Twelve years of coronary artery surgery in South Australia

Twelve years' results of coronary artery bypass surgery in South Australia have been reviewed. The preoperative assessment parameters and operative profiles of 4001 patients who underwent isolated coronary artery grafting between 1970 and 1982 have been examined. In addition, all surviving patients received a follow-up questionnaire; only 48 patients have remained untraced. Survival curves for the patient group have been calculated and compared with those for the Australian population. The risk factors which influenced long-term survival have been identified. Surviving patients described their anginal symptoms as diminished in 93% of cases at the time of review. When recurrent angina was described, 58% of patients experienced it within 12 months of the operation. Postoperative activity was improved in 71% of patients; 8% described a deterioration. A second operation was performed in 2.1% of patients. This study provides a comprehensive review of the efficacy of coronary artery bypass surgery both in the short and in the medium term.     

冠心病合并2型糖尿病的冠状动脉造影特点及支架置入术的疗效观察

目的分析冠心病合并2型糖尿病患者的冠状动脉造影结果,并评估冠脉内支架置入术的临床疗效.方法比较206例冠心病合并糖尿病患者(A组)与492例无糖尿病冠心病患者(B组)的冠状动脉造影结果,并比较118例冠心病合并糖尿病患者(C组)与311例无糖尿病冠心病患者(D组)冠脉内支架置入术的疗效.结果与无糖尿病冠心病相比,冠心病合并糖尿病的冠脉病变更复杂、更严重,外科冠状动脉旁路术多(36.89%vs 19.10%,P＜0.05).两组即刻手术成功率高(100%vs99.68%),前组无严重并发症发生.结论冠心病合并糖尿病患者冠脉内支架置入术安全有效,能显著降低心脏不良事件发生率.     

Coronary artery bypass surgery in the diabetic patient

Coronary artery and peripheral occlusive arterial disease frequently complicate diabetes mellitus, with death due to atherosclerotic coronary artery disease being three times more likely in diabetic compared to non-diabetic patients. The profile of 32 diabetic patients and 32 matched controls who underwent coronary artery bypass (CABG) is studied and their early and late postoperative outcomes are described. The mean age was 61±1 year in both groups. The diabetic group comprised 26 non-insulin dependent and 6 insulin dependent diabetics, who had a mean duration of diabetes of 8.5 years (range 2 months – 35 years). The median number of grafts per patient performed in the diabetic group and the control group was 3.5 and 3 respectively. There was no mortality in the series, however considerably greater wound morbidity rates were encountered in the diabetic group when compared to matched controls. One renal transplant patient in the diabetic group suffered irreversible acute tubular necrosis and became dialysis dependent post-operatively. Longterm follow-up showed no longterm mortality in either group, with full relief of angina achieved in 75% of diabetic patients compared with 87.5% of matched controls. In addition diabetic patients suffered greater longterm cardiac morbidity than the control group (21.8% versus 12.5%). The results of this study suggest that CABG is a safe operation for the diabetic patient. Diabetic patients receive satisfactory symptomatic relief of angina, but suffer increased perioperative wound complications and greater incidence of longterm cardiac morbidity.     

女性冠心病合并2型糖尿病患者的临床和冠脉造影特点

目的:研究女性冠心病(CAD)合并2型糖尿病(DM)患者的临床及冠状动脉造影特点。方法:入选病例为1999-2004 年在我心脏中心住院的240例女性CAD心绞痛患者,根据有无DM分成两组,比较两组的临床特点和冠状动脉造影情况。结果:108个患者(45％)有DM史两组患者在年龄、高血压、血脂异常、吸烟、左主干病变方面比较没有统计学差异(P>0．05), 但DM组绝经患者少于非DM组(P<0．05);DM组的三支血管病变和弥漫性血管病变较多(P<0．05);DM病程对冠状动脉造影所示血管病变无影响(P>0．05);随着空腹血糖水平的升高,三支血管病变和弥漫性病变也增多(P<0．05)。结论:女性 2型DM患者在绝经期前患CAD者多于非DM患者,DM组三支血管病变和弥漫性病变较多。DM病程对冠状动脉造影所示血管病变无影响,但空腹血糖水平的升高促使及加重冠状动脉血管病变。     

The diabetic day-care unit. I. Development of an index to evaluate diabetes control.

In order to measure the effect of a diabetic day-care unit on diabetes control two scoring scales were constructed, one for insulin-dependent diabetics and the other for patients managed by diet or oral agents or both. Both scales were based on observations of blood and urine glucose concentrations, ketonuria, symptoms of diabetes and deviation from ideal weight. The scale for insulin-dependent diabetics also included the frequency and severity of insulin reactions and frequency of hospital admission for acidosis. Scores for 45 insulin-dependent patients and for 55 diabetics treated by diet with or without oral agents in the unit indicated significant improvement in diabetes control in both groups.     

血管外科与糖尿病足血流重建在2008

Diabetes mellitus has an increased incidence of atherosclerotic vascular disease and infection involving the lower extremity over. Lower limb arterial disease is more common among patients with diabetes. The pathologic basis of diabetic lower limb ischemia is atherosclerosis. Two types of vascular disease are seen in patients with diabetes. (1-4) The first is a nonocclusive microcirculatory dysfunction involving the capillaries and arterioles of the kidneys, restina, and peripheral nerves. This microvascular abnormality is relatively unique to diabetes and most likely contributes to the eye (retinopathy), kidney (nephropathy), and nerve (neuropathy) complication of diabetes. The second type of diabetic vascular disease is a macroangiopathy. Morphologically and functionally, this is similar in both diabetic and nondiabetic patients and is characterized by atherosclerotic lesions of the coronary and peripheral arterial circulation. For the peripheral arterial circulation, dabetics with reconstructible vascular lesions do just as well as non-diabetics with similar disease although diabetics tend to have worse atherosclerotic disease in the distal arteries. Diabetics should never be written off as having nonreconstructible disease until an arteriogram is obtained, and they should be offered the same surgical options as other patients with good expectations for limb salvage. (5) As we know, ischemia is a fundamental consideration for the vascular surgeon faced with the diabetic foot. Diabetic lower limb ischemia with a natural outcome of limb necrosis and necessary amputation in most patients is difficult to treat, it even can become life-threatening in some untreated cases. Lower limb revascularization is indicated to prevent limb loss in paptients with leg ischemia. For the vascular surgeon, three methods for revascularization are recommended here. The first is arterial bypass, especialy distal bypass. The second is endovascular interventional therapy, including percutaneous transluminal angioplasty (PTA) with or without stenting. The last is transplantation of autologous stem cells.     

糖尿病肾病与非糖尿病肾病患者维持性血液透析疗效比较

目的分析研究血液透析对糖尿病肾病与非糖尿病肾病的临床疗效,以减少患者的并发症,提高其生活质量和长期的生存率。方法回顾2007年1月至2008年1月在我院治疗的52例糖尿病肾病患者的临床资料,选取同期收治的50例非糖尿病肾病患者的临床资料作为对照。比较两组患者的死亡原因、并发症以及生存率。结果 3年后,糖尿病肾病组患者生存28例,生存率为53.85%;对照组患者生存39例,生存率为78%,糖尿病肾病患者的3年生存率明显低于对照组,两组比较差异有统计学意义(P<0.05)。糖尿病肾病组患者因感染死亡11例,占45.83%,心血管疾病死亡5例,占20.83%,脑血管疾病死亡3例,占12.5%,其他5例,占20.83%。结论血液透析治疗糖尿病肾病疗效较非糖尿病肾病差,对于糖尿病肾病患者,尽早进行血液透析,积极控制血压、血脂、血糖,并改善患者自身的贫血状况,可以改善患者的临床症状,提高患者生存率。     

Repair of left ventricular aneurysm during off-pump coronary artery bypass surgery

Background Acute myocardial infarction can result in left ventricular aneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia and thromboembolic events. This study evaluates results achieved with a modified linear closure of left ventricular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 to May 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysm during off-pump coronary artery bypass surgery. Repair was completed on the beating heart to minimize ischaemia and allow assessment of wall function and viability to guide closure. All patients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia. The majority (75%) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejection fraction was 26%±9%. The mean left ventricular, end diastolic diameter was (57.5±7.1) mm. The ventricular preoperative and postoperative performances were compared. χ2 test and Student’s t test were used to analyse the outcomes. A P value less than 0.05 was considered significant.Results Hospital mortality was 1.3% (1/75). Coronary artery bypass was performed with an average of (3.3±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. The mean NYHA class and ejection fraction increased significantly (P&lt;0.001). The mean left ventricular, end diastolic diameter decreased significantly (P&lt;0.001). Conclusions Surgical closure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. The operation is associated with a low inhospital mortality and morbidity. A postoperative improvement in the early term cardiac functions and symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.     

冠心病合并糖尿病患者冠状动脉病变的临床观察

目的：探讨冠状动脉粥样硬化性心脏病（冠心病）合并糖尿病患者的冠状动脉病变特点。方法：回顾分析本院１９９５￣１９９７年冠状动脉造影阳性患者１５３例,分为糖尿病组（３３例）、糖耐量减低组（ＩＧＴ,２３例）和非糖尿病组（９７例）,观察其年龄、冠心病危险因素（包括高血压、高胆固醇血症和吸烟）、心肌梗死发生率和冠状动脉受累情况。结果：３组在年龄、性别、危险因素、 梗死发生率等方面均无显著性差异。糖尿病组冠状     

影响70岁以上老年人冠脉搭桥远期预后独立因素分析

目的探讨70岁以上老年人冠脉搭桥远期死亡率的独立影响因素。方法前瞻性分析2005年1月～2011年5月70～86岁(平均74岁)接受冠脉搭桥术(不合并其他手术)的345例患者术前、术中及术后临床资料,并进行远期随访。按照随访结局不同,将患者分为随访死亡组(n=45)和随访存活组(n=300),比较两组患者术前,术中及术后临床资料的数据,筛选P<0.05的因素进入Cox多元回归分析,分析影响70岁以上老年人冠脉搭桥远期死亡率的独立影响因素。结果接受体外循环冠脉搭桥术患者74例,非体外循环冠脉搭桥术患者219例及体外循环辅助下心脏不停跳搭桥术患者52例,院内死亡15例,死亡率4.35%,随访72个月[1～72个月,中位随访时间68个月;平均随访(62.557±1.282)个月],随访率100%;累计死亡45例,累计死亡率13.04%;经过Cox多元回归分析(向前LR法)后,共筛选出5个因素为70岁以上老年人冠脉搭桥远期死亡率的独立影响因素:插管时间RR:1.002,95%CI(1.001-1.003);术后肾功能不全RR20.59,95%CI(6.131-69.154);术前合并CVDRR4.605,95%CI(1.796-11.806);术后规律服用他汀类药物RR0.334,95%CI(0.158-0.706);术后血压控制良好RR0.135,95%CI(0.047-0.385)。结论术后插管时间、术后肾功能不全、术前合并CVD为危险因素,术后规律服用他汀类药物、术后血压控制良好为改善70岁以上老年人冠脉搭桥远期预后的保护因素,该结果对今后改善70岁以上老年冠脉搭桥患者长期预后有一定的指导意义。     

Platelet aggregation. Adult-onset diabetes mellitus and coronary artery disease

Using a turbidimetric technique, we determined 1.7 micrometer adenosine diphosphate--induced platelet aggregation and disaggregation at 37 degrees C in the platelet-rich plasmas of two groups of men with coronary artery disease. Eleven men were nondiabetic and 11 had adult-onset diabetes mellitus without retinopathy. There were no significant differences (P greater than .05) between diabetics and nondiabetics of the following variables: age, platelet count in platelet-rich plasma, first and second phases of platelet aggregation, maximum extent of aggregation, and percent disaggregation at three minutes after maximum aggregation occurred. Although the mean adenosine diphosphate--induced platelet aggregation in the platelet-rich plasmas of adult-onset diabetic men with coronary artery disease and no retinopathy was not enhanced, and the mean rate of disaggregation was not reduced, when compared with nondiabetic men with coronary artery disease or with healthy men; a slow rate of platelet disaggregation (less than 10%) occurred more frequently in the platelet-rich plasmas of men with coronary artery disease.     

首次冠状动脉造影患者糖代谢分布及血管造影特点分析

目的调查首次冠状动脉造影人群的糖代谢分布,分析血管造影特点。方法对553例疑似冠心病患者测量形体参数,检验血液生化指标,进行冠状动脉造影。用1999 WHO糖尿病诊断标准评价糖代谢分布,美国心脏病协会规定的冠状动脉狭窄程度评判标准和Gensin i评分系统对造影结果进行定量评价,根据造影结果及糖代谢状态对患者进行分组比较。结果研究对象平均年龄60岁(60.1±9.7),277例(50.1%)糖耐量正常,276例(49.9%)糖代谢异常,其中糖调节受损127例(23.0%),新诊断糖尿病61例(11.0%),已知糖尿病88例(15.9%)。冠心病组中糖代谢异常者多于非冠心病组(56.4%和34.5%,P<0.05)。糖尿病组多支病变发生率和Gensin i积分均高于非糖尿病组,分别为63.8%和44.1%,15分和20分(P均<0.05)。结论冠状动脉造影人群糖代谢异常多见,糖尿病患者多支病变发生率和冠状动脉狭窄程度高于非糖尿病患者。     

经皮冠状动脉介入治疗对冠心病合并2型糖尿病高龄患者的疗效观察

目的:探讨冠心病合并2型糖尿病(T2DM)高龄患者的冠状动脉病变特点和介入治疗的特点。方法:对经临床诊断为冠心病高龄患者进行冠状动脉造影40例,按是否合并2型糖尿病分为两组进行统计学分析。结果:冠状动脉造影显示,糖尿病组以多支病变、C型病变、弥漫性病变为主,而非糖尿病组以单支病变、B型病变。两组患者在病变支数和病交类型差异有显著意义(P<0.01,P<0.05)。介入治疗显示,糖尿病组患者需要支架后扩张、支架重叠、平均病交长度、术前参考血管直径、每个病变支架长度、平均每台手术时间、术中无复流现象,与非糖尿病组患者差异有显著意义(P<0.01,P<0.05)。结论:冠心病合并2型糖尿病患者比非合并糖尿病患者的冠状动脉病变的范围大,程度重,介入治疗难度大,并发症多。     

60岁以上糖尿病患者的冠状动脉旁路移植术围术期处理

目的回顾性分析60岁以上老年糖尿病患者行冠状动脉旁路移植术(coronary artery bypass grafting,CABG)的围术期治疗效果和经验.方法对671例60岁以上接受CABG患者的情况进行回顾性分析,其中糖尿病组158例,非糖尿病组513例.按常规方法行非体外循环和体外循环下搭桥术,搭桥材料常规使用左侧乳内动脉(IMA)和大隐静脉(SV).术前术后严密监测血糖,采用以口服降糖药或皮下注射胰岛素为主的血糖调控策略,将血糖控制在术前6 mmol/L、术后8 mmol/L左右.术中使用即时超声血流仪(TTFM)测量移植血管血流,保证吻合口通畅.术后加强物理治疗和营养支持.结果围术期总死亡率1.0%,糖尿病组病死率(1.9%)显著高于非糖尿病组(0.77%),(P＜0.05).总并发症发生率2.53%,糖尿病组并发症率(3.8%)显著高于非糖尿病组(2.1%)(P＜0.05).术后脑梗死发生率糖尿病组(1.2%)也显著高于非糖尿病组(0.7%),(P＜0.05).结论糖尿病是老年患者CABG围术期死亡和脑卒中等并发症的危险因素.围术期应采用精细的血糖监测和调控及综合治疗措施控制手术死亡率和并发症率,使老年糖尿病患者取得很好的手术效果.     

左心室室壁瘤患者行左室成形术与单纯冠脉旁路移植术的中远期疗效对比

目的评价左心室室壁瘤（left ventricular aneurysm, LVA）患者分别行左室成形术（surgical ventricular restoration, SVR）及 单纯冠脉旁路移植术（coronary artery bypass grafting, CABG）的中远期疗效。方法回顾性分析1997年1月~2012年12月在我 中心诊断为LVA的205例患者资料,其中行SVR115例,行单纯CABG90例,采用1∶1配对方法,以术前超声心动图指标（室壁瘤 大小、左室收缩末期容积指数LVESVI、左室射血分数LVEF）及EuroSCORE危险因素为配对标准,筛选32对纳入研究。比较两 组患者围术期及术后1年、3年、5年心脏结构及功能变化、生存率及MACCEs发生率的差异。结果与单纯CABG对比,SVR术 后心脏超声指标（左室内径LVEDD、左室收缩末期容积LVESV、LVESVI、左室舒张末期容积LVESDV、左室舒张末期容积指数 LVEDVI）较术前明显减小,LVEF明显增加,NYHA分级明显改善;CABG术后仅LVEDD及LVEF较术前有所改善,随时间推 移,两组心脏超声指标均呈上升趋势,组间差异逐渐缩小,并在术后5年差异无统计学意义（P>0.05）。两组在中远期生存率及 MACCEs事件发生率方面差异无统计学意义（P>0.05）。结论对于LVESVI小于60 mL/m2的LVA患者,与单纯CABG对比, SVR并未减少MACCEs事件发生率,也未明显提高中远期生存率。     

Epidural morphine for outpatients with severe anginal pain

Seven patients who had chronic coronary artery disease and had undergone coronary artery bypass surgery still suffered from anginal attacks several times daily despite optimal medical treatment. An epidural system of analgesia was implanted subcutaneously and treatment with epidural morphine started. The morphine was administered by the patients themselves or members of their family. During a median observation time of four months (range three to 11) all patients were free of pain while receiving this treatment.     

Stanford A型主动脉夹层手术死亡风险因素分析

目的 收集Stanford A型夹层患者围术期的临床资料以分析探讨夹层术后死亡的独立风险因素.方法 收集2012年1月-2020年1月安徽医科大学第一附属医院心脏大血管外科收治共68例Stanford A型主动脉夹层手术患者的围手术期资料,根据患者预后分为术后存活组(50例)和术后死亡组(18例).收集患者临床资料,对...     

Comparative study of coronary collaterals in diabetic and nondiabetic patients by angiography

Myocardial ischaemia is known to be significantly related to the development of coronary collaterals, but there are considerable variations in their formation. The nature of this variability is not well understood. Likewise it remains unclear whether diabetes mellitus. DM has any effect on coronary collaterals. The aim of this study was to evaluate the effect of diabetes mellitus on coronary collaterals. This prospective case- control study was done from January to December 2000 in patients undergoing coronary angiography in National Institute of Cardiovascular Diseases (NICVD), Dhaka, who fulfilled the inclusion criteria of having < or = 75% stenosis in at least one coronary artery. The patients with diabetes having CAD without other modifiable major risk factors (hypertension, smoking, dyslipidaemia) were constituted case study group (n=36) and nondiabetic patients having CAD with those risk factors were constituted control group (n=50). Coronary collaterals were graded according to Rentrope scoring system and the collateral score was calculated by summing the Rentrope number of every patient. There was no statistical difference between patients with and without diabetes in clinical characteristics. The mean number of diseased vessel in DM group 2.6+/-0.6 was higher than that in nondiabetic patients (2.1+/-0.8, P>.05). The mean collateral score was 0.5+/-0.6 in DM group and 1.2+/-1.0 in nondiabetic group. These findings suggest that coronary collateral development is significantly poorer in diabetic than on diabetic patients.     

The ethnic prevalence of hypertension in a diabetic clinic

Using the WHO criteria of hypertension, we have demonstrated that 40% of randomly selected diabetic clinic attenders under the age of 65 were hypertensive. Black diabetics had a significantly greater prevalence (P less than 0.001) of hypertension than either white or Asian diabetics. Hypertension was commoner in black and white females compared with males (P less than 0.001); in Asians this difference was not statistically significant. Systolic hypertension was the most common form in all ethnic groups. Only 38.7% of diabetics receiving antihypertensive therapy had normal blood pressure readings. Blood pressure measurement should therefore be routinely performed in all diabetic patients under the age of 65, particularly in females of all ethnic groups and in black males.     

Coronary artery stenting in diabetes mellitus--unfavourable clinical outcome due to increased rate of myocardial ischemia and percutaneous interventions

Diabetes mellitus is one of the major risk factors for cardiovascular diseases. The aim of this study was to analyze if diabetic patients, compared to nondiabetic patients, have a worse angiographic and clinical success rate and a reduced clinical and angiographic outcome at three-months follow-up after coronary artery stenting according to postprocedural complications, recurrent angina, myocardial ischemia, restenosis and revascularization. A total of 307 unselected patients with coronary artery disease and myocardial ischemia who underwent intracoronary stenting were included in this study. Diabetes was present in 49 patients. Morphological criteria, angiographic results and clinical in-hospital outcome did not differ significantly between both groups. At follow-up diabetics presented significantly more often recurrent angina and myocardial ischemia. The rate of restenosis and target lesion revascularization was not different. Among diabetics, the rate of percutaneous coronary interventions because of different lesions was significantly increased. Diabetes does not reduce the angiographic result initially and at follow-up after coronary artery stenting. Diabetes mellitus limits the clinical outcome because of recurrent angina, myocardial ischemia and the need of coronary interventions.