急诊冠状动脉内支架置入治疗不稳定性心绞痛

目的　探讨在不稳定性心绞痛病人症状未缓解状态下行急诊冠状动脉内支架置入的疗效及安全性。方法　对53例不稳定性心绞痛病人在心绞痛反复发作时即行冠状动脉造影，明确病变后行冠状动脉支架置入术。结果　53处病变置入56个支架，术中无严重并发症，34例心绞痛消失；9例有不典型胸痛，症状在1～2天内消失，无急诊冠状动脉搭桥及死亡。随访3个月～3年,6例冠脉造影证实再狭窄，5例行再次PTCA术后症状消失，1例行PTCA后仍有症状行冠状动脉旁路移植术(CABG)，无死亡病例。结论　冠状动脉内支架置入治疗急性冠状动脉综合征近期及远期效果较好，治疗成功率及安全性较高。     

经皮腔内冠状动脉成形术(附10例报告)

我院自1988.8～1992.11共完成经皮腔内冠状动脉成形术(PTCA)10例.患者均为冠心病,心肌梗塞后心绞痛8例,不稳定心绞痛2例.冠脉造影示2支血管病变4例,单支血管病变6例.10例PTCA中成功7例.共扩张8处狭窄,术后残余狭窄为0～20%.术后随访3个月～3年,其中冠脉造影随访1例,未见再狭窄.术后复查ECT,示心肌缺血明显改善.     

支架内再狭窄的介入治疗

目的介绍支架内再狭窄的处理经验.方法回顾分析156例支架内再狭窄患者经PTCA或支架植入术治疗的即刻和术后随访结果.支架内再狭窄治疗前后行冠脉造影,并于术后5.7±3.8个月复查冠脉造影.结果 156例支架内再狭窄患者PTCA或支架术治疗均获成功,其中134例(144支血管)行PTCA治疗,占86.7%;22例(22支血管)行再次支架置入术,占13.3%.156例经再次PTCA或支架术治疗后随访平均6个月的再狭窄率为24.3%.40处弥漫性支架内再狭窄经PTCA处理后18处(45%)再次再狭窄,而96处局限性支架内再狭窄中有17处再次再狭窄(18%),弥漫性支架内再狭窄经PTCA治疗后,再次再狭窄率明显高于局限性支架内再狭窄(P<0.01).支架内狭窄严重程度(>75%)也是影响PTCA疗效的主要因素.结论对于大多数支架内再狭窄(70%)采用PTCA治疗安全有效,术后再狭窄率与首次支架置入术相似.     

PTCA术后早期治疗对康复的影响

目的；冠脉成形术（PTCA）是心脏内科治疗冠心病、心绞痛的重要方法之一。本文对131例接受PTCA术的患者30天治疗的医学疗效和并发症进行观察。以探讨PTCA术后早期治疗对康复的影响。方法：131例患者中心肌梗塞72例；心绞痛59例；男112例；女19例；平均年龄58士8岁，均经冠动脉造影及ECG确定冠脉狭窄、心肌缺血。行选择性PTCA术后送入CCU病房监护治疗：1．监测：心电、血压、出、凝血时间／凝血酶元。2．观察穿刺部位有无出血及皮下血肿。3．药物治疗：A．抗凝药物／阿斯匹林或力抗栓；B选用扩血管药物：硝酸酯、ACEI、钙括抗剂…     

肥厚型心肌病伴胸痛的临床研究

探讨肥厚型心肌病 (HCM )伴胸痛的诊断与治疗。本组 18例HCM ,临床上均有典型心绞痛发作并伴心电图 (ECG)ST T缺血改变。行冠状动脉造影 (CAG)检查 ,造影示冠状动脉正常 11例 ,狭窄Ⅱ级 2例 ,Ⅲ级 5例。其中 1例回旋支 90 %狭窄 ,行经皮冠状动脉内成形术 (PTCA)成功 ,4例前降支心肌桥压迫冠状动脉 ,收缩期狭窄 >75% ,舒张期正常。外科行肌桥松解术或冠脉旁路移植术 ,术后病人心绞痛消失 ,ECG改善。随访 6个月至 3年效果良好。HCM伴胸痛 ,ECG显示明显缺血 ,药物治疗反应差者应行CAG检查 ,如有心肌桥压迫冠状动脉血管或粥样硬化狭窄者 ,应行介入治疗或外科手术治疗     

PTCA术中并发冠脉血栓病人的处理及近期后果

本文回顾分析了PTCA术中血栓合并症的经验,研究三种不同治疗方法,并对各组患者的临床情况、冠状动脉造影结果、治疗措施及发生各种并发症之间的关系进行了分析探讨。在983例PTCA病人中有62例并发了冠脉内血栓形成。依据治疗方法,将病人分为三组。第一组18例保守性治疗,第二组17例用球囊导管行再扩张;第三组27例冠脉内     

高危不稳定心绞痛老人的冠脉成形术

一般而言,经药物治疗无效的70岁以上不稳定心绞痛老人,若不宜或禁忌冠脉搭桥术(cABG)者, 常选行冠脉成形术(PTCA)治疗。然而有报道称,此类患者术后失败率远较非老年者高,故认为年龄本身即为PTCA的相对危险因素。本文特就70岁以上不稳定心绞痛老人PTCA后近、远期预后进行了比较分析。 131例不稳定心绞痛老人,年龄≥70岁,皆行PTCA治疗,其中82例因不同原因而未行cABG。CABG高危因素包括:不稳定心绞痛频发131例(100％),静息心绞痛87例(66％),可逆性EcG缺血改变52例(40％),1周内患发AMI 54例(41％),既往心衰15例(11％),既往卒中6例(5％),LvEF≤0.35占16％,3支冠脉病变61例(47％),曾行CABG57例(44％),伴有慢阻肺14例(11％)、外周血管病13例(10％)、脑血管病10例(8％)、肾衰8例(6％)、糖尿病23例(18％)。具有不宜行PT-CA的相对禁忌证包括:在总计174枚被扩张段冠脉中,血栓形成34枚(20％),病损长度>2cm50枚(29％),冠脉完全闭塞27枚(16％)。     

“稳定的”不稳定型心绞痛患者造影所示狭窄的进展及冠状动脉事件

研究提示血管造影所发现的复杂性冠脉狭窄患者短期预后不良,然而,还不知道用药物治疗后病情稳定的不稳定型心绞痛患者是否如此。 方法 前瞻性研究85例能用药物控制但仍需血管成形术(PTCA)治疗阻塞性冠脉病变的不稳定型心绞痛患者。不包括(1)诊断性治疗后需做急诊PTCA的患者;(2)原先     

钾防治血管成形术后再狭窄的临床研究

目的 观察钾在临床上预防PTCA术后再狭窄的安全性的有效性。方法 80例PTCA患随机分为对照组（40例）用常规治疗；治疗组（40例）常规治疗加钾缓释片（Slow-K)1.2g,q8h,于术前3d开始服药至术后6个月。将两组的多项观察指标进行比较分析。结果 77例完成随访，治疗组平均能提高血钾浓度0.3mmol/L，血Na^ 、Cl^-、Ca^2 、Mg^2 水平两组间无显性差异；可疑心绞痛和心肌缺血于对照组有14例（28.9%)，而治疗组仅有7例（17.9%）；冠脉造影随访对照组21例中有11例出现再狭窄，而治疗组17例中有6例；随访期间对照组有23.7%；治疗组有10.2%需再次进行血管重建术（包括PTCA和CABC），但两组比较P=0.116。结论 钾剂治疗初步显示：PTCA术后心肌缺血再发率、冠脉造影再狭窄例数以及因再狭窄需要再次行血管重建术例数，治疗组较对照组有减少趋势。     

经皮腔内冠脉球囊成形术(PTCA)后预测再狭窄的临床、生理、解剖及技术因素

本资料来自随机双盲对照法评价阿司匹林-潘生丁联合用药防止 PTCA后 7个月内发生再狭窄调查试验。行 PTCA前将所有同意参加本试验的病人随机分入阿司匹林-潘生丁联合用药组及安慰剂对照组、在行PTCA后的4—7个月内(除非症状复发需在4个月内行冠脉造影)力争再做一次冠脉造影。共有1,895例病人登记行PTCA,剔除后376例病人随机分入药物组及安慰剂组。最     

Comparison of Results of Coronary Angioplasty in Patients with Unstable vs. Stable Angina

Objectives To compare the short and mid - term outcomes in cases of percutaneous transluminal coronary angioplasty (PTCA) in patients with unstable v stable angina. Methods Patients selected for PTCA/stenting were divided in to two groups, one with stable angina pectoris (SA group, n = 92) and one with unstable angina pectoris (UA group, n = 112). The outcomes of coronary an giographies (CAG), initial (30-d) success of the procedure, and follow - up status in the two groups were compared. Results Baseline characteristics were similar, although the patients with unstable symptoms more females ( P< 0. 05), and had a higher average CCS class (P< 0. 05) and a higher incidence of postinfarction angina ( P< 0. 01). The frequency of ' complex stenosis in patients with unstable angina was higher than that of patients with stable angina, 33% v 20% ( P< 0. 01). A total of 309 vessels ac cepted the procedure; including 210 stents were sue cessfully delivered to 156 patients. 143 and 67 stents were implanted in the     

不稳定型与稳定型心绞痛冠状动脉成形术的比较

目的　比较不稳定型心绞痛 (UA)与稳定型心绞痛 (SA)患者接受冠状动脉成形术 (PTCA)的疗效。方法　行PTCA的心绞痛患者 2 0 4例 ,分组比较UA与SA患者冠状动脉造影结果及PTCA术的近期和中期疗效。结果　①分组 :2 0 4例病人中 ,UA组 112例 (5 5 % ) ,SA组 92例 (45 % )。其中UA组心绞痛分级高于SA组 (P <0 0 5 )。②UA组复杂病变血管支数为 74(3 3 % ) ,SA组复杂病变血管 43支(2 0 % ) ,两组比较差异显著 (P <0 0 1) ;而SA组多支血管病变的发生较UA组为多 (P <0 0 5 )。③支架植入情况 :UA组有 114支血管共植入支架 143枚 ,占病变血管数的 5 1% ;SA组 5 4支血管共 67枚 ,占 2 5 % ,两组比较差异显著 (P <0 0 1) ,共 15 6例病人接受支架术。④术后 3 0d内无重大并发症发生 ,UA组复发胸痛较SA组高 (9%vs 3 % ,P <0 0 5 )。⑤随访 3～ 9个月 ,发生心肌梗死 3例 ,其中UA患者2例。复发胸痛两组分别为 12例和 16例 ,占 13 %和 14% ;临床再狭窄发生率分别为 2 0 %和 2 2 % ,均无显著差别。结论　PTCA/支架术对不稳定型与稳定型心绞痛患者的疗效相似 ,即刻成功率高 ,中期疗效满意     

Immediate and follow-up results of the conservative coronary angioplasty strategy for unstable angina pectoris.

To assess the results of a conservative coronary angioplasty strategy in unstable angina pectoris, the records of 1,421 consecutive patients without previous myocardial infarction undergoing a first percutaneous transluminal coronary angioplasty (PTCA) between 1986 and 1990 were reviewed. Of these patients, 631 had unstable and 790 had stable angina pectoris. Only after an intense effort to medically control symptoms, the unstable patients underwent PTCA at an average of 15.4 days (range 1 to 76) after hospital admission. Primary clinical success was achieved in 91.7% of patients with unstable and in 94.4% of those with stable angina pectoris (p = not significant). In-hospital mortality rates were 0.3 and 0.1%, respectively (p = not significant). Nonfatal in-hospital event rates for acute myocardial infarction, cerebrovascular accident and coronary bypass surgery were only slightly higher in patients with unstable angina pectoris; however, the difference from the stable group was significant when all events were combined (9 vs 5.9%; p less than 0.04). During 6-month follow-up, no significant difference in adverse events was found between the groups. The respective rates for the unstable and stable groups were 0.4 and 0.2% for death, 5.5 and 5.1% for major nonfatal events, and 17.7 and 20.1% for repeat PTCA. These results suggest that use of a conservative PTCA strategy in the treatment of patients with unstable angina pectoris results in favorable and similar immediate and 6-month outcomes compared with those in patients with stable angina pectoris.     

PTCA支架术后血清肌钙蛋白I的变化及其相关因素

目的 :观察经皮腔内冠状动脉成形术 （PTCA）和支架术后血清肌钙蛋白 I（c Tn I）和磷酸肌酸激酶 （CK）的变化并分析相关因素。方法 :分别测定不同临床类型冠心病患者 85例 PTCA支架术前及术后 2 4 h的 c Tn I和 CK水平 ,并分组比较。结果 :稳定型心绞痛 16例 ,不稳定型心绞痛 4 1例 ,陈旧性心肌梗死 2 8例 PTCA支架术后 ,c Tn I水平均较术前升高 （P<0 .0 1） ;而 CK手术前后无明显变化 （P>0 .0 5 ）。 c Tn I升高组的扩张时间、扩张压、扩张次数、支架术、手术血管严重狭窄 （≥ 95 % ）的比例高于未升高组 （P<0 .0 1） ;不稳定型心绞痛组与陈旧性心肌梗死组术后c Tn I升高的比例高于稳定型心绞痛组 （P<0 .0 1）。结论 :PTCA支架术可造成心肌的轻度损伤。c Tn I升高可能与扩张的时间、压力、次数、置入支架数量、原来血管狭窄程度、临床类型有关     

不稳定型心绞痛危险度分层和冠状动脉造影的关系

目的探讨不稳定型心绞痛危险度分层和冠状动脉病变的关系,观察能否通过不稳定型心绞痛危险度分层预测不稳定型心绞痛患者的冠状动脉病变程度。方法按照中华医学会心血管病学分会提出的不稳定型心绞痛危险度分层,将145例不稳定型心绞痛患者分为高、中、低三个危险组,比较三组间冠状动脉造影术显示的病变程度。采用Gensini积分方法,对各支冠状动脉病变程度进行定量评定,将其危险度分层赋予分值,低危险组1分,中危险组2分,高危险组3分,测定该分组和冠状动脉病变危险程度、冠状动脉完全闭塞病变及三支病变的关系。结果低、中、高三个危险组冠状动脉病变积分分别为30．43、39．10和68．05分,高危险组积分显著高于低、中危险组（P=0．000）,而低、中危险组之间积分差异无统计学意义。不稳定型心绞痛危险度分组与冠状动脉病变程度显著相关。结论不稳定型心绞痛危险度分层和冠状动脉病变程度相关,可以作为冠状动脉完全闭塞病变和三支病变的预测因素。     

冠状动脉重构的血管内超声研究

目的：探讨冠状动脉重构在冠心病发生中的作用以及与临床表现之间的关系。方法：73例冠心病患者,根据临床表现分为急性心肌梗死(AMI)组,共27例；不稳定性心绞痛(UAP)组,共22例；稳定性心绞痛(SAP)组,共24例。对“罪犯”病变进行血管内超声(IVUS)检查,测定重构指数,确定重构方向,并进行分组对比研究。结果：正性重构在急性心肌梗死组最常见,其次为不稳定性心绞痛组,稳定性心绞痛组最少见。相反,负性重构在稳定性心绞痛组最常见,其次为不稳定性心绞痛组,急性心肌梗死组最少见。正性重构病变有较大的外弹力膜面积、斑块面积和斑块负担。结论：正性重构与急性冠状动脉综合症的发生有关,负性重构易引起心绞痛的发生却使斑块趋于稳定。     

Percutaneous transluminal coronary angioplasty for patients with unstable angina pectoris.

Percutaneous transluminal coronary angioplasty (PTCA) was successful in 91% of 76 patients with unstable angina pectoris refractory to pharmacological treatment. However, the rate of acute occlusion and reocclusion was rather high (95). Restenosis developed in 56.5% of successful cases after initial PTCA, and 29 patients underwent 2nd, and nine 3rd PTCA. Most refractory unstable angina can be controlled by PTCA, which may require repeating in some patients.     

稳定型与不稳定型心绞痛冠状动脉造影特点的对比分析

目的:分析稳定型与不稳定型心绞痛患者的冠脉造影特点,评估不稳定型心绞痛的危险性并指导其临床治疗和预后判断。方法:选择在我院进行冠脉造影的80例稳定型心绞痛和136例不稳定型心绞痛(初发劳力性、恶化劳力性、静息性)患者,并对所有冠脉造影结果进行对比分析。结果:初发劳力性心绞痛单支病变较其它组心绞痛多见(P<0.05);恶化劳力性、静息性心绞痛左主干病变较初发劳力性多见(P<0.05);稳定型心绞痛冠脉病变形态以A型病变多见,不稳定型心绞痛以C型病变多见,两者之间有着显著性差异(P<0.01);不稳定型心绞痛总的血栓检出率高于前者(P<0.05)。结论:不稳定型心绞痛患者冠脉病变较稳定型心绞痛患者冠脉病变形态复杂、血栓发生率高,病变的不稳定导致其病情严重、预后差。     

Short and long term outcome of percutaneous transluminal coronary angioplasty in unstable versus stable angina pectoris: a report of the 1985-1986 NHLBI PTCA Registry

In a cohort of 1,720 consecutive patients from the National Heart, Lung, and Blood Institute, Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry (August 1985-May 1986), we compared 768 patients (45%) with stable angina and 952 patients (55%) with unstable angina pectoris. Unstable angina patients exhibited at least one of the following characteristics: new onset angina, rapidly progressing angina, angina at rest, angina refractory to medication, variant angina, acute coronary insufficiency, or angina recurring shortly after an acute myocardial infarct. The distribution of single- and multi-vessel disease was similar among stable and unstable angina patients; multi-vessel disease predominated. Average severity of stenosis and incidence of tubular and diffuse stenosis morphology were higher among patients with unstable angina (both p less than 0.001). Patient success rates were similar in stable and unstable patients. However, on a per lesion basis, overall angiographic success rate and average reduction of severity of stenosis in successfully dilated lesions were significantly higher among patients with unstable angina (both p less than 0.001). Incidence of major patient complications (p less than 0.01) and of emergency coronary bypass surgery (p less than 0.05) were also higher in patients with unstable angina but consistent with their more precarious clinical condition and stenosis morphology. During a two year follow-up, the cumulative distributions of death, myocardial infarct, repeat PTCA, and coronary bypass surgery were not significantly different in patients with stable angina compared to patients with unstable angina. Comparison of the current PTCA Registry cohort with the cases reported in the 1979-1982 Registry revealed a 19% higher success rate for both stable and unstable angina patients. Major complication rates decreased between time periods for stable but not for unstable angina patients. Incidence of emergency bypass surgery decreased more for stable than for unstable angina patients. Coronary angioplasty is indicated in properly selected patients with unstable angina and both single- and multi-vessel coronary disease.