肌钙蛋白T检验对不稳定型心绞痛预后的评价

目的 探讨肌钙蛋白T对不稳定型心绞痛预后的临床意义.方法 收集笔者所在医院55例经确诊为不稳定型心绞痛的患者,进行肌钙蛋白T检测,观察并随访4周或至发生急性心脏事件为止.结果 55例患者中,cTnT检测阳性38例（A组）,阴性17例（B组）.其中A组出现心脏事件10例,发生率为26.3%;B组3例,心脏事件发生率为17.1%.结论 血清肌钙蛋白T检测对高危的不稳定心绞痛患者具有较高的敏感性,对其近期预后有预测价值.     

复方丹参滴丸对不稳定型心绞痛患者血小板活化功能的影响

目的探讨复方丹参滴丸治疗冠心病心绞痛的临床疗效及其对血小板活化功能的影响。方法选择本院2012年8月～2013年10月收治的不稳定型心绞痛患者90例,随机分为两组,两组均给予抗凝、降脂、扩血管治疗,研究组患者在常规治疗的基础上给予复方丹参滴丸治疗。观察两组治疗效果,治疗前后采集静脉血,检测CD62p、GMP-140水平,评估患者治疗前后患者血小板活化功能的变化情况。结果两组心绞痛治疗总有效率比较,研究组明显高于对照组,差异有统计学意义（P〈0．05）。两组治疗前CD62p、GMP-140差异均无统计学意义,治疗后两组CD62p、GMP-140均较治疗前降低,但研究组CD62p、GMP-140均明显低于对照组（P〈0．05）。结论复方丹参滴丸辅助治疗不稳定型心绞痛疗效较好,并且可以有效抑制血小板活化功能的异常,值得应用。     

静舒氧辅助治疗老年不稳定型心绞痛患者的效果观察

目的了解静舒氧对老年不稳定型心绞痛患者的治疗效果。方法将40例患者随机分为静舒氧组和对照组各20例,静舒氧组使用静舒氧仪对输液瓶充氧助推输液,对照组使用鼻导管给氧,2～4L/min,均1h/d,连续14d。结果治疗后静舒氧组SpO2值显著高于对照组(P<0.05),心绞痛发作频率及持续时间显著少于和短于对照组(均P<0.05)。结论应用静舒氧辅助治疗老年不稳定型心绞痛可显著提高给氧疗效。     

三联抗血小板治疗不稳定型心绞痛疗效观察

目的观察替罗非班联合氯吡格雷与阿司匹林治疗不稳定型心绞痛的临床疗效。方法选择不稳定型心绞痛患者110例,随机分成两组：对照组50例,给予常规抗心绞痛治疗;治疗组60例,给予常规抗心绞痛治疗同时加替罗非班静注。观察两组患者心绞痛发作次数、持续时间、常规心电图改变。结果三联抗血小板治疗不稳定型心绞痛方法疗效显著（P〈0.05）,明显控制了心绞痛发作频率及时间,并有效防治了心肌梗死的发生及心脏猝死。结论联合抗血小板治疗不稳定型心绞痛疗效显著且安全。     

低分子量肝素在不稳定型心绞痛治疗中的作用

目的:观察低分子量肝素治疗不稳定型心绞痛患者的疗效.方法:不稳定型心绞痛患者38例,随机分为常规治疗组和低分子量肝素组,分别为16、22例,常规治疗组应用硝酸酯类、β受体阻滞剂、钙拮抗剂和阿司匹林等药物治疗；低分子量肝素组加用低分子量肝素5000u,皮下注射,每日2次,连续应用7天.结果:低分子量肝素治疗不稳定型心绞痛疗效显著,可更有效地减少心绞痛发作次数和硝酸甘油含片用量,缩短心绞痛发作时间,且对血凝指标无明显影响.结论:低分子量肝素是一种有效、安全的治疗不稳定型心绞痛的药物.     

氯吡格雷联合阿托伐他汀治疗不稳定型心绞痛88例临床观察

目的观察氯吡格雷联合阿托伐他汀治疗不稳定型心绞痛（UAP）的疗效。方法88例UAP患者,随机分为对照组和治疗组,每组各44例。对照组给予硝酸甘油、β受体阻滞剂、钙通道阻滞剂、阿司匹林等常规治疗,治疗组在上述常规治疗的基础上加用阿托伐他汀和氯吡格雷。治疗4周后比较两组治疗效果。结果治疗组治疗后心绞痛症状改善及心电图改善总有效率均为95.5％（42／44）,高于对照组的75.0％（33144）、72.7％（32／44）,差异均有统计学意义（P〈0.05）,且无明显不良反应。结论氯吡格雷联合阿托伐他汀是一组治疗UAP有效、安全的药物。     

冠状动脉钙化积分评估经皮冠状动脉介入治疗术后稳定型心绞痛患者预后

目的评价冠状动脉钙化(CAC)积分在经皮冠状动脉介入治疗(PCI)术后稳定型心绞痛(SAP)患者预后的价值。方法对400例PCI术后SAP患者行MSCT检查,CAC积分根据标准Agatston钙化计分方法。根据CAC积分分为低CAC积分组(CAC积分≤300)235例,高CAC积分组(CAC积分300)165例,分析CAC积分与临床特征、手术并发症、重大不良事件(MACE)的关系。结果 CAC积分与年龄(r=0.34,P0.001)、收缩压(r=0.20,P=0.020)正相关;单因素分析显示,高CAC积分组手术并发症发生率比低CAC积分组增加4.62倍(P=0.020),经年龄、糖尿病史、多支血管病变校正后,CAC积分仍是手术并发症的独立危险因素(OR=4.56,P=0.033);Kaplan-Meier生存分析显示,低CAC积分组、高CAC积分组累积无事件生存率分别为88.94%和77.58%,差异有统计学意义(P=0.038)。结论 CAC积分是PCI术后SAP患者发生MACE的独立预测因素,与手术发症有关。     

Thoracic epidural anesthesia and central hemodynamics in patients with unstable angina pectoris

The effects of high thoracic epidural anesthesia (TEA) on central hemodynamics as measured by pulmonary arterial catheterization were studied in nine patients with severe coronary artery disease and unstable angina pectoris. The patients were also treated with a combination of beta-blockers, calcium antagonists, and nitrates, as well as salicylates, low-dose heparin, and nitroglycerin infusion for greater than 24 hr. Management of pain with high TEA was started with the bolus epidural injection of 4.3 +/- 0.2 mL bupivacaine (5 mg/mL), which induced a sympathetic blockade from Th. During ischemic chest pain, pulmonary artery and pulmonary capillary wedge pressures were significantly increased. TEA, while relieving the chest pain, significantly decreased systolic arterial blood pressure, heart rate, and pulmonary artery and pulmonary capillary wedge pressures, without any significant changes in coronary perfusion pressure, cardiac output, stroke volume, and systemic or pulmonary vascular resistances. In some patients, ST-segment depression was less pronounced during TEA. Thus, during ischemic chest pain, TEA has beneficial effects on the major determinants of myocardial oxygen consumption, without jeopardizing coronary perfusion pressure. TEA may therefore favorably alter the oxygen supply/demand ratio within ischemic myocardial areas.     

芪参益气滴丸治疗终末肾衰竭合并心绞痛的临床疗效观察

目的 观察芪参益气滴丸对终末期肾衰竭心绞痛的临床疗效.方法 将60例维持性血液透析的肾衰竭患者随机分成对照组和治疗组,每组各30例.对照组给予常规抗心绞痛治疗;治疗组在对照组的基础上加用芪参益气滴丸,每日3次,每日1包,治疗4周为1疗程.观察治疗前后心绞痛症状、心电图改变及肾功能变化等指标.结果 治疗组心绞痛治疗有效率、发作次数等临床疗效优于对照组(P＜0.05),生化指标等无明显差别.结论 芪参益气滴丸对终末期肾衰竭合并心绞痛疗效确切.     

Results of emergency aortocoronary venous bypass surgery after failed percutaneous transluminal coronary angioplasty in patients with unstable angina pectoris

During a 4-year period from January 1985 to December 1988 140 patients underwent percutaneous transluminal coronary angioplasty (PTCA) of the culprit-vessel for unstable angina. Seventeen patients (12%) needed emergency aorta coronary bypass surgery (ACVB) for failed angioplasty. In 15 cases the culprit-vessel was the LAD and in 2 cases a dominant right coronary artery. Only in 2 cases a history of myocardial infarction was present. Twelve patients were in hemodynamic stable condition after arriving in the operating-room. Five patients were hemodynamic unstable, 4 of them were in cardiogenic shock. Four patients died representing an operative mortality rate of 23%. Three patients died from pump failure despite intraaortic balloon counterpulsation in 2 cases. One patient died from cerebral damage 12 day after surgery. All patients who died were in cardiogenic shock preoperatively. Two patients who survived suffered an extensive myocardial infarction. Thus including the patients who died from pump failure the perioperative infarction rate was 30%. From these results it is concluded that emergency ACVB after failed PTCA of the culprit-vessel in patients with unstable angina results in a significant higher mortality and morbidity as compared with patients who had primary surgery for unstable angina. The prognosis of patients after failed PTCA for unstable angina depends on the hemodynamic situation thereafter and becomes worse in patients with cardiogenic shock.     

70岁以上高龄不稳定型心绞痛患者的临床特点分析

目的：探讨70岁以上高龄不稳定型心绞痛（UAP）患者的临床特点及治疗效果。方法回顾性分析我院收治的160例70岁以上UAP患者的相关发病因素,以及采取针对性治疗后的临床疗效。结果 UAP的主要发病诱因为情绪激动,其次为劳累和饱食;男性患者和女性患者情绪激动、劳累、饱食、感染、心动过速、甲亢等发病诱因及无诱因所占比例比较,差异无统计学意义（P＞0.05）;单纯药物治疗组患者与药物＋PCI治疗组患者心绞痛发作＞1次/月和心绞痛再次入院发生率比较,差异无统计学意义（P＞0.05）。结论采取有效预防和药物治疗措施对改善UAP患者发病率和预后效果具有重要意义。     

术中静脉输注美托洛尔对心脏病患者非心脏手术后心脏并发症的影响

目的 评价术中静脉输注美托洛尔对心脏病患者非心脏手术后心脏并发症的影响.方法 拟行胸部手术或腹部手术的心脏病患者87例,年龄55～78岁,随机分为对照组(n=42)和试验组(n=45).试验组切皮前5 min静脉注射美托洛尔20 μg/kg负荷量,随后以0.1～1.0 μg·kg-1·min-1速率静脉输注至术毕,控制HR较术前降低15%～20%,但维持HR≥50次/min、平均动脉压≥60 mm Hg.分别于术前24 h内(术前)及术后24 h内(术后)持续监测心电图,记录平均HR、早搏次数、异位心律失常及心肌缺血的发生情况;记录术后7 d内心脏事件的发生情况.结果 与术前比较,术后对照组平均HR增快(P<0.05),而试验组差异无统计学意义(P<0.05);与对照组比较,术后试验组早搏次数、异位心律失常发生率和心肌缺血发生率降低(P<0.05),术后心脏事件发生率差异无统计学意义(P<0.05).结论 术中静脉输注美托洛尔(静脉注射负荷量20 μg/kg后以0.1～1.0 μg·kg-1·min-1的速率静脉输注)可降低心脏病患者非心脏手术后心脏并发症的发生.     

早期干预,关注瓣膜病全程:美国《2014心脏瓣膜病患者管理指南》部分热点探讨

2014年美国心脏瓣膜病指南重要的更新内容之一是更加重视早期干预瓣膜病.本文对该指南中主动脉瓣狭窄、主动脉瓣关闭不全、二尖瓣狭窄、二尖瓣关闭不全、三尖瓣关闭不全及感染性心内膜炎等疾病的早期干预相关内容逐一进行了分析和解读,并结合中国的实践经验及自己的体会理解对相关热点问题进行了探讨,强调对心脏瓣膜病应早期干预并关注瓣膜病全程.     

167例缺血性脑血管病的多层螺旋CT血管造影分析

目的探讨MSCTA诊断缺血性脑血管病（ICVD）的临床价值。方法回顾性分析并对比167例临床确诊ICVD患者的头颈部MSCTA及DSA表现。结果头颈部MSCTA发现123例患者动脉狭窄,15例单纯前循环动脉狭窄,41例单纯后循环动脉狭窄,67例前、后循环动脉均有狭窄,多见于椎动脉（179／413,43．34％）、颈内动脉（217／539,40．26％）和大脑中动脉（135／539,25．05％）,99例共641支动脉存在硬化斑块。以DSA为金标准,MSCTA诊断头颈动脉狭窄的敏感度为97．54％（119／122）,特异度为91．11％（41／45）。结论MSCTA可准确评价头颈部动脉狭窄,在判断ICVD病因方面具有优势。