曲美他嗪在PCI所致的对比剂肾病中的预防作用研究

目的评价血肌酐升高的患者行PCI后,曲美他嗪在对比剂肾病中的预防作用。方法治疗组口服曲美他嗪20mg,3次/d,术前48h开始口服,术后继续服用3d。所有患者在术前12h开始静脉输注0.9%氯化钠溶液〔1ml/(h.kg)〕,持续至术后12h。血肌酐于术后3d内升高44.2μmol/L以上或基础值的1/4以上定义为对比剂肾病(contrast-induced nephropathy,CIN)。结果在治疗组对比剂肾病发生率为2.9%(3/102),在对照组对比剂肾病发生率18.2%(21/115),两组比较差异有统计学意义(P0.05)。结论肾损害的患者行PCI时,用0.9%氯化钠溶液水化的同时给予口服曲美他嗪来预防对比剂肾病,比单独水化更有效。     

N-乙酰半胱氨酸对冠心病患者PCI术后造影剂肾病的影响

目的:研究N-乙酰半胱氨酸(NAC)对冠心病患者PCI术后造影剂肾病(CIN)的影响。方法:于我院行PCI术的94例冠心病患者被分为水化组(48例，接受术前水化治疗)及NAC组(46例，水化组基础上接受NAC)。比较两组一般临床资料，术前、术后24h、48h血清肌酐(Scr)水平、胱抑素C(CysC)及视黄醇结合蛋白(RBP)水平、肌酐清除率(CrCl)、估测的肾小球滤过率(eGFR),CIN发生率。结果:与术前比较，术后24h、48h,两组Scr水平[水化组：(68.90±12.57)μmol/L比(80.77±12.83)μmol/L比(87.26±13.84)μmol/L,NAC组：(68.03±14.02)μmol/L比(77.29±13.70)μmol/L比(86.42±13.80)μmol/L]均显著升高，CrCl[水化组：(73.01±18.54)ml/min比(61.69±13.56)ml/min比(57.02±12.15)ml/min, NAC组：(75.99±19.95)ml/min比(66.26±16.64)ml/min比(58.78±13.36)ml/min]、...     

尿NGAL对ACS患者PCI术后对比剂肾病的早期诊断价值

目的:探讨尿液中性粒细胞明胶酶脂质载脂蛋白(NGAL)对急性冠脉综合征(ACS)患者PCI术后对比剂肾病(CIN)的早期诊断价值。方法:选择在我院住院的ACS并行择期冠脉介入术患者104例为ACS组,与之相匹配的稳定型冠心病择期行冠脉介入术患者110例为稳定型冠心病组。根据是否患有CIN,每组被进一步分为CIN亚组和非CIN亚组。收集术前、术后6h及术后24h患者尿液标本,测定各组尿NGAL水平,比较术前、术后肾功能及尿NGAL水平的变化。结果:在ACS组内,与非CIN组比较,CIN组术后72h肾小球滤过率[(81.59±27.46)ml·min~(-1)·1.73m~(-2)比(45.29±28.34)ml·min~(-1)·1.73m~(-2)]明显降低,血清肌酐(Scr)水平[(96.80±21.98)μmol/L比(132.69±43.03)μmol/L]明显升高(P均0.01);而CIN组尿NGAL水平在术后6h即明显高于非CIN组[(1.57±0.43)μg/L比(0.94±0.31)μg/L,P0.01]。ACS组和稳定型冠心病组的两CIN亚组比较,NGAL水平无显著差异(P均0.05)。结论:尿NGAL水平对于经皮冠状动脉介入术后对比剂急性肾损伤诊断比血清肌酐更为敏感,是一个比血清肌酐更早的对比剂肾病诊断标志物。     

前列地尔对老年冠心病患者介入治疗后造影剂肾病的预防作用

目的探讨前列地尔对老年冠心病患者PCI术后造影剂肾病(CIN)的预防作用。方法前瞻性入选天津市胸科医院心内科拟行PCI的老年冠心病患者300例,按照随机数字表法分为前列地尔组150例,常规治疗组150例。其中前列地尔组给予20μg前列地尔+水化治疗,常规治疗组仅给予单纯水化治疗。观察2组患者PCI术前及术后3d血肌酐、肌酐清除率、尿素、β2微球蛋白、24h尿蛋白、C反应蛋白(CRP)、白细胞介素6(IL-6)、TNF-α、谷胱甘肽过氧化物酶(GPX)和超氧化物歧化酶(SOD)水平的变化,并分析2组患者CIN发病情况,记录前列地尔组低血压不良事件。结果前列地尔组PCI术后CRP[(1.28±1.28)mg/L vs(1.66±1.72)mg/L]、IL-6[(136.42±43.76)ng/L vs(141.26±65.70)ng/L]、SOD[(2.05±1.48)mg/L vs(2.38±1.41)mg/L]、GPX[(6.46±2.32)μg/L vs(6.94±2.09)μg/L)]、24h尿蛋白[(189.55±87.56)mg vs(197.51±89.62)mg]、CIN发病率[(2.7%vs8.7%)]较常规治疗组明显降低,肌酐清除率[(97.75±27.20)ml/min vs(91.70±17.85)ml/min]较常规治疗组明显增高,差异有统计学意义(P<0.05)。2组PCI术后CRP、IL-6、SOD、GPX、24h尿蛋白较术前明显增高,差异有统计学意义(P<0.05);而2组术后肌酐清除率、血肌酐、尿素、β2微球蛋白、TNF-α水平较术前无明显变化(P>0.05)。结论前列地尔具有保护接受PCI术冠心病患者肾功能的作用,对CIN可能有一定的预防作用。     

探讨高剂量他汀对冠脉介入手术术后对比剂肾病的研究

目的探讨高剂量的他汀对冠脉介入手术(PCI)术后对比剂肾病的研究。方法选取2014年1月~2014年3月收治的急性冠脉综合征接受择期PCI的患者75例作为研究对象,排除肌酐清除率30 ml/min的重度肾功能不全的患者,随机分为A、B、C三组,各25例。A组PCI术前24 h给予20 mg的瑞舒伐他汀;B组PCI术前24 h给予10 mg的瑞舒伐他汀;C组空白对照。分别术后24 h观察血肌酐(Scr),根据公式将血肌酐换算成肌酐清除率(Ccr),肌酐清除率的换算公式:Ccr=[(140-年龄)×体重(kg)]/[0.818×Scr(umol/L)]。结果 A组和B组较C组均能明显增加肌酐清除率且差异有统计学意义(P0.05),但A组和B组一般资料差异无统计学意义(P0.05)。结论瑞舒伐他汀能够减少PCI术后对比剂肾病的发病率,高剂量他汀对其影响与常规剂量相当。     

单次大剂量瑞舒伐他汀钙对高龄冠心病患者介入术后造影剂肾病的影响

目的探讨术前给予单次大剂量瑞舒伐他汀钙对高龄冠心病患者PCI术后造影剂肾病(CIN)的影响。方法选取我科住院择期行PCI的高龄冠心病患者58例,随机分为试验组30例和对照组28例。所有患者采用标准治疗和给予瑞舒伐他汀钙5mg/d的基础上,试验组术前12～24h瑞舒伐他汀钙加量至10mg顿服。观察2组患者术前及术后24、48及72h血清肌酐、肌钙蛋白I(cardiac troponin I,cTnI)、肌酸激酶、丙氨酸转氨酶(ALT)、高敏C反应蛋白(hs-CRP)、天冬氨酸转氨酶(AST)、估算肾小球滤过率(eGFR)及CIN的发病率。结果 2组术前血清肌酐、eGFR、cTnI、肌酸激酶、ALT、hs-CRP及AST水平比较,无统计学差异(P0.05)。与术前比较,2组不同时间点血清肌酐明显升高,术后72hhs-CRP明显下降,且对照组术后48h、72h血清肌酐[(78.9±13.7)μmol/L vs(69.9±12.9)μmol/L;(88.3±15.8)μmol/L vs (69.8±13.6)μmol/L]及术后72hhs-CRP[(5.9±1.3)mg/L vs (5.3±1.6)mg/L]明显高于试验组,差异有统计学意义(P0.05)。对照组不同时间点eGFR均明显低于术前,且术后48h及72heGFR明显低于试验组,差异有统计学意义(P0.05,P0.01)。试验组术后24hcTnI明显升高[(0.083±0.212)μg/L vs (0.065±0.126)μg/L,P0.05],术后48及72h逐渐下降,但差异无统计学意义(P0.05)。对照组术后不同时间点cTnI明显升高,差异有统计学意义(P0.05,P0.01)。试验组发生CIN 1例,对照组发生CIN 4例,试验组CIN发病率明显低于对照组(3.3%vs 14.3%,P=0.035)。2组均未见明显的不良反应。结论PCI术前给予单次大剂量瑞舒伐他汀钙能够减轻肾功能的损伤、减少CIN的发生率,预防老年冠心病患者PCI术后并发症的发生。     

不同方式连续肾脏替代治疗对急性非ST段抬高型心肌梗死并心肾功能不全患者预后的影响

目的对合并心力衰竭、肾功能不全的急性非ST段抬高型心肌梗死患者在住院治疗期间予以连续性肾脏替代治疗(continuous renal replacement therapy,CRRT),观察其预防对比剂肾病(contrast-induced nephropathy,CIN)的疗效及总体预后。方法纳入79例心功能不全合并肾功能不全的急性非ST段抬高型心肌梗死患者[入院纽约心脏协会(NYHA)心功能II~III级,血肌酐177μmol/L]行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗,其中36例于PCI治疗后行CRRT(后CRRT组),33例于PCI治疗前及治疗后均行CRRT(前-后CRRT组),其余10例为对照组,不予CRRT,仅予静脉水化及常规药物治疗。CRRT模式均为血液透析滤过,于术前8 h内和(或)术后12 h内进行。收集相应的临床资料,术前用Mehran法进行CIN的风险评分,冠状动脉造影术后予以Gensini评分。评估住院期间血清肌酐、尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)和apelin浓度的变化趋势,以及CIN的发病率。1.5年后随访,评估主要不良心血管事件发生率。结果前-后CRRT组CIN发生率显著低于后CRRT组,差异有统计学意义(P0.05);在观察期内,前-后CRRT组肾功能水平显著高于后CRRT组,差异有统计学意义(P0.05)。前-后CRRT组500 d内随访终点(composite endpoint,CEP)发生率显著低于后CRRT组,差异有统计学意义(P0.05);但两组患者长期预后相似。结论心肾功能不全的非ST段抬高型心肌梗死患者术前及术后均行CRRT可能降低CIN的发病率、改善预后。     

阿魏酸钠对单侧输尿管梗阻大鼠肾脏损害的改善作用

目的观察阿魏酸钠(SF)对单侧输尿管梗阻(UUO)大鼠肾脏损害的改善作用。方法将W istar大鼠48只随机分为假手术组、UUO组、苯那普利治疗组及阿魏酸钠治疗组,于给药2和4 w后分别检测各组大鼠肾脏指数、左右肾重比、尿NAG酶活性、尿液尿素氮、尿肌酐、血尿素氮、血肌酐及24 h尿蛋白排泄量等指标。结果给药2 w后,与模型组比较,阿魏酸钠组大鼠肾脏指数(0.64±0.10)、尿NAG酶活性〔(18.0±5.43)U/L〕、血尿素氮〔(7.3±1.1)mmol/L〕、血肌酐〔(35.2±8.4)μmol/L〕及24 h尿蛋白排泄量〔(9.8±4.4)mg/24 h〕均明显降低(P<0.05),苯那普利组与阿魏酸钠组结果相似;给药4 w后,阿魏酸钠组大鼠肾脏指数(0.57±0.23)、尿肌酐〔(551±196)μmol/L〕和血尿素氮〔(11.1±1.8)mmol/L〕均较模型组明显减低(P<0.05)。结论阿魏酸钠对UUO引起的大鼠肾损害具有明显改善作用。     

不同剂量阿托伐他汀联合水化预防冠脉介入术后造影剂肾病的临床研究

目的：比较80mg/d与40mg/d阿托伐他汀分别联合水化预防急性心心肌梗死(AMI)患者冠脉介入术后造影剂肾病(CIN)的效果。方法：将2014年1月～2016年12月入选的172例AMI患者随机分为高剂量组(88例)与低剂量组(84例),在常规PCI治疗基础上,高剂量组患者入院后～术后72h口服60mg/d阿托伐他汀,低剂量组口服40mg/d阿托伐他汀,同时两组患者围术期均予静滴生理盐水水化治疗,记录两组手术指标、治疗前后生物学标志物及肾功能变化,比较两组CIN及临床不良事件发生率。结果：两组患者造影剂用量、接触时间、水化量及冠状动脉旋磨比例、平均每例患者支架植入数量差异均无统计学意义(P均＞0.05)。高剂量组术后3d ln(NT-proBNP)、hs-CRP、MMP-9较术前下降数值均显著高于低剂量组[(0.52±0.22 vs.0.37±0.17) pg/ml、(7.8±2.4 vs.6.3±1.9) mg/L、(27.5 ±9.5 vs.23.7±7.7) μg/L](P均＜0.05)。高剂量组术后3d Scr、BUN较术前升高数值与eGFR下降数值均显著低于低剂量组[(11.9±3.5 vs. 19.6±5.8)μmol/L、(1.53±0.52 vs. 2.38±0.65)mmol/L、(5.0±2.2 vs. 9.2±3.8)ml/min.     

替罗非班对急诊PCI治疗心肌梗死患者内皮细胞功能的影响

目的:研究替罗非班对急诊经皮冠状动脉介入(PCI)治疗心肌梗死患者内皮细胞功能的影响。方法:选择2014年1月至2016年1月期间于我院行急诊PCI治疗的124例心肌梗死患者。根据随机数字表法,患者被随机均分为常规治疗组(术中使用普通肝素)和替罗非班组(术前给予盐酸替罗非班)。测量比较两组在PCI术前,术后2h、6h和36h的一氧化氮(NO)和血管假性血友病因子(vWF)浓度,以及两组住院期间的主要不良心血管事件(MACE)。结果:与术前比较,常规治疗组术后2h、6h和36h的NO浓度均显著降低,vWF浓度均显著升高(P0.05或0.01);替罗非班组术后2h、6h和36h的NO浓度无显著改变(P均0.05),仅2h、6h的vWF浓度显著升高(P均0.01),36h的vWF与术前比较无显著差异(P=0.879)。与常规治疗组比较,替罗非班组术后2h、6h、36h的NO浓度[6h:(40.46±9.79)μmol/L比(54.84±10.76)μmol/L,36h:(49.42±9.82)μmol/L比(55.39±12.34)μmol/L]显著升高,vWF浓度[6h:(243.14±19.99)μmol/L比(121.58±18.92)μmol/L,36h:(223.38±19.76)μmol/L比(105.32±23.05)μmol/L]显著降低,P0.05或0.01。替罗非班组住院期间MACE发生率显著低于常规治疗组(4.8%比16.1%),P=0.040。结论:急诊PCI治疗心肌梗死患者应用替罗非班能够显著改善内皮细胞功能,提高再灌注效果,值得推广。     

Right coronary artery coronary sinus fistula with coronary sinus ostium stenosis

Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. The draining site of a right coronary artery (RCA) fistula may usually be the right ventricle, right atrium, or pulmonary artery. Here, we present a patient with right coronary artery to coronary sinus fistula (RCACSF) complicated by aneurysmal dilatation of the coronary sinus (CS) and stenosis of CS ostium.     

Iatrogenic coronary artery stenosis following coronary stenting

We present 6-month follow-up of 435 patients undergoing stent deployment. Forty-four patients were referred because of myocardial ischemia related to the stented artery. In six of these patients (14%), the stented vessel revealed a new proximal lesion separated from the stented portion, which warranted further intervention. It is felt that these new lesions are related to the stenting technique as a result of local trauma induced from the guiding catheter. Cathet. Cardiovasc. Intervent. 46:393–397, 1999. © 1999 Wiley-Liss, Inc.     

小冠状动脉狭窄性病变的介入治疗

目的 :探讨小冠状动脉 （直径 <3 mm）狭窄性病变实施普通球囊、切割球囊或小支架介入治疗的疗效和并发症。方法 :小冠脉狭窄性病变介入治疗 （PCI）患者 13 6（男 87,女 49）例 ,年龄 3 2～ 85（54± 17）岁。根据手术方法分为普通球囊组、切割球囊组和小支架组。残余狭窄率 <3 0 %且无动脉夹层、撕裂等并发症者为手术成功 ,术后 6个月复查冠脉造影。结果 :普通球囊组 3 2例 ,手术成功 2 6例 （81% ） ,出现动脉夹层或扩张不满意改支架术 6例 （2 4% ）。切割球囊组 48例 ,手术成功 43例 （90 % ） ,出现动脉夹层或扩张不满意改支架术 3例 ,出现造影剂血管外漏 2例。支架组 56例 ,手术成功 53例 （95% ） ,出现造影剂血管外漏 2例 ,出现心包填塞抢救成功 1例。3组均未出现血管急性闭塞。术后 6个月 ,切割球囊组、小支架组、普通球囊组冠脉造影狭窄率分别为 2 3 % （11例 ）、16% （9例 ）、3 8% （12例 ）。结论 :小冠脉狭窄性病变实施介入治疗能取得显著效果 ,小支架术优于普通球囊扩张术 ,切割球囊扩张与普通球囊扩张具有近似疗效     

Complex coronary angioplasty: Multiple coronary dilatations

Selected patients underwent PTCA of multiple stenoses in different vessels or in the same vessel. Three hundred nine patients underwent 685 PTCA procedures in various combinations of arterial and vein graft stenoses. A multiple dilatation procedure was defined as successful when all lesions attempted were successfully dilated, or when the considered-critical-stenosis was successfully dilated and this resulted in a patient clinical improvement. Angiographic success was achieved in 599 of 685 lesions attempted (87.4%) and in 285 of 309 patients (92.2%). Complications included a mortality rate of 1.0%, an MI rate of 4.2% per patient and 1.9% per lesion attempted, and a 3.6% incidence of emergency CABG. Follow-up data show that 58 patients (20.4%) had clinical evidence of a lesion recurrence, and that 92.5% (37 of 40 patients) who underwent repeat angioplasty had a successful procedure. A sustained clinical improvement was obtained in 264 of 309 patients (85.4%). The data indicate that multiple dilatations are feasible with good success rates and acceptable complication rates. Further evaluation of this extended application of PTCA is needed to clearly establish its role in the therapy of CAD.     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

冠状动脉造影后即刻PTCA与择期PTCA的比较

目的　研究冠状动脉造影后即刻冠状动脉成形术的成功率及并发症率进而探讨其临床应用价值。方法　对冠状动脉造影后即刻冠脉成形术及靶病变特点与其相似的择期冠脉成形术各７０ 例进行对比分析。结果　Ａ 和Ｂ型病变的成功率和并发症率两组间差异无显著性,Ｃ型病变的成功率即刻组低于择期组（５７．１４％ 对９２．８６％ ,Ｐ＜ ０．０５）而并发症率高于择期组（５７．１４％ 对１４．２９％ ,Ｐ＜ ０．０１）,闭塞性病变的成功率及并发症率两组间差异无显著性。结论　Ｃ型病变不宜于造影后即刻行冠脉成形术。闭塞性病变可于造影后即刻试行冠脉成形以避免次全闭塞进展为完全闭塞后才进行手术。造影后即刻冠脉成形有一定的临床应用价值     

Percutaneous coronary intervention of bifurcation coronary disease

Bifurcation coronary artery disease is a frequent problem faced by interventional cardiologists and it affects approximately 15-20% of patients undergoing percutaneous coronary intervention (PCI). The application of drug-eluting stents (DES) technology to prevent restenosis after PCI represents one of the success stories in cardiology, but DES have not resolved the bifurcation PCI challenge. Bifurcation PCI remains associated with higher procedural failure and worse outcomes compared with PCI of non-bifurcated lesions even in DES era. A dependable strategy for PCI of bifurcation lesions has yet to be established, which is likely due to the paucity of studies evaluating the anatomical intricacies of the bifurcation as well as the lack of large scale randomized therapeutic trials. Further, bifurcation has many anatomical variants and it is unlike that one technique will fit all. Currently, we are left with the option of a tailor-made strategy for each patient and bifurcation anatomy and make the most of the limited evidence available to support our therapeutic decisions. In this review, we attempted to describe the current understanding of bifurcation anatomy and corresponding PCI strategies.