低压力球囊预扩张及高压力冠状动脉内支架置入临床疗效观察

目的 :评估低压力球囊预扩张、高压力冠状动脉 (冠脉 )内支架置入的可行性和效果。方法 :10 6例选择性支架置入的冠心病患者 ,低压力 (40 5 .3～ 6 0 7.9kPa)球囊预扩张后 ,冠脉内置入支架 ,高压力 12 15 .9～ 16 2 1.2kPa)释放。结果 :共 12 7处病变置入支架 135只 ,球囊预扩张平均压力为 4 86 .4kPa ,平均支架释放压力为 136 7.9kPa ,即刻支架置入和释放的成功率为 10 0 %。低压力预扩张冠脉内膜撕裂发生率为 3.9%(5 / 12 7处 )。结论 :选择性冠脉内支架置入 ,低压力球囊预扩张、高压力支架置入是一种安全、有效和可行的方法 ,可能减少冠脉内膜撕裂的发生率。     

冠状动脉内直接支架术对无再流现象的影响

目的　评价冠心病患者冠状动脉 (冠脉 )内直接支架术对术后无再流的影响。方法　包括 12 7例接受冠脉内直接支架术的患者 (直接支架组 )和一般情况匹配的 12 7例球囊扩张后行冠脉支架术的患者 (常规支架组 ) ,比较两组的一般情况、冠脉造影及介入治疗即刻和临床随访结果。结果　直接支架组患者冠脉狭窄程度较轻 (82 %± 6 %和 87%± 11% ,P <0 0 5 ) ,支架置入术最终扩张压力明显增高 [(15± 5 )atm和 (12± 3)atm ,P <0 0 5 ],11例 (8 7% )支架置入后发生无血流现象 [常规支架组18例 (14 2 % ) ,P =0 17]。随访期两组严重心脏不良事件发生率差异无显著性 ;但无血流组患者严重心脏不良事件发生率显著增高 (4 8%和 8% ,P =0 0 0 1)。结论　冠脉内直接支架或常规支架术对术后无血流现象发生的影响差异无显著性 ;初次冠脉支架术后发生无血流现象患者预后较差。     

血栓抽吸术后急诊支架与延迟支架置入对ST段抬高型心肌梗死的疗效比较

目的:比较血栓抽吸术后急诊支架与延迟支架置入对ST段抬高型心肌梗死(STEMI臆者的治疗效果。方法:入选2012-l1至2014-01期间因STEMI行充分血栓抽吸并经血栓抽吸导管冠状动脉(冠脉)内注射替罗非班、硝普钠和硝酸甘油后梗死相关动脉恢复心肌梗死溶栓治疗(TIMI)血流3级的患者共计82例,由SAS软件产生的随机数字法分为急诊支架组(n=41例)和延迟支架组(n=41例)。急诊支架组患者立即置入支架,而延迟支架组患者则不立即置入支架,而是继续抗血小板和抗凝治疗10~14天后再行支架置入。对两组主要指标和次要指标进行比较,主要指标包括心电图ST段回落幅度、慢血流/无复流发生率及心肌染色3级的百分比,次要指标包括支架置入参数、对心室重塑的影响及主要不良心血管事件。结果:延迟支架组在经皮冠状动脉介入治疗(PCI)术后的心电图ST段回落幅度、TIMI血流3级和心肌染色3级百分比以及校正TIMI帧数分别为(68.2±9.2)%、97.5%、69.0%和(19.5±5.2)帧,与急诊支架组比较差异有统计学意义(P0.05)。延迟支架组与急诊支架组在PCI术中发生无复流/慢血流的比例分别为2.5%和31.0%,两组比较差异有统计学意义(P0.01)。延迟支架组和急诊支架组支架数量分别为(1.21±0.32)枚和(1.76±0.76)枚,平均支架长度分别为(283±11.7)mm和(33.7±12.9)mm,平均支架直径分别为(3.17±0.76)nm和(2.82±0.87)mm,差异有统计学意义(P0.01);延迟支架组的扩张压力(18.5±6.2)atm]也明显高于急诊支架组[(13.6±7.1)atm],而延迟支架组75%的患者采取了高压后扩张,高于急诊支架组(23.8%),差异有统计学意义(P0.01)。随访6个月时发现,延迟支架组和急诊支架组在左心室射血分数、左心室收缩短分数与1周时有下降趋势,但差异无统计学意义(P0.05)。而左心室舒张末期容积(LVEDV)及左心室舒张末期内径(LVETD)与1周时比较有明显的增加(P0.05);而这种变化在急诊支架组更为明显(P0.05)。随访6个月时结果显示,与急诊支架组比较延迟支架组主要不良事件发生率明显下降(P0.05)。结论:STEMI患者PCI中血栓抽吸术后延迟支架置入可以减少支架术后慢血流/无复流现象的发生,改善支架贴壁和心肌灌注,减少不良心血管事件发生。     

冠状动脉内直接支架置入治疗急性冠状动脉综合征--与传统支架置入方法的随机对比研究

目的 :采用与传统支架置入术 (CS)随机对比研究的方法 ,评价冠状动脉 (冠脉 )内直接支架置入术 (DS)治疗急性冠脉综合征相关病变的可行性和安全性。　　方法 :将 15 0例急性冠脉综合征患者随机分为DS组和CS组 ,两组的基本临床特征和造影特征及术前治疗无显著差异。实验第一终点是影像学的成功 :支架置入后靶病变残余狭窄 <2 0 % ,心肌梗死溶栓治疗临床试验 (TIMI) 3级血流 ,“无再流或慢血流现象”的减少 ;第二终点为严重并发症发生率和手术操作时间及花费的评价。　　结果 :DS组和CS组组间手术成功率无差异 (DS组为 94 7% ,CS组为 96 0 % )。无再流或慢血流现象发生率DS组为 5例 (6 7% ) ,CS组为 4例 (5 3 % ) ,两组间亦无差异 (P =NS)。手术时间、球囊导管及造影剂用量DS组均低于CS组 ,两组比较有极显著差异 (P <0 0 1)。住院期间效果及严重并发症两组间无差异 ;6个月随访结果两组比较亦无显著性差异。　　结论 :本随机研究证实了一些回顾性研究的结果 ,DS治疗急性冠脉综合征的相关病变具有可行性和安全性 ,与CS相比较 ,这一策略的突出优点是显著增加效益费用比 ,而对急性并发症特别是“无再流或慢血流”现象的发生无影响。     

预防急性心梗支架后慢血流临床研究

目的探讨急性心肌梗死介入治疗中预防慢血流现象的方法。方法将160例急性冠状动脉完全闭塞患者随机分为实验组81例及对照组79例,实验组介入治疗中球囊扩张以及支架放置后,冠脉内推注硝酸甘油及肝素生理盐水,扩张支架压力不超过标准压。对照组仅冠脉内推注硝酸甘油,按需要扩张支架压力可超过该支架的标准压。结果实验组慢血流合计3例,对照组11例,实验组慢血流发生率低于对照组（P〈0．05）。结论对急性冠脉完全闭塞病变实施扩张、冲洗以及不实施超标准加压扩张的方法可减少无复流或慢血流现象。     

预扩张球囊导管的选择对冠状动脉支架置入操作的影响

目的 :探讨预扩张球囊导管的选择对支架置入操作的影响。方法 :将内径≥ 3.0mm的前降支开口以远病变 (长度≤ 2 0mm、狭窄 80 %～ 99%、中度以下钙化、TIMIⅡ～Ⅲ级、近端弯曲≤ 4 5°)的患者 5 0例随机分为 2 .0mm、2 .5mm和 3.0mm球囊预扩张组 ,采用同一品牌的指引导管、导丝和球囊导管进行预扩张 ,观察球囊充盈程度、球囊通过病变率、TIMI血流率和夹层发生率。对达到支架样扩张效果者结束操作 ,其他病变均置入相同品牌的预装混合支架并观察 :支架到位率、球囊充盈程度、近端血管直径与球囊直径、残余狭窄程度、TIMI改善率。结果 :各组预扩张压力和时间差异无显著性意义 (P >0 .0 5 )。与 2 .5mm球囊组相比 ,2 .0mm球囊组预扩张后TIMI改善率低、支架不能通过病变率高 (均P <0 .0 5 ) ;与 2 .5mm球囊组相比 ,3.0mm球囊组的TIMI改善率、支架通过率虽然较高 ,但血管夹层的发生率亦明显增加 (P <0 .0 5 ) ;对直径 3.0mm的病变血管采用 2 .5mm球囊预扩张夹层发生率低、支架通过率高、TIMI改善率适中。结论 :预扩张操作最好选用比病变血管内径小10 %～ 2 0 %的球囊 ,如此可达到较好的预扩张效果、便于支架到位 ,同时又不至于明显加重血管损伤或造成新的需要处理的血管夹层。     

冠状动脉支架置入术后九天亚急性血栓形成一例

1 临床资料 患者女性,56岁.主因"反复发作胸闷,胸痛1年,突发胸痛持续2小时",急诊入院.9天前行冠状动脉(冠脉)造影示:左前降支近段弥漫狭窄90%,用maverick球囊10 atm(1 atm=101.325 kPa)10s反复扩张4次,置入3.0×33 mm firebird支架1枚,16atm 20 s释放,支架完全覆盖病变,心肌梗死溶栓治疗临床试验(TIMI)血流3级.     

切割的球囊预扩张对支架置入后再狭窄的影响

目的 :探讨切割的球囊预扩张对支架内再狭窄的影响。方法 :86例Multilinkstent置入患者 ,按预扩张所用球囊不同 ,分为切割的球囊血管成形术 (CBA)组和单纯球囊血管成形术 (POBA)组 ,比较两组支架置入后即刻及远期血管造影随访结果。结果 :治疗后即刻及追踪造影结果显示 ,两组在最小血管径 (MLD)、狭窄度(DS)、晚期内径丢失方面无明显差别 ,内径丢失指数CBA组 (0 .2 8± 0 .15 )较POBA组 (0 .4 2± 0 .2 8)为低 (P <0 .0 5 ) ,再狭窄率CBA组为 15 .4 % ,POBA组为 2 5 .0 % ,CBA组呈低的倾向。结论 :CBA预扩张有可能对支架内再狭窄产生有益影响 ,值得进一步探讨     

直接冠状动脉内支架置入术对急性心肌梗死无复流的影响

目的评价直接冠状动脉(冠脉)内支架置入术对ST段抬高型急性心肌梗死无复流的影响。方法对157例ST段抬高型急性心肌梗死患者分别行直接冠脉内支架置入(直接支架组,85例)和球囊预扩张后支架置入(常规支架组,72例)。比较两组介入治疗时平均X线曝光时间、造影剂用量、术后TIMI血流分级和心电图ST段变化。结果直接支架组和常规支架组比较,前者节省球囊,平均X线曝光时间和造影剂用量均显著降低[(24.6±16.9)minvs(34.4±17.5)min,(115±37)mLvs(166±61)mL;P均<0.05];二者术后TIMI3级差异无统计学意义(91.8%vs83.3%,P=0.107);前者TIMI0~1级未见显著降低,但有明显的下降趋势(3.5%vs11.1%,P=0.064);前者心电图ST段无回落发生率显著降低(22.4%vs41.7%,P=0.009)。结论对于ST段抬高型急性心肌梗死中适当的冠脉病变,直接冠脉内支架置入术不仅可以节省球囊,减少X线曝光时间和造影剂用量,而且可能减少无复流发生。     

球囊预扩张充盈压对冠脉支架植入术临床疗效的影响

目的 :评估球囊低压力预扩张对冠脉内支架术后临床疗效的影响。方法 :依据不同球囊预扩张压力将入选的91例冠心病患者分为低压力组 （最大扩张压力≤ 12 atm ）、高压力组 （>12 atm ） ,观察住院期间严重临床事件率和术后 6～ 18个月无心脏事件存活率。结果 :低压力组球囊最大预扩张压力为 8.3± 1.6 atm ,高压力组为 13.9± 0 .3atm （P<0 .0 5 ） ,144个支架均成功置入。低压力组和高压力组在术中的血管夹层及撕裂的发生率分别为 8.2 %和19.0 % （P<0 .0 5 ） ,住院期间低压力组发生死亡为 0例 ,高压力组为 1例 ;6 8例患者接受了术后 6～ 18个月的临床随访 ,无心脏事件存活率低压力组为 74% ,高压力组为 6 1% ,其中 13例在随机冠状动脉造影随访中发现支架内再狭窄 ,低压力组为 6例 ,高压力组为 7例。结论 :低压力球囊预扩张可减少支架术中的急性血管并发症 ,不影响支架置入的远期疗效。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.