扩容、止痛减少经皮腔内冠状动脉成形术后血管迷走神经反射的研究

目的 了解经扩容、止痛处理对减少经皮腔内冠状动脉成形术(PTCA)后血管迷走神经反射的作用。方法 将PTCA术后56例冠心病患者随机分为预防组和对照组，前者在拔除股动脉鞘管前给予扩容及止痛处理，后者直接拔管。结果 扩容及止痛处理后，预防组PTCA术后血管迷走神经反射发生率较对照组减少25．13％。结论 PTCA术后拔管前进行扩容和止痛处理能有效预防血管迷走神经反射，可作为常规预防方法。     

经皮冠状动脉腔内成形术后低血压反应的原因分析及对策

目的：探讨经皮冠状动脉腔内成形术后低血压反应的原因及对策。方法：回顾总结100例患者PTCA后10例发生低血压反应的资料。结果：经皮冠状动脉腔内成形术后低血压反应发生率10％(10／100)。原因分别为：压迫穿刺动脉用力过度7例；拔鞘管局部疼痛刺激1例；穿刺部位大血肿1例；冠状动脉痉挛1例。结论：PTCA血管鞘拔除后低血压反应为迷走反射增强所致，通过正确处理可以迅速纠正。     

扩容、止痛预防PTCA术后拔管致血管迷走神经反射的临床观察

经皮冠状动脉腔内成形术(PTCA)已成为冠心病介入治疗的常用方法,然而在术后(4～6小时)拔除股动脉鞘管时很多患者常出现心率减慢、血压下降等血管迷走神经反射(Vasovagal Reactions,VVRs)症状。本研究对扩容、鞘管周围及其深层浸润麻醉止痛预防VVRs的效果进行了观察。现报     

扩容和局部止痛对预防经皮冠状动脉内成形术后拔管反应的观察

<正> 经皮冠状动脉腔内成形术(PTCA)已成为冠心病介入治疗的主要方法,术后保留鞘管6～7小时后拔除,拔管时患者出现心率减慢、血压下降等迷走神经兴奋的症状,称之为拔管反应,若抢救不及时可致死亡.国内曾有射频消触术后拔管反应的报道,但我们尚未检索到PTCA术后拔管反应的文献.本临床观察目的在于,经充分扩容及穿刺部位局部止痛后拔管对减少拔管反应产生的意义.     

冠脉介入术后拔管综合征的护理对策

心血管冠脉介入治疗已被广泛应用,拔管顺利与否关系到手术的成败,术后拔管综合征已成为临床关注的重要问题之一。心血管介入术后在拔除动脉鞘管时,由于疼痛的刺激,反射性地引起迷走神经兴奋,进而出现血压降低、心率减慢、出冷汗、呕吐等低血压休克的症状,这一系列的反应称为拔管综合征。自1995年以来,我院行冠脉介入术1223例,术后发生拔管综合征139例,经有效的治疗和精心的护理,效果满     

与PTCA有关的菌血症

PTCA术后留置动脉鞘管及加压滴注肝素,增加了局部感染和/或菌血症的危险性,为明确其发生率和术后发热的意义,本文对164例PTCA术进行了前瞻性研究。 患者平均年龄57.1±0.9(26～85岁),男性占71％,伴糖尿病者占21％,心肌梗塞后14天内行PTCA者占31％。164例中,122例为首次股动脉穿刺,余42例在原穿刺部位的同侧股动脉,其中25例在原穿刺部位穿刺,有17例留置动脉鞘。手术时间28.7±1.3(5～90)min,鞘管自插入至拨出留置时间为(24.5±0.9)h。12例多次行PTCA术,     

冠脉内支架植入术治疗PTCA术后冠脉再狭窄19例疗效观察

2002年5月~2004年7月,我们采用冠状动脉(冠脉)内支架植入术治疗经皮冠脉成形术(PTCA)术后冠脉再狭窄患者19例,疗效较好。现报告如下。临床资料:选择同期收治的PTCA术后再狭窄患者38例,男30例,女8例;年龄(59.8±12.4)岁。随机分为PTCA组、支架组各19例。均有缺血临床症状和证据(心绞痛,不正常的心脏负荷试验及201铊扫描);单支冠脉病变在成功行1次或多次PTCA术后,再狭窄程度超过其管腔内径的50%;受损血管长度≤10mm。方法:术前常规口服阿司匹林300mg,噻氯匹啶500mg,术中用肝素15000U。采用Seldinger法穿刺左或右股动脉,放入动脉鞘管,…     

非全身肝素化冠状动脉造影安全性的临床评价

目的评价非全身肝素化状态下冠状动脉造影（CAG）的安全性。方法100例择期冠状动脉脉造影的病人随机分为常规肝素抗凝组50例（肝素组）和无肝素抗凝组50例（非肝素组），非肝素组要求从鞘管进入股动脉到CAG结束在10min内完成。观察CAG期间及其后6h内病人发生卒中、新发生的外周动脉血栓、穿刺及非穿刺部位出血并发症情况。结果肝素组术中及术后无卒中、新发生的外周动脉血栓和非穿刺部位出血发生，穿刺部位血肿4例（8．0％）；非肝素组术后1例（2．0％）发生短暂性脑缺血发作，无新发生的外周动脉血栓、穿刺和非穿刺部位出血发生。结论对技术熟练的术者，在10min内，非全身肝素化状态下完成从鞘管进入股动脉到CAG操作是安全的，可减少穿刺和非穿刺部位出血并发症的发生。     

经皮冠状动脉腔内成形术的术后护理观察

经皮冠状动脉腔内成形术 ,简称PTCA ,是将远端带有一可膨胀球囊的特殊导管送至病变的冠状动脉 ,利用球囊的机械性挤压作用造成血管内膜或部分中层撕裂 ,使病变狭窄的血管管腔扩大 ,血液增加 ,从而改变心肌血液供应 ,缓解症状并减少急性心肌梗死发生的一种导管治疗技术。近三年来 ,我院共行PTCA 4 0例 ,现对其术后护理观察要点总结如下 :1 PTCA术后的病人应回CCU病房 ,。给予心电血压监测 ,并常规记特护记录 2 4小时至 4 8小时 ,密切观察生命体征的变化 ,并准确记录。 2 对术后心前区疼痛的护理观察 :PTCA术后的心前区疼痛多是出于…     

经皮腔内冠状动脉成形术加支架术后穿刺部位远期出血1例

患者,男,60岁。于1999年6月1日因“心前区疼痛3年,加重2个月”之主诉入院。诊断:1原发性高血压期,2冠心病、劳累型心绞痛。于1999年6月10日行冠状动脉造影术,结果示前降支中段99%狭窄。回旋支远端80%狭窄,右冠状动脉完全闭塞。术后常规伤口压沙袋8h,12h后下床活动,伤口愈合良好,但有-6cm×5cm皮下淤血斑。于6月17日在局麻下行经皮腔内冠状动脉成形术(PTCA)加支架术,手术及鞘管拔除均顺利。伤口压沙袋8h,伤口局部无出血及淤血斑,鞘管拔除后12h下床活动。术后按常规给抵克力得250mg口服,每日1次,低分子肝素0.4ml皮下注射,每12h1次,连用1周。…     

Entrapment of a folded-over introducer sheath in the lliofemoral artery: An unusual complication of PTCA guiding catheter exchange

An arterial introducer sheath became folded over in the iliac artery during PTCA. This probably resulted from withdrawal of a doubled over Judkins left coronary guiding catheter through the introducer sheath. Nonsurgical, atraumatic removal was accomplished after the acute bend of the introducer sheath had been withdrawn to the site of arterial entrance.     

Entrapment of a folded-over introducer sheath in the iliofemoral artery: an unusual complication of PTCA guiding catheter exchange

An arterial introducer sheath became folded over in the iliac artery during PTCA. This probably resulted from withdrawal of a doubled over Judkins left coronary guiding catheter through the introducer sheath. Nonsurgical, atraumatic removal was accomplished after the acute bend of the introducer sheath had been withdrawn to the site of arterial entrance.     

Use of FemoStop system for arterial puncture site closure after coronary angioplasty

Different protocols exist concerning the method and timing of post-coronary angioplasty arterial puncture site closure. Easy handling and good effectiveness are well-documented for the Femostop femoral artery compression system; however, no hard data exist concerning the relationship between heparin anticoagulation level and femoral artery compression time (FSCT). Thus, we prospectively randomized 267 patients after elective percutaneous transluminal coronary angioplasty (PTCA) into two groups [group A (n=137) had early sheath removal 6 to 8 hours after PTCA; group B (n=130) had late sheath removal 14 to 16 hours after PTCA] and analyzed the dependence of the FSCT on the heparin anticoagulation level (aPTT) and the incidence of vagal reactions and puncture site complications. FSCT was significantly longer in group A (69+/-27 minutes versus 45+/-15 minutes; p<0.001) with high heparin anticoagulation level (aPTT, 88+/-46 seconds) in comparison to group B with low heparinization (aPTT, 59+/-34 seconds). Vagal reactions occurred more frequently in group A (15.3% versus 10.0%; p<0.01) and the incidence of minor hemorrhage at the arterial puncture site was also increased (9.5% versus 3.1%; p<0.05). In the clinical setting of intensive heparin anticoagulation and early sheath removal after PTCA (<8 hours), the FemoStop system cannot be recommended due to prolonged femoral artery compression times.     

Percutaneous transluminal coronary angioplasty utilizing prolonged balloon inflations: initial results and six-month follow-up

Coronary angioplasty (PTCA) using prolonged balloon inflation has obviated emergency coronary bypass surgery in some patients with acute occlusions at the time of PTCA. However, the use of prolonged balloon inflations has not been shown to improve long-term restenosis rates. As an alternative to the passive autoperfusion catheter, we evaluated a hemoperfusion system in which blood was obtained from the side arm of an arterial sheath and infused through the central lumen of standard balloon catheters via a modified Medrad IV pump during balloon inflation. PTCA was performed in 71 male patients (median age 57 yr). The median balloon inflation time was 4.8 minutes and the median rate of blood perfusion was 30 ml/min. PTCA was successful (lumen increase by 20 percentage points) in 83% of patients (59/71) with diameter stenosis decreasing from a median 82% to 30%. Emergency coronary bypass was required in four patients (5%). Angiographic data for six-month followup was available on 37 patients. The restenosis rate (loss of 50% of gain) was 46% (17/37). The conclusion is that prolonged balloon inflation angioplasty has a role in complicated PTCA but offers no advantage in improving long-term restenosis rates in elective PTCA.     

Percutaneous transluminal coronary angioplasty and nursing implications

Percutaneous transluminal coronary angioplasty is a new procedure used in the treatment of coronary artery disease. The procedure involves the use of a small balloon-tipped catheter that is advanced into the stenotic coronary artery. The soft atheroma is compressed against the arterial wall by the inflation of the balloon across the lesion, thereby reducing the stenosis. Preoperative nursing care of the PTCA patient includes thorough assessment and preoperative teaching. Post-operative nursing care involves close assessment and prompt attention to potential complications.     

Percutaneous transluminal coronary angioplasty: Comparison of arterial vs. venous activated clotting time

When arterial blood samples for activated clotting time (ACT) are difficult to obtain from the arterial sheath during coronary intervention, venous ACT serves as a substitute. Data are lacking on whether arterial and venous ACT are identical and whether one can serve as an effective substitute for the other. Forty-eight patients undergoing percutaneous transluminal coronary angioplasty (PTCA) were prospectively evaluated to answer this question. Simultaneous arterial and venous ACT samples were drawn from femoral artery and vein vascular sheaths before and during each procedure, and ACT values were determined with a Hemochron automated electronic timer. Porcine heparin dosing was guided by arterial ACT in the first 25 patients and by venous ACT in the last 23 patients. The target ACT value used for continued heparin dosing was 400 sec. At baseline and throughout the study up to 60 min, venous ACT was slightly and significantly greater than arterial ACT. Despite this statistical difference in ACT values, there was no difference in complication rate between the two groups, and the amount of heparin used during either guiding regimen was the same. Therefore, although venous ACT values are slightly higher than arterial, the more convenient venous ACT can be safely used to guide heparin dosing during PTCA when using a target ACT value of 400 sec. © 1996 Wiley-Liss, Inc.     

Bacteremia associated with percutaneous transluminal coronary angioplasty

Bacteremia after diagnostic cardiac catheterization is uncommon, but bacteremia after percutaneous transluminal coronary angioplasty (PTCA) has not been studied prospectively. Unlike diagnostic cardiac catheterization, PTCA involves the use of an indwelling arterial sheath after completion of the procedure, which is connected to a pressurized heparin solution, both of which increase the risk of local infection and/or bacteremia. During a 16-week period, we prospectively evaluated patients undergoing 164 PTCA procedures in order to determine the frequency of bacteremia and the significance of fever in this patient population. Blood cultures were obtained from the femoral catheter at the conclusion of the procedure and again 30 min later from the indwelling arterial sheath. Temperature was recorded every 30 min for 2 h following PTCA, then every 4 h over the subsequent 36-hr period. Bacterial isolates were recovered from 23/286 blood cultures (8.0%), with Staphylococcus epidermidis the most common organism present (74%). Only one isolate of Staphylococcus aureus was considered to represent true bacteremia and corresponded with the only documented infectious complication. Fever, defined as ?101°F developed in four (2.4%) patients but was procedure related in only one case. The use of the ipsilateral femoral artery for repeat procedures was not associated with either positive blood cultures or difference in maximum temperature elevation. We conclude the overall risk of bacteremia after PTCA is low; therefore, antimicrobial prophylaxis is not warranted. © 1995 Wiley-Liss, Inc.     

Immediate femoral sheath removal after 6 French routine coronary angioplasty with a weight-adjusted low-dose heparin: results of a prospective registry

This study assesses the feasibility and safety of immediate sheath removal after coronary angioplasty with the use of 6 French (Fr) guiding catheters by the femoral route and weight-adjusted low-dose heparin (100 IU/kg). We prospectively evaluated such a strategy among a single-center cohort of 261 consecutive patients undergoing routine percutaneous transluminal coronary angioplasty (PTCA). Immediate sheath withdrawal was performed in cases when post-PTCA residual coronary stenosis was less than 30%, with or without stenting. One hundred eighty-two (70%) of the enrolled patients were eligible for immediate sheath removal. When compared with non-eligible patients (sheath removal 4 hours or more post-PTCA), we observed a reduction of hematoma occurrence (15% vs. 30%; p < 0.01), time to manual hemostasis of the puncture site (13.8 +/- 7 vs. 19.7 +/- 12 minutes; p < 0.0001), and time to hospital discharge (2.2 +/- 1.9 vs. 2.8 +/- 1.8 days; p < 0.02), while ischemic event rate was similar (1 vs. 2 non-Q wave myocardial infarction; 2 vs. 1 repeat PTCA for out-of-lab acute vessel closure). In conclusion, a good angiographic result at completion of PTCA using a 6 Fr sheath, even without stenting, makes an immediate sheath removal feasible at no increased risk and with a potential reduction in minor bleeding complications.     

Evaluation of an active coronary perfusion balloon device using Doppler flow wire during PTCA

The aim of this study was to assess whether active coronary perfusion catheters (APC) can provide a sufficient coronary flow in large caliber vessels during balloon inflation. To prevent myocardial ischemia during PTCA, these APC may be employed. However, it is as yet unknown whether the active flow rate of these devices approaches the flow rate prior to PTCA during balloon inflation. Therefore, we measured the efficacy of the APC during balloon inflation in vessels supplying a large amount of myocardium. In 12 patients (1 female, 11 males, 53 ± 12.6 yr) with stenosed vessels (average diameter 3.4 ± 0.26 mm), the coronary flow velocity was measured using a 0.014“ Doppler guidewire, which was placed distally bypassing the balloon of the APC. The active perfusion balloon catheter was advanced through a 7F guiding catheter along a 0.014” guidewire. After removal of the guidewire, arterial blood being withdrawn from the side port of the femoral angioplasty sheath was pumped through the catheter to the distal coronary vessel. The perfusion volumes of the pump were set to different levels between 30 to 60 ml/min. Intracoronary flow rate was calculated by the angiographically assessed vessel luminal area × average peak velocity × 0.5. The mean coronary flow rate prior to PTCA was 43 ± 17.7 ml/min. Maximum flow during PTCA was 55 ± 19.6 ml/min. We found a good correlation between the preset external pump rate and the coronary flow in situ (r=0.92). Pre-PTCA flow rates were achieved in 11 of 12 patients (92%) during balloon inflation. No relevant decrease in the arterial pressure occurred during dilation times of 4.6 ± 1.63 min. Only two patients showed significant ECG changes during these balloon inflations. After an average follow-up period of 13 ± 6.3 mo, only one patient (8%) had a significant re-stenosis requiring the implantation of a stent. The combination of intravascular Doppler velocity measurements with quantitative coronary angiography offers the opportunity of exact online flow registration during angioplasty. Using APC, it is possible to maintain a sufficient coronary flow in the distal vessel during balloon inflation even in large vessels. Therefore, as compared with mechanical circulatory assist devices, coronary assist by APC is a little invasive, but according to our measurements it might be a sufficient tool for performing PTCA also in high-risk patients. Cathet. Cardiovasc. Diagn. 42:84-89, 1997. © 1997 Wiley-Liss, Inc.     

Coronary artery vasoconstriction routinely occurs after percutaneous transluminal coronary angioplasty. A quantitative arteriographic analysis

To determine whether percutaneous transluminal coronary angioplasty (PTCA) increases coronary artery luminal dimensions by stretching and injuring ("paralyzing") the smooth muscle of the arterial wall, we prospectively analyzed spontaneous changes and then intracoronary nitroglycerin-induced changes in segmental coronary artery diameters during the first 30 minutes after uncomplicated single-vessel PTCA in 10 patients. Five additional patients received intravenous nitroglycerin throughout the procedure to determine whether nitroglycerin could prevent vasoconstriction after PTCA. All of the patients were maintained on oral doses of diltiazem and aspirin at the time of the study. Coronary arteriography was performed at 2, 5, 15, and 30 minutes after PTCA and then 3 minutes after 300 micrograms i.c. nitroglycerin. Quantitative measurements (computerized edge-detection) were performed at each time, in coronary segments centered in the dilated segment, distal to the dilated segment, and in a control vessel not manipulated with the balloon catheter or guidewire. Progressive vasoconstriction (defined as a loss of diameter that was reversed by intracoronary nitroglycerin) was observed after PTCA in the dilated and distal segments (10 of 10 patients) but not in the control segment. The vasoconstriction in the dilated segment at 30 minutes (mean, 30 +/- 4%) was highly statistically significant compared with vasoconstriction at 2 and 5 minutes after PTCA (p less than 0.001) and compared with the control segment at 30 minutes (p less than 0.005). There was no significant loss of diameter after PTCA in the dilated segment in the five patients who received intravenous nitroglycerin. In conclusion, 1) spontaneous coronary artery vasoconstriction after PTCA occurs routinely at and distal to the site of balloon dilatation despite pretreatment with aspirin and calcium channel blockers; 2) coronary artery vasoconstriction after PTCA is rapidly reversed by intracoronary nitroglycerin and can be prevented by the continuous administration of intravenous nitroglycerin during and after the procedure; 3) these results are incompatible with the hypothesis that PTCA improves coronary luminal dimensions by arterial "paralysis"; and 4) these findings have implications concerning the etiology and prophylaxis of abrupt vessel closure after PTCA.