急性心肌梗死患者经皮冠状动脉介入治疗术后并发急性脑梗死一例

患者,男,74岁,因“突发胸闷、胸痛3小时”入院.既往有高血压10年,糖尿病5年.患者3小时前无明显诱因突然出现心前区疼痛,胸骨后闷痛,伴心悸、出汗,无肩背痛,无黑朦、晕厥,含服硝酸酯类药物胸痛不缓解,2013年11月8日就诊于我院急诊科.心电图检查示：Ⅲ度房室传导阻滞,V1～V5导联ST-T抬高,考虑急性广泛前壁ST-T抬高型心肌梗死,立即给予阿司匹林300 mg,硫酸氢氯吡格雷300 mg口服,并收住院.入院查体：T 36.5℃,P 50次/分,Bp 125/70 mmHg,R 19次/分.神志清楚,表情痛苦,面色苍白,末梢凉,双侧瞳孔等大等圆,对光反射存在,双肺少许湿罗音,心率50次/分,心音弱,律齐,无杂音,其余查体无明显异常.     

冠状动脉造影术后并发急性肺栓塞1例

患者女性，59岁。因发作性胸闷、胸痛、心慌2年，加重10天入院，其胸痛为心前区钝痛，持续1min左右自行缓解。既往有高血压病史。入院查：BPl35／80mmHg，神志清，言语流利切题，全身皮肤无黄染，浅表淋巴结无肿大。头颅无畸形，颜面浮肿。双侧瞳孔等大等圆，对光反射灵敏，口唇无紫绀，     

经皮冠状动脉介入治疗出血并发症的治疗进展

冠状动脉疾病（CAD）是心内科的常见病,近年来对于该疾病的治疗有了迅速的发展,经皮冠状动脉介入治疗（PCI）作为一种有效治疗CAD的手段日益应用广泛,使得缺血事件大大降低,但出血并发症却不断增加。现对PCI患者出血、贫血和输血等情况作一综述。     

经皮冠状动脉介入治疗并发急性心包填塞临床分析

目的探讨经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后急性心包填塞的早期诊断、治疗及其预防措施。方法回顾性分析2009年5月至2014年4月中国人民解放军第二五二医院完成的4800例经皮冠状动脉介入治疗中并发急性心包填塞4例,其中男2例,女2例,平均(63.25±11.76)岁。结果 4800例经皮冠状动脉介入治疗中发生急性心包填塞4例,发生率为0.08%。4例发生于慢性完全闭塞性病变,其中前降支2例,回旋支1例,右冠状动脉1例。导丝至冠状动脉穿孔4例。3例行心包穿刺置管持续引流、鱼精蛋白中和肝素;1例为带膜支架覆盖冠脉内穿孔处,4例抢救成功。结论急性心包填塞是PCI治疗严重并发症,早期诊断并及时治疗是减少死亡率的关键。     

经皮冠状动脉介入治疗后致死性肺栓塞的临床分析

目的针对经皮冠状动脉介入治疗后并发致死性肺栓塞的患者,探讨其临床转归和处理方法。方法选择我科6年来所有冠状动脉介入术后并发致死性肺栓塞的病例,观察其发生、发展和转归。结果共7例患者(男5例,女2例)冠状动脉介入术后并发致死性肺栓塞;平均年龄(55.9±11.7)岁;其中单纯冠状动脉造影5例,介入治疗2例;所有患者均表现为冠状动脉介入术24 h 后下地时或排便时突发呼吸心跳停止。经紧急心肺复苏,除颤后仍直接死亡3例,4例恢复呼吸心跳。恢复呼吸心跳患者均行溶栓治疗,最终脑死亡1例,好转后出院3例,该3例经过6个月～6年随访均症状稳定,无再发肺栓塞。结论经皮冠状动脉介入治疗后致死性肺栓塞的发生罕见,急性期预后极差,如果抢救成功,远期预后较好。     

经皮冠状动脉介入治疗导致正常冠状动脉急性血栓闭塞2例

目的报告2例急性心肌梗死患者行经皮冠状动脉介入治疗(PCI)导致相邻正常冠状动脉发生急性血栓闭塞的经过。方法1例患者在前降支行PCI时,造成正常左回旋支内急性血栓闭塞。另1例在行左回旋支PCI时,造成正常前降支内急性血栓闭塞。结果1例患者因发生前降支和回旋支急性闭塞,产生心室颤动而死亡。另1例对前降支新发血栓行PCI等抢救成功。结论对急性心肌梗死患者靶血管行PCI时,可导致血栓逆行栓塞其相邻的正常血管,造成冠状动脉急性闭塞,故在操作中注意技巧。     

急性冠状动脉综合征介入治疗最新进展

急性冠状动脉(冠脉)综合征(ACS)是急性心肌缺血引起的临床综合征。这类患者的致死率和致残率高,早期再灌注治疗可明显降低主要终点事件(死亡、心肌梗死、卒中)的风险,而高龄ACS患者介入治疗经风险评估后年龄并不是治疗策略的唯一决定因素,应采取积极的干预策略;新一代药物洗脱支架在ACS的治疗中表现出优于裸金属支架,MGuard栓塞保护支架治疗ACS显示出较好的初步结果;血栓抽吸装置可降低无再流发生,但临床终点事件(主要心脏不良事件、死亡、再梗死率、支架内血栓形成、主要出血发生率)仍有争议,有待进一步探讨。     

高龄急性冠状动脉综合征经皮冠状动脉介入治疗患者近期死亡的预测因素

【目的】 探讨真实治疗世界急性冠状动脉综合征(acute coronary syndrome,ACS)行经皮冠状动脉介入治疗(percutaneous coronary intervention PCI)的患者近期死亡的预测因素。【方法】采用前瞻性队列研究的方法,对408例行PCI的患者(ACS-PCI)进行登记,患者平均年龄71岁,记录患者体检和生化指标基线特征、合并症,并发症,治疗和干预方法,随访30天,记录发生的心血管事件,研究终点：全因死亡。应用二项Logistic回归向后逐步删除法：似然比统计量(backward∶likelihood Ratio)分析进行纳入研究的参数做多因素回归分析,得出ACS-PCI患者死亡的独立危险因素【结果】对于ST抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)PCI患者：高龄(平均年龄75岁),高的泵功能分级,使用主动脉球囊反搏(intra-aortic balloon pump IABP) (OR:1.1,2.9,10.4;P值：0.001,<0.0001,<0.0001)是该类患者短期全因死亡的独立危险因素。对于NSTEACS-PCI患者：高龄(80岁以上),合并糖尿病,高的泵功能分级(3级以上)以及入院时存在肾功能不全(OR:6.6,4.3,3.4,5.6;P值：0.002,0.019,<0.0001, 0.003)是患者短期全因死亡的独立危险因素。【结论】对于高龄ACS-PCI患者,3级以上泵功能,使用IABP,合并糖尿病,入院时肾功能不全是死亡的独立预测因素。对于这些患者应仔细评估PCI治疗的获益和风险,慎重选择治疗策略。     

经皮冠状动脉介入治疗并发急性心包填塞的临床分析

目的:分析和探讨冠心病介入治疗(PCI)并发急性心包填塞(ACT)的原因、诊断和处理方法。方法:回顾性分析1546例冠状动脉患者PCI中ACT的发生率、原因和诊断处理方法。结果:在1546例行PCI的患者中,根据临床表现及超声心动图检查,证实有5例因冠状动脉穿孔并发ACT,发生率为0.32%。5例全部行心包急诊穿刺引流,无一例死亡。结论:PCI中应尽早期发现ACT,并及时心包穿刺及持续引流,可以避免外科开胸手术治疗。     

冠心病介入治疗后并发急性脑卒中的研究进展

冠心病的发病率逐年增高,并逐渐成为心脏病住院和死亡的首要原因。经皮冠状动脉介入治疗(PCI)能够明显改善冠心病患者的生活质量,因其操作简便、痛苦小、风险小、术后恢复快等诸多优点,已成为冠心病治疗的首选方式。但PCI术后可能并发脑卒中,虽然发生率低,但后果极为严重,危及生命,存活者也大多合并不同程度的肢体功能障碍或不全失语等。本文将对冠心病患者PCI术后并发急性脑卒中的发病机制、危险因素、治疗及预后等方面作一综述。     

Acute sialadenitis after percutaneous coronary intervention

A 63 year old woman developed a swelling of the submandibular glands following PTCA. An ENT specialist made the presumptive diagnosis of viral sialadenitis. The submandibular swelling subsided completely within 48 hours.Sialadenitis is a rare side effect of ionic and nonionic radiocontrast agents. The pathogenic mechanism is not known. The swelling is self-limited with an excellent prognosis without specific therapy.     

Acute gastrointestinal bleeding after percutaneous coronary intervention

Bleeding from the GI tract is a commonly encountered clinical problem after percutaneous coronary intervention. The GI tract is likely to become the most commonly encountered site of bleeding as cardiologists adopt smaller access sheath sizes, percutaneous closure devices and a radial artery approach, further reducing access-site bleeding. To appropriately manage gastrointestinal bleeding in this setting, the clinician must strike a balance between arresting hemorrhage and preventing ischemic coronary complications. To do so, an appreciation of both cardiovascular and gastrointestinal issues is required. This review aims to provide the required knowledge, as well as a series of recommendations from our practice, to assist in the management of this potentially fatal complication.     

Acute pulmonary embolism after pneumonectomy

Pulmonary embolism (PE) by occlusion of the pulmonary arterial bed may lead to acute life-threatening but potentially reversible right ventricular failure, one of the most severe complications of thoracic surgery. Still, the incidence of acute pulmonary embolism after surgery is reduced by comprehensive anticoagulant prevention, improved surgical techniques, appropriate perioperative management and early ambulation. However, there is difficulty in diagnosing PE after thoracic surgery due to the lack of specific clinical manifestations. So that optimal diagnostic strategy and management according to the clinical presentation and estimated risk of an adverse outcome is fundamental.     

冠心病介入诊疗后的胆固醇结晶栓塞

目的观察冠状动脉造影及介入治疗术后胆固醇结晶栓塞的发生情况、临床特点及治疗情况。方法6例动脉粥样硬化患者因急性肾衰竭、外周皮肤缺血性损害,诊断为胆固醇结晶栓塞,收集其临床资料,并随访预后情况。结果6例患者中5例为男性,平均年龄72岁,多数伴有高血压、糖尿病、吸烟等动脉粥样硬化的危险因素。6例患者均在冠状动脉造影后出现血肌酐水平进行性升高,皮肤损害表现为肢端蓝紫色淤斑。1例患者的足趾皮肤活检见到胆固醇结晶栓子。所有患者应用他汀类药物治疗,2例患者给予肾替代治疗。随访有3例患者死亡,3例患者仍为慢性肾衰竭。结论医源性胆固醇结晶栓塞的发病率逐渐增高,临床医生对此病应有足够的认识。     

Acute coronary insufficiency due to pulmonary embolism

A study of forty-one consecutive fatal cases of pulmonary embolism confirmed by autopsy showed that acute coronary insufficiency is an important factor in determining the electrocardiographic and myocardial effects following embolism of the pulmonary artery. The electrocardiographic pattern of “acute cor pulmonale” (deep S₁ and Q₃, depressed RS-T in Lead I, elevated RS-T in Lead III and T₃ inversion) occurred in only a minority of cases. In the majority the electrocardiographic changes were those characteristic of acute coronary insufficiency, namely, RS-T depression and T wave inversion in one or more leads and often in all leads.     

Concomitant occurrences of pulmonary embolism and acute myocardial infarction in acute coronary syndrome patient undergoing percutaneous coronary intervention: a case report

<正>Pulmonary embolism(PE), a form of venous thromboembolism, is a relatively frequent cardiovascular emergency, and a potentially lifethreatening condition that needs prompt identification and treatment.^[1] PE is often misdiagnosed or unrecognized with many patients experiencing atypical symptoms.^[2,3]     

Acute stent thrombosis during percutaneous coronary intervention

Although rarely reported, acute instent thrombosis can be life threatening, especially in cases where there are no ST segment changes. For this reason, careful history taking, follow-up, and prompt coronary angiography may be lifesaving. Herein, a case of acute stent thrombosis with no ST segment changes on electrocardiogram that was resolved with intracoronary tirofiban is presented.     

Cholesterol embolism after percutaneous transluminal coronary angioplasty procedure: a case report

A 68-year-old man with chest pain was treated under a diagnosis of angina pectoris based on coronary angiography by percutaneous transluminal coronary angioplasty including stent implantation performed by the femoral approach. About 1 month after intervention, his renal function deteriorated and purpura appeared on both feet, especially at the toe tips. He was treated under a tentative diagnosis of cholesterol embolism conservatively at the out-patient clinic. However, he was admitted by ambulance due to worsening renal failure 2 months later and died from multiple organ failure 2 weeks after admission. Autopsy examination identified cholesterol embolism due to crystal emboli in several organs. Cholesterol embolism rarely occurs after angiographic or interventional procedures, but is difficult to diagnose clinically and there is no established therapy. The number of intervention and angiography procedures is increasing, so the occurrence of embolism as a complication of these procedures might also increase.     

冠心病患者介入治疗术后的康复治疗

随着人们生活水平的不断提高,冠心病特别是心肌梗塞的发生率逐年升高,已经成为当今社会严重危害人类健康,致死、致残的主要疾病之一.恢复冠状动脉血运,改善心肌缺血,挽救濒临死亡心肌是冠心病治疗的主要措施之一,其中经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)已经成为冠心病血管重建的重要手段.