女性急性心肌梗死临床及冠状动脉病变分析

目的探讨女性急性心肌梗死（AMI）患者临床及冠状动脉病变特点。方法将同期AMI患者按性别进行临床资料、部分行冠状动脉造影（coronary angiography,CAG）病例及经皮冠状动脉介入治疗（percutanneous coronary intervention,PCI）病例的对比分析。结果女性AMI组年龄大,糖尿病、高血压、高脂血症为其主要危险因素,冠状动脉多支病变比例大。结论年龄大、糖尿病为女性AMI患者独立危险因素,冠状动脉以多支病变为主,行PCI病死率高。     

Association between hospital process performance and outcomes among patients with acute coronary syndromes

Context  Selected care processes are increasingly being used to measure hospital quality; however, data regarding the association between hospital process performance and outcomes are limited. Objectives  To evaluate contemporary care practices consistent with the American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations, to examine how hospital performance varied among centers, to identify characteristics predictive of higher guideline adherence, and to assess whether hospitals' overall composite guideline adherence was associated with observed and risk-adjusted in-hospital mortality rates. Design, Setting, and Participants  An observational analysis of hospital care in 350 academic and nonacademic US centers of 64 775 patients enrolled in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) National Quality Improvement Initiative between January 1, 2001, and September 30, 2003, presenting with chest pain and positive electrocardiographic changes or cardiac biomarkers consistent with non–ST-segment elevation acute coronary syndrome (ACS). Main Outcome Measures  Use of 9 ACC/AHA class I guideline-recommended treatments and the correlation among hospitals' use of individual care processes as well as overall composite adherence rates. Results  Overall, the 9 ACC/AHA guideline-recommended treatments were adhered to in 74% of eligible instances. There was modest correlation in hospital performance among the individual ACS process metrics. However, composite adherence performance varied widely (median [interquartile range] composite adherence scores from lowest to highest hospital quartiles, 63% [59%-66%] vs 82% [80%-84%]). Composite guideline adherence rate was significantly associated with in-hospital mortality, with observed mortality rates decreasing from 6.31% for the lowest adherence quartile to 4.15% for the highest adherence quartile (P<.001). After risk adjustment, every 10% increase in composite adherence at a hospital was associated with an analogous 10% decrease in its patients' likelihood of in-hospital mortality (adjusted odds ratio, 0.90; 95% confidence interval, 0.84-0.97; P<.001). Conclusion  A significant association between care process and outcomes was found, supporting the use of broad, guideline-based performance metrics as a means of assessing and helping improve hospital quality.      

急性冠脉综合征患者冠状动脉造影分析

目的　初步探讨急性冠脉综合征 (ACS)患者冠脉病变特点。方法　对 1 35例ACS患者的冠状动脉造影结果进行分析 ,对其病变特点进行研究。结果　ACS患者病变血管数量为无显著病变为 4例 ,单支病变 5 7例 ,双支病变 4 4例 ,三支病变 30例 ;所累及的血管分别为 :左主干 (LM) 3例 ,左前降支 (LAD) 1 0 1例 ,回旋支 (LCX) 5 4例 ,右冠状动脉 (RA) 74例 ;病变形态特征为 :A型病变 5 3例 ,B型病变 1 0 1例 ,C型病变 32例 ,完全闭塞型病变为 4 9例 ;病变狭窄程度为 :轻度狭窄 4 4例 ,中度狭窄 72例 ,重度狭窄 81例 ,完全闭塞型病变为 4 9例。结论　冠状动脉造影目前是评价冠脉病变的最好方法。     

Euroheart急性冠状动脉综合征调查中急性冠状动脉综合征患者的年龄、临床表现和预后

目的:年龄是急性心肌梗死最有力的预后决定因素之一,但是有关其对所有急性冠状动脉综合征(ACS)影响的近期数据相对较少。在一项大型ACS患者抽样调查中观察了年龄增加对临床表现和院内预后的影响。方法和结果:对EuroheartACS调查中来自25个国家103所医院的10253例患者进行研究。调查发现年龄与ST段抬高的可能性之间存在显著负相关。每隔十岁,出现ST段抬高的概率下降0.82(95%CI0.79～0.84,P<0.0001)。老年患者较少接受心脏病医生的治疗,较少进行广泛研究,出现ST段抬高后较少行再灌注治疗。与<55岁的患者相比,55～64岁、65～74岁、75～…     

Concepts in acute coronary syndromes

Landmark pathological studies have deepened our understanding of the mechanisms behind acute coronary syndromes over the last decade. Thrombosis plays a key role and is a unifying feature in the pathogenesis. Platelet-rich thrombus superimposed over the disrupted atherosclerotic plaque or eroded plaque endothelium, with or without fibrin-thrombus extension, is evident in postmortem necropsy, angiographic and angioscopic studies. However features which contribute to the risk of acute events lie in the atherosclerotic plaque itself. Plaque content and not plaque size is the important factor. A vulnerable plaque may be invisible on clinical stress testing and even coronary angiography; but it is prone to rupture if it has only a thin cap and a proportionally larger lipid core. There is a cellular preponderance of activated macrophages and T-lymphocytes; and high activity of matrix metalloproteinases in vulnerable plaques. Smooth muscle cell proliferation and collagen synthesis are downregulated. These features may serve as possible targets for detecting plaques at risk or for reversing the risk of vulnerable plaques.     

应激与急性冠脉综合征

冠状动脉粥硬化性心脏病 (冠心病 )是中老年的常见病、多发病 ,近 3 0年来在我国呈增多趋势 ,对冠心病的防治成为当前国内外研究的重要课题。冠心病的发生与多种因素有关 ,如高血压、高血脂、肥胖、糖尿病、吸烟、心理社会因素等 ,这些因素统称为冠心病的危险因素。这些因素中容易忽视的是心理社会因素 ,也就是应激。1　什么是应激虽然我们经常使用应激这个词 ,可是应激概念模糊 ,难以用单独的量度来确定。“应激”一词的原意是指一个系统在外力作用下 ,竭尽全力对抗时的超负荷过程。Selye及Lazarus两位著名应激研究者将应激引入医学研究 ,…     

优化急诊护理流程在急性心肌梗死行经皮冠脉介入术患者中的应用效果

目的:观察优化急诊护理流程在急性心肌梗死行经皮冠脉介入术患者中的应用效果。方法:选取急诊科80例急性心肌梗死行经皮冠脉介入术(PCI)患者作为研究对象,按随机数字表法将其分为对照组和观察组各40例,对照组采取常规急诊护理,观察组在对照组的基础上采取优化急诊护理流程,比较两组抢救效率、并发症发生率、救治成功率、疾病复发率、再PCI率。结果:观察组急救时间、开始PCI时间均明显短于对照组,差异有统计学意义(P<0.05);观察组救治成功率明显高于对照组,并发症发生率、疾病复发率、再PCI率明显低于对照组,差异均有统计学意义(P<0.05)。结论:在常规急诊护理基础上采用优化急诊护理流程在急性心肌梗死行经皮冠脉介入术患者中的应用效果优于单纯常规急诊护理效果。     

急性冠脉综合症介入治疗的临床观察

目的：观察急性冠脉综合症（ACS）病人经皮冠状动脉或形术（PTCA）或（和）支架置入术的安全性和有效性。方法：ACS病人不稳定型心绞痛18例,急性Q波性心肌梗死4例,非Q波心肌梗死1例。病变血管28支。单支病变6例、双支病变12例、三支病变5例,分别行PTCA和（或）支架置入术,结果：成功22例、失败1例、成功病例血管TIMI均恢复为Ⅲ级。随后2－20个月,2例有心绞痛发作,但均能用药物控制。结论：PTCA或（和）支架置入术是ACS病人安全而有效的治疗方法,也是目前治疗冠心病最有效的方法。     

急性冠脉综合症介入治疗的临床观察

目的 观察急性冠脉综合症(ACS)病人经皮冠状动脉成形术(PTCA)N(或)支架置人术的安全性和有效性。方法 46例ACS病人不稳定型心绞痛36例，急性Q波心肌梗死8例，非Q波心肌梗死2例；单支病变12例，双支病变24例，三支病变10例。分别行PTCA和(或)支架置人术。结果 成功45例，失败1例，成功病例血管TIMI均恢复为Ⅲ级。随诊2～22个月，4例有心绞痛发作，但均能用药物控制。结论 PTCA和(或)支架置人术是ACS病人安全有效的治疗方法，也是目前治疗冠心病最有效的方法。     

急性冠脉综合征行急诊冠状动脉搭桥的疗效

目的评价急诊冠状动脉搭桥(CABG)治疗急性冠脉综合征的疗效。方法对24例急性冠脉综合征患者行急诊CABG,观察手术效果及术后并发症发生情况,并进行随访。结果体外循环时间为(89±26)min,主动脉阻断时间为(47±19)min。每例患者搭桥支数为(3．1±1．2)支,总搭桥支数为74支。共9例患者置入主动脉内球囊反搏(IABP),其中5例于术后24 h内拨除,4例于术后48 h内拨除。本组无手术死亡,无围术期心肌梗死及低心排血量综合征,亦无脑出血或栓塞并发症。术后出现胸腔积液3例、肺部感染2例,经相应治疗后均治愈。术后平均纵隔心包引流量为(548±339)mL,仅3例引流量较大,达1 100～1 400 mL,其中2例应用止血药等治疗后出血逐渐减少至停止,1例行再次开胸止血。患者出院前行运动试验,均为阴性。出院后所有患者经12～34个月的随访,平均为(18±2)个月,均无心绞痛发作,运动耐量接近正常,恢复正常生活。结论在心肌梗死尚未发生时对急性冠脉综合征患者及时行急诊CABG,有利于改善预后。     

老年急性冠脉综合征的介入治疗

目的探讨65岁以上急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)的临床疗效。方法82例平均年龄(72.5±7.5)岁的老年ACS患者,男58例,女24例,所有患者均行冠脉造影证实病变,根据造影结果对“病变血管”进行经皮冠状动脉成形术和/或支架置入术。结果82例中,79例介入治疗成功,成功率为96.3%;138处靶病变,133处治疗成功,成功率为96.4%。支架完全覆盖靶病变,扩张满意,血管腔残余狭窄<20%,TIMI血流3级达到率96%。病变直径狭窄由89.5%±8.6%减轻至3.2%±8.6%(P<001)。结论老年ACS患者及早、充分、持续地开通“病变血管”,恢复前向血流,可挽救濒临坏死的心肌,挽救生命,防止左心室重构,明显改善老年ACS患者的近期和远期预后。