PTCA导丝在冠状动脉造影桡动脉痉挛时的应用价值

目的探讨经皮冠状动脉(冠脉)腔内血管成形术(percutaneous transluminal coronary angioplasty,PTCA)导丝在冠脉造影桡动脉痉挛时的应用价值。方法将行经桡动脉冠脉造影和(或)介入治疗术发生桡动脉痉挛的106例分为PTCA导丝组36例和药物组70例。PTCA导丝组在造影路径指导下更换泥鳅导丝为PTCA导丝完成造影;药物组沿鞘管侧管注入维拉帕米1 mg和硝酸甘油200μg,等待5 min后再次行桡动脉造影,观察两组经桡动脉冠脉造影成功率及并发症。结果药物组重度痉挛占88.6%,弥漫痉挛占38.6%;PTCA导丝组重度痉挛占97.2%,弥漫痉挛占41.7%,两组痉挛严重及弥漫程度比较差异无统计学意义(P>0.05)。PTCA导丝组PTCA导丝均通过病变部位,在PTCA导丝指引下5 F造影导管通过病变部位冠脉造影成功率94.4%。药物组再次造影桡动脉痉挛改善,经桡动脉冠脉造影成功率84.3%,两组比较差异无统计学意义(P>0.05)。药物组、PTCA导丝组手术时间分别为(45.6±18.1)min、(29.1±13.7)min,两组比较差异有统计学意义(t=4.80,P=0.001)。PTCA导丝组出现血管并发症2例(5.6%);药物组出现血管并发症18例(25.7%),两组比较差异有统计学意义(χ2=7.41,P=0.01)。结论冠脉造影桡动脉痉挛时可尝试使用PTCA导丝完成造影,该方法安全可行。     

冠脉旁路移植术中桡动脉的应用

目的：探讨冠脉旁路移植术中获取桡动脉的技术及安全措施。方法：通过对桡动脉解剖的认识,从术前判断、术中获取技术和术后防止血管桥痉挛3个方面回顾总结63例不停跳冠脉旁路移植术中获取桡动脉的经验。结果：所有患者均无前臂运动功能障碍,3例出现短暂感觉异常。无前臂及手部缺血并发症。桥血管近期通畅率满意。结论：正确的术前评价、术中和术后适当地保护桡动脉是安全获取桡动脉作为血管桥材料的必要保证。     

Migraine and Angina Pectoris by Coronary Artery Spasm

A migrainous patient who experienced chest pain attributed to engine pectoris by coronary artery spasm during a migraine attack is reported. Previous reports have already mentioned the association of these two conditions and suggested that it might be the manifestation of a generalized vasospastic disorder. This new report offers an opportunity to review and discuss the available data on such an association.     

经皮冠状动脉内多普勒超声技术对冠状动脉血流储备的研究

在１１例正常人和２０例冠状动脉狭窄（≥５０％）患者中，采用冠状动脉内多普勒超声血流钢丝和冠脉内注射罂粟碱测量冠状动脉血流储备（ＣＦＲ）。结果表明，冠状动脉狭窄组平均最大血流速度（ＡＰＶ）和ＣＦＲ均低于正常组测值（Ｐ值＜０．００１），冠状动脉内注射罂粟碱安全、可靠。这一方法的临床应用对冠心病患者冠状动脉血流储备的评价提供了可靠的新方法     

Coronary CT Angiography for the Detection of Obstructive Coronary Artery Disease

Contemporary CT scanners offer high temporal and spatial resolution, permitting visualization of the rapidly moving heart and coronary arteries. The imaging of coronary artery lumen and detection of obstructive coronary artery disease is feasible with 64-detector-row and higher generation CT scanners. The diagnostic accuracy of coronary CT angiography as compared to invasive coronary angiography is good (sensitivity of 85%–100%, specificity of 85%–99%). The major strength of coronary CT angiography is the high negative predictive value (96% to 99%) that permits excluding significant coronary artery stenosis with high accuracy, when optimal image quality is achieved. Therefore, coronary CT angiography is an appropriate diagnostic test for a selected patient population with a low to intermediate probability of coronary artery disease.     

Aortoiliac Angiography During Coronary Artery Angiography Detects Significant Occult Aortoiliac and Renal Artery Atherosclerosis in Patients with Coronary Atherosclerosis

PURPOSE: Peripheral atherosclerosis (renal and aortoiliac localizations) are frequently detected in aged patients with concomitant coronary artery disease (CAD): the risk of finding peripheral disease is increased in patients with CAD. Angiography of the aortoiliac vessels performed at the time of coronary angiography may detect any occult renal artery stenosis and atherosclerotic involvement of the aortoiliac segment. We sought to determine utility of performing angiography of aortoiliac and renal arteries during coronary arteriography in patients with known or suspect coronary atherosclerosis. METHODS: Medical records of all patients undergoing combined coronary and aortoiliac angiography between May 1998 and December 2002 was retrospectively reviewed. Moderate to severe arterial stenosis (>50% stenosis), vessel occlusion, aneurismal vessels were noted as significant angiographic findings. Contrast-induced nephropathy was defined as a rise in serum creatinine of > or =25% form baseline. RESULTS: In the study period 112 patients (81 males, mean age 68.4+/-7.8 years) with known or suspected CAD underwent combined cardiac catheterization and aortoiliac angiography. Pretreatment with 0.45% saline at a rate of 1 ml/kg/h for 12 h was administered to all patients. Significant findings were reported in 37 (33%) patients including 14 renal artery stenoses, 8 aortic aneurismal disease, and 15 aortoiliac lesions. Most patients with significant findings had 2 and 3-vessel CAD. A strong correlation was found between the number of risk factors and the frequency of angiographic findings (r = 0.92). Complications include six contrast-induced nephropathy: no case required renal replacement therapy. CONCLUSIONS: Aortoiliac and renal atherosclerosis is frequently associated to multivessel CAD. In selected patients undergoing cardiac catheterization aortoiliac angiography may be practical in detecting occult renal or aortoiliac artery lesions. Further clinical outcome studies are strongly required to support this strategy.     

实验性冠状动脉痉挛及缓解痉挛的超声心动图研究

以麦角新碱诱发实验犬的冠状动脉痉挛及巯甲丙脯酸缓解冠状动脉痉挛进行了超声心动图研究。结果表明，痉挛组左室扩大，室壁运动呈节段性减弱或不协调，心功能下降；治疗组左室轻度扩大，室壁运动幅度减弱及心功能下下降逐渐恢复正常；痉挛组和治疗组各项指标均相差非常显著。     

Coronary Artery CT Angiography for Plaque Imaging

Cardiac CT is becoming a mainstream and integral part of many cardiology practices based on a vast base of literature supporting and validating its clinical utility. As the technology continues to advance, coronary imaging has improved in stride. In the next several years, cardiac CT may become the “gatekeeper” of cardiac testing, surpassing the more common and widespread nuclear testing as the initial strategy in evaluating ischemia. Unfortunately, in spite of an arsenal of tests available to detect clinically significant stable coronary artery disease, many people continue to suffer acute myocardial infarction and other acute coronary syndromes, leading to significant morbidity and mortality due to unstable coronary artery disease. These unstable, “vulnerable” plaques continue to plague cardiologists across the globe. The ability to identify vulnerable plaque is a step in the right direction toward therapy. It is in this particular arena that advancements in cardiac CT technology may bear the most fruit. A growing body of evidence supporting the utility of cardiac CT in plaque imaging has emerged and has demonstrated that potentially unstable coronary artery disease is able to be identified accurately and noninvasively.     

冠状动脉造影对心肌桥的检测及临床意义

目的 探讨冠脉造影中心肌桥的检出率及其临床意义。 方法 根据冠状动脉造影显示冠状动脉管腔收缩期狭窄判定心肌桥，并根据收缩期狭窄程度分为3级。 结果 1447例行冠状动脉造影的患者中共检出心肌桥10例，检出率2．2％，全部位于左前降支。2例在心肌桥近端有粥样硬化病变，管腔固定狭窄达70％以上，置入支架。其他有症状病例经药物治疗，临床症状消失。 结论 冠状动脉造影时收缩期狭窄是判定心肌桥的惟一依据，心肌桥可导致缺血性心脏事件，对有缺血症状者应予适当治疗。     

共用型造影导管在经桡动脉行冠状动脉造影的应用

目的探讨使用4F、5F共用型导管经桡动脉径路冠状动脉造影的可行性。方法入选2004年11月至2005年6月，在我院行择期经桡动脉径路冠状动脉造影65例患者，术前给予阿司匹林、波立维等抗血小板药物。并进行Allen试验，穿刺右侧桡动脉。选择Temm04F、5F共用型造影管，当使用共用型造影管难以完成时换用Judkins造影导管。结果64例患者经桡动脉穿刺成功，成功率98．4％，1例改为肱动脉穿刺成功。冠状动脉造影正常18例，冠状动脉造影异常48例，行冠状动脉介入治疗19例。结论经桡动脉行冠状动脉造影，使用共用型导管操作较简单，节省时间，较易进入左冠状动脉口，造影成功率高，本组不论选择4F或5F共用型造影导管均顺利完成左冠状动脉造影，但使用其做右冠状动脉造影需要一定经验和技巧。若难以完成时核用JudkinsR型造影导管，本组未发生桡动脉痉挛现象。1例出现前臂血肿，未经特殊处理，自行吸收，2例加压不当，引起手部浮肿。总之，使用共用型造影管经桡动脉径路冠状动脉造影，操作简便快速，病人痛苦少，安全有效，成功率高，值得临床推广应用。     

冠状动脉造影同时行选择性肾动脉造影的临床意义

目的评估冠状动脉(冠脉)造影的同时行选择性肾动脉造影的可行性、安全性及其临床意义.方法2001年7月至2002年7月,共纳入792例在冠脉造影后即刻行选择性双侧肾动脉造影的病人,分析肾动脉造影情况、肾动脉狭窄发病率及其相关因素,并随机抽取145例病人测定其手术前后血清肌酐变化.结果冠脉造影同时行双侧肾动脉选择性造影成功率高(99.6%),造影病人术前后血清肌酐无明显变化(78μmol/L±11μmol/L;77μmol/L±3μmol/L,P＞0.05);肾动脉狭窄总体发生率为19.1%(151/792),明显狭窄(＞50%)占7.2%(57/792),双侧肾动脉明显狭窄发生率为4%(32/792);多因素分析显示肾动脉明显狭窄与年龄(＞70岁)、高血压、多支冠脉病变显著相关.结论在冠脉造影病人中行选择性双侧肾动脉造影安全、可行,对准确发现肾动脉狭窄有重要意义.     

无创检查对冠状动脉造影术前左冠状动脉主干病变的预测价值

目的:探讨无创检查在冠状动脉造影术(CAG)前预测左冠状动脉主干病变(LMD)的临床价值。方法:回顾性分析我院2003年4月～2008年4月经CAG确诊的27例LMD临床特点,以及CAG前心电图(ECG)、活动平板运动试验(TET)、64层CT(64-MSCT)检查结果,总结预测LMD的因素。结果:27例中单纯LMD7例,合并3支血管病变20例。27例均有静息性心绞痛(AP)发作史,21例静息ECG有导联分布广泛缺血性改变,27例AP发作时均有导联分布广泛缺血性改变。9例行TET均诱发AP且伴缺血性改变,6例出现室性心律失常。7例行64-MSCT检查均提示LMD。结论:对程度严重静息性AP发作尤其合并晕厥、左心衰竭等血流动力学紊乱者,应高度怀疑LMD,静息ECG正常者亦不能排除LMD。ECG、TET及64-MSCT检查可作为CAG前LMD筛查手段。     

冠心病患者行肾动脉造影的临床意义

[目的]探讨冠心病患者动脉粥样硬化性肾动脉狭窄(RAS)的发生率和危险因素.[方法]对行冠状动脉造影的484例患者同时进行肾动脉造影.[结果]在冠心病患者中,RAS的发生率为12.1%(38/314).RAS的发生率随着冠状动脉病变程度的加重而增加(P<0.01).[结论]对冠心病患者,尤其多支病变,应根据病情需要行肾动脉造影.     

经食管心脏超声及冠脉造影对冠状动脉的对照研究

采用经食管心脏超声技术在20例成年患者中成功的显示了27条左和/或右冠状动脉.并对其中10例作了同期冠脉造影,结果提示两种方法对冠脉直径测定值近似。结论认为,作为非创伤、非放射线性冠状动脉解剖学诊断措施。经食管心脏超声具有潜在优势。     

冠状动脉造影患者中肾动脉狭窄的相关研究

目的在进行冠状动脉造影的患者中同时进行肾动脉造影,观察肾动脉狭窄的发生率及相关因素研究。方法200例冠状动脉造影患者全部行选择性双侧肾动脉造影,对临床资料和肾动脉狭窄之间的关系进行单变量分析。结果肾动脉狭窄者27例,占13.5%,其中轻度狭窄者（〈50%）13例,占6.5%,明显狭窄者14例,占7.0%。明显肾动脉狭窄单变量分析,年龄、吸烟、高血压、糖尿病、颈动脉斑块形成、严重冠状动脉病变是肾动脉狭窄的影响因素。结论在冠状动脉造影尤其冠心病患者中,肾动脉狭窄发生率高,多见于老年合并高血压、严重冠状动脉病变患者,在冠心病患者行冠状动脉造影的同时应常规进行肾动脉造影,以便及早发现肾动脉狭窄。     

经桡动脉和股动脉途径行冠状动脉造影和介入治疗的比较

目的:比较经桡动脉和股动脉两种途径行冠状动脉造影和介入治疗(PCI)的优劣,评价经桡动脉途径的安全性、可行性。方法:选择2004年1月-2007年2月行冠状动脉造影检查及介入治疗的338例患者为研究对象,按途径分为两组,桡动脉组153例,男性102例,女性51例,平均年龄63±11岁;股动脉组185例,男性131例,女性54例,平均年龄64±12岁,比较两组手术成功率、并发症发生率、手术操作时间和住院时间。结果:桡动脉组和股动脉组造影成功率分别为96.7%、98.9%(P>0.05);曝光时间分别为8′54″±4′30″,6′45″±3′38″(P>0.05)。PCI的成功率分别为98.0%、98.9%(P>0.05);曝光时间分别为16′30″±7′20″,18′49″±4′30″(P>0.05)。严重并发症(死亡和急诊冠脉旁路移植术)两组无区别,桡动脉组2例(1.3%)死亡,2例(1.3%)血肿,1例(0.7%)出现右侧桡动脉闭塞,1周后桡动脉搏动恢复;股动脉组局部出血总发生率为10.2%(19例),发生排尿困难需留置导尿18例(9.7%),拔管时迷走反射6例(3.2%)。死亡1例(0.5%)。两组住院时间分别为2.3±1.3 d和3.5±1.1d,桡动脉组住院时间较短(P<0.05)。结论:与股动脉途径相比,经桡动脉途径行冠状动脉造影和介入治疗术后并发症少,住院时间短,患者依从性高,是一种安全、有效的方法,值得推广。     

64排螺旋CT冠状动脉造影与传统冠状动脉造影的对照研究

目的探讨64排螺旋CT冠状动脉造影（computed tomography coronary angiography, CTCA）,,对冠状动脉疾病的诊断价值。方法56例确诊或怀疑为冠心病的患者均行64排螺旋CT冠状动脉成像和传统冠状动脉造影（conventional coro-nary angiography,CCA）检查,并以CCA的诊断结果作为金标准,采用美国心脏协会冠状动脉改良分段法,分析共825个冠状动脉节段CTCA图像质量及其对冠状动脉狭窄的显示情况,得出CTCA诊断有意义病变（冠状动脉狭窄≥50％）fl＇,J正确性,并分析影响CTCA图像质量的主要因素。结果798个冠状动脉节段图像可以满足诊断要求,12个节段中因运动伪影或15个节段管壁严重钙化无法对血管腔进行评估。64排螺旋CT冠状动脉成像诊断≥50％狭窄总的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为88．1％、97．8％、89．9％、97．4％和96％。影响图像质量主要因素为快心率、严重钙化。结论64排螺旋CT冠状动脉成像图像质量高,对冠状动脉疾病的诊断十分准确,可作为一种简便易行、安全可靠的无创性筛查冠心病的有效方法。