经皮冠状动脉介入治疗术后再狭窄研究进展

经皮冠状动脉介入治疗（PCI）是目前治疗冠心病的最为有效的方法之一,但术后6个月内30％～45％的再狭窄（RS）高并发率严重影响了PCI的临床疗效。随着支架置入术的应用,支架置入术后RS率仍为10％～20％,PCI的远期疗效受到了很大限制,因而RS的防治成为目前心血管病防治研究的重要课题。尽管近年来对RS发生发展的分子生物学机制进行了较为深入研究,但至今无良好对策。     

经皮冠状动脉成形术的临床研究

目的探讨应用经皮冠状动脉成形术（ＰＴＣＡ）治疗冠心病的临床效果。方法４２例冠心病患者经选择性冠状动脉造影术证实２７例为单支病变，１３例为双支病变，２例为三支病变；５９支病变血管中左前降支（ＬＡＤ）３５支，左回旋支（ＬＣＸ）７支，右冠状动脉（ＲＣＡ）１７支；狭窄程度为７５～１００％。采用Ｇｒｕｅｎｔｚｉｇ等建立的方法进行ＰＴＣＡ。结果４２例患者扩张成功４０例，成功率为９５．２％；５９支病变血管扩张成功５３支，成功率为８９．８％；７５处狭窄扩张成功６６处，成功率为８８％。术后４０例扩张成功患者的症状均得以缓解或消失。结论ＰＴＣＡ对冠心病有显著的治疗效果，但应注意术中的一些问题并防止并发症的发生。     

Study on influence of Sini Decoction on quality of life of patients after percutaneous transluminal coronary angioplastyon quality of life of patients after percutaneous transluminal coronary angioplasty

Objective: To determine the influence of Sini Decoction (SND) on quality of life(QOL) of patients after percutaneous transluminal coronary angioplasty (PTCA).Methods: Randomized case-control clinical trial was conducted to evaluate QOL of 40 post-PTCA patients before and after SND treatment by scoring.Results: The scores in physical symptoms, sense of well-being, degree of depression, index of satisfaction of life and work capacity of the patients after PTCA were improved significantly as compared with before PTCA,P< 0.01. Scores of patients who received SND treatment were higher than those untreated with SND in the first three criteria, P<0.05, particularly in relieving palpitation and dyspnea.Conclusion: SND is helpful in improving QOL of patients after PTCA.     

Changes in serum cardiac troponin I levels after percutaneous transluminal coronary angioplasty

OBJECTIVE: To evaluate the possible effect of percutaneous transluminal coronary (PTCA) on myocardium. METHODS: Serum cTnl and CK-MB were measured in 60 patients with coronary artery disease (CAD) who underwent PTCA before and at the 6th, 12th, 24th, 48th and 72nd hour after the interventional procedure respectively. RESULTS: The serum cTnl levels began to increase at 6 hours (9.65 +/- 6.27 micrograms/L) in 18 patients, reached the peak levels during 12-24 hours (20.43 +/- 11.28 micrograms/L, 18.52 +/- 9.52 micrograms/L), and returned to normal range till 48-72 hours (7.35 +/- 7.62 micrograms/L, 5.51 +/- 3.13 micrograms/L) after PTCA. The serum cTnl and CK-MB levels were kept normal range pre- and post-PTCA in 30 cases. The levels of cTnl in 12 cases were over baseline either before or after the procedure, while for CK-MB, only in 3 cases were over normal range after PTCA. Compared with normal cTnl group, elevated cTnl levels were related to total inflation times and dilated times (P < 0.05). CONCLUSIONS: PTCA may cause some minor damage in myocardium, serum cTnl level was more sensitive and specific for monitoring myocardial injury.     

冠心病经皮冠状动脉内成形术的临床应用

目的：观察心绞痛、心肌梗死经皮冠状动脉内成形术（PTCA）的安全性和有效性。方法：不稳定型心绞痛3例,急性心肌梗死2例。其中病变血管6支,回旋支远端狭窄1例,左前降支完全闭塞1例,左前降支近端狭窄3例（其中1例合并右冠状动脉中段狭窄）。分别行PTCA或PTCA加支架术。结果：PTCA成功4例,失败1例。PTCA后有3例发现内膜撕裂和血管壁塌陷,随即行支架植入。术前急性心肌梗死溶栓治疗临床试验（TIMI）血流0－1级,术后均恢复TIMI血流3级。术后随访1－3个月,患者均无心绞痛发作。结论：PTCA和支架植入,是冠状血管再通安全而有效的方法。     

The effect of magnetic stent on coronary restenosis after percutaneous transluminal coronary angioplasty in dogs

探讨磁化支架对经皮经腔冠状埃及成形术 (PTCA)后冠状动脉再狭窄的防治作用。方法　 2 0只健康杂种犬 ,超大球囊反复扩张损伤靶血管 (前降支或旋支中段 )制备PTCA术后冠状动脉狭窄模型(>5 0 % ) ,后随机分成对照组和实验组各 10只。对照组靶血管置入普通Palmaz支架 ,实验组靶血管置入磁化Palmaz支架。手术前后不用抗血小板药和抗凝药 ,术后 6个月冠状动脉造影 ,并处死犬切取靶血管 3cm进行组织病理学检查。结果　冠状动脉造影冠状动脉再狭窄率对照组 30 % ,实验组 0 ;组织病理学检查靶血管平均内膜厚度 (对照组 2 .98± 0 .5 6mm) ,(实验组 1.13± 0 .4 1mm)有显著差异 ,P <0 .0 5。结论　磁化支架对犬PTCA术后冠状动脉再狭窄可能具有防治作用。     

Retrospective analysis of percutaneous transluminal coronary angioplasty and coronary stenting

Objective To examine long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA),coronary stenting and to assess the factors affecting its efficacy. Methods A total of 790 patients who underwent successful PTCA and PTCA+stent in this ho spital were followed by direct interview or letter. The rate of follow-up was 84.2% and the period of follow-up was 0.9-12.7 (3.5±2.4) years. Results During follow-up, 4 (0.5%) patients died, 22 (2.8%) had nonfatal acute myocar dial infarction, 10 (1.3%) had coronary artery bypass surgery, and 98 (12.4%) had repeat PTCA. The rate of recurrent angina pectoris was 31.1%. The cardiac event-free survival rate calculated by the Kaplan-Meier method was 88.2% at 1 year and 80.6% at 12.7 years. Cox regression analysis showed that there was a positive correlation between AMI history, stent implantation and the risk of cardiac events, and there was a negative correlation between the number of disea sed arteries and the risk of cardiac events. Compared to the PTCA group, patien ts with PTCA+stent had significantly lower rates of total cardiac events. Conclusion The long-term efficacy of PTCA, especially PTCA + stent in Chinese patients was very satisfactory, suggesting that PTCA+stent therapy should be the major treat ment for revascularization in patients with coronary heart disease.     

Changes in serum cardiac troponin I levels after percutaneous transluminal coronary angioplasty.

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急性冠脉综合征经皮冠状动脉腔内成形术中并发症及处理

目的探讨老年急性冠脉综合征经皮冠状动脉腔内成形术(PTCA)中的并发症及处理。方法63例老年急性冠脉综合征患者经常规治疗病情稳定后行冠状动脉造影+PTCA+支架术,并观察术中并发症情况并及时处理。结果术中发生并发症4例次,并发症发生率6.3%,其中血管内膜撕裂1例,心室纤颤1例,支架内血栓1例,急性血管闭塞1例,处理后得到控制。结论及时发现并处理经皮冠状动脉成形术+支架植入治疗老年急性冠脉综合征术中发生的并发症非常重要。     

基因治疗PTCA术后再狭窄的研究进展

PTCA术后再狭窄是影响手术远期效果的一个重要的术后并发症 ,目前研究发现药物预防及治疗再狭窄效果不理想 ,基因治疗通过将目的基因转移至病变血管并表达基因产物抑制SMC的增生和血栓形成 ,从而起到防治PTCA术后血管再狭窄     

低分子肝素在经皮冠状动脉腔内成形术及支架术后抗凝疗效分析

目的：观察低分子肝素对经皮冠状动脉腔内成形术（PTCA）及支架植入术（CASI）后早期抗凝的作用。方法：将64例PTCA和支架植入术后患随机分为低分子肝素（LMWH）组与普通肝素组（SH）组，观察两组7天内临床疗效，并发症发生率等。结果：LMWH组无一例出现并发症，及急性心血管事件，SH组4例牙龈出血，2例于12小时内出现血尿。2例导管穿刺部位出现血肿、渗血。两组比较出血并发症有显性差异（P＜0．05），心血管事件发生率无显差异（P＞0．05）。结论：LMWH与SH一样具有较强抗凝作用，能预防PTCA术后急性血栓形成，且出血并发症少。     

冠状动脉成形术对p波离散度的影响

目的:观察在冠状动脉(简称冠脉)成形术过程中,球囊扩张引起的急性心肌缺血对p波离散度的影响.方法:选择单支冠脉病变的患者76例,分为在球囊扩张时有心肌缺血改变和无心肌缺血改变两组.心肌缺血组又分为左前降支(LAD)、左回旋支(LCX)和右冠脉(RCA)三个亚组.同步记录球囊扩张前和球囊扩张期间12导联心电图,计算p波离散度.结果:①球囊扩张前,各组p波离散度无差异(37.5±4.97ms,36.7±5.70ms,36.9±4.59ms,36.4±4.76ms,P＞0.05),②球囊扩张期间,无心肌缺血组p波离散度与球囊扩张前比较无显著性差异(37.5±4.97 vs 37.9±4.61ms,P＞0.05);而心肌缺血组与球囊扩张前比较,p波离散度均明显增大(36.7±5.70 vs 46.3±4.21ms,36.9±4.59 vs 44.7±6.47ms,36.4±4.76 vs 44.8±5.88ms,P＜0.001).结论:p波离散度增大可作为严重急性心肌缺血的一个指标.     

经皮冠状动脉腔内成形术对急性心肌梗死患者左室重构及心功能的影响

目的 探讨经皮冠状动脉腔内成形术(PTCA)对急性心肌梗死(AMI)患者左室重构及心功能的影响.方法 61例首次AMI患者按发病到达医院时间不同随机分两组,6h内为A组共30例行急诊PTCA,6h后为B组共31例行延迟PTCA.两组均于术后3d、1个月、3个月行心脏彩超检查,测定左心功能各项指标:测定左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、左室射血分数(LVEF),并进行比较分析.结果 PTCA术后3 d、1个月和3个月.A组LVEDV、LVESV和LVEF均显著优于B组(P<0.05、P<0.05和P<0.05).A组1个月时与3d比,LVEDV及LVESV显著缩小(P<0.05和P<0.05),LVEF显著增加(P<0.05);3个月时与1个月比LVEDV、LVESV、LVEF仍有改善,但差异无显著性.B组1个月时与3 d比,LVEDV、LVESV和LVEF有改善,但差异无统计学意义;3个月时与3 d比,LVEDV、LVESV明显降低(P<0.05),LVEF有改善,但差异无显著性.结论 急诊PTCA能挽救濒死心肌,抑制左室重塑,改善左心功能,其效果优于延迟PTCA,延迟PTCA虽不能显著改善左心功能,但可抑制左心室重塑.     

组织多普勒成像对经皮冠状动脉腔内血管成形术效果的评价

目的:探讨组织多普勒成像对经皮冠状动脉腔内血管成形术的效果评价。方法:回顾性分析64例行经皮冠状动脉腔内血管成形术患者的临床资料。结果:观察组手术前、术后的E/A比值、等容收缩期、等容舒张期时限与对照组相比差异有统计学意义(P<0.05);观察组术后收缩期、舒张早期的峰值速度及时间速度积分均低于对照组(P<0.05)。结论:组织多普勒成像可评价经皮冠状动脉腔内血管成形术效果,值得临床推广应用。     

益气活血复方对兔颈总动脉球囊损伤后VCAM-1表达的影响

目的观察益气活血复方（YQHXFF）对兔颈动脉内皮损伤后血管内膜增生及血管细胞黏附分子-1（VCAM-1）表达的影响。方法将雄性新西兰白兔28只,随机分为3组,空白组给予普通饲料8周;模型组和益气活血复方组给予高脂喂养6周后,用球囊拉伤法建立兔颈总动脉内皮损伤模型,第8周末处死动物,免疫组化法检测损伤处颈总动脉组织中VCAM-1表达,HE染色观察颈动脉组织病理形态学改变。结果与模型组对比,益气活血复方可明显抑制损伤后的动脉内膜增殖反应,下调损伤局部VCAM-1的表达水平（P〈0．05）。结论益气活血复方可抑制球囊损伤后动脉内膜增殖反应,其机制可能与下调VCAM-1表达有关。     

联合转染VEGF和PCNA-ASODN对血管成形术后再狭窄的影响

目的探讨联合转染血管内皮生长因子(VEGF)基因和增殖细胞核抗原反义寡核苷酸(PCNA-ASODN)对血管成形术后再狭窄的影响。方法 32只新西兰纯种大白兔随机平均分为对照组、转染VEGF组、转染PCNA-ASODN组、联合转染VEGF和PCNA-ASODN组(联合转染组)。构建兔的股髂动脉球囊损伤术后再狭窄模型,以医用生物蛋白胶作为缓释载体,将300μg PCNA-ASODN或VEGF均匀喷布于处理血管段外膜。取损伤处理血管段标本,光学显微镜观察损伤血管内膜、中层结构和局部血栓形成情况;电子显微镜观察新生内膜内皮细胞及内膜、中膜,计算内膜/中膜(I/M)面积比与厚度比;采用RT-PCR法检测VEGF与PCNA基因的表达,采用免疫组化从蛋白质水平检测VEGF与PCNA的表达。结果联合转染组与其他组相比,其血管内皮较完整、光滑,内膜轻度增生,平滑肌细胞排列规则,外膜无明显变化;I/M面积比与厚度比明显较低(P<0.05);RT-PCR检测VEGF表达水平明显升高(P<0.05);免疫组化检测血管组织中VEGF蛋白表达阳性率较高(P<0.05)。结论联合转染VEGF和PCNA-ASODN能更有效地抑制球囊损伤术后的血管内膜增生和再狭窄的发生。     

用冠脉内心电图监测PTCA期间心肌缺血的变化

记录２３例冠心病患者经皮冠状动脉腔内成形术（ＰＴＣＡ）时体表心电图（Ｓ－ＥＣＧ）和单极冠状动脉心电图（ＩＣ－ＥＣＧ）发现，前者显示ＳＴ段抬高１４例（６１％）而后者显示ＳＴ段抬高２１例（９１％）ＩＣ－ＥＣＧ显示，随球囊充盈次数增加，其ＳＴ段抬高幅度逐渐减低，因此，ＰＴＣＡ期间作ＩＣ－ＥＣＧ监测对检出心肌缺血和估价预适应，具有一定的临床价值。