普罗帕酮与胺碘酮治疗心律失常效果对比及其对血清hs-CRP的影响

目的探讨观察在心律失常患者中分别应用普罗帕酮与胺碘酮的疗效及不同治疗方案对血清超敏C反应蛋白(hs-CRP)水平的影响。方法选取92例心律失常患者随机、均等分为甲组和乙组;两组分别给予普罗帕酮与胺碘酮治疗,将临床疗效、血清hs-CRP及心率变异相关参数变化及不良反应作为观察指标,评估不同治疗方案的应用价值。结果甲组与乙组康复、有效和无效等级差异显著显著(P0.05),且甲组总有效率(78.26%)远低于乙组(97.83%)(P0.05);治疗后血清hs-CRP均较治疗前显著降低(P0.05),且治疗后乙组远低于甲组(P0.05);治疗后rMSSD、SDNN和sDNNindex均较治疗前显著升高(P0.05),且治疗后乙组各指标水平均远高于甲组(P0.05);甲组不良反应发生率远高于乙组(P0.05)。结论胺碘酮在心律失常治疗中的效果和安全性均较普罗帕酮有明显的优势,且对hs-CRP的抑制作用也更为理想。     

梗塞前心绞痛对急性心肌梗塞患者的有益作用

43例首次穿壁性急性心肌梗塞(AMI)患者于静脉内溶栓后90min行冠状动脉造影.其中24例AMI前6h内有心绞痛(甲组),另19例梗塞前无心绞痛(乙组).尽管两组多支冠状动脉病变及侧支循环发生率相似.但甲组异常Q波导联数、QRS积分、CPK峰值及CPK峰值距发病时间显著低于乙组.而梗塞相关冠状动脉再通率显著高于乙组.22例IRA开通患者中,有心绞痛者其基础左心室功能较无心绞痛者好.出院前超声心动图检查显示,甲组左心室局部和整体收缩功能、舒张充盈明显改善,而乙组收缩功能降低、舒张充盈无明显变化.住院期心脏事件发生率甲组显著低于乙组.本文提示,梗塞前心绞痛可能由于早期心肌再灌注和缺血预适应对梗塞大小、左心室功能及预后具有益作用.     

七氟醚和丙泊酚对老年冠心病患者麻醉诱导期心率变异性的影响

目的分析七氟醚和丙泊酚对老年冠心病患者麻醉诱导期心率变异性的影响。方法选择我院2014年5月~2015年4月之间收治的56例老年冠心病患者作为观察对象,用随机数法将患者分为甲组和乙组各28例。甲组应用七氟醚,乙组患者应用丙泊酚麻醉诱导。观察两组患者不同时间点的SBP、心率等临床指征的变化。结果对比麻醉之前,两组患者的血压水平和心率在麻醉诱导之后5min和10min均下降,差异显著(P0.05);诱导之后乙组患者的血压低于甲组、心率高于甲组(P0.05);应用七氟醚的患者表现为低频缓慢下降,应用丙泊酚的患者表现为高频缓慢下降。结论七氟醚对于老年冠心病麻醉诱导期心率变异性影响较小,具有高应用价值。     

妊娠高血压疾病子痫前期患者终止妊娠时机的预后观察

目的 探究妊娠高血压疾病子痫前期患者终止妊娠的时机及分娩方式。方法 随机抽取2015年2月至2018年12月我院46例妊娠高血压疾病子痫前期患者为观察对象,对其临床资料进行回顾分析,结合终止妊娠孕周将其分为三组,甲组(孕周34周,12例)、乙组(孕周为34-37周,14例)、丙组(孕周37周,20例),对比不同妊娠终止时机下的血压水平、分娩结局及并发症发生情况。结果 (1)甲组、乙组、丙组各组间新生儿体质量存在显著差异(P0.05);甲组和丙组新生儿窒息发生率、新生儿缺血缺氧性脑病发生率均显著高于乙组(P0.05);丙组孕产妇并发症发生率高于甲组、乙组(P0.05)。(2)甲组舒张压水平及收缩压水平较乙组和丙组更高(P0.05);但乙组和丙组之间的舒张压水平及收缩压水平无显著差异(P0.05)。结论 妊娠高血压疾病子痫前期患者终止妊娠的时机为孕周为34-37周,而血压控制效果欠佳,可提早妊娠时机,故为预防产妇并发症、新生儿窒息及新生儿缺血缺氧性脑病发生,临床应积极给予患者控压治疗。     

老年糖尿病患者的心电图改变临床分析

目的分析老年糖尿病患者的心电图改变情况。方法搜集2012年9月—2013年9月该院接收的老年糖尿病44例患者作为甲组,将同期接收的老年其他疾病44例患者作为乙组。对甲组和乙组的心电图进行分析,并对比。结果甲组心电图异常率高于乙组,最高心率较高,最低心率较低,窦性、交界性、房性、传导阻滞、室性、ST-T改变病例较多,差异显著,有统计学意义(P<0.05)。结论老年糖尿病患者心电图改变的发生率较高,必须重视心电图检查,加强早期诊断。     

冠状动脉造影正常而心电图有心肌缺血改变者的相关冠状动脉血流储备功能减低

目的 :观察临床上心电图长期有心肌缺血改变但冠状动脉 (冠脉 )造影完全正常者的冠脉血流储备情况。方法 :临床上冠脉造影完全正常者 33例 ,以心电图有无缺血性ST T改变 (ST水平型或下斜型压低≥ 0 0 5mV或成组导联T波深倒置 )分为两组。甲组 17例 ,心电图有ST T改变 ,乙组 16例 ,无ST T改变。采用冠脉内多普勒导丝血流速度测定的方法计算冠脉血流储备 ,并对两组受试者的冠脉微血管病危险因素做比较分析。结果 :甲组心电图示前壁心肌缺血者的前降支血流储备以及下壁心肌缺血者的右冠脉血流储备值显著低于乙组( 2 16± 0 48vs .2 92± 0 5 2 ,P =0 0 0 2及 2 2 7± 0 5 1vs .3 40± 0 6 3,P <0 0 0 1) ,有显著性差异 ;甲组中有 14例( 82 35 % )存在冠脉血流储备的异常 ,乙组中仅有 2例 ( 12 5 0 % )存在异常 ;甲组 17例中有 13例 ( 76 47% )有冠脉微血管病基础 ,而乙组 16例中仅有 5例 ( 31 2 5 % )有冠脉微血管病危险因素 ,两组差别有统计学意义 (P =0 0 35 )。结论 :冠脉造影正常而心电图有心肌缺血改变者中 82 35 %的患者存在相关冠脉血流储备异常 ,提示存在冠脉微血管病变     

平板运动试验中室性早搏ST段下移诊断冠状动脉病变的价值

探讨平板运动试验中室性早搏(VPCs)ST段下移程度对反映冠状动脉(简称冠脉)病变的价值。将休息和平板运动试验中均发生VPCs并且在3个月内进行冠脉造影的92例患者按冠脉造影结果分成冠心病组和非冠心病组,比较两组VPCsST段下移程度,下移程度与冠脉狭窄程度的关系以及VPCsST段下移诊断冠心病的价值。结果:冠心病组运动中VPCsST段下移及ST/R均大于非冠心病组。其中ST/R>10%对冠心病诊断灵敏度为91%,特异度为75%;对单支、2支、3支血管病变诊断灵敏度分别为84%、91%、100%。冠脉狭窄≥90%组运动中VPCsST段下移和ST/R大于狭窄为50%~69%组。结论:运动试验中VPCsST段下移可作为诊断冠心病的有效参考指标,其下移程度可能与冠脉狭窄程度有关。     

心肌梗塞患者的疾病防治与护理

目的探讨与分析心肌梗塞患者的疾病防治与有效的护理措施。方法从我院在2010年2月到2014年2月期间收治的心肌梗塞患者中抽取92例进行回顾性分析,依照随机数字表的方式给予其中46例患者综合治疗和优质护理(甲组),给予另46例患者临床常规治疗与护理(乙组),对两组患者的治疗有效率和护理满意度进行对比,并观察并发症发生情况。结果经相应防治与护理,在治疗总有效率上,甲组为95.7%、乙组为82.6%,两组差异显著具有统计学意义(P0.05);在护理满意度上,甲组为97.8%、乙组为78.3%,两组差异显著具有统计学意义(P0.05);在并发症发生率上,甲组为2.2%、乙组为17.4%,甲组显著少于乙组(P0.05)。结论对于心肌梗塞患者来说,早期实施综合治疗与优质护理可使治疗效果和患者满意度得到提高,使患者的生活质量得到增强,对于有效防治心肌梗塞有着重要的意义。     

老年股骨颈骨折患者全髋关节置换术不同手术时机对术后髋关节功能及并发症的影响

目的分析老年股骨颈骨折患者在不同手术时机实施全髋关节置换术对患者术后髋关节功能及并发症的影响。方法对84例老年股骨颈骨折患者的临床资料进行回顾性分析,按照其手术时机的不同分为甲组、乙组,甲组在24 h内接受急诊手术治疗,乙组在72 h内接受延期手术治疗,对比两组手术情况、术后恢复情况及并发症发生情况。结果甲组手术时间、术中出血量及总住院天数均明显少于乙组(P0.05)。两组术前及术后3个月Harris关节功能评分比较无显著差异(P0.05);术后1个月,甲组Harris关节功能评分明显高于乙组(P0.05)。甲组术后并发症发生率为4.76%,明显低于乙组(19.05%,P0.05)。结论老年股骨颈骨折患者接受急诊全髋关节置换术治疗,有利于患者早期髋关节功能恢复,并发症发生率低。     

心肌梗塞存活者血浆脂蛋白(a)与梗塞区供血冠脉再通的关系

选择初次心梗发作后一周以上、未经溶栓治疗或冠脉成形术的存活病人105(男75女30)例;年龄30～80岁。根据冠脉造影结果分组:甲组52例梗塞区供血冠脉再通;乙组53例梗塞区供血冠脉持续阻塞。心梗后23±13(5～44)个月禁食取静脉血样备测。 甲乙两组的年龄、性别、种族、心脏活性药物的使用、梗塞区供血冠脉、冠脉病变的范围和程度、左室作功均无显著差异。甲组血浆脂蛋白a浓度低于乙组(18.5±21.7对49.1±44.8mg/dL,P<0.001),而血浆纤     

Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: results of the French multicenter "TULIPE" study.

BACKGROUND: In previous prospective studies, a strategy of (a) stenting of the main branch, (b) provisional T-stenting of the side branch, and (c) final kissing balloon inflation, was associated with high success and low target lesion revascularization (TLR) rates on the long-term. OBJECTIVES: To examine the performance of this strategy in a multicenter study. METHODS: Consecutive patients were treated at 14 French medical centers for de novo coronary bifurcation lesions with the same technique used. Immediate results and clinically-driven TLR at 7 months were examined. RESULTS: The mean reference diameters of the main and side branches were 3.2 +/- 0.6 mm and 2.4 +/- 0.5 mm, respectively. The side branch was stented in 34% of patients. A <30% residual stenosis in the main branch was achieved in 99%, <50% in the side branch in 90%, and both in 89% of procedures. The in-hospital major adverse cardiovascular event were a Q-wave and 5 non-Qwaves MI (0.54% and 2.7%). At 7 months of follow-up, 3 patients (1.76%) had died, 1 suffered a non-Q-wave MI (0.59%), and 28 (15.88%) underwent TLR. By multivariate analysis, a lower left ventricular ejection fraction (OR: 0.934), moderate calcifications (OR: 7.86), and non-use of the "jailed" wire technique (OR: 4.26) were associated with reinterventions during follow-up. CONCLUSIONS: A strategy of provisional T-stenting with a tubular stent and final kissing balloon angioplasty for the treatment of coronary bifurcation lesions was safe and associated with a low TLR rate at 7 months. This strategy should be applicable to the new era of drug eluting stents.     

Grading the angiographic extent of collateral filling

Angiography frequently demonstrates a collateral circulation in severe coronary artery disease. An easily applicable method to quantify collateral flow might be a useful adjunct for the assessment of the hemodynamic effects of coronary artery disease. The purpose of this study was to validate a visual scaling of the extent of angiographic collateral filling by comparison with flowmeter- and microsphere-derived measurements of collateral flow. In 12 open-chest dogs, collaterals from the circumflex artery were angiographically visualized (n = 80) by creating acute critical left anterior descending artery occlusion. The extent of collateral filling was graded in four levels from 0 = no visible filling to 3 = complete epicardial filling. Collateral filling correlated with the change in flow of the collateral supplying circumflex artery (Q; r = 0.84) which was + 5.3 ±4.6% with grade 1, + 9.1 ±3.5% with grade 2 and + 14.6 ±4.7% with grade 3 (p < 0.01). In parallel, coronary flow reserve decreased from 4.1 ±0.8 with grade 0 to 2.9 ±0.2 with grade 3 (p < 0.01). Colored microspheres were injected subselectively into the circumflex artery of 9 dogs (45 injections). The ratio of microspheres counted in the collateralized myocardium of the left anterior descending artery to the total number injected increased from 0.6 ±0.9% for grade 0 to 17.1 ±2.8% with grade 3 (p < 0.01). Absolute collateral flow derived from microsphere counts averaged 5.5 ±0.9 ml/min with grade 3 and closely correlated with collateral filling grade (r = 0.88). Semiquantitative grading of angiographic collateral filling in response to acute coronary occlusion in a canine model correlates with an increase in collateral source artery flow, absolute collateral flow and a decrease in source artery flow reserve. These data suggest that this scale might be a simple but useful adjunct tool to assess the hemodynamic significance of a collateral circulation.This work was supported by a grant from the NLHBI 1 R01 HL40865. Dr. Schuhlen is the recipient of a grant from the Deutsche Forschungsgemeinschaft (#Schu657/1-1 and 1–2).     

Embolization complicating coronary angioplasty in the presence of an intracoronary thrombus

Two cases of coronary occlusion and subsequent embolization during percutaneous coronary angioplasty (PTCA) are described. Prior to PTCA, angiographic evidence of intracoronary thrombus was present. Abrupt reclosure after dilation was treated by successful redilation. However, coronary embolization of thrombus debris occurred downstream in one patient and into an adjacent coronary branch in the second patient.     

非罪犯冠脉斑块研究的进展

加强冠心病的二级预防是目前防控急性冠脉综合征（ACS）的重要手段。本文对ACS与非罪犯冠脉斑块的关系作了综述。     

Is short-stay coronary angioplasty safe?

Percutaneous transluminal coronary angioplasty (PTCA) is usually performed as an inpatient procedure and the patients are monitored for several days afterward. Over a 13-month period, in 91 of 373 PTCA procedures, the clinical condition of the patient did not necessitate inpatient status before PTCA. PTCA was done the day of admission and discharge planned the following. Overall hospital stay was planned as less than 24 hours. PTCA was done in one vessel in 62 patients, two vessels in 24, three vessels in 3, and four vessels in 2 patients. PTCA was initially successful (less than 50% residual stenosis) in 85 patients (93%). In one of these, acute occlusion occurred the next morning and urgent bypass surgery was done. PTCA failed in 6 patients who left the catheterization laboratory with unchanged coronary anatomy. Bypass surgery was performed that day in 2 patients, on another admission in 1 patient, and medical therapy continued in the other 3 patients. Of the 88 patients not receiving same admission bypass surgery, 84 (95%) were discharged in less than 24 h. Hospitalization was prolonged (1-5 days) in 4 patients. This was because of nonobstructive dissection treated with heparin for approximately 24 h in 2 patients; a catheterization site hematoma in 1 patient, and post-PTCA noncardiac chest pain in another. No patient had inhospital myocardial infarction or death. The only late complication was in a patient treated with heparin and monitored for 2 days; 3 weeks later angina returned and he died suddenly. These data suggest PTCA can safely be done in selected patients with both single and multivessel disease in a short stay inhospital setting.(ABSTRACT TRUNCATED AT 250 WORDS)     

LAD-right ventricular fistula complicating PTCA: Another case

Coronary perforation caused by percutaneous transluminal coronary angioplasty (PTCA) occurs rarely and most often leads to communication to the pericardial space. We report a case where PTCA caused a coronary artery rupture and fistulization to the right ventricular outflow tract. Cathet. Cardiovasc. Diagn. 42:34–36, 1997. © 1997 Wiley-Liss, Inc.     

Treatment of ruptured coronary aneurysm with a novel covered stent

Coronary artery aneurysms are relatively rare but have been diagnosed with increasing frequency since the advent of coronary arteriography. Their reported incidence varies from 1.5% to 5% with male dominance and a predilection for the right coronary artery (RCA), accounting for over 40% of all cases. The most common etiology amongst adults remains atherosclerosis accounting for 50% of coronary aneurysms. We describe the first use of a novel flexible pericardium covered stent for successful treatment of a ruptured coronary aneurysm in 76 year old lady. © 2008 Wiley‐Liss, Inc.     

Techniques for palmaz-schatz stent deployment in lesions with a large side branch

Palmaz-Schatz coronary stent implantation in lesions with a large side branch are reported. The first case describes how to manage plaque shifting after stent implantation. The second and third cases demonstrate a kissing balloon predilatation and stent dilatation technique of a bifurcational lesion. The final case demonstrates a stent implantation technique through the stent struts of a previously deployed stent.     

Angiographic demonstration of coronary sinus thrombosis: A potential consequence of trauma to the coronary sinus

Abnormalities of the coronary sinus are rarely encountered. A case is presented demonstrating for the first time the angiographic appearance of coronary sinus thrombosis. This may have been the result of surgical trauma during mitral valve replacement or inadvertent cannulation of the coronary sinus during right heart catheterization or pacemaker insertion. Although the clinical significance of coronary sinus thrombosis is uncertain, obstruction of coronary sinus blood flow should not be deleterious because of multiple anastomoses between the coronary sinus system and the anterior cardiac veins. Difficulty in cannulating the coronary sinus for physiologic studies should suggest the possibility of coronary sinus thrombosis, especially in patients who have undergone mitral valve replacement. This may be confirmed by observing the venous phase of selective left coronary arteriography. Finally, coronary sinus thrombosis may be important as a source of pulmonary emboli. The prevalence of this serious complication requires further study.     

Coronary arteriovenous-arterial fistula

A case of multiple arteriovenous fistulae is described in an adult with coronary artery disease. One of these fistulae drained into the anterior interventricular vein, which in turn communicated with and perfused an obstructed left anterior descending coronary artery.