冠心病行冠状动脉内支架置入术病人的护理

总结42例冠心病行冠状动脉内支架置入术病人的护理,认为术后密切观察病情变化,术侧肢体制动,加强拔管护理和生活护理可以促进行冠状动脉内支架置入术的冠心病病人的早日康复,提高其生活质量.     

高尿酸与冠状动脉严重程度及支架置入后的预后相关性

目的探讨高尿酸与冠心病患者冠状动脉病变严重程度及置入支架后预后的相关性。方法采取回顾性研究收集2013年10月至2014年12月在山西医科大学第二医院住院患者270例,经冠状动脉造影检查确诊冠心病,并置入第二代药物洗脱支架,进行随访1年。根据尿酸水平分为尿酸升高组(n=120例)和尿酸水平正常对照组(n=150例),搜集两组病例冠状动脉病变部位、程度及性质,采用Gensini积分评估冠状动脉严重程度。随访两组患者1年主要心脑血管不良事件(MACCE)发生情况,根据随访结果分析两组1年后MACCE差异性,并采用Cox多因素回归分析判断高尿酸与冠心病支架置入患者MACCE相关性。结果高尿酸组较对照组冠状动脉病变重,表现为长病变所占比例更大[63.33%(76/120)vs.44.00%(66/150),P=0.02],闭塞病变所占比例更大[28.33%(34/120)vs.15.33%(23/150),P=0.009],Gensini积分更高[(61.225±26.56)分vs.(47.467±25.03)分,P<0.001]。随访1年,高尿酸组MACCE累积发生率高于对照组[20.83%(25/120)vs.10.67%(16/150),P=0.02]。Cox比例风险模型分析得出,吸烟(OR=1.274,95%CI 1.057~2.860,P=0.04)、糖尿病(OR=1.190,95%CI 1.050~2.400,P=0.03)、年龄(OR=1.095,95%CI 1.096~2.027,P=0.03)、心功能(OR=1.086,95%CI 1.035~2.145,P=0.02)、高尿酸(OR=1.051,95%CI 1.026~1.986,P=0.01)及Gensini积分(OR=1.009,95%CI 1.001~1.986,P=0.05)分别是影响MACCE发生的独立预测因素。结论高尿酸与冠心病冠状动脉病变严重程度呈正相关,高尿酸是支架置入后1年内发生MACCE的独立预测因素。     

Immediate and long-term outcomes after "Ephesos" coronary stent implantation in patients with stable or unstable angina

AIM: An open non-randomized trial was initiated to assess clinical and angiographic results of using the coronary stent "Ephesos" in 457 patients with stable or unstable angina pectoris and native coronary affections. MATERIAL AND METHODS: 268 stents have been implanted in 231 patients with stable angina (SA) and 271 stents--in 226 patients with unstable angina (UA). 46% lesions were complicated. The length of stenosis was 12.9 +/- 6.7 mm in the group SA and 14.1 +/- 7.4 mm in the group UA, 30% stenoses were long. RESULTS: Successful stenting was stated in 99% without cases of acute thrombosis. Non-fatal myocardial infarction took place in hospital in 1.3% of SA patients and in 2.6% of UA patients. Incidence of cardiac complications (death, recurrent angina pectoris, myocardial infarction, restenosis, repeated revascularization) for 6-month follow-up was 15.6% in SA group and 18.1% in UA group. At angiographic control, the index of vascular diameter loss made up 0.22 +/- 0.2 in SA group and 0.3 +/- 0.27 in UA group. Incidence of restenosis was 12 and 14%, respectively. 18-month follow-up found no differences in frequency of complications: 21.6 and 22.6% in groups SA and UA, respectively. CONCLUSION: Implantation of the stent "Ephesos" is effective in prevention of thrombosis and restenosis in patients with stable or unstable angina pectoris at high risk of intervention.     

D型人格与冠状动脉内支架置入者的生活质量

背景：国外多数研究表明D型人格是冠状动脉粥样硬化性心脏病等重大慢性疾病预后不良的重要危险因素。不同文化种族的中国冠心病患者情况是否与国外相同，国内学者在这一方面进行了一些初步地探讨。 目的：探讨D型人格对冠状动脉支架置入后患者情绪和生活质量的影响。 设计、时间及地点：调查分析，于2006—01／12在大连市某三级医院心内科门诊完成。 对象：抽取大连市某三级医院心内科门诊随访的曾行冠状动脉内支架置入的患者137例。共获得有效问卷132份，男90例，女42例。 方法：采用D型人格量表（DS14）将132例患者分为2组，D型人格组41例；非D型人格组91例。分别对于D型人格组和非D型人格组采用一般问卷、抑郁自评量表（SDS）、焦虑自评量表（SAS）和生活质量综合评定问卷（GQOL-74）评估。 主要观察指标：D型人格组患者和非D型人格组患者一般情况、抑郁与焦虑评分及生活质量的比较。 结果：①D型人格在冠状动脉支架术后患者中约占31．1％。②支架置入至少3个月后，D型人格组和非D型人格组各项评估揭示：D型人格组有经历重大生活事件和抽烟行为的人数比例多于非D型人格组，而进行适当适量体育运动的人数比例少于非D型人格组；D型人格组较非D型人格组更容易出现抑郁情绪；生活质量方面D型人格组在躯体、心理、社会和总分方面都较非D型人格组更差。 结论：D型人格的冠状动脉支架置入者情绪和生活质量比非D型人格患者差，人格因素影响着冠状动脉支架置入者的生活质量和预后。     

冠状动脉支架植入病人生活质量研究进展

从生活质量研究工具、影响生活质量的因素、护理干预等方面对冠状动脉支架植入病人生活质量研究进展进行了综述。     

冠状动脉支架植入病人生活质量研究进展

从生活质量研究工具、影响生活质量的因素、护理干预等方面对冠状动脉支架植入病人生活质量研究进展进行了综述。     

丹红注射液对冠状动脉支架置入患者血管内皮功能的影响(英文)

背景:众多研究证实丹参能抑制中性粒细胞的黏附、聚集及氧自由基的产生,具有活血化瘀的疗效,但目前对于其保护血管内皮以及抗血栓形成具体机制,尤其是在冠状动脉支架置入后作用机制的研究很少.目的:观察丹红注射液对急性冠脉综合征患者冠状动脉支架置入前后血管内皮功能的影响.方法:采用随机对照方法将60例急性冠脉综合征患者分为2组,常规治疗组在冠状动脉支架置入后给予常规药物治疗;丹红组在冠状动脉支架置入后给予常规药物治疗基础上加用丹红注射液20 mL/d,疗程10 d.支架置入前后及丹红治疗前后测定内皮依赖性血流介导的血管舒张反应、血浆内皮素、血栓烷B2、6-酮-前列腺素水平,双重评价其血管内皮功能;同时观察两组患者近期预后.结果与结论:与支架置入前比较,支架置入后两组患者血浆内皮素、血栓烷B2均明显提高,6-酮-前列腺素水平明显下降(P<0.05).与支架置入后比较,两组治疗后血浆内皮素、血栓烷B2均明显降低(P<0.05,P<0.01);内皮依赖性血流介导的血管舒张反应、6-酮-前列腺素明显提高(P<0.05,P<0.01),丹红组更明显(P<0.05).住院期间丹红组心血管事件发生较常规治疗组略有下降,但差异无显著性意义(P>0.05).结果表明丹红注射液可显著改善支架置入急性冠脉综合征患者血管内皮功能,使血管舒张,改善供血,抑制血小板聚集,且有改善近期预后的倾向.     

置入心血管支架后冠状动脉粥样硬化性心脏病患者的C-反应蛋白变化

背景:心血管支架作为一种异体物质,置入后存在明显的炎症反应过程,主要表现在凝血系统的激活以及炎性标志物血清C-反应蛋白的显著升高.目的:总结探讨支架置入后冠状动脉粥样硬化性心脏病患者炎症反应及C-反应蛋白的变化.方法:应用计算机检索中文期刊全文数据库1990/2009相关文献,检索词为"心血管支架,C-反应蛋白,炎症反应",同时检索PubMed数据库1990/2009相关文献,检索词为"cardiovascular stent on plasma,c-reactive protein".结果与结论:药物涂层支架以金属支架为载体携带药物到达血管损伤局部,使药物在较长的时间内充分释放到血管壁内,减少支架置入后再狭窄的发生.抗炎药物涂层支架主要药物为地塞米松、甲泼尼龙等.抗迁移、抗增生药物涂层支架主要药物为雷帕霉素、紫杉醇、放线菌素D等.支持内膜愈合的药物涂层支架主要药物为雌二醇等.经皮冠状动脉支架置入可诱导和加重局部炎症反应,这对血管内皮的增生与再狭窄有重要影响.反映急性炎症反应的敏感指标如血清C-反应蛋白的浓度对于经皮冠状动脉支架置入后心血管事件的发生有预测价值.冠状动脉内支架置入可显著升高血浆C-反应蛋白水平,所以应充分认识炎症反应及血浆C-反应蛋白、细胞因子的变化对防止心血管支架置入后再狭窄起到的重要作用,及早进行预防及干预,从而减少再狭窄率,提高介入治疗效果.     

Cost-effectiveness of paclitaxel-coated balloon angioplasty and paclitaxel-eluting stent implantation for treatment of coronary in-stent restenosis in patients with stable coronary artery disease

Background  

Recent studies have demonstrated the safety and efficacy of drug-coated balloon (DCB) angioplasty for the treatment of coronary in-stent restenosis (ISR). The cost-effectiveness of this practice is unknown.     

Performance of the chronic kidney disease epidemiology collaboration equation to estimate glomerular filtration rate in diabetic patients

OBJECTIVE

The best method to estimate glomerular filtration rate (GFR) in diabetic patients is still largely debated. We compared the performance of creatinine-based formulas in a European diabetic population.

RESEARCH DESIGN AND METHODS

We compared the performance of Cockcroft and Gault, simplified Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration equations in 246 diabetic patients by calculating the mean bias and the interquartile range (IQR) of the bias, 10% (P10) and 30% (P30) accuracies, and Bland-Altman plots. GFR was measured by inulin clearance.

RESULTS

For the whole population, the IQR was slightly lower for CKD-EPI, but the mean bias was lower and P10 and P30 were higher for MDRD. Similar results were observed in specific subgroups, including patients with mild renal insufficiency, obese patients, or type 2 diabetic patients.

CONCLUSIONS

In our population, the CKD-EPI formula does not exhibit better performance than the simplified MDRD formula for estimating GFR.Using a creatinine-based formula is the most common way to evaluate the glomerular filtration rate (GFR) in clinical practice. However, it can lead to an inaccurate evaluation, especially in patients with normal renal function (1). A new GFR formula, the Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration equation, has recently been developed and has exhibited better performance than the other creatinine-based formulas in the general population (2). Therefore, we compared the performance of the CKD-EPI equation to Cockcroft and Gault (CG) and simplified Modification of Diet in Renal Disease (MDRD) equations in a population of diabetic patients.     

The treatment of coronary artery disease in patients with chronic kidney disease

Premature cardiovascular disease is the largest cause of mortality, and a major cause of morbidity, in patients with chronic kidney disease (CKD). Patients with end-stage kidney disease (ESKD) are at extreme risk, but cardiovascular event rates are increased even in early CKD. There is little controlled trial evidence on which to base treatment, as most therapeutic trials have excluded CKD patients. Current treatment strategies are therefore based upon small prospective studies or retrospective analyses of controlled trials and registry data. It is thus unclear whether CKD patients benefit from modern secondary preventive treatments in the same manner as patients with normal renal function. There is a need for randomized trials to identify effective drugs to prevent and treat coronary artery disease in CKD. Revascularization by CABG in CKD has been widely reported in registry data to provide better results than medical treatment or angioplasty. Recent angioplasty data in patients with CKD, however, show improving results, and the risks of CABG in CKD remain high. It is not clear which revascularization technique has a better outcome in patients 'equally suitable' on angiographic criteria for either procedure. The high rate of late adverse cardiovascular events after both CABG and angioplasty accentuates the need for effective secondary preventive therapy disease in these high-risk patients.     

Predictive value of C-reactive protein in patients with unstable angina pectoris undergoing coronary artery stent implantation

In-stent restenosis is a major problem following coronary stent implantation, and inflammation plays an active role. We evaluated the effectiveness of the inflammatory marker C-reactive protein (CRP) as a predictor of in-stent restenosis after successful stent implantation, in 86 patients with unstable angina pectoris. Plasma CRP was measured in all patients before the procedure, and at 48 - 72 h and 1, 2 and 3 months post-procedure. An angiographic loss of 50% at follow-up was accepted as in-stent restenosis. We found negative and positive predictive values of the pre-procedural plasma CRP for determining 6-month in-stent restenosis of 34% and 61%, respectively. We also found a strong correlation between the 3-month post-procedural CRP value and 6-month in-stent restenosis; the negative and positive predictive values being 8% and 76%, respectively. In conclusion, we showed that a plasma CRP value > 3 mg/l in the third month after coronary stent implantation was a strong predictor of angiographic in-stent restenosis.     

简化肾脏病膳食改善方程在慢性肾脏病诊断及治疗中的应用

目的通过检测患者肾小球滤过率（GFR）了解住院患者的肾功能及肾脏损害程度。应用简化肾脏病膳食改善（MDRD）方程估算GFR,为临床选择药物及用药量提供更可靠的依据。方法通过统计8 940例住院成年患者的基本信息,按照性别、年龄、疾病的不同类型及血肌酐水平进行分组。利用MDRD方程估算出患者的GFR。肾损害程度分期采用美国肾病学会（NKF）2002年的慢性肾脏病（CKD）分期。结果8 940例患者中,40.1%的患者存在肾功能不全（GFR〈90 mL/min）,32.1%的患者存在隐匿性肾功能不全（血肌酐〈106μmol/L,GFR〈90 mL/min）。506例体检者中有15.2%存在隐匿性肾功能不全。结论由于住院患者多数存在肾功能受损情况,院外部分人群存在隐匿性肾功能不全的隐患,因此应用MDRD方程能更准确地估算GFR值,有利于临床医生在治疗中采用不同的治疗方案。     

简化肾脏病膳食改善方程在慢性肾脏病诊断及治疗中的应用

目的通过检测患者肾小球滤过率(GFR)了解住院患者的肾功能及肾脏损害程度。应用简化肾脏病膳食改善(MDRD)方程估算GFR,为临床选择药物及用药量提供更可靠的依据。方法通过统计8 940例住院成年患者的基本信息,按照性别、年龄、疾病的不同类型及血肌酐水平进行分组。利用MDRD方程估算出患者的GFR。肾损害程度分期采用美国肾病学会(NKF)2002年的慢性肾脏病(CKD)分期。结果8 940例患者中,40.1%的患者存在肾功能不全(GFR<90 mL/min),32.1%的患者存在隐匿性肾功能不全(血肌酐<106μmol/L,GFR<90 mL/min)。506例体检者中有15.2%存在隐匿性肾功能不全。结论由于住院患者多数存在肾功能受损情况,院外部分人群存在隐匿性肾功能不全的隐患,因此应用MDRD方程能更准确地估算GFR值,有利于临床医生在治疗中采用不同的治疗方案。     

艾司西酞普兰治疗冠心病支架植入术患者伴发焦虑抑郁情绪对照研究

目的：探讨放松训练联合草酸艾司西酞普兰对冠心病支架植入术后患者伴发焦虑抑郁情绪的临床疗效和安全性以及对生活质量的影响。方法将65例冠心病冠脉支架植入术后伴焦虑抑郁患者随机分为两组,均予以冠心病常规治疗及放松训练,研究组在此基础上联合草酸艾司西酞普兰治疗,观察8周。采用汉密顿焦虑量表、汉密顿抑郁量表评定焦虑抑郁情绪,生活质量量表评定生活质量,副反应量表评定不良反应。结果治疗后两组汉密顿焦虑量表、汉密顿抑郁量表评分较治疗前显著下降（P＜0．01）,研究组较对照组下降更显著（P＜0．01）;研究组生活质量量表的4个领域、对照组1个领域评分较治疗前显著升高（P＜0．01）,研究组5个领域评分显著高于对照组（P＜0．01）。治疗过程中两组不良反应均轻微,各项实验室检查均无异常改变。结论放松训练联合草酸艾司西酞普兰能显著改善冠心病冠脉支架植入术患者伴发的焦虑抑郁情绪,提高患者的生活质量,且安全性高,优于单用放松训练治疗。     

经皮冠脉支架置入术患者创伤后成长的质性研究

目的:探讨经皮冠脉介入治疗术(PCI)后患者的创伤后成长(PTG)特点及相关影响因素,为开展冠心病患者的心理健康教育提供依据。方法:运用质性研究的方法,对30例行PCI治疗的患者进行深度访谈,采用Colaizzi的7步分析法和质性分析软件Nvivo对资料进行编码、分析。结果:运用质性研究方法提炼出5个树节点,感恩心;珍爱生命;同情心;自信心;公益心。这是患者经历PCI治疗后所产生的积极的、正性的改变指标。结论:感恩程度是PCI患者PTG的重要影响因素,珍爱生命、同情、自信、公益是PTG的主要表现形式,及时、准确地判定和正确引导并加以启发,有助于PCI患者从创伤中成长,获得身心康复的最佳状态。     

D型人格对冠状动脉支架置入术病人生命质量影响的研究

[目的]比较冠心病病人中D型人格与非D型人格病人冠状动脉支架置入术后生命质量的差异;探索D型人格对冠状动脉支架病人生命质量的影响。[方法]采用目的抽样法,选取冠心病行支架置入术病人,运用简明36项健康问卷(SF-36)、D型人格量表(DS14)及一般人口统计学问卷,分别于冠状动脉支架手术前、术后3个月进行调查。[结果]在所调查的104例病人中,D型人格病人占37.5%,支架置入术后D型人格病人生命质量评分为69.8分±10.5分,非D型人格病人为74.5分±9.2分,二者比较有统计学意义。在术后生命质量的"生理机能""情感职能""精神健康"方面D型人格比非D型人格病人得分低,D型人格进入到生命质量的多元逐步回归方程中。[结论]D型人格是影响冠状动脉支架置入术病人生命质量的危险因素,这类人格的病人在行冠状动脉支架置入术后较非D型人格病人恢复差,表现在生命质量的多个方面,在临床中应重视这类病人的护理。