冠心病患者临床特征、外周微循环状态与冠状动脉病变程度的关系

目的 探讨冠心病患者临床特征、外周微循环状态与冠状动脉病变程度的关系.方法 选取我院2016年3月-2021年3月220例冠心病患者作为研究对象,根据冠状动脉病变程度将患者分为轻、中度组(n=142)和重、极重度组(n=78).收集两组入院时年龄、性别、身体质量指数(BMI)、糖尿病、高血压各项信息.测定两组入院1 d...     

高脂血症和冠心病

预防和治疗冠心病仍是目前医疗实践中的一个重点。在冠心病的众多发病因素中,高脂血症与其关系最为密切。大量动物实验和流行病学调查都已证实高脂血症,特别是高胆固醇血症与冠心病的发病率及死亡率有明显的正相关关系, 而通过饮食控制和采用他汀类降脂药物进行治疗、在冠心病的一级或二级预防中降低血浆胆固醇和低密度脂蛋白都可使冠心病的发病率及死亡率明显下降,且使冠状动脉粥样斑块稳定或消退。理解高脂血症与冠心病之间的关系,对于更有效地预防和治疗冠心病是非常重要的     

血清E-选择素在冠心病中的变化及其意义

目的探讨血清E-选择素在冠心病患者中的变化及其意义。方法冠心病患者70例，其中稳定型心绞痛（SA组）24例、不稳定型心绞痛（UA组）24例和急性心肌梗死（AMI组）22例；同时选择30例冠状动脉造影阴性者作为对照组。Gensini积分法评价冠状动脉病变程度，将70例冠心病患者分为两个亚组：A组22例（Gensini积分1～20），B组48例（Gensini积分〉20）。酶联免疫吸附法检测E-选择素水平，并进行比较。结果血清E-选择素水平冠心病各组均显著高于对照组（均为P〈0．01），冠心病各组间亦有显著性差异（均为P〈0．05）；B组血清E-选择素显著高于A组（P〈0．05）。结论E-选择素可能参与了冠心病的发病过程，且与冠状动脉粥样硬化程度有关。     

心电图、超声心动图与冠状动脉造影在冠心病诊断中的比较研究

目的 评价心电图(ECG)、超声心动图(UCG)对冠心病的诊断价值。方法 选择216例冠状动脉造影检查的患者，造影前行ECG检查，测ST—T；行UCG检查，测左室射血分数(LVEF)、左室短轴缩短率(FS)、舒张早期充盈峰(E)、舒张晚期充盈峰(A)、E／A比值。结果 ECG与UCG诊断冠心病敏感性分别为90．3％，98．6％，特异性分别为20．8％，11．1％。结论 ECG、UCG对冠心病的诊断具较高的敏感性，且无创、费用低，可作为冠心病诊断的基本方法。     

冠心病患者幽门螺杆菌感染与血清中氧化低密度脂蛋白水平及冠状动脉病变严重程度的相关性研究

目的探讨冠心病患者幽门螺杆菌(HP)感染与血清中氧化低密度脂蛋白(ox-LDL)水平及冠状动脉病变严重程度的相关性。方法选取66例确诊为冠心病的患者,其中33例非HP感染患者设为对照组,33例HP感染患者设为观察组。比较2组患者血清ox-LDL及血脂水平,探讨HP感染程度与血清ox-LDL水平的关系,探讨HP感染患者血清ox-LDL水平与冠状动脉病变严重程度的关系。结果观察组患者血清ox-LDL、TC、TG、LDL-C水平显著高于对照组(P0.05)。观察组患者血清ox-LDL水平显著高于对照组,且观察组重度感染患者血清ox-LDL水平显著高于轻度感染患者(P0.05)。HP感染冠心病患者血清ox-LDL水平与冠状动脉病变严重程度呈显著正相关(P0.05)。结论冠心病患者感染HP可引起体内脂质代谢紊乱,血清ox-LDL水平升高,加重冠状动脉病变程度。     

Barriers to coronary heart disease risk modification in women without prior history of coronary heart disease

PURPOSE: To explore the extent to which women perceive barriers to coronary heart disease (CHD) risk modification and to determine if access to a nurse practitioner (NP) decreases perceived barriers to CHD risk modification. DATA SOURCES: Surveys completed by 120 women between the ages of 35 and 60 years, with no known history of CHD. The barriers scale was used to examine women's perceived barriers to CHD risk modification. CONCLUSIONS: Women with access to an NP had less perceived barriers to CHD risk modification. IMPLICATIONS FOR PRACTICE: NPs are ideally suited to decrease the mortality and morbidity associated with CHD through education strategies and attention to individual barriers women face when attempting to incorporate CHD risk factor modification into their lifestyles.     

Diet and coronary heart disease

One of the most debated issues in medicine in the last decade was quietly put to rest last year when the Coronary Primary Prevention Trial convincingly demonstrated that risk of coronary heart disease can be reduced by lowering the serum cholesterol level. This study has given hope to investigators who have been looking at various dietary strategies for lowering cholesterol level, such as eating little meat and animal fat and much vegetable on and fish. Drs Fletcher and Rogers outline the dietary factors that may affect cholesterol level and describe their strategy for helping patients change eating habits for a healthier heart.     

川崎病并发冠状动脉病变的危险因素分析

目的探讨川崎病并发冠状动脉病变的危险因素。方法对60例确诊为川崎病患儿的临床表现,超声心动图、急性期C-反应蛋白、胆固醇、血沉、血小板、血红蛋白、白细胞等资料进行计量资料t检验、计数资料χ2检验、Logistic多元回归分析。结果60例川崎病并发冠状动脉病变18例(30%)。单因素分析显示:发热天数、血小板、C-反应蛋白、胆固醇与冠状动脉病变发生率有密切关系(P<0.01)。多因素Logistic多元回归分析显示:C-反应蛋白、胆固醇与冠状动脉病变密切相关(P<0.01)。结论对川崎病进行综合分析,可对该病作出及时的预后判断,予早期干预治疗,促进冠状动脉病变的恢复。     

不同中医体质冠心病病人冠状动脉病变程度的比较分析

[目的]探讨冠心病中医体质与冠状动脉病变程度的关系。[方法]选择经冠状动脉造影确诊为冠心病的290例病人进行中医体质判定,应用Gensini积分和冠状动脉病变支数来评价冠状动脉病变程度,比较平和质和偏颇体质间冠状动脉病变的特点。[结果]290例病人中医体质分布情况:平和质(正常质)18例,占总病例数的6.21%;偏颇体质(病理体质)272例,占总病例数的93.79%。偏颇体质病人冠状动脉Gensini评分中、高分组所占比例高,且Gensini总评分高于平和质病人,两者比较差异有统计学意义(P0.05)。[结论]偏颇体质发生冠心病的倾向较平和质高,冠状动脉狭窄程度较平和质严重。说明冠状动脉病变与中医体质类型有一定的关系,由此可预测冠心病发病的危险体质因素。     

Characteristic analysis of clinical coronary heart disease and coronary artery disease concerning young and middle-aged male patients

BACKGROUNDCoronary heart disease (CHD) is a type of coronary atherosclerotic heart disease. In recent years, the incidence of CHD has been increasing annually, with an increasing number of young patients. Severe CHD may cause severe myocardial ischemia or myocardial necrosis, which in turn may cause myocardial infarction and related complications that seriously affect the life and health of the patient.AIMTo examine the coronary arteries and clinical features of young and middle-aged male patients with CHD.METHODSFrom February 2019 to January 2020, 110 male CHD patients admitted to our hospital were selected as research subjects and were divided into two groups by age: middle-aged group (n = 55) and young group (n = 55). The coronary arteries and clinical features of the patients were compared.RESULTSThere were no significant differences in dyslipidemia, stroke history, high-density lipoprotein cholesterol, or triacylglycerol (P > 0.05) between the two groups. In the young group, age, diabetes, hypertension, smoking history, body mass index, family history of CHD, drinking history, fibrinogen, low-density lipoprotein cholesterol, total cholesterol, and single-vessel disease were higher than those in the middle-aged group. Correspondingly, serum uric acid, hyperuricemia, myocardial infarction, Gensini score > 50, collateral circulation, multivessel disease, double vessel disease, involvement of the right coronary artery, and involvement of the left main coronary artery were lower in the young group than in the middle-aged group. The middle-aged group mainly suffered from a high Gensini score, implicating multiple arteries, whereas the young group was mainly affected by single-vessel disease. The between-group difference was significant (P < 0.05).CONCLUSIONIn CHD attacks, multiple coronary arteries are implicated in middle-aged male patients and single-vessel disease in young male patients.     

对冠心病患者实施疾病管理的实践与效果

目的探讨对冠心病患者进行疾病管理的效果。方法对305例冠心病患者进行生活方式问卷调查,综合评估危险因素后建立健康档案,制订相应的疾病管理计划,有针对性地实施健康教育和随访,并进行个体化的健康指导,观察并分析疾病管理效果。结果患者的不良生活方式较管理前有明显改善(P0.05或P0.01)。其中患者戒烟率达92.57%,戒酒率达90.10%,能够坚持低盐低脂饮食的患者达64.85%,能够坚持运动锻炼的患者达89.60%。结论对冠心病患者实施疾病管理,患者不良生活方式有明显改善,可有效提高患者的自我防护意识,对预防不良心脏事件的发生有重要作用。     

Stress, coronary disease, and coronary death

Evidence of a positive association between cardiovascular illness and psychological stress presented in the literature is generally not totally convincing, which in part is due to methodological problems in defining and measuring psychophysiological and psychosocial variables. However, both reports in the literature and the clinical experience of most physicians present numerous examples of sudden, unexpected cardiac death, in which the event in all probability has been either induced or hastened by stressful life experiences. This applies to fatal and non fatal cardiac attacks, since both are often preceded by emotional stress. There is pathoanatomical evidence of specific myocardial damage induced by catecholamine release during stressful emotions. Histochemical studies have revealed copious amounts of noradrenaline stored in myocardium especially in patients with ischaemic heart disease. Epidemiological surveys on the relationships between life-stress and coronary mortality and morbidity have demonstrated certain positive associations in many cross-sectional studies as well as in certain prospective studies. Most positive evidence has been accumulated from studies on the influence of loneliness on cardiovascular morbidity and mortality. Animal experiments have demonstrated repeatedly that psychological stress evoked by aversive sensoric stimuli or unsuccessful social striving induce cardiovascular pathology including myocardial damage, hypertension, vascular changes and increased risk of sudden cardiac death.     

同型半胱氨酸和基质金属蛋白酶9与冠心病的相关性研究

目的 通过观察不同类型冠心病(coronary heart disease,CHD)患者血浆高敏C反应蛋白(high sensitivity C-reactive protein,hsCRP)、同型半胱氨酸(homocysteine,HCY)及基质金属蛋白酶9(matrix metalloproteinases-9,MMP-9)的水平变化,探讨hsCRP、HCY和MMP-9与CHD的发生发展及与动脉粥样硬化斑块稳定性的相关性.方法 选取我院心内科因胸痛症状入院且入院后行冠状动脉造影术的患者267例,其中CHD组202例,对照组(冠状动脉造影正常者)65例,CHD组又分为急性心肌梗死组(AMI)68例,不稳定型心绞痛组(UA)81例,稳定型心绞痛组(SA)53例.采用双抗体夹心酶联免疫吸附测定法(ELISA)检查血浆MMP-9的水平,hsCRP、HCY由检验科用免疫散射比浊法检测.结果 ①CHD组hsCRP、HCY、MMP-9水平均高于对照组(P<0.01).②AMI组、UA组患者血浆hsCRP、HCY 和MMP-9水平均显著高于对照组及SA组(P<0.05).③AMI组与UA组hsCRP水平及HCY水平差异无统计学意义.④AMI组MMP-9水平显著高于UA组(P<0.01).⑤CHD患者血浆hsCRP分别与HCY、MMP-9呈正相关(r=0.128、0.199,P<0.05),HCY和MMP-9之间亦成正相关(r=0.400,P<0.05).⑥Logistic逐步回归分析显示:年龄、高血压史、总胆固醇、高密度脂蛋白胆固醇、吸烟、hsCRP、MMP-9、HCY 是冠心病的独立影响因素,且HCY、MMP-9及吸烟是急性冠状动脉综合征患者的独立相关因子.结论①hsCRP、HCY、MMP-9水平升高是CHD的独立危险因素;②急性冠状动脉综合征患者(AMI组和UA组)hsCRP、HCY、MMP-9水平升高可能提示动脉粥样硬化斑块的不稳定性.     

慢性肺源性心脏病合并冠心病的诊断体会

目的探讨慢性肺源性心脏病合并冠心病的临床特点及诊断。方法将慢性肺源性心脏病的患者150例,分两组：慢性肺源性心脏病合并冠心病的患者（A组,54例）和不合并冠心病患者（B组,96例）,并将两组临床资料进行分析。结果两组比较,易患因素高血压、糖尿病和肥胖比率有显著差异（P〈0.05）,临床表现陈旧性心肌梗塞史、完全性左束枝传导阻滞（LBBB）、心界向左或向左下扩大、持续缺血的ST-T改变、Ⅱ～Ⅲ度房室传导阻滞、电轴右偏和重度右心衰竭有显著差异（P〈0.05）。结论慢性肺源性心脏病合并冠心病时症状、体征相互掩盖,使病情更加复杂,漏、误诊率高,故根据上述临床表现及辅助检查诊断该病非常重要。     

重症冠心病非体外循环冠状动脉搭桥术

目的 总结21例重症冠心病非体外循环冠状动脉搭桥手术的临床体会。方法 先行乳内动脉与前降支的吻合，或在主动脉内球囊反搏支持下完成手术。结果 平均手术时间216（196-286）分钟，3例搭桥3根，15例搭桥4根，3例搭桥5根（4根/人），平均术后呼吸机辅助时间6（3-8）小时，术后应用多巴胺和多巴酚丁胺进行循环功能支持者14例，应用主动脉内球囊反搏2例，均于术后48小时内撤除，术后早期发生房颤，房扑伴阵发性室上速者12例，频发室性早搏者3例，心包填塞二次开胸止血者2例，结论 重症冠心病非体外循环冠状动脉搭桥手术，应充分进行术前准备，制订合理的麻醉和手术方案。加强术中密切配合，重视全面的术后处理。     

老年女性冠心病的危险因素及冠状动脉病变特点

目的探讨老年女性冠心病的危险因素及冠状动脉病变的特点。方法选择冠状动脉造影术的老年女性282例（≥65岁）,分为冠心病组（n=202）和非冠心病组（n=80）,详细记录病史、体检资料,检验尿酸、雌激素、孕激素及雄激素的含量,并记录冠状动脉造影结果。结果与非冠心病组比较,冠心病组闭经年龄较早,糖尿病、高脂血症、高血压所占比例高,尿酸水平明显升高（P〈0.01）,雌二醇水平明显降低（P〈0.01）,两组间孕激素及雄激素水平差异无统计学意义（P〉0.05）;Logistic回归分析显示,尿酸水平与冠心病呈正相关,雌激素水平与冠心病呈负相关;冠心病组中受累血管支数、血管狭窄程度与危险因素数目显示有相关性（P〈0.05）。结论老年女性冠心病与糖尿病、高血压及高脂血症有关,血清雌激素降低及尿酸升高是老年女性冠心病发病的独立危险因素,冠状动脉病变严重程度与危险因素的多少有关。     

冠心病患者血管内皮功能与冠状动脉病变严重程度的关系

目的 探讨冠心病患者的血管内皮功能改变及其与冠状动脉病变严重程度的关系.方法 73例拟行冠状动脉造影术的患者,根据冠状动脉造影结果将其分为冠心病组39例和非冠心病组34例.13例健康、无冠心病危险因素者作为对照组.运用高频线阵超声测定肱动脉流量介导的血管扩张作用指标流量介导血管扩张比(FMD)及硝酸酯介导的血管扩张作用指标硝酸酯介导血管扩张比(NTG-MD),评估患者的血管内皮功能状况,以探讨血管内皮功能与冠状动脉狭窄间的关系.结果 冠心病组、非冠心病组和对照组的FMD分别为(4.81±2.33)%、(9.29±3.88)%和(13.58±1.80)%,3组间两两比较差异均有统计学意义(F值为48.012,P＜0.01);NTG-MD分别为(13.72±3.27)%、(15.64±2.65)%、(16.54±2.98)%,3组问差异有统计学意义(F值为6.015,P＜0.01),冠心病组与其余2组相比差异均有统计学意义(P均＜0.05).FMD与管径基础值、冠状动脉受累支数及冠状动脉最大狭窄程度呈负相关(r分别为-0.224、-0.316、-0.721,P分别为0.038、0.003和＜0.001).NTG-MD与管径基础值、冠状动脉受累支数及冠状动脉最大狭窄程度亦呈负相关(r分别为-0.483、-0.258、-0.372,P分别为＜0.001、0.027、0.001).多项逐步回归分析显示FMD与冠状动脉最大狭窄程度、管径基础值呈线性关系(r分别为-0.012、-0.022,P均＜0.001).NTG-MD与管径基础值及冠状动脉最大狭窄程度呈线性关系(r分别为-0.032、-0.0073.P均＜0.001).结论 冠心病患者内皮损害程度与冠状动脉狭窄严重程度之间呈线性相关.     

脉压、收缩压与冠状动脉病变程度相关性研究

目的 探讨冠心病患者脉压（PP）、收缩压（SBP）与冠状动脉病变程度相关性。方法选择心内科行冠状动脉造影的患者241例,根据冠状动脉造影结果分为冠状动脉狭窄组（n=135）与非冠状动脉狭窄组（n=106）。比较冠状动脉狭窄组与非冠状动脉狭窄组以及不同病变支数患者的血压参数。分析各血压参数与冠状动脉狭窄发生率的关系,各血压参数与冠状动脉病变程度的相关性。结果 ①冠状动脉狭窄组冠状动脉狭窄评分、年龄、收缩压、脉压显著高于非冠状动脉狭窄组（P〈0．05～0．01）,且年龄、冠状动脉狭窄评分、SBP、PP随着狭窄支数的增加而逐渐增高,尤其以3支病变患者更为显著（P〈0．05）。而DBP低于非冠状动脉狭窄组（P〈0．05）。且随着狭窄支数的增加有逐渐降低趋势,但没有统计学意义（P〉0．05）。②Pearson直线相关分析：年龄、糖尿病史、吸烟、SBP、PP、总胆固醇、低密度脂蛋白胆固醇与冠状动脉病变支数、冠状动脉狭窄记分呈正相关（r分别为：0．325,0．241,0．227,0．385,0．517,0．087,0．053,P〈0．05～0．01）。③多因素Logistic逐步回归分析：SBP、PP、年龄、糖尿病史、吸烟与冠状动脉3支病变的发生有相关性（OR分别为：1、283,1．787,1．535,1、950,1．779,P〈0．05）。④多元线性回归分析显示：年龄、SBP、PP、吸烟、与冠状动脉狭窄记分呈正相关（β=0．301,1．955,0．107,0．240,P〈0．05～0．01）。结论 PP、SBP增高,冠状动脉狭窄性病变的发生率增加,冠状动脉狭窄程度加重。冠状动脉狭窄程度与PP、SBP呈正相关,PP是冠状动脉病变程度的独立预测因子。     

两种负荷心电图试验对冠心病的诊断价值研究

目的 评价运动心电图试验(EET)、双嘧达莫心电图负荷试验(DPET)及联合应用(联合试验AD对冠心病的诊断价值。方法 选择183例冠状动脉造影(CAG)检查的患者，并在同期内(间隔小于1周)接受。EET、DPET检查。将CAG结果分别与EET、DPET和AT结果进行对比分析。结果 这两种无伤检查和联合检查诊断冠心病的敏感性分别为67．2％、60．3％和55．2％，特异性分别为：70．4％、74．4％和92．8％，准确性分别为：69．4％、69．9％和85．3％。结论 EET和DPET联合应用对冠心病的诊断具有较高的特异性和准确性，且费用低、无创伤，适宜基层医院推广。