCI.     

替罗非班与维拉帕米治疗急性冠脉综合征介入术后无复流的临床疗效对比研究

目的对比观察替罗非班与维拉帕米治疗急性冠脉综合征(ACS)介入术后无复流的临床疗效。方法选取经皮冠状动脉介入术后无复流ACS患者60例随机分为替罗非班治疗组和维拉帕米治疗组。经冠状动脉给药后48h,观察并记录两组患者TIMI血流分级及心电图变化;术后2周,观察并记录心源性猝死、再发心绞痛、新发心肌梗死等心脏不良事件的发生率。结果替罗非班组TIMI血流0级、1级发生率显著低于维拉帕米组,TIMI血流2级、3级发生率显著高于维拉帕米组,两组比较差异有显著性(P0.05);替罗非班组心电图改善明显,与维拉帕米组比较差异有显著性(P0.05);术后2周替罗非班组不良心脏事件发生率显著低于维拉帕米组(P0.01)。结论替罗非班治疗急性冠脉综合征介入术后无复流现象安全有效,值得临床推广使用。     

心脏康复护理对冠心病PCI术后患者运动耐力及生活质量的影响

目的观察心脏康复护理在冠心病经皮冠状动脉介入(PCI)术后患者中的应用效果。方法将我院120例接受PCI术治疗的冠心病患者随机分为对照组(n=60,常规护理)和观察组(n=60,常规护理+心脏康复护理)。比较两组的干预效果。结果护理后,两组的无氧阈、峰值氧耗量、METs、最大运动功率、LVEF、CI及生理机能、躯体疼痛、社会功能、精神健康、精力评分均升高,LAVImax及Gensini评分均降低,且观察组优于对照组(P<0.05)。结论给予冠心病PCI术后患者心脏康复护理,有助于增强患者的运动耐力,改善其心脏功能及冠脉扩张能力,提升生活质量。     

高敏C反应蛋白结合压力导丝在临界冠脉病变介入治疗中的应用效果评价

目的探讨高敏C反应蛋白联合压力导丝检查对冠心病临界病变介入治疗的指导作用及对术后发生主要心脏不良事件的影响。方法75例临床诊断冠心病患者术前检测高敏C反应蛋白（hs—CRP）,经冠状动脉造影检查明确至少有1支主要冠状动脉狭窄程度在40％--70％,所有患者均行压力导丝检查测定血流储备分数（FFR）。根据FFR值将患者分为PCI组和对照组,PCI组：对FFR〈0．75的病变行PCI治疗,其中根据hs-CRP值又分为hs-CRP升高组（≥3mg／L）和hs-CRP正常组（〈3mg／L）;对照组：对FFR≥0．75的病变予药物保守治疗。观察PCI组中患者病变处及支架植入数量,比较3组住院和随访期间发生典型心绞痛、非致死性心肌梗死、心源性死亡和靶血管重建等主要心脏不良事件（MACE）的发生率。结果hS—CRP升高PCI组共有31处临界狭窄病变,置入支架45枚;hs-cRP正常PCI组共有26处临界狭窄病变,置人支架29枚;2组患者在临界病变数及植入支架数方面比较差异均有统计学意义（P〈0．05）。主要心脏不良事件方面,bCI冲升高PCI组显著高于hs-CRP正常PCI组（P〈0．01）;而hs-CRP正常PCI组与对照组比较无显著差别。结论hs-CRP检测联合FFR检查可指导冠心病临界病变介入治疗,并可预测术后的心脏不良事件发生率。     

Response of serum C-reactive protein to percutaneous coronary intervention has prognostic value

BACKGROUND: Data are sparse regarding the association between C-reactive protein (CRP) and percutaneous coronary intervention (PCI) in long-term prognosis. Previous studies have shown that PCI evokes an inflammatory response. We tested the hypothesis that the CRP response to PCI has a prognostic value. METHODS: We investigated 891 consecutive patients presenting with stable or unstable angina pectoris, with serum concentrations of cardiac troponin T < or =0.03 microg/L, who were undergoing a variety of PCIs. Serum concentrations of CRP and cardiac troponin T were determined before and the day after PCI. The mean follow-up time after PCI was 2.6 years, and the endpoint was death or nonfatal myocardial infarction. RESULTS: Seventy-six patients reached the endpoint (4.6% death, 3.9% nonfatal myocardial infarction), whereas 21% developed myocardial infarction during the procedure. CRP increased more than 2-fold after the procedure. Patients in the third tertile of the CRP response to PCI had an increased risk for death or nonfatal myocardial infarction in multivariate analysis. CONCLUSIONS: Increased serum CRP in response to PCI is an independent predictor of death or nonfatal myocardial infarction independent of myocardial injury during the procedure. CRP determinations might be of value in risk stratification after PCI.     

冠心病PCI术后患者心脏康复认知现状及影响因素分析*

目的: 探讨冠心病PCI术后的患者心脏康复认知水平,分析影响心脏康复认知水平的相关因素。方法: 采用一般资料调查表、冠心病健康信念量表、自制心脏康复认知度量表对首次行PCI术的115例冠心病患者进行现况调查。结果: 冠心病PCI术后患者的心脏康复认知水平得分为(14.54±3.69)分,处于中下水平;年龄、文化程度、是否接受过相关知识宣教、知觉到益处及知觉到严重度影响冠心病患者的心脏康复认知水平（P<0.05）。结论: 冠心病PCI术后患者的心脏康复认知水平处于中下水平,有较大提升空间。医护人员可针对年龄较大、文化程度较低的冠心病患者开展个性化的心脏康复知识宣教,以促进患者更好地了解心脏康复的益处、改善患者的心脏康复认知现状,从而提高患者心脏康复的依从性及参与水平。     

血管内超声技术在介入治疗左主干病变中的应用价值

目的 评价血管内超声显像(IVUS)在介入治疗左主干病变中的应用价值.方法 对左主干病变63例患者进行IVUS检查,根据IVUS面积狭窄率进行分组,IVUS面积狭窄率I>50%为介入治疗组(33例)及IVUS面积狭窄率<50%为对照组(30例).介入治疗组采取介入干预治疗;对照组采取常规药物治疗.观察IVUS面积狭窄率及斑块的特征,并进行随访观察并发症.结果 介入治疗组斑块性状以软斑块及偏心性斑块为主,介入治疗中无明显的并发症,随访1年,介入治疗组再发心绞痛4例(12.1%).对照组发生再发心脏事件18例(60.0%),其中发生心绞痛6例,阵发性室速5例,急性心肌梗死3例(均行IVUS,显示左主干为罪犯血管),频发室性期前收缩3例,猝死1例.2组患者心脏事件发生率比较差异有统计学意义(x2=13.81,P<0.01).结论 IVUS对左主干的狭窄程度及指导介入治疗有一定的价值,对IVUS面积狭窄率≥50%的病变进行介入治疗预后良好.

Abstract：

Objective To evaluate the clinical application value of intravascular ultrasound(IVUS) in the treatment of left main coronary stenosis. Methods Sixty-three patients with left main coronary stenosis were identified by IVUS to evaluate the plaque characteristics and the severity of the stenosis. According to the severity of the stenosis,the patients were divided into percutaneous coronary intervention ( PCI) group (IVUS=50% ) (n = 33 ) and control group (IVUS < 50% ) (n = 30). The group of PCI was treated by PCI. The control group was treated by routine therapeutic agents. The profiles of plaques and stenosis were described. The complications were recorded by follow-up visits. Results More soft and eccentric plaques were found in PCI group. After one year follow up,cardiac events (angina) occurred in 4 cases (12. 1% ) in PCI group. In control group, cardiac events ocurred in 18 patients (60. 0%), including 6 cases of angina, 5 case of paroxysmal ventricular tachycardia,3 cases of myocardial infarction (confirmed by IVUS,showing that the left main coronary artery was responsible for the event), 3 cases of frequent premature ventricular contraction and 1 case of sudden death. There was a significant difference in the occurrence rate of cardiac events between PCI group and non-PCI group (x2 = 13. 81 ,P <0.01). Conclusion IVUS is useful for the identification and treatment guidance. Intervention therapy produces good prognosis in patients with IVUS-identified left main coronary stenosis by more than 50% of the area.     

对经皮冠状动脉介入术后超声观察心功能变化研究现状与进展

随着社会结构向老龄化转变,心血管疾病发病率逐渐攀升。及时采用经皮冠状动脉介入(PCI)是治疗急性冠脉综合征(ACS)和改善预后的重要手段。超声成像技术对评价ACS患者缺血心肌及心功能改变情况具有突出优势,对判断病情发展与预后有重要意义。本文对超声技术评估PCI术后心功能变化研究现状及进展进行综述。     

Percutaneous coronary intervention for ST-segment and non-ST-segment elevation myocardial infarction at hospitals with and without on-site cardiac surgical capability

OBJECTIVE: To compare the safety and efficacy of percutaneous coronary intervention (PCI) for acute myocardial infarction performed at a hospital without cardiac surgical capability with PCI performed for acute myocardial infarction at a center with on-site surgery. PATIENTS AND METHODS: We included patients with acute myocardial infarction in whom PCI was performed from March 1, 2000, through May 31, 2002, at a community hospital (Immanuel St Joseph's) without on-site surgery. The procedural success, in-hospital adverse cardiac events, and 6-month follow-up were compared with those of PCI performed for acute myocardial infarction in matched controls from January 1, 2000, through February 28, 2002, at a center with cardiac surgery (Saint Marys Hospital). RESULTS: One hundred sixty patients (and 160 matched controls) underwent PCI for acute myocardial infarction. The procedural success rate was high and similar for the 2 groups (96% vs 95%; P=.79). In-hospital mortality, Q-wave myocardial infarction, and target vessel revascularization were low and similar for the 2 groups. No patient was referred for emergency coronary artery bypass graft surgery for failed PCI. Six-month survival from all-cause mortality was 96% for the Immanuel St Joseph's group and 94% for the Saint Marys Hospital group (P=.92). Subgroup analysis of patients with primary PCI for ST-segment elevation acute myocardial infarction revealed high procedural success and low and similar rates of major cardiac adverse events in the 2 groups. CONCLUSION: This study shows that PCI for acute myocardial infarction can be performed safely and effectively in a community hospital without on-site cardiac surgery.     

信息-动机-行为模型在冠心病患者经皮冠状动脉介入术后心脏康复中的应用研究

目的 探讨信息-动机-行为(information-motivation-behavioral,IMB)模型在冠状动脉粥样硬化心脏病(冠心病)患者经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术后心脏康复中的应用效果。方法 选取2021年1月-12月在心血管内科行PCI术的120例冠心病患者。按照随机数字表法将其分为对照组和研究组,各60例。对照组给予心脏康复健康教育,研究组在对照组基础上应用IMB模型进行个体化教育,比较2组干预3个月后的心脏康复信息需求和依从性。结果 干预3个月后,研究组心脏基础知识、营养知识、药物知识、心理压力、紧急与安全、风险因素评分及心脏康复依从性各条目评分均高于对照组(P＜0.05)。结论 应用IMB模型进行个体化教育,能改善冠心病PCI术后患者的心脏康复信息需求和依从性。     

冠心病患者 PCI 术后心肌纤维化与心脏功能的变化

【目的】探讨冠心病患者PCI术后心肌纤维化与心脏功能的变化。【方法】选取自2013年6月至2015年1月在本院接受经皮冠状动脉介入治疗（PCI）的150例冠心病患者,观察患者在PCI手术前及术后3个月、6个月、12个月的血清Ⅰ、Ⅲ型前胶原（PCⅠ、PCⅢ）、层黏蛋白（LN）、透明质酸（HA）水平的变化以及左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）的改善情况。【结果】PCI手术后,冠心病患者血清PCⅠ、PCⅢ、LN、HA水平较术前明显降低,LVEF较术前明显增加,LVEDD较术前明显降低,差异均具有统计学意义（均P＜00．5）。【结论】PCI手术能够明显改善冠心病患者心肌纤维化及心脏功能。