球囊跟踪辅助技术在经桡动脉冠脉介入中的应用

目的:探讨应用球囊跟踪辅助技术推送导管通过迂曲、痉挛挠动脉,完成经桡动脉介入治疗(transradial intervention,TRI)的安全性及有效性。方法:选取2016年11月—2019年6月行TRI的1251病例中,28例患者沿PTCA导丝同时推送导管及球囊通过桡动脉痉挛、迂曲嵌顿部位,通过迂曲、痉挛段后退出PTCA导丝及球囊,更换J型导丝,完成造影和介入治疗操作。结果:28例患者(男性12例,女性16例),应用球囊跟踪辅助技术,26例成功完成冠状动脉造影,7例(70%)患者随后完成PTCA及植入冠脉支架植入治疗。失败2例(由于环形迂曲导管无法跟进),所有患者术后即刻造影显示无造影剂外渗,术后即刻至术后3d内无穿刺点出血、前臂血肿、迷走反射及假性动脉瘤,术后监测血压良好。结论:球囊跟踪辅助技术是一种解决经桡动脉冠脉介入治疗中因桡动脉痉挛、迂曲及损伤后无法送入导管的有效方法,有助于治疗顺利完成。     

冠脉边支血管超声引导下开通无残端分支CTO病变的临床研究

目的探讨冠脉边支血管超声引导下无残端分支冠状动脉慢性完全闭塞病变(CTO)介入开通手术治疗的临床效果。方法采用回顾性研究方式,选取2012年8月至2017年5月哈尔滨市第一医院介入治疗的无残端分支冠状动脉CTO患者16例,均在冠脉边支血管超声(IVUS)引导下完成经皮冠状动脉介入(PCI)治疗。观察介入治疗情况和效果。结果 IVUS引导下完成CTO残端导丝穿刺的患者13例,成功率为81.25%;在CTO残端导丝穿刺成功后经由阻塞血管进入真腔的患者11例(68.75%); CTO残端导丝穿刺成功后没有进入真腔的2例患者,均选择逆向导丝穿刺方法完成CTO开通治疗。穿刺成功的13例患者均首先选择常规PCI导丝进行CTO残端导丝穿刺,1例患者未成功到达远端真腔,改为逆向导丝穿刺术后成功,其余12例患者均选择CTO专用导丝进行穿刺后,成功完成开通手术。结论冠状动脉IVUS引导下完成无残端分支冠状动脉CTO介入开通手术具有较好的效果,而CTO专用导丝的硬度相对较高,治疗效果优于常规导丝。     

国产覆膜支架在食管颈胸段恶性肿瘤的应用

目的 介绍国产覆膜支架在颈胸段食管恶性肿瘤放置的方法和体会。方法 27例晚期食管癌病人在DSA透视监视下送入导丝和导管至胃内，交换导丝后将食管推送器送至病变段处，准确定位后释放支架。结果 27例病人共置入29枚覆膜支架，3d后摄片或钡餐复查见支架膨胀良好，造影剂通过顺利瘘口封堵满意。结论 支架置入的关键取决于导丝能够通过狭窄段，支架置入其上端准确定位至关重要，晚期食管癌行国产覆膜支架置入操作简单、安全．可行。     

血流储备分数在冠状动脉临界病变介入治疗中的指导价值

目的 在冠状动脉（冠脉）临床病变的介入治疗当中,依据血流储备分数（FFR）给予对应治疗,分析其指导作用。方法 共纳入68例冠心病患者作为研究对象,病例来源为福建医科大学附属漳州市医院,病例收治时间为2020年1月—2022年1月,按照不同治疗方案分为两组。对照组纳入31例患者,经冠脉造影（CAG）检查显示冠脉管腔狭窄率为50%～70%,实行经皮冠脉介入（PCI）治疗;观察组纳入37例患者,均接受CAG检查,确认符合冠脉临界病变标准,即刻进行FFR测定,并根据FFR值分组。FFR>0.80的14例患者纳入药物组,进行强化治疗,包括他汀类药物、阿司匹林;FFR≤0.80的23例患者纳入PCI组,均进行药物治疗并联合PCI手术。比较两组患者的临床资料、CAG参数（病变部位、血管狭窄比例、参考血管直径、最小管腔直径）、PCI治疗相关观察指标（造影剂使用量、支架植入数量、手术时间）及随访结果（心脏不良事件发生率、再发心绞痛发生率）。结果 对照组与观察组的CAG参数比较差异均无统计学意义。PCI组的造影剂使用量、支架植入数量均明显少于对照组,手术时间明显较对照组短[造影剂使用量（mL）:19...     

冠状动脉慢性完全闭塞病变介入治疗临床疗效分析

目的:探讨国人冠状动脉慢性完全闭塞病变(CTO)患者的介入治疗特点及影响因素。方法:入选2017年中国冠状动脉慢性闭塞病变俱乐部(CTOCC)的CTO患者40例,分析介入治疗过程的特点以及操作成功率。结果:40例患者闭塞时间为3~56个月,均为首次介入治疗失败者,J-CTO评分均≥3分,术前均行冠状动脉CT检查,双侧造影使用率为100%。通过前向技术成功开通血管23例,血管内超声(IVUS)指导下正向钢丝技术及平行导引钢丝技术为术者最常采用的正向技术,其中5例患者采用正向内膜下重回真腔(antegrade dissection reentry,ADR)技术4例获得成功;逆向导丝通过法成功完成介入治疗14例,使用Reverse CART技术10例。术中使用平均钢丝数为5.07根,术者最常用软导丝是Sion系列钢丝35例(82.5%),其次为Runthrough钢丝22例(55%),再次为锥形导丝Fielder系列钢丝15例(37.5%),成功通过病变5例(12.5%)。使用硬导引钢丝通过病变32例(80%),通过CTO病变术者最常使用的硬导引钢丝为Gaia系列钢丝23例(57.5%),其次为Conquest系列导引钢丝19例(47.5%),再者为Pilot系列钢丝18例(45.0%)。术中微导管使用率为100%,其中Cosair导管最常使用(33例,82.5%)。操作中IVUS使用22例(55%),主要用于判断导丝远端是否位于真腔、植入支架时管腔直径判断及寻找闭塞血管入口。40例患者平均球囊使用3.24个,平均植入支架2.53个,均为药物洗脱支架,PCI成功37例,未成功3例,PCI成功率达92.5%。住院期间无主要心血管不良事件发生。结论:2017年CTOCC病例介入治疗成功率高于目前国内外CTO介入治疗的平均成功率;这得益于术者经验丰富、术前充分阅片、冠脉CT使用率高、术中IVUS充分使用以及合理的使用导丝、器械及合理的策略选择。     

PTCA导丝在冠状动脉造影桡动脉痉挛时的应用价值

目的探讨经皮冠状动脉(冠脉)腔内血管成形术(percutaneous transluminal coronary angioplasty,PTCA)导丝在冠脉造影桡动脉痉挛时的应用价值。方法将行经桡动脉冠脉造影和(或)介入治疗术发生桡动脉痉挛的106例分为PTCA导丝组36例和药物组70例。PTCA导丝组在造影路径指导下更换泥鳅导丝为PTCA导丝完成造影;药物组沿鞘管侧管注入维拉帕米1 mg和硝酸甘油200μg,等待5 min后再次行桡动脉造影,观察两组经桡动脉冠脉造影成功率及并发症。结果药物组重度痉挛占88.6%,弥漫痉挛占38.6%;PTCA导丝组重度痉挛占97.2%,弥漫痉挛占41.7%,两组痉挛严重及弥漫程度比较差异无统计学意义(P>0.05)。PTCA导丝组PTCA导丝均通过病变部位,在PTCA导丝指引下5 F造影导管通过病变部位冠脉造影成功率94.4%。药物组再次造影桡动脉痉挛改善,经桡动脉冠脉造影成功率84.3%,两组比较差异无统计学意义(P>0.05)。药物组、PTCA导丝组手术时间分别为(45.6±18.1)min、(29.1±13.7)min,两组比较差异有统计学意义(t=4.80,P=0.001)。PTCA导丝组出现血管并发症2例(5.6%);药物组出现血管并发症18例(25.7%),两组比较差异有统计学意义(χ2=7.41,P=0.01)。结论冠脉造影桡动脉痉挛时可尝试使用PTCA导丝完成造影,该方法安全可行。     

Significance of PTCA Guidewire in the Radial Artery Spasm during Coronary Artery Angiography

目的 探讨经皮冠状动脉(冠脉)腔内血管成形术(percutaneous transluminal coronary angioplasty,PTCA)导丝在冠脉造影桡动脉痉挛时的应用价值.方法 将行经桡动脉冠脉造影和(或)介入治疗术发生桡动脉痉挛的106例分为PTCA导丝组36例和药物组70例.PTCA导丝组在造影路径指导下更换泥鳅导丝为PTCA导丝完成造影;药物组沿鞘管侧管注入维拉帕米1 mg和硝酸甘油200 μg,等待5 min后再次行桡动脉造影,观察两组经桡动脉冠脉造影成功率及并发症.结果 药物组重度痉挛占88.6％,弥漫痉挛占38.6％;PTCA导丝组重度痉挛占97.2％,弥漫痉挛占41.7％,两组痉挛严重及弥漫程度比较差异无统计学意义(P＞0.05).PTCA导丝组PTCA导丝均通过病变部位,在PTCA导丝指引下5F造影导管通过病变部位冠脉造影成功率94.4％.药物组再次造影桡动脉痉挛改善,经桡动脉冠脉造影成功率84.3％,两组比较差异无统计学意义(P＞0.05).药物组、PTCA导丝组手术时间分别为(45.6±18.1) min、(29.1±13.7)min,两组比较差异有统计学意义(t=4.80,P=0.001).PTCA导丝组出现血管并发症2例(5.6％);药物组出现血管并发症18例(25.7％),两组比较差异有统计学意义(x2 =7.41,P=0.01).结论 冠脉造影桡动脉痉挛时可尝试使用PTCA导丝完成造影,该方法安全可行.     

支架嵌顿于右冠状动脉及升主动脉内抓捕成功1例

经皮冠状动脉介入治疗发生支架脱载或嵌顿、导丝断裂是非常少见的并发症,主要由于操作技术或病变程度如闭塞病变、扭曲病变、钙化病变以及分叉病变。本例患者由于右冠状动脉近端闭塞病变,在开通血管后分别由远至右冠脉开口植入3枚支     

非ST段抬高急性冠状动脉综合征患者的介入治疗

目的：分析急性冠脉综合征患者非ST段抬高时行经皮冠状动脉介入治疗术(PCI)的有效性和安全性。方法：从2001年1月至2003年10月在我院住院的72例非ST段抬高急性冠脉综合征病人，包括不稳定型心绞痛病人UAP)48例，非ST抬高急性心肌梗死(NSTEMI)病人24例，除常规内科治疗外，接受冠状动脉造影及介入治疗(PTCA和支架植入术)。造影提示单支血管病变31例(43．1％)，双支血管病变25例(34．7％)，三支血管病变16例(22．2％)，分别行PTCA和支架植入术。结果：介入治疗的成功率97．2％(70／72)，失败的两例患者主要是导丝不能通过闭塞病变所致。在70例患者中，共植入支架91枚。随访至术后30d，无症状或症状明显缓解的61例；2例发生ST段抬高急性心肌梗死；4例多支血管病变患者再次行介入治疗；3例患者转外科行CABG术；2例患者死亡。结论：经皮冠状动脉介入治疗是非ST段抬高急性冠脉综合征的有效和安全的治疗方法。     

经皮冠脉内介入治疗的围手术期护理干预

目的探讨围手术期护理干预对经皮冠脉内介入治疗的患者的脑利钠肽（BNP）的影响。方法将经皮冠脉内介入治疗的患者90例，随机分为观察组和对照组，各45例，对照组实行常规护理，观察组在常规护理的基础上实行护理干预。分别观察2组患者在干预前后的脑利钠肽的变化。结果观察组患者的血浆BNP降低水平较对照组大，差别有统计学意义（P〈0．05）。讨论围手术期的护理干预对经皮冠脉内介入治疗患者的血浆BNP的降低有一定的支持作用。     

Initial clinical experience with a remote magnetic catheter navigation system for ablation of cavotricuspid isthmus-dependent right atrial flutter

Background: A remote magnetic navigation system (MNS) is available and has been used with a 4‐mm‐tip magnetic catheter for radiofrequency (RF) ablation of some supraventricular and ventricular arrhythmias; however, it has not been evaluated for the ablation of cavotricuspid isthmus‐dependent right atrial flutter (AFL). The present study evaluates the feasibility and efficiency of this system and the newly available 8‐mm‐tip magnetic catheter to perform RF ablation in patients with AFL. Methods: Twenty‐six consecutive patients (23 men, mean age 64.6 ± 9.6 years) underwent RF ablation using a remote MNS. RF ablation was performed with an 8‐mm‐tip magnetic catheter (70°C, maximum power 70 W, 90 seconds). The endpoint of ablation was complete bidirectional isthmus block. To assess a possible learning curve, procedural data were compared between the first 14 (group 1) and the rest (group 2) of the patients. Results: The initial rhythm during ablation was AFL in 20 (19 counterclockwise and 1 clockwise) and sinus rhythm in six patients. Due to technical issues, the ablation in the 18th patient could not be done with the MNS, and so we switched to conventional ablation. The remote magnetic navigation and ablation procedure was successful in 24 of the 25 (96%) remaining patients with AFL. In one patient (patient 2), conventional catheter was used to complete the isthmus block after termination of AFL. The procedure, preparation, ablation, and fluoroscopy times (median [range]) were 53 (30–130) minutes, 28 (10–65) minutes, 25 (12–78) minutes, and 7.5 (3.2–20.8) minutes, respectively. Patients in group 2 had shorter procedure (45 [30–70] min vs 80 [57–130] min, P = 0.0001), preparation (25 [10–30] min vs 42 [30–65] min, P = 0.0001), ablation (20 [12–40] min vs 31 [20–78] min, P = 0.002), and fluoroscopy (7.2 [3.2–12.2] min vs 11.0 [5.4–20.8] min, P = 0.014) times. No complication occurred during the procedure. Conclusion: Using a remote MNS and an 8‐mm‐tip magnetic catheter, ablation of AFL is feasible, safe, and effective. Our data suggest that there is a short learning curve for this procedure.     

Catheter Ablation of Scar‐Related Ventricular Tachycardia in Patients with Electrical Storm Using Remote Magnetic Catheter Navigation

Background: A remote magnetic navigation system (MNS) has been used for ablation of ventricular arrhythmias. However, irrigated tip catheter has not been evaluated in large series of patients. Objective: To evaluate acute and long‐term efficiency of the newly available irrigated tip magnetic catheter for radiofrequency (RF) ablation of scar‐related ventricular tachycardia (VT) in patients with ischemic heart disease. Methods: Between January 2008 and October 2009, a total of 30 consecutive patients with ischemic heart disease (26 men, age 70.1 ± 8.7 years, left ventricular ejection fraction: 30 ± 9%) and electrical storm due to monomorphic VT underwent RF ablation using a remote MNS and a magnetic irrigated tip catheter. Results: Acute success was defined as noninducibility of any monomorphic VT during programmed right and left ventricular stimulation, and obtained in 24 (80%) patients. A total of 1–6 VTs (mean 2.3 ± 1.2, 394 ± 108 ms, 210–660 ms) were inducible during each procedure. The duration of RF energy application was 41.2 ± 23.3 minutes, with total procedure and fluoroscopy times of 158 ± 47 minutes and 9.8 ± 5.3 minutes, respectively. No acute complications were observed during the procedures. During mean follow‐up of 7.8 months, 21 patients (70%) had no recurrence of VT and received no implantable cardioverter defibrillator therapy. Among patients who were noninducible during programmed right ventricular stimulation (n = 25), ≥1 monomorphic VT was inducible during programmed left ventricular stimulation in four (16%) that was ablated successfully in three of them. Conclusions: Irrigated ablation of scar‐related VT using remote MNS is an effective modality for management of the monomorphic VT in patients with ischemic cardiomyopathy with minimal radiation exposure. Programmed left (in addition to right) ventricular stimulation might be necessary to assess acute outcome of the ablation procedure. (PACE 2010; 1312–1318)     

Remote magnetic navigation for catheter ablation of atrioventricular nodal reentrant tachycardia: a systematic review and meta-analysis

Catheter ablation has become a well-established, first-line therapy for atrioventricular nodal reentrant tachycardia (AVNRT), the most common reentry supraventricular tachycardia in humans. Robotic systems are becoming increasingly common in both complex and simple ablation procedures with presumed potential improvements in procedural efficacy and safety. The authors of this article conducted a systematic review and meta-analysis on the effectiveness and safety of the magnetic navigation system (MNS) in comparison with conventional catheter navigation for AVNRT ablation. An electronic search was performed using Cochrane Central database, Medline, Embase and Web of Knowledge between 2002 and 2012. References were searched manually. Outcomes of interest were: acute and long-term success, complications, total procedure, ablation and fluoroscopic times. Continuous variables were reported as standardized difference in means (SDM); odds ratios (OR) were reported for dichotomous variables. Thirteen studies (seven of which were nonrandomized controlled, four were case series and two were randomized controlled studies) involving 679 adult patients were identified. Twelve studies were based on a single center and one study was multicentral. MNS was deployed in 339 patients. The follow-up period ranged between 75 and 180 days. Acute success and long-term freedom from arrhythmia were not significantly different between MNS and control groups (98 vs 98%, OR: 0.94 [95% CI: 0.21–4.1] and 97 vs 96%, OR: 1.18 [95% CI: 0.35–4.0], respectively). A shorter fluoroscopic time was achieved with MNS; however, this did not reach statistical significance (15 vs 19 min, SDM: -0.26 [95% CI: -0.64–0.12]). Longer total procedure but similar ablation times were noted with MNS (160 vs 148 min, SDM: 3.48 [95% CI: 0.75–6.21] and 4 vs 6 min, SDM: -0.83 [95% CI: -2.19–0.53], respectively). The overall complication rate was similar between both groups (2.7 vs 1.0%, OR: 1.28 [95% CI: 0.33–4.96]). Our data suggest that the usage of MNS results in similar rates of success and complications when compared with conventional manual catheter ablation for AVNRT. MNS had a trend for reduced fluoroscopic time. Longer total procedure time was observed with MNS while the actual ablation time remained similar. Prospective randomized trials will be needed to better evaluate the relative role of MNS for catheter ablation of AVNRT.     

A Randomized Comparison of Transseptal and Transaortic Approaches for Magnetically Guided Ablation of Left‐Sided Accessory Pathways

Objectives: Radiofrequency catheter ablation of left‐sided accessory pathways (APs) can be performed either by a transseptal (TS) or transaortic (TA) approach. When performed manually, these techniques are equally effective. The aim of this prospective randomized study was to compare these approaches using a magnetic navigation system (MNS) (Niobe, Stereotaxis, St. Louis, MO, USA). Methods: Twenty‐two consecutive patients were randomized to undergo ablation of a left‐sided AP by either a TS or a TA approach. The MNS was used in all patients for catheter navigation and eventual ablation, after electrophysiology study (EPS) confirmed the presence of left‐sided APs. Crossover was allowed after failure of the initial approach. Success rates, procedure, fluoroscopy, and ablation times were compared. Results: Of 11 procedures, 10 (91%) were successful in the TS group. The patient crossed over to the TA approach remained unsuccessful. Successful elimination of the AP was obtained in nine (82%) of 11 of the TA procedures. Of the two patients who crossed over to a TS procedure in the same session, one was successful and one remained unsuccessful. Total procedure time did not differ in both groups (87.1 ± 30.8 vs 90.9 ± 26.5 minutes). When total procedure and patient fluoroscopy times were divided into EPS time, time to first application, to successful application, and time to perform TS puncture or to retrogradely cross the aortic valve, only the last measurement differed significantly for both groups (P < 0.01). Ablation times were comparable in both groups. No major complications occurred. Conclusions: Our data show that TS and TA approaches are equal in success rate and total procedure, patient fluoroscopy, and ablation time when using the MNS for left‐sided AP ablation. However, crossing the aortic valve with the MNS is faster than completing a TS puncture. (PACE 2010; 1298–1303)     

抑制性rTMS刺激联合镜像神经元训练系统对脑卒中后完全性失语的作用研究

目的：探讨抑制性重复经颅磁刺激(rTMS)联合镜像神经元训练系统(MNS)对脑卒中后完全性失语的临床疗效及其作用机制。方法：50例脑卒中后完全性失语患者按随机数字表法随机分为对照组16例、MNS组16例和联合组18例。对照组仅给予常规的言语康复训练,MNS组在对照组的基础上给予镜像神经元系统训练,联合组在MNS组的基础上给予右侧Broca同源区1Hz的rTMS刺激,于治疗前和治疗3周后评定3组患者西方失语成套测验(WAB)以及波士顿失语症程度分级（BDAE）评分。结果：治疗3周后,3组WAB各项评分和BDAE评分均较治疗前明显提高（P<0.05）;且联合组WAB各项评分及BDAE评分显著高于MNS组和对照组（P<0.05）,MNS组WAB评分中自发语评分及AQ评分亦高于对照组（P<0.05）,BDAE评分MNS组和对照组治疗后比较差异无统计学意义。结论：抑制性rTMS刺激右侧Broca同源区联合MNS训练系统对改善脑卒中后完全性失语患者的语言功能有一定作用。     

冠状动脉慢性完全闭塞病变患者经皮冠状动脉介入术后不同时程双联抗血小板药物治疗及预后观察

目的观察冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后不同时程双联抗血小板药物治疗(dual antiplatelet therapy,DAPT)及预后情况。方法选取PCI术后采用DAPT的冠状动脉CTO 480例,按照DAPT时程不同将其分为两组,采用DAPT>12个月方案者为延长DAPT组(274例),采用DAPT 12个月方案者为标准DAPT组(206例)。观察比较两组一般资料、DAPT用药情况及冠状动脉病变、PCI情况,记录比较两组随访主要和次要终点事件情况,应用Kaplan-Meier生存曲线和Log-Rank检验评估比较两组无主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular events,MACCE)生存情况。结果延长DAPT组有PCI史所占比例高于标准DAPT组,差异有统计学意义(P<0.05)。两组其他一般资料及冠状动脉病变、PCI情况比较差异均无统计学意义(P>0.05)。采用阿司匹林加硫酸氢氯吡格雷方案延长DAPT组258例(94.2%)多于标准DAPT组172例(83.5%);采用阿司匹林加替格瑞洛方案延长DAPT组16例(5.8%)少于标准DAPT组34例(16.5%),差异有统计学意义(P<0.01)。延长DAPT组MACCE发生率和非致死性心肌梗死发生率低于标准DAPT组,差异有统计学意义(P<0.05)。Kaplan-Meier生存曲线分析结果显示,延长DAPT组无MACCE生存率高于标准DAPT组,差异有统计学意义(Log-Rank P<0.05)。结论冠状动脉CTO患者PCI术后50%以上选择延长DAPT,采用延长DAPT患者预后优于采用标准DAPT患者,且不增加中重度出血。     

急诊PCI围术期多岗位协作运行模式应用效果研究

目的：观察多岗位协作运行模式在急诊PCI患者围术期护理中的应用效果。方法将多岗位协作运行模式实施前(2015年1~6月)和实施后(2015年7~12月)于本院接受急诊PCI治疗的110患者作为研究对象,实施前后病例组分别设为对照组(55例)和试验组(55例),对照组接受急诊PCI常规护理,试验组接受多岗位协作运行模式干预,对两组干预后的各观察指标进行比较。结果试验组病例干预后的状态焦虑与特质焦虑评分、门球时间、住院时间、治疗依从性及心脏不良事件发生率均显著低于对照组,服务满意度显著高于对照组( P<0.05)。结论将多岗位协作运行模式应用于急诊PCI患者的围术期护理实践之中,能够显著降低该类护理对象的焦虑程度,提高护理效果和服务满意度。     

冠心病介入治疗后冠状动脉再狭窄的中医证候特点--附33例病例资料分析

目的:了解冠心病介入治疗术后再狭窄的证候特点.方法:对56例冠心病介入治疗后患者进行辨证分型和冠状动脉(冠脉)造影检查,比较术后再狭窄组(33例)和无再狭窄组(23例)的证型特点.结果:再狭窄组只有痰浊证显著高于无再狭窄组(18例,54.5%比6例,26.1%,P<0.05),其他证型的差别无显著性;再狭窄组的实证高于无再狭窄组(8例,24.2%比1例,4.3%),而无再狭窄组的虚证(2例,8.7%比1例,3.0%)和虚实夹杂证(20例,87.0%比24例,72.7%)高于再狭窄组(P均<0.05);无再狭窄组的二证相兼比例高于再狭窄组(15例,65.2%比16例,48.5%);单证型(3例,9.1%比2例,8.7%)、三证相兼(11例,33.3%比6例,26.1%)、四证相兼(3例,9.1%比0)后者高于前者(P均<0.01).结论:痰浊证是冠脉再狭窄的主要证型,冠脉介入治疗后再狭窄组比无再狭窄组的证型更趋复杂化.     

急性心肌梗死反向转运经皮冠状动脉介入治疗的临床观察

目的 评估借助外埠心脏介入专家赶赴县市级医院(反向转运),就地急诊经皮冠状动脉介入(PCI)治疗急性心肌梗死的安全性、可行性及有效性.方法 2004年3月至2008年9月,我院共对81例急性心肌梗死患者采用外请心脏介入专家(转运医生),就地实施急诊PCI进行治疗.男46例,女35例;年龄36.0 ～ 83.0岁,平均(68.6±3.6)岁;前壁心肌梗死56例,下壁心肌梗死25例(其中11例并右心室梗死).起病时间2.0 ～12.0 h,平均(6.2±1.8)h.结果 81例中,除3例病变严重,转上级医院行冠状动脉搭桥外,对78例就地实施了急诊PCI,66例为直接PCI,12例为补救性PCI,梗死相关动脉共植入支架81枚.1例因球囊不能通过病变而失败,手术成功率98.7％.共有4例发生围手术期心脏事件,其中死亡2例.随访32 ～86个月,共4例死亡,其中1例为心源性死亡,3例非心源性死亡,剩余患者中无致死性心血管事件发生.结论 采用外请专家就地行急诊PCI术(反向转运PCI)治疗急性心肌梗死的方法安全、可行、有效.但有必要进行大规模临床研究证实.     

高强度间歇与中强度持续有氧训练对经皮冠状动脉介入术后运动康复分层低危患者的影响

目的:探讨高强度间歇与中强度持续有氧训练对经皮冠状动脉介入术(PCI)后运动康复分层低危患者的影响。方法:选取PCI术后运动康复分层低危患者43例,按照随机数字表法将其分为高强度间歇有氧训练组(高强度间歇组,22例)和中强度持续有氧训练组(中强度持续组,21例)。2组患者均采用功率自行车进行训练,高强度间歇组采用高强度...