易化PCI治疗急性心肌梗死的安全性及有效性

目的了解易化经皮冠脉内溶栓治疗术(PCI)治疗急性心肌梗死的安全性与有效性。方法对比100例易化PCI与100例直接PCI心肌梗死治疗后患者的心肌梗死面积和心室功能。同时年轻正常人群作为对照组与易化PCI治疗后的患者进行对比。结果通过对比可知,易化PCI治疗与直接PCI治疗相比心肌梗死面积明显低于直接PCI(P<0.05)。心室功能方面,易化PCI明显高于直接PCI(P<0.05)。而低于对照组的心室功能指标进行测定。结论易化PCI治疗对于心肌梗死有较好疗效,相较于直接PCI,易化PCI具有成本低、治疗快的优势,适于临床推广。     

延迟PCI与直接PCI治疗急性心肌梗死的比较

目的　探讨经皮延迟冠脉介入 (PCI)与直接PCI在治疗急性心肌梗死 (AMI)疗效的差异。方法　 14 5例连续行PCI的AMI患者分为直接PCI组 (75例 )和延迟PCI组 (70例 ) ,分析两组患者一般临床特征及心血管事件的发生率。结果　住院期间两组患者各项心脏事件均无显著差异。平均随访 (12 1± 4 5 )个月时 ,直接PCI组患者在不稳定性心绞痛 (9 3%vs 32 9% ,P <0 0 1)、非致死性心衰 (4 0 %vs14 3% ,P <0 0 5 )、死亡 (0vs 7 1% ,P <0 0 5 )及复合终点事件 (12 %vs 4 0 % ,P <0 0 1)方面较延迟PCI组明显降低。但两组间在非致死性再次心肌梗死、缺血性靶血管重建及总的心脏性死亡率无显著差异。近期内LVEF值延迟PCI组较直接PCI组显著降低 (0 5 8± 0 14vs 0 6 3± 0 10 ,P <0 0 5 )。结论　与直接PCI相比 ,延迟PCI治疗AMI近期内同样安全有效 ,1年死亡率无显著降低 ,但不稳定性心绞痛、非致死性心衰、死亡及复合终点事件发生率增加。     

延迟PCI治疗老年人急性心肌梗死的临床研究

目的探讨延迟PCI治疗老年人急性心肌梗死的临床疗效及远期效果.方法248例老年急性心肌梗死患者分为直接PCI治疗组,延迟PCI治疗组,非PCI治疗组.观察住院期间和随访期间的临床不良事件和超声心动图的变化.结果①平均住院时间延迟PCI组较非PCI组短（P＜0.05）,住院期间复合终点事件延迟PCI组较非PCI组少（P＜0.05）;住院及随访期间各项临床不良事件延迟PCI组与直接PCI组无差异性（P＞0.05）.②住院及随访期间左室射血分数（EF）及左室短轴缩短率（FS）延迟PCI组高于非PCI组（P＜0.05）,而低于直接PCI组（P＜0.05）;左房内径、左室舒张末期径及E/A延迟PCI组显著低于非PCI组（P＜0.05）;与直接PCI组无差异（P＞0.05）.结论延迟PCI可取得与直接PCI相仿治疗效果,可防止老年急性心肌梗死患者临床不良事件的发生和改善左室功能,可改善老年患者急性心肌梗死预后,因此可作为老年患者急性心肌梗死安全有效的治疗选择,但延迟PCI应尽量提前.     

急性心肌梗死溶栓治疗失败后补救性PCI治疗临床观察

急性心肌梗死是心内科常见病 ,多发生心源性休克、心律失常、心功能不全等多种并发症。静脉溶栓治疗即可使 60 %～65 %的病人在 90min内恢复TIMI 3级血流[1] ,且无需特殊设备 ,短时间内即可使用。在临床上 ,尤其是基层医院由于人员和设备的限制 ,不能很快做经皮冠状动脉介入治疗 (PCI) ,溶栓治疗仍为首选 ,但溶栓失败率仍有 3 5 %～ 40 % ,现就溶栓治疗失败后进行补救性PCI治疗 ,疗效情况报道如下。1　资料与方法1.1　临床资料　随机抽取我院 1998年— 2 0 0 2年因急性心肌梗死住院病人进行溶栓治疗的 82例 ,溶栓未成功者 2 9例 ,未进行…     

延迟PCI治疗急性ST段抬高型心肌梗死的远期疗效

目的探讨延迟经皮冠状动脉介入(PCI)治疗急性ST段抬高型心肌梗死(STEMI)的远期疗效。方法 563例STEMI患者分为直接PCI组157例、延迟PCI组124例、溶栓组131例和药物治疗组151例。平均随访(45±27)个月,观察心脏不良事件、心功能和心肌梗死面积变化。结果延迟PCI组平均住院时间为(13.8±9.7)d,显著少于溶栓组(20.7±9.1)d和药物组(19.8±8.9)d(P<0.05);与直接PCI组相近(P>0.05)。延迟PCI复合终点事件发生率显著少于溶栓和药物组(P<0.05)。随访期间,延迟PCI组心力衰竭及复合终点事件发生率显著低于溶栓组和药物组(P<0.05);延迟PCI组LVEF显著高于非PCI组(P<0.05);延迟PCI组的LAD和LVDd均显著小于非PCI组。延迟PCI组的心肌梗死面积回缩率(0.376±0.129)显著大于药物组(0.173±0.098)(P<0.05),而与直接PCI组(0.384±0.167)和溶栓组(0.289±0.181)相似。结论延迟PCI能缩短STEMI平均住院时间,减少心脏事件发生率,改善左室功能和使心肌梗死面积缩小及改善预后。但其效果不如直接PCI。     

急性心肌梗死直接PCI与溶栓后补救性PCI的对比研究

目的:研究急性心肌梗死后直接经皮冠脉介入治疗(PCI)和溶栓后补救性PCI的临床造影结果和短期预后,观察终点为30天的死亡率。 方法:连续入选150例ST段抬高的急性心肌梗死患者。按溶栓与否分为直接PCI组110例(73.3％)和溶栓后补救性PCI组40例(26.7％),溶栓药物包括重组葡激酶、重组组织型纤溶酶原激活剂、重组纤溶酶原激活剂和尿激酶。分析其临床、造影和预后特点。 结果:与溶栓后补救性PCI组比较,直接PCI组CK和CK-MB峰值低(P<0.05),校正的心肌梗死溶栓临床试验的帧数(corrected TIMI framecounts,CTFC)低(P<0.05),心肌梗死溶栓临床试验心肌灌注分级(TIMI myocardial perfu-sion grades,TMPG)高(P<0.05),死亡率显著降低(P<0.01)。 结论:溶栓后补救性PCI可能使心肌酶增高,死亡率增加。     

易化PCI治疗心肌梗死

急性心肌梗死(AMI)是由于病变血管内血栓形成而发生的急性闭塞,AMI的治疗从80年代的溶栓疗法,到逐渐发展起来的经皮冠状动脉介入(PCI)治疗,冠脉搭桥及干细胞移植等方案都是围绕AMI的治疗原则:尽快恢复梗死相关血管的前向血流灌注以挽救濒死心肌,防止梗死扩大及缩小心肌缺血范围,保护和维持心脏功能而展开的。但目前各种治疗方案都存在其一定的有限性。易化PCI方案是指AMI发生后首先尽可能地予以院前(或患者家中)药物溶栓再灌注疗法,同时静脉给血小板GpIIb/IIIa受体拮抗剂或口服氯吡格雷,并在这种药物易化了的再灌注治疗过程中尽快…     

急性心肌梗死PCI术后临床护理路径的构建及应用

目的 构建急性心肌梗死PCI术后患者临床护理路径并应用于临床,探讨路径在改善患者生活自理能力方面、降低焦虑发生、减少住院时间与费用,提高满意度方面的作用。方法 通过文献检索及德尔菲专家咨询制定临床护理路径。按照纳排标准选择入组对象,采用随机数字表法将患者分为干预组和对照组,每组60例。对照组采用PCI术后常规康复方法,干预组采用本研究构建临床护理路径进行护理。结果 两组患者PCI术后生活自理能力较低、中度焦虑状态（P>0.05）;通过临床护理路径的实施,与对照组相比,可以提高患者术后第3 d、7 d生活自理能力,降低焦虑状况,可以减少住院时间及费用,可以提高满意度,差异有统计学意义（P<0.05）。结论 本研究构建的PCI术后患者临床护理路径可有效提高患者的生活自理能力,降低患者焦虑评分、减少住院时间及费用、提高满意度。该临床护理路径可以应用于临床护理工作中。     

不同性别急性心肌梗死患者临床症状及PCI术后效果的差异性研究

目的 探讨不同性别急性心肌梗死患者临床症状及PCI术后效果的差异。方法 收集我院2013年1月-2015年10月所收治182例急性心肌梗死患者进行研究,根据性别不同予以分组,男性102例、女性80例。所有患者均于就诊1周内予以选择性冠状动脉造影及PCI手术,比较男性与女性基线资料、临床症状及PCI术后效果的差异。结果 男性患者平均年龄为(61.6±6.9)岁,低于女性(68.7±9.4)岁;LVEF为(65.3±4.8)%,高于女性(49.7±5.4)%;男性患者中30例(29.4%)合并高血压,少于女性的38例(47.5%),19例(18.6%)合并糖尿病,少于女性的33例(41.3%),70例(68.6%)有吸烟史,明显多于女性的7例(8.8%),差异均有统计学意义(P＜0.05)。男性患者中持续性剧烈胸痛、大汗、胸闷、放射痛等临床症状发生率均高于女性患者,女性患者恶心呕吐及无症状发生率则明显高于男性患者,差异均有统计学意义(P＜0.05)。男性患者非靶血管狭窄、术后TIMI血流﹤3级、并发心力衰竭、并发肺炎、住院期间死亡等的发生率分别为56.9%、2.0%、3.9%、2.9%、3.9%,低于女性患者72.5%、11.3%、12.5%、11.3%、12.5%,差异有统计学意义(P＜0.05)。结论 男性心肌梗死发病率高于女性,且发病年龄更小,合并高血压、糖尿病及吸烟史等危险因素几率也更高,但女性患者临床症状以恶心呕吐为主或无症状,缺乏典型性,因而治疗易被延误而导致PCI术的预后差于男性,提示女性患者更易注重定期身体检查。     

急性心肌梗死直接PCI与其他治疗方法的疗效比较

急性心肌梗死作为一种严重威胁人类健康的疾病，在过去的20年里，住院死亡率明显下降，这与治疗方法的改变是密不可分的。尤其是直接经皮冠状动脉介入治疗(PCI)的应用。本文旨在于比较直接PCI与其他冠状动脉血运重建方法的优缺点。     

心肌缺血预适应对单支动脉闭塞性急性心肌梗死患者的影响

目的 :观察心肌缺血预适应 （IPC）对急性心肌梗死 （AMI）患者并发症及预后的影响。方法 :对照分析 40例无 IPC的 AMI患者 （A组 ）和 5 0例有 IPC的 AMI患者 （B组 ）的近期临床资料。结果 :B组梗死后泵功能障碍发生率及程度、磷酸肌酸激酶 （CPK）峰值、并发症均显著低于 A组 ,近期预后有改善。结论 :缺血预适应组 CPK的峰值降低 ,梗死后所致心肌坏死面积减小 ,从而使泵功能障碍的发生率降低、梗死后室性心律失常、 度以上房室传导阻滞及再灌注性心律失常发生率减少。这可能是 IPC使 AMI患者死亡率降低的主要原因。     

Factors associated with development of stroke long-term after myocardial infarction: experiences from the LoWASA trial

OBJECTIVE: To describe factors associated with the development of stroke during long-term follow-up after acute myocardial infarction (AMI) in the LoWASA trial. PATIENTS: Patients who had been hospitalized for AMI were randomized within 42 days to receive either warfarin 1.25 mg plus aspirin 75 mg daily or aspirin 75 mg alone. DESIGN: The study was performed according to the probe design, that is open treatment and blinded end-point evaluation. SETTING: The study was performed in 31 hospitals in Sweden. The mean follow-up time was 5.0 years with a range of 1.7-6.7 years. RESULTS: In all, 3300 patients were randomized in the trial, of which 194 (5.9%) developed stroke (4.2% nonhaemorrhagic, 0.5% haemorrhagic and 1.3% uncertain. The following factors appeared as independent predictors for an increased risk of stroke: age, hazard ratio and 95% confidence interval (1.07; 1.05-1.08), a history of diabetes mellitus (2.4; 1.8-3.4), a history of stroke (2.3; 1.5-3.5), a history of hypertension (2.0; 1.5-2.7) and a history of smoking (1.5;1.1-2.0). Most of these factors were also predictors of a nonhaemorrhagic stroke whereas no predictor of haemorrhagic stroke was found. CONCLUSION: Risk indicators for stroke long-term after AMI were increasing age, a history of either diabetes mellitus, stroke, hypertension or smoking.     

既往脑卒中患者急性心肌梗死的处理

急性心肌梗死患者存在脑卒中病史者并不少见,而既往脑卒中病史为急性心肌梗死的处理带来了一系列的临床问题。常规心肌梗死处理过程中存在的抗血小板、抗凝、溶栓和经皮冠状动脉介入治疗可能会造成卒中复发,尤其是致命性的颅内出血,导致心血管医生在处理急性心肌梗死时面临两难抉择。文章对既往卒中患者出现急性心肌梗死时如何选择介入治疗、溶栓治疗或保守治疗策略,以及抗血小板、抗凝治疗对卒中的影响进行了阐述,以提高医生的临床实践能力。     

Characteristics of elevated cardiac troponin I in patients with acute ischemic stroke

Objective To study prognostic characteristics of cardiac troponin I (cTnI) elevation in acute ischemic stroke. Methods We retrospectively studied patients (n = 248) with acute ischemic stroke, acute ST-segment elevation myocardial infarction, and acute non-ST-elevation myocardial infarction who were treated between January 2013 and October 2015. Baseline demographic data and changes in cTnI levels among these three groups were compared. Patients with acute ischemic stroke were assigned to either the cTnI elevation group (cTnI > 0.034 ng/mL) or the no cTnI elevation group (cTnI ≤ 0.034 ng/mL). Logistic regression analysis was used to identify risk factors associated with elevated serum cTnI in patients with acute ischemic stroke. Moreover, the duration of hospital stay and incidence of major cardiovascular outcomes were compared in patients with acute ischemic stroke, with or without elevated cTnI. Results In this study population of patients with acute ischemic stroke (n = 178), acute ST-segment elevation myocardial infarction (n = 35), and acute non-ST-elevation myocardial infarction (n = 35), patients with acute ischemic stroke with elevated cTnI comprised 18.54% of subjects. Patients with elevated cTnI were older and more likely to have a history of hypertension. In addition, these patients had higher levels of inflammatory markers, reduced renal functions, increased D-dimer levels, higher NIH stroke scores, and lower left ventricular ejection fractions. Logistic regression analysis showed that both percentage of neutrophil and NIH stroke scores were elevated; estimated glomerular filtration rate and left ventricular ejection fraction were decreased in patients with acute ischemic stroke who had elevated cTnI, and they had more frequent major cardiovascular events during hospital stay. Conclusion Elevated cTnI detected in patients with acute ischemic stroke, indicated a greater likelihood of poor short-term prognosis during hospital stay.     

直接经皮冠脉介入治疗在抢救急性心肌梗死合并心源性休克中的应用

目的探讨急性心肌梗死合并心源性休克的抢救方法。方法用急诊直接经皮冠脉介入治疗(PCI)治疗意大利波洛尼亚大学附属医院2001—2002年收治的15例急性心肌梗死合并心源性休克患者。结果15例患者中,共有13例抢救成功。结论急诊PCI是治疗急性心肌梗死合并心源性休克的有效方法。     

急诊经皮冠状动脉介入治疗老年急性心肌梗死合并心源性休克的临床观察

目的探讨急诊PCI对老年急性心肌梗死(AMI)合并心源性休克(CS)的近期和中期疗效,并分析患者院内存活率的影响因素。方法选择行PCI的老年AMI合并CS患者共86例,按治疗结果分为院内病死组(病死组,32例)和院内存活组(存活组,54例),采用logistic回归分析死亡的预测因素,统计患者的临床特点、影像学特点、介入治疗成功率、院内病死率及存活时间。结果病死组既往有心肌梗死患者高于存活组(43.8%vs24.1%,P=0.049),存活组发病至PCI时间明显低于病死组[(9.8±3.2)hvs(12.7±5.9)h,P=0.004];病死组梗死发生部位为前降支,发生率明显高于存活组(59.4%vs35.2%,P=0.025);Kaplan-Meier生存分析显示1年生存率为51.2%。logistic多元回归分析显示,发病至PCI时间及梗死相关动脉与院内病死率显著相关(P<0.05)。结论急诊PCI对老年AMI合并CS患者有较好的近期和中期疗效。     

心肌缺血预适应对急性心肌梗死影响的观察

目的:探讨心肌缺血预适应对急性心肌梗死(AMI)临床表现及其预后的影响。方法:根据AMI前有无心绞痛发作分为预缺血组和无预缺血组,分组观察AMI患者血清肌酸磷酸激酶(CPK)峰值,住院期间并发症(心衰、心源性休克、严重心律失常),以及住院期间心性病死率。结果:预缺血组血清CPK峰值明显低于无预缺血组(P<0.05),住院期间心源性休克及严重心律失常发生率明显低于无预缺血组(P<0.05)。结论:心肌缺血预适应可减轻心肌坏死程度,缩小梗死面积,并减少AMI并发症的产生。     

Human hematopoietic stem/progenitor-enriched CD34(+) cells are mobilized into peripheral blood during stress related to ischemic stroke or acute myocardial infarction

The hematopoietic and non-hematopoietic stem/progenitor cells harvested directly from the bone marrow (BM) or G-CSF mobilized peripheral blood were demonstrated to play an important role in regeneration of damaged organs (1, 2). Here, we asked if the stroke- or acute heart infarct-related stress triggers mobilization of stem/progenitor-enriched CD34(+)cells from the BM into the peripheral blood, which subsequently could contribute to regeneration of damaged tissues. To address this question the peripheral blood samples were harvested from patients with ischemic stroke during the first 24 h of manifestation of symptoms and on the second and sixth day afterwards or during the first 24 h of acute cardiac pain as well as on the second and sixth day of infarct. We measured in these patients (i) percentage of circulating hematopoietic stem/progenitor-enriched CD34(+) cells in peripheral blood by employing fluorescence activated cell sorter (FACS) and (ii) number of hematopoietic progenitor cells for the granulocyte-monocytic colony-forming unit (CFU-GM) and erythoid burst-forming unit (BFU-E) lineages circulating in peripheral blood. We concluded that stress related to ischemic stroke or acute myocardial infarction triggers the mobilization of hematopoietic stem/progenitor-enriched CD34(+) cells from the BM into peripheral blood. These circulating stem/progenitor-enriched CD34(+) cells may contribute to the regeneration of ischemic tissues, however, this possibility requires further studies.     

Viral and bacterial infections in patients with acute myocardial infarction

The association of both viral and bacterial infections with acute myocardial infarction was investigated in a case-control study involving 40 consecutive patients with an acute myocardial infarction, 41 random controls and 30 patients with chronic coronary heart disease. All individuals were males aged 50 years or less. A rise in enterobacterial common antigen antibodies (15/40) and a recent influenza-like illness (11/40) were significantly more common among patients with acute myocardial infarction compared with the other groups. No differences were observed between the groups in the occurrence of antibodies against eight other bacterial antigens or 16 viruses.