1985～1994年与1995～1997年期间冠心病介入治疗的对比研究

回顾性对比分析本院1985～1994年与1995～1997年期间冠心病介入治疗的病例资料,观察从开展PTCA、逐步到熟练掌握这项技术的过程中,病例适应证、临床疗效的演变.     

1994～1995年STD门诊病人流行病学分析

北京协和医院皮肤科ＳＴＤ门诊１９９４年初诊人数８５７例，检出主要ＳＴＤ３４１例，占３７．７９％。ＳＴＤ发病率依次为尖锐湿疣（１４．５９％），淋病（９．５７％），由沙眼衣原体感染引起的非淋菌性尿道炎（９．３３％），梅毒（５．２５％），由ＨＳＶ－Ⅱ型感染引起的生殖器疱疹（１．０５％）。１９９５年初诊人数６９１例，检出主要ＳＴＤ３０９例，占４４．４７％。ＳＴＤ发病率依次为尖锐湿疣（１５．２９％），非淋菌性尿道炎（１２．５９％），梅毒（８．１０％），淋病（６．８０％），生殖器疱疹（１．３０％）。１９９５年检出ＨＩＶ阳性１例。２年中尖锐湿疣发病率均占第一位，淋病发病率从１９９４年的第二位降至１９９５年的第四位，而非淋菌性尿道炎自第三位升至第二位。     

上海市1994～1997年性病流行病学分析

对1994～1997年上海市性病监测点疫情资料进行流行病学分析．结果表明：上海市性病流行呈现以下特点：（1）性病发病率逐年上升,发病率由1994年的90．74／10万上升至1997年的254．25／10万;（2）病种构成以淋病为主,平均构成为71．51％,但其构成比逐年下降,非淋菌性尿道（宫颈）炎和梅毒的构成比逐年上升;（3）男性发病率普遍高于女性,但尖锐湿疣和潜伏梅毒发病率女性高于男性;（4）20～29岁组人群性病发病率高于其它年龄组,平均发病率为431．63／10万。     

青海省兴海县1995～1997年大骨节病病情分析

本文对青海省兴海县唐乃亥乡上、下鹿圈村１４９名７～１２岁青少年进行了流行病学调查及临床、Ｘ线检查，其结果临床检出率１９９５年为１．９８％，１９９６年为１３．９７％，１９９７年为３７．５８％。Ｘ线检出率由１９９５年５０．３３％降到１９９６年４６．３３％，１９９７年的３７．５８％。说明兴海县大骨节病病情三年间相比病情有所下降，但与其它省（区）相比病情很重，致病因子仍然活跃     

吉林市1995～1997年老年人恶性肿瘤死亡分析

一、材料与方法　　材料取自吉林市肿瘤防治研究办公室1995～1997年全市城市居民死因调查的资料。死因分类按国际疾病分类第9次修订本(ICD-9)编码分类,分析资料为60岁以上各年龄组人口数及恶性肿瘤死亡人数,计算各种肿瘤死亡率,调整死亡率。对70年代、90年代资料加以比较,标化死亡率采用1964年、1982年中国标化人口计算。调查资料基本按照1993年全国肿瘤防治研究办公室制定方法所需各项数据指标整理。显著性检验采用u检验。　　二、结果与讨论　　吉林市城区1995～1997年60岁以上老年人人口数为325451人,占同期人口数的7.78%,其中男性1687…     

1994～1995年伊犁地区六县布鲁氏菌病监测报告

新疆伊犁地区1992年被确定为达到布病控制标准的地区。我们于1994、1995年对该地区昭苏、尼勒克、察布查尔、新源、霍城、伊宁县进行了市病检测工作。互监测目的通过监测，系统地调查与布病相关的各种流行因素，及早发现和了解流行状况，考核防治效果，及时纠正防治程序，采取预防措施，做好预报，进一步提高疗效，控制市病的发生和流行。2监测方法和结果选择受市病威胁的15～60岁农牧民作为监测对象。在各监测县的农牧区、半农半牧区选择3个点，进行有代表性的抽查。2．互监测方法：确定为调查点的各乡场采血IOO多人份，每县300多人份，…     

1994～1997年河北省保定市人群弓形虫感染调查

弓形虫病(Toxoplasmosis)是一种人兽共患寄生虫病。主要传染源是猫、狗等动物。为了解保定地区弓形虫感染情况,我们于1994～1997年对保定市各医院就诊的患者(来自保定市各地)进行了弓形虫血清学检查,现将结果报告如下。1　资料与方法调查对象为保定市二院、第一中心医院等8所医院就医的患者。取被检查者静脉血2mL,自然分离血清,56℃30min灭活后做IHA实验,血清稀释度从1∶4开始,顺序做倍比稀释。所用试剂购自广西壮族自治区卫生防疫站(在有效期内使用并严格按操作规程进行)。2　调查结果检查573名就医患者,阳性者53人,阳性率为9.25%。滴度…     

1995～1997年楚雄州克山病监测结果分析

目的　为准确掌握克山病发病消长趋势,科学指导和评价克山病防治工作。方法　按１９９４ 年全国克山病病情监测会议修订的《全国克山病病情监测方案》进行。结果　全州克山病发病率由１９９５ 年的０．５４／１０ 万升至１９９７ 年的１．９１／１０ 万。新发病例主要是成人慢型克山病。监测点连续３ 年普查,慢型克山病检出率在０．０８％ ～０．４０％ 之间,潜在型克山病检出率为１．５１％ ～１．８８％ ,异常心电图检出率在３．７２％ ～２．９４％ 之间。结论　克山病病情平稳低发,成人慢克是防治重点之一。     

沧源县1995～1997年疟疾监测情况分析

目的了解沧源县1995～1997年疟疾流行情况。方法采用发热病人血检、居民原虫调查、媒介监测等方法。结果原发病例和疫点高度分散,发热病人血检阳性率呈逐年上升趋势,1995～1997年分别为0.48％,1.41％和1.80％,恶性疟原虫比例分别为31.82％,81.58％和50.55％。结论沧源县的疟疾流行虽已控制在一个较低的水平,但近年来却呈逐年上升趋势,故应加强监测和疫点处理     

经皮冠状动脉球囊成形与腔内斑块旋磨治疗冠心病

本文报道我院１９９２年７月至１９９５年９月间采用经皮冠状动脉腔内成形术治疗１８例冠心病，对２３支血管２５处病变进行扩张，狭窄度由８１％±１２％降至１８％±１５％；采用经皮冠状动脉腔内斑块旋磨治疗１０例冠心病，成功９例，对２５处斑块进行旋磨，两例补偿性球囊扩张，斑块处狭窄度平均值由术前的８６．２％降至２０．２％。     

Percutaneous Transluminal Coronary Angioplasty in Octogenarians

Revascularization is a theoretically ideal technique for treating repeated angina pectoris in elderly patients. Coronary angioplasty is an attractive option if it can be performed safely. In this report, we describe our experience with 80 angioplastic procedures in 72 patients older than 80 years. Seventy-two of these procedures (90%) were performed after 1990 using the currently available, improved angioplasty equipment. A third of these patients did not have any risk factors for coronary artery disease and 45% had only 1 risk factor. A history of previous myocardial infarction or coronary bypass surgery was present in 48 (67%) patients. In most patients (72%), angioplasty was performed during an admission for unstable angina or acute myocardial infarction. Single-vessel disease was present in 22% of patients. Successful angioplasty was performed in 92% of patients and major complications occurred in 8% of patients. Four patients (6%) died; in all of them, angioplasty was performed emergently to treat cardiogenic shock. None of 68 patients who underwent elective angioplasty for stable angina or a semielective procedure for unstable angina died during the hospitalization. We conclude that angioplasty can be performed safely in the carefully selected octogenarian. There is a low-risk subgroup of patients with limited disease in whom angioplasty is an attractive treatment strategy.     

Percutaneous Transluminal Coronary Angioplasty of Single Coronary Artery

The presence of single coronary artery is a very rare finding on coronary arteriography. This type of coronary artery anomaly was revealed in a 54-year-old patient with exertional angina refractory to full medical treatment and positive exercise test. The unique coronary vessel presented significant stenosis in the distal segment of circumflex artery—which continued as right coronary artery—and was successfully dilated with conventional balloon angioplasty.     

Percutaneous Coronary Revascularization in Patients With Single Coronary Artery

IntroductionSingle coronary artery (SCA) is a rare congenital coronary anomaly. Its incidence in various angiographic series is from 0.024% to 0.066%. Percutaneous coronary intervention (PCI) of coronary artery disease (CAD) in these patients is technically challenging.MethodsWe retrospective analyzed the cardiac catheterization procedures of last 15 years and found 12 cases of SCA (incidence 0.084%). To determine the course of anomalous coronaries, angiographic “dot and eye” method and computed tomography (CT) were used. The course of the SCA was classified as per the modified Lipton criteria. PCI was performed as per the standard protocol for a significant epicardial coronary artery stenosis.ResultsOut of total 12 patients of SCA, 9 patients had PCI of significant CAD. The mean age of 9 PCI patients was 63.8 ± 8.2 years (5 males, 4 females). The origin of the SCA was from the right sinus of Valsalva in 6 cases and from left sinus of Valsalva in 3 cases. Eleven successful PCI procedures were performed, which included PCI of left main, coronary bifurcation lesion, chronic total occlusion, and multi-vessel disease. Four patients had intravascular imaging and 3 patients had rotablation of calcified lesions.ConclusionPCI of SCA is technically challenging, which requires considerable expertise and experience. An appropriate selection of hardware along with technical expertise can make the procedure simpler with optimal end results.     

经皮冠状动脉腔内成形术并发冠状动脉穿孔

目的 :探讨经皮冠状动脉腔内成形术 (PTCA)并发冠状动脉穿孔的发生及其适当处理对策。　　方法 :对我院进行的所有 PTCA病例发生冠状动脉穿孔者进行回顾性分析。　　结果 :共行 PTCA治疗 172 8例 ,并发冠状动脉穿孔 6例 ,均为完全闭塞性病变 ,发生率为 0 .35 %。3例漏入心包 ,2例形成冠状动脉左心室瘘 ,1例形成冠状动脉右心室瘘。经球囊长时间加压扩张 ,穿孔全部闭合 ;无一例需要进行心包穿刺引流和急诊冠状动脉旁路移植术及死亡。　　结论 :PTCA并发冠状动脉穿孔并不常见 ,只要及时发现 ,恰当处理 ,可以避免严重并发症的发生。     

经皮冠状动脉腔内成形术并发急性血管闭塞

目的：探讨急性血管闭塞的发生及治疗。方法：回顾总结我院１０３４例经皮冠状动脉腔内成形术（ＰＴＣＡ）的急性血管闭塞及治疗情况。结果：３１例（３．０％）患者发生急性血管闭塞,其中８例系急性心肌梗塞（ＡＭＩ）;１６例为不稳定性心绞痛,７例为稳定性心绞痛。发生急性血管闭塞的时间：２８例（９０．３％）患者在ＰＴＣＡ术中,３例在术后。９例患者因血压降低需用升压药,其中５例需主动脉内球囊反搏（ＩＡＢＰ）支持。４例急性血管闭塞时发生心室颤动,１例出现心室停搏。处理结果：３１例患者中２４例用球囊长时间加压;１８例植入支架;２５例治疗成功,成功率为８０．６％。２例（６．５％）死亡;３例（９．７％）发生心肌梗塞;１例（３．２％）急诊行冠状动脉旁路移植手术。结论：急性血管闭塞的发生与不稳定性心绞痛、多支血管病变、复杂病变有关,采取冠状动脉内支架及长时间加压治疗有助于减少并发症。     

Economic and Ethical Considerations in Percutaneous Coronary Revascularization

New devices for catheter-based coronary revascularization provide substantial economic and ethical challenges. It is important for new technologies to undergo rigorous evaluation, and for the outcome assessment to include long-term follow-up. The outcome should include medical resource use and economic end points, as well as the traditional clinical measures, so that the cost-effectiveness of new technology can be assessed. Society must strike a balance between uncontrolled proliferation of new technology and the stifling of innovation by restrictive regulatory and reimbursement policies. The clinical investigator and interventional cardiologist must be aware of the potential of new technology to pose ethical dilemmas, and establish checks and balances to protect against abuses .     

Diltiazem Reduces Restenosis After Percutaneous Transluminal Coronary Angioplasty

In a prospective, randomized, and double-blinded protocol, the effect of oral diltiazem (180 mg) over placebo on the restenosis rate was assessed in 189 consecutive patients (150 males. 39 females, 57.6 ± 8.4 years) eligible for follow-up angiography after 3.6 ± 0.6 months (diltiazem 90.4%, placebo 89.6%). Pre-PTCA stenoses were similar in both groups (diltiazem 83.9%; placebo 84.4%). Immediately after PTCA, the remaining stenoses were identical in both groups (22.6% vs 22.8%). At follow-up angiography there was a highly significant difference (P < 0.01) in favor of diltiazem (minimal lumen diameter 38.6% vs 50.3%). Restenosis rate (> 50% stenosis or loss of > 50% of the initial gain) was significantly (P < 0.03) reduced by diltiazem (18 [21.4%] of 84 patients) compared to placebo (33 [38.4%] of 86 patients). Diltiazem was superior to placebo in all vessels: (1) left anterior descending coronary artery: 21.6% vs. 32.7%, (2) right coronary artery: 25% vs 46.7%; and (3) left circumflex. 16.7% vs 36%. The benefit of diltiazem was most pronounced in calcified plaques (33.3% vs 47.1%), in diabetics (15% vs 46.2%), in hypercholesterolemia (20.4% vs 44.2%, P < 0.05), in the age range of 41–50 years (21.4% vs 44.4%), and in patients with CCS Class 2 (11.1% vs 64%, P < 0.01). In stratified analysis, the effect was apparent in both sexes, independent from concomitant therapy, regardless of whether or not coronary artery disease had progressed in segments other than the dilated ones. Thus, in this limited series of patients, diltiazem significantly reduced the number and extent of restenosis. Confirmation in a larger cohort is necessary .     

Role of Platelets in Restenosis After Percutaneous Coronary Revascularization

The role of platelets in the process of restenosis after percutaneous coronary intervention is not fully understood. After vascular injury there is extensive platelet activation, adhesion, aggregation and secretion. Through the liberation of growth factors, such as platelet-derived growth factor, and surface expression of cell adhesion molecules, such as the glycoprotein IIb/IIIa integrin, platelets appear to be a pivotal mediator of the vascular injury response. Experimental models have demonstrated that profound, prolonged thrombocytopenia, or blockade of the IIb/IIIa receptor, may reduce neointimal hyperplasia after arterial balloon injury. However, multiple clinical trials testing conventional or new platelet agents have not yielded any salutary effects. The recent finding that abciximab, a monoclonal antibody fragment directed against IIb/IIIa, reduced clinical restenosis after coronary angioplasty by 26% in patients raises questions about the mechanism of benefit. The _vβ₃ vitronectin receptor is responsible for binding endothelial cells to platelets, and it also has a key role in modulating smooth muscle cell migration. It is possible that the antibody fragment exerts its effect on restenosis by means of _vβ₃, because abciximab fully cross-reacts to this integrin owing to the shared β₃ subunit. To date, the other platelet glycoprotein IIb/IIIa inhibitors, including Integrelin, Tirofiban, Lamifiban and Xemilofiban, are specific in binding to this particular integrin. Considerable further study is necessary to unravel the effects of platelets on the restenosis process.

(J Am Coll Cardiol 1996;28:1643–51)>