冠心病行PTCA患者的归因偏差与对策

对冠心病行PTCA患者的归因偏差进行阐述，其归因偏差包括生理因素和行为因素。患者的归因偏差与知识缺乏有关，受性别和社会文化背景的影响。提出了解患者归因倾向、控制危险因素、强化健康教育、保持情绪稳定、提高自我效能、进行归因干预，可消除患者的归因偏差，减少心脏突发事件，有利于疾病康复，提高患者生活质量。     

终末期肾病并存冠心病患者行冠状动脉介入治疗的护理

对6例终末期肾病并存冠心病患者行冠状动脉造影检查和介入治疗,结果患者均顺利完成治疗,心绞痛症状缓解.提出术前加强心理护理、术前准备,充分血液透析,适当水化治疗,术后严密观察病情变化、做好血液透析护理、预防感染等是治疗成功的保证.     

经皮冠状动脉腔内成形术后早期体位护理效果观察

目的 探讨经皮冠状动脉腔内成形术(PTCA)术后患者早期体位护理的效果.方法 将择期行PTCA患者300例随机分为对照组(146例)和观察组(154例).对照组按PTCA术后常规护理;观察组拔除动脉鞘管2 h后,在不影响伤口的情况下,早期协助患者躯体平移,改变患者的体位,按摩腰背部受压部位.对两组患者睡眠质量、穿刺处出血情况以及PTCA术前、后的心率、收缩压、呼吸频率进行观察.结果 观察组失眠发生率显著低于对照组(P＜0.01);两组术后穿刺部位出血率比较,差异无显著性意义(P＞0.05);观察组术后心率、收缩压、呼吸与术前比较,差异无显著性意义(均P＞0.05);两组患者术后心率、收缩压、呼吸比较,差异有显著性意义(均P＜0.01).结论 PTCA术后早期改变患者卧位,能有效提高患者的卧位舒适度和睡眠质量,维持生命体征稳定,使患者处于较佳的身心康复状态.     

Coronary Artery Bypass Following Percutaneous Transluminal Coronary Angioplasty

During a 4-year period, 286 patients underwent coronary artery bypass grafting (CABG) following percutaneous transluminal coronary angioplasty (PTCA). Seventy-three patients had single-vessel and 213 (74.5%) had multivessel coronary artery disease. Twenty-nine patients underwent PTCA because of an evolving acute myocardial infarction (MI). Forty-two patients had previously undergone 47 CABG procedures.One hundred fifteen patients underwent CABG on an emergency basis. Indications for emergency CABG after PTCA were prolonged chest pain (79.1%), worsening of coronary artery obstruction (59.1%), “current of injury” by electrocardiogram (31.3%), cardiogenic shock (27.8%), and, in a lesser incidence, ventricular fibrillation, coronary artery dissection (without obstruction), heart block, and intractable cardiac arrest. The 286 patients underwent 2.1 CABG procedures per patient with a thirty-day mortality of 6.3% (18 patients). The incidence of acute MI was 43.5 versus 4.1%; low cardiac output syndrome, 34.8 versus 7.0%; and operative death, 11.3 versus 2.9% in the emergency and nonemergency groups, respectively. Other significant predictors of operative death were previous CABG (16.7 versus 4.5%), multivessel coronary artery disease (8.0 versus 1.4%), and preoperative cardiogenic shock (15.6 versus 3.2%). Late follow-up reveals a mortality of 1.4% per year in those patients who were early survivors of CABG.     

Percutaneous Transluminal Coronary Angioplasty

The relief of coronary obstruction by surgical grafting was the first effective treatment to be directed at the cause of ischemic heart disease. PTCA represents the second major step in relieving coronary stenosis. It seems timely to review where this second step has led in order to understand how percutaneous transluminal coronary angioplasty (PTCA) relates to surgery and to understand future implications of this procedure.
This review will reflect many of the authors biases and prejudices derived from their experience at Mayo Clinic.¹ It will also be a somewhat practical assessment. Such a pragmatic approach can be defended because PTCA itself is built on pragmatism. It is more of the world of craftsmen than of the world of scientists. We are still waiting for science to "catch up" to help solve important remaining problems such as the issue of acute rethrombosis and restenosis.
Our ability to review the Mayo Clinic experience is made possible only by having a dedicated team of colleagues in the catheterization laboratory and a dedicated support group managing our PTCA Registry. Experience with other large registries (the NHLBI CASS Registry and the PTCA Registry) has taught us that this is a valuable method of collecting and reviewing the experience with a new procedure as it develops. This approach is likely to be more widely applied in the future.     

Haemorrhagic Complication Following Percutaneous Transluminal Angioplasty for Carotid Stenosis

Summary  We report 2 cases with haemorrhagic complications following percutaneous transluminal angioplasty (PTA) for carotid stenosis. Computed tomography (CT) scanning of these cases demonstrated diffuse subarachnoid haemorrhage in 1 case, and intracerebral haemorrhage in the other case on the next day after PTA. In the latter case, we measured cerebral blood flow velocity and mean transit time with transcranial doppler (TCD) and dynamic CT scan, which demonstrated remarkable increases in the blood flow velocity and peak height, respectively. From these results, postoperative hyperperfusion was suggested to have caused haemorrhagic complications.     

Virtual Percutaneous Transluminal Coronary Angioplasty System for an Educational Support System

With the increase of ischemic diseases of the circulatory system in Japan, the necessity for cardiovascular intervention continues to increase. However, because intervention operations have been developed only recently, the education system for the corresponding specialists in our country has not been established yet. In this study, an intervention educational support system using a virtual reality (VR) technique was developed. Of course, intervention includes percutaneous transluminal coronary angioplasty (PTCA). PTCA is an operation enlarging the stenosis of the coronary artery with a balloon through a guide catheter. The technique that lets the guide wire for the PTCA balloon cross the stenosis is one of the most difficult. A simulation system for the manipulation of a torque device for the PTCA guide wire was developed with this technology for VR. In virtual space, reconstitution of the 3-dimensional coronary artery with atherosclerosis was performed, and the virtual PTCA system was produced experimentally. An interesting system was produced experimentally as a system for the training of doctors studying to become interventional specialists. After the system was combined with an Expert system for treating ischemic heart diseases, its usefulness was steadily increased. With the development of more sophisticated VR methodology in the future, a PTCA training system without using a patient will be embodied.     

Percutaneous Transluminal Angioplasty of Infrainguinal Vessels

In the last decade, percutaneous angioplasty (PTA) has been used with increasing frequency to treat infrainguinal atherosclerotic lesions. In hopes of better delineating the role of PTA, we undertook a retrospective analysis of infrainguinal PTA in one hospital over a 7-year period. The charts of all patients receiving infrainguinal PTA from 1989 to 1996 were reviewed. Demographics, site and type of lesion, and results of treatment were recorded. Survival curves were plotted using the Kaplan-Meier method following current Society of Vascular Surgery/International Society for Cardiovascular Surgery (SVS/ISCVS) guidelines. Differences in times to first failure were tested using the log rank method. Failures were documented by duplex ultrasound. All patients requiring repeat intervention underwent contrast angiography. In selected patients with stenotic lesions <3 cm, infrainguinal PTA may be an appropriate initial treatment modality. However, 5-year patency rates are significantly lower than those achieved by saphenous vein grafting. The efficacy of the procedure is markedly decreased when used to treat arterial stenoses >3 cm in length as well as occlusions, and surgical revascularization may be a more appropriate initial therapeutic procedure.     

Percutaneous Transradial Coronary Angiography and Angioplasty in Patients with Occlusive Atherosclerotic Iliofemoral Disease

Not all coronary angiograms can be acquired through the femoral route. The transradial catheterisation procedure in patients with occlusive atherosclerotic iliofemoral disease is described. Transfemoral left-sided cardiac catheterisation was performed in approximately 99.5% of patients referred for coronary angiography, while out of 48 patients in whom transfemoral access was impossible, transradial coronary angiography was successful in 37. With the exception of one, all patients with coronary artery disease had lesions of the right coronary artery, more than 70% had multivessel disease and 14% had stenosis of the left main coronary artery. Ten patients had angioplasty performed during the same procedure. Complications occurred in 5 out of 39 cases, 2 (5%) of these were severe. Although the femoral route was used in more than 99% of an unselected population referred for coronary angiography, it was found that transradial angiography and angioplasty can be performed in patients with occlusive atherosclerotic iliofemoral disease with considerable success and an acceptable complication rate.