药物涂层球囊与药物洗脱支架应用于冠状动脉介入治疗后支架内再狭窄患者的临床效果及安全性

目的 探讨药物涂层球囊、药物洗脱支架对冠状动脉(简称冠脉)介入治疗后支架内再狭窄患者的治疗效果及安全性,为临床治疗提供参考。方法 选取2021年1月至2023年12月沭阳仁慈医院行冠脉介入治疗后支架内再狭窄的57例患者作为研究对象进行前瞻性研究,按照随机数字表法分为对照组(28例)和观察组(29例)。对照组患者采用药物洗脱支架,观察组患者采用药物涂层球囊,比较两组患者左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、每搏输出量(SV),以及最小管腔直径、不良心血管事件发生率。结果 治疗后,两组患者LVEF、LVEDD、LVESD、SV均优于治疗前,但组间比较差异均无统计学意义(均P>0.05);两组患者最小管腔直径比较,差异无统计学意义(P>0.05);两组患者心血管不良事件总发生率比较,差异无统计学意义(P>0.05)。结论 药物涂层球囊、药物洗脱支架的治疗效果相当,均可改善心功能指标、降低不良心血管事件发生率、但药物洗脱支架改善狭窄的效果更好,临床可根据患者的实际情况选择治疗方法。     

老年心肌梗死患者冠状动脉内支架植入术的护理

冠状动脉支架植入术是目前治疗老年心肌梗死患者的重要手段之一。现将本院开展此项技术的护理体会报道如下。     

心血管支架置入后循环血中内皮素1的变化与血管内再狭窄

目的:探讨心脏支架置入过程中及置入后宿主内皮素1水平的变化及与血管内再狭窄的关系.方法:由第一作者应用计算机检索维普数据库,检索时限为1994-01/2009-10.检索关键词:支架植入;再狭窄;内皮素1;药物洗脱支架.共保留相关文献22篇进行分析. 结果:内皮素1是目前已知作用最强和效应最持久的内源性缩血管活性肽,它对全身血压、局部血流灌注、促有丝分裂及细胞增殖等具有重要作用.经皮冠状动脉腔内成形后再狭窄是一个内皮功能失调的过程,正常情况下内皮细胞释放的生长因子和生长抑制因子之间有一个动态平衡,经皮冠状动脉腔内成形后内皮细胞受到损伤,这一平衡被打破,结果生长刺激因子活性占优势,从而导致血管平滑肌细胞增殖、迁移,促进再狭窄的形成.结论:药物洗脱支架可有效地抑制宿主内皮素1水平升高,可能是预防再狭窄的机制之一.     

冠状动脉内支架植入术后的护理

冠状动脉内支架植入术主要用于治疗冠心病,预防急性冠状动脉再梗塞和闭塞。由于手术成功率高,残余狭窄小,创伤小,并发症少,疗效好,常被用于急性心肌梗塞紧急抢救治疗。我们通过对106例冠状动脉内支架植入术患者的护理实践,总结出了一些经验,在确保患者术后康复中起到了很好作用。现总结汇报如下:1 临床资料 我院自1998年5月至2002年8月共做冠状动脉内支架植入术106例,其中男性77例,年龄最小29岁,最大77岁。女性29例,年龄最小49岁,最大78岁。其中43例有高血压病病史,12例有糖尿病病史,术后血肿5例,并发心跳骤停7例,死亡3例,其余均获得成功,成功率达97.2％。2 术后护理要点2.1 持续心电监护 术后头3天病情未稳定,可能出现心律失常,再     

冠状动脉内支架植入术的护理

冠状动脉内支架植入术(Stenting)已成为治疗经皮冠状动脉成形术(PTCA)后冠脉急性闭塞和减少PTCA后再狭窄的有效方法.支架降低再狭窄的主要原因是介入治疗后即刻的管腔扩大,防止血管弹性回缩并通过外力使斑块固定在管壁与支架之间[1].我院2002年1～6月施行Stenting36例,共植入支架42个.现将护理体会报告如下.     

老年患者冠状动脉内支架植入术后的护理研究进展

随着冠状动脉内支架植入术（PCI）技术的成熟,越来越多的老年患者接受了PCI术。本文概括了老年冠心病患者生理、病理及心理上的各种特点,罗列了介入治疗的各种常见并发症及针对性的护理观察要点,并重点突出老年患者PCI术后护理中较同类手术患者更需高度关注的护理内容。     

经皮冠状动脉药物洗脱支架置入术后支架内血栓形成的护理

冠心病介入治疗是经皮穿刺周围动脉（股动脉、桡动脉等）,沿动脉向心脏方向送入球囊导管或支架等介入治疗器械至冠状动脉目标部位,对其狭窄病变进行扩张、疏通的一类心导管治疗技术。近10年来,随着介入技术和器械的日臻完善以及循证医学对其临床应用价值的评价,冠心病的介入治疗已经非常成熟,安全性亦得到显著提高,目前已成为与药物治疗、外科冠状动脉旁路移植手术（coronary artery bypass graft,CABG）并驾齐驱的治疗手段。     

药物洗脱支架治疗冠状动脉支架内再狭窄的长期疗效观察

目的：评价药物洗脱支架治疗支架内再狭窄的长期疗效。方法：经药物洗脱支架治疗的支架内狭窄患者63例,平均随访22个月,观察有无主要心脏不良事件发生。结果：63例患者中,主要心脏不良事件的发生率为46．5％,未发生支架内血栓形成及心肌梗死事件。药物洗脱支架治疗药物洗脱支架术后支架内再狭窄疗效优于金属裸支架术后支架内再狭窄。Logistic多因素分析显示,药物洗脱支架治疗支架内再狭窄的疗效与年龄、性别、病变严重程度、病变直径、原支架种类及药物支架涂层材料无显著相关。结论：药物洗脱支架治疗支架内再狭窄安全、有效。     

冠状动脉支架植入术后药物洗脱球囊联合切割球囊的疗效

目的 研究冠状动脉支架植入术后药物洗脱球囊联合切割球囊的疗效。方法 采取前瞻性研究,以冠状动脉支架置入手术后发生支架内再狭窄（ISR）（狭窄率≥50%）并于2021年7-12月期间在广东省第二人民医院治疗72例患者作为研究对象,将ISR患者的分为观察组以及对照组,每组36例,观察组患者采取药物洗脱球囊联合切割球囊治疗,对照组患者给予药物洗脱球囊治疗。分析两组的治疗效果、心功能、不良心血管事件之间的差异。结果 经过治疗后,两组患者的血管内径以及狭窄率显著改善（P <0.05）,且观察组患者的血管内径显著高于对照组（P <0.05）,狭窄率显著低于对照组（P <0.05）,经过治疗后,两组患者的LVEF、LAD显著升高（P <0.05）,RVD、LVD、LVEDV下降（P <0.05）,且观察组患者的LVEF、LAD显著高于对照组（P <0.05）,RVD、LVD、LVEDV低于对照组（P <0.05）;观察组术后6个月发生复发性心绞痛、非致死性心肌梗死、靶血管血运重建、心力衰竭显著低于对照组（P <0.05）。观察组患者术后的Mb、cTnⅠ...     

药物洗脱支架的发展

药物洗脱支架广泛应用于冠心病介入治疗,具有重要的临床应用价值。本文主要对当前常见的药物洗脱支架及其作用机制进行了论述,指出了药物洗脱支架在临床应用中存在的问题以及改进的方向。     

健康成年人性活动后血浆内皮素水平的变化

目的:观察健康成年人性活动后血浆内皮素水平的变化。方法:选择2004-06/08来自北京市石景山区某社区自愿参加本实验的成年已婚者共46人为观察对象,经实验前教育详细讲解实验流程、要求和实验目的,以及性活动的性欲期、高潮期的界定,签署知情同意书,仔细询问病史初选观察对象,在进行必要的体格检查和实验室检查后进一步筛选,最终选择26人符合条件的观察对象纳入实验。2人因实验资料不全而被剔除,最后实际观察对象24人。男女各12人,分男女2组,每组12人。观察对象在自己家中惯常的条件下进行男上位的性活动,现场采集其性活动前基线状态及性活动高潮期后10min内、30min、60min的肘静脉血,以放射免疫法检测其血浆内皮素水平,以配对t检验分析性活动后内皮素梯度变化,t检验行性别组间对比。结果:46人中最终进入结果分析24人。①女性组只在性高潮后30min血浆内皮素水平较基线状态显著性下降犤(31.139±10.185),(39.790±12.250)ng/L,t=2.254,P<0.05犦。②男性组性活动后各时段10min内、30min、60min血浆内皮素水平与基线状态比较无显著性变化犤(35.872±15.195),(41.024±15.846),(39.812±22.630),(36.755±9.777)ng/L,P>0.05犦。③男女性别组间基线状态,性高潮后10min内,性高潮后30min,性高潮后60min各时段血浆内皮素水平差异均不显著。结论:性活动相伴的血浆内皮素变化应引起血管先反应性舒张继而收缩的效应,这个过程男性持续时间较短、恢复较快,而女性持续时间较长、恢复较慢。除女性在性高潮后30min时血浆内皮素水平较基线状态有显著性下降外,健康成年男女在性活动后血浆内皮素水平的无显著性梯度变化;男女性别组间未发现显著性差异。     

药物洗脱支架与裸支架在心肌梗死支架介入治疗中的作用：临床效益与安全性的比较

目的:评价药物洗脱支架与裸支架的临床效益及其安全性,为临床应用提供依据。方法:由作者应用计算机检索PubMed2004-04/2007-03与药物洗脱支架安全性和疗效相关的文献,检索词"drug elutingstents,sirolimus eluting stents,paclitaxel-eluting stents,coronary",限定文献语种为"English";同时检索万方数据库2004/2007相关文章,检索词为"药物洗脱支架,雷帕霉素洗脱支架,紫杉醇洗脱支架,冠心病",并限定文章语言种类为中文。纳入标准:近5年文献,发表在较权威杂志;内容与药物洗脱支架和金属裸支架在急性心肌梗死介入治疗中的应用相关。排除标准:较陈旧及重复文献。机检得到200余篇文献,阅读标题和摘要进行初筛,52篇文献符合标准,进一步查找全文阅读,最后纳入25篇进行综述。结果:①与金属裸支架比较,雷帕霉素或紫杉醇洗脱支架可以明显降低择期PCI患者术后再狭窄率和靶血管重建率。②既住研究认为药物洗脱支架的安全性与金属裸支架相当,近期研究显示药物洗脱支架增加远期非心性死亡和晚期血栓所致的心性死亡/心肌梗死风险。③除了晚期血栓形成外,药物洗脱支架置入后的过敏反应、延迟的药物洗脱支架内再狭窄和药物洗脱支架置入后的血管瘤应引起关注。结论:药物洗脱支架降低了支架再狭窄和靶血管重建,然而是否增加了支架晚期血栓形成,是否有增加死亡和心肌梗死的危险,有待随访更多病例,通过更长时间临床观察,才能得出最后结论。     

Early outcome after placement of a metallic intracoronary stent: initial Mayo Clinic experience

After percutaneous transluminal coronary angioplasty, 3 to 7% of patients have in-hospital coronary closure, and the risk of subsequent myocardial infarction is high, even with an urgent bypass operation. Disrupted coronary morphologic integrity, particularly with large dissections, may be associated with an increased risk of acute coronary closure. A percutaneously placed coronary vascular stent may rapidly alleviate acute or threatened coronary closure and could reduce morbidity. Between October 1989 and June 1990, placement of a balloon-expandable, flexible metallic coil (Gianturco-Roubin) coronary stent was attempted 16 times in 15 Mayo Clinic patients--for treatment of actual or threatened abrupt coronary closure in 10 patients, for primary treatment of a lesion judged to be at high risk for dissection with conventional balloon angioplasty in 1, and for elective treatment of restenotic lesions in 5. Placement of the stent was successful in 15 attempts (94%). Associated complications, which were uncommon, were similar to those noted after balloon angioplasty. No early deaths occurred, and no patient required coronary artery bypass grafting. Stents were successfully placed in both urgent and elective circumstances in native coronary arteries and saphenous vein grafts, and they were used in primary atheromatous and restenotic lesions. Our initial experience with this metallic coil stent indicates that it is efficacious for vascular disruption that is threatening or causing coronary closure after angioplasty. Furthermore, elective placement of a stent may be safely undertaken in patients with high-risk coronary lesions or recurrent restenotic lesions. The long-term outcome in all groups of patients who receive coronary stents is unknown.     

Drug eluting coronary stent: in vitro evaluation of magnet resonance safety at 3 Tesla.

PURPOSE: To evaluate MR safety at 3 Tesla for a drug eluting coronary stent. METHODS: A drug eluting coronary stent (Endeavor, cobalt alloy, Medtronic Vascular, Santa Rosa, CA) was evaluated for magnetic field interactions, heating, and artifacts at 3 Tesla. MRI-related heating was assessed with the stent in a gelled saline-filled phantom using a transmit/received RF body coil with a whole body averaged SAR of 2.0 W/kg. Artifacts were characterized using T1-weighted, spin echo, and gradient echo pulse sequences. RESULTS: The stent exhibited minor magnetic field interactions that will not cause migration. Heating was not substantial (+0.5 degrees C). Artifacts may create a problem if the area of interest is in the same area or close to the stent (e.g., for a T1-weighted, spin echo pulse sequence, within approximately 16 mm; for a gradient echo pulse sequence, within approximately 23 mm). Conclusion. The findings indicated that it would be safe for a patient with this cobalt alloy-based, drug-eluting coronary stent to undergo MRI at 3 Tesla or less. Importantly, because of the relative lack of magnetic field interactions, MRI may be performed immediately after implantation.     

Changes in pro-oxidant-antioxidant balance after bare metal and drug eluting stent implantation in patients with stable coronary disease

ObjectivesIn this study we aimed to assess the changes in pro-oxidant–antioxidant balance (PAB) after the placement of either a drug-eluting-stent (DES) or bare-metal-stent (BMS) in patients with stable coronary artery disease.Design and methodsPercutaneous coronary interventions (PCI) with either BMS or DES were undertaken for 152 patients (82 in the BMS and 70 in the DES groups respectively). PAB values were measured 24 h before and after PCI.ResultsBaseline PAB values were 80.68 (64.98–99.37) and 98.86 (64.70–140.62) for BMS and DES group, respectively, which were not significantly different between the 2 groups (P > 0.05). Following PCI, median PAB values decreased to 72.10 (61.40–96.13) and 81.40 (54.15–121.90) in BMS and DES groups, respectively. The reduction was significant in both BMS and DES groups (P < 0.05). The changes in PAB values were ?2.81 (?12.76 to 2.31) for BMS and ?2.82 (?29.88 to 8.93) for DES group, which were not significantly different between the 2 groups (P > 0.05).ConclusionWe found that the reported difference in clinical outcomes following DES or BMS implantation cannot be attributed to differences in early changes in oxidative stress induction as assessed by changes in PAB values.     

A multicenter study of the tolerability of tirofiban versus placebo in patients undergoing planned intracoronary stent placement

BACKGROUND: The use of intravenous glycoprotein IIb/IIIa-receptor antagonists has been shown to improve outcomes in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Tirofiban has shown benefit in a wide range of patients presenting with acute coronary syndromes. Although this agent has been used in patients undergoing percutaneous coronary intervention, a literature search identified no prospective data comparing tirofiban with placebo in patients undergoing planned intracoronary stent placement. OBJECTIVE: This study examined the tolerability of tirofiban in patients undergoing percutaneous intervention with planned intracoronary stent placement. METHODS: This was a multinational, multicenter, prospective, randomized, double-blind, placebo-controlled trial in patients scheduled to undergo PTCA with planned intracoronary stent placement. Patients were randomized in a 3:2 ratio to receive tirofiban as an intravenous bolus (10 microg/kg over 3 minutes) and maintenance infusion (0.10 microg/kg per minute for 36 hours) or a bolus and infusion of placebo. All patients received periprocedural aspirin and heparin and an optional postprocedural thienopyridine (ticlopidine or clopidogrel). Laboratory and safety monitoring were performed throughout the 36 hours after the procedure and at hour 40 or hospital discharge. The primary end point was the proportion of patients with bleeding, defined according to Thrombolysis in Myocardial Infarction (TIMI) trial criteria. The number of patients with cardiac events (death, myo- cardial infarction, urgent revascularization) during the first 30 days after stent placement was also assessed. RESULTS: Eight hundred ninety-four patients (536 tirofiban, 358 placebo) were enrolled, all of whom received aspirin and heparin periprocedurally and optional ticlopidine or clopidogrel after the procedure. No significant between-group differences were observed in the incidence of TIMI major bleeding (0.2% tirofiban, 0.6% placebo) or any TIMI bleeding (3.2% and 1.7%, respectively). The incidence of TIMI minor bleeding was higher with tirofiban than with placebo (2.8% vs 0.6%). The 30-day incidence of the composite end point of any cardiac event was 3.9% in both groups. CONCLUSIONS: On a background of concomitant aspirin, heparin, and a thienopyridine, tirofiban was generally well tolerated in patients undergoing PTCA with planned intracoronary stent placement. Further investigation is needed to ascertain the optimal dosing of tirofiban and heparin to achieve reductions in ischemic complications of intracoronary stenting with an acceptable incidence of bleeding complications.     

冠状动脉支架置入后相关炎症因子的变化及其干预

背景：冠状动脉粥样硬化性心脏病支架置入治疗后的炎症反应以及其严重程度与再狭窄明显存在相关性,医学工作者试图从中寻找新思路预防支架置入后再狭窄,提高治疗质量。目的：评价各种干预措施以及监测手段在冠状动脉置入术后炎症治疗中的应用价值和临床前景。方法：电子检索EMbase（1980-01/2011-05）,MEDLINE（1966-01/2011-05）,中国生物医学文献数据库（CBM,1978/2011-05）和中国期刊全文数据库（CNKI）,筛查相关文章的参考文献。中文检索词＂冠状动脉支架,炎症因子,炎症,CRP,再狭窄＂,英文检索词为＂Coronary stent,inflammatory cytokines,inflammation,CRP,restenosis＂。结果与结论：临床试验结果显示支架置入后炎症反应明显加重,使用雷帕霉素药物洗脱支架,添加地塞米松、塞来昔布、瑞舒伐他汀等可更大程度上降低支架置入后炎症反应。动物试验发现使用雷帕霉素洗脱支架可减少支架置入段新生内膜的形成和缩小炎症面积。提示各种干预措施可降低支架置入后炎症反应从而降低远期再狭窄的发生,可进一步改良加以应用于临床观察其疗效。     

冠状动脉支架置入后相关炎症因子的变化及其干预

背景:冠状动脉粥样硬化性心脏病支架置入治疗后的炎症反应以及其严重程度与再狭窄明显存在相关性,医学工作者试图从中寻找新思路预防支架置入后再狭窄,提高治疗质量.目的:评价各种干预措施以及监测手段在冠状动脉置入术后炎症治疗中的应用价值和临床前景.方法:电子检索EMbase(1980-01/2011-05),MEDLINE(1966-01/2011-05),中国生物医学文献数据库(CBM,1978/2011-05)和中国期刊全文数据库(CNKI),筛查相关文章的参考文献.中文检索词冠状动脉支架,炎症因子,炎症,CRP,再狭窄,英文检索词为Coronary stent,inflammatory cytokines,inflammation,CRP,restenosis.结果与结论:临床试验结果显示支架置入后炎症反应明显加重,使用雷帕霉素药物洗脱支架,添加地塞米松、塞来昔布、瑞舒伐他汀等可更大程度上降低支架置入后炎症反应.动物试验发现使用雷帕霉素洗脱支架可减少支架置入段新生内膜的形成和缩小炎症面积.提示各种干预措施可降低支架置入后炎症反应从而降低远期再狭窄的发生,可进一步改良加以应用于临床观察其疗效.     

药物支架治疗冠状动脉心肌桥的有效性和安全性

目的探讨药物支架治疗缺血性冠状动脉心肌桥的有效性和安全性。方法65例缺血性心肌桥患者随机分为两组。介入组33例均植入药物支架,药物组32例给予抗血小板、β受体阻断剂和钙拮抗剂等药物治疗。治疗6~12个月,随访心电图和心肌灌注显像心肌缺血改善情况和心脏事件的发生情况、并行冠状动脉造影随访。结果介入组患者共植入药物支架33枚,手术顺利,无并发症发生。随访发现,在药物组和介入组临床治愈者各有11例vs24例(P<0.01),稳定型心绞痛(AP)11例vs 6例(P>0.05),不稳定型心绞痛(UAP)分别是6例、3例(P>0.05),急性心肌梗死(AMI)分别是4例vs 0例(P=0.05)。冠状动脉造影随访发现,药物组有缺血表现的21例患者中,11例接受冠状动脉内支架治疗,占34.4%(11/32)。介入组9例有缺血表现的患者,发现支架内再狭窄4例,并再次行支架治疗,占12.1%(4/33)(P<0.05)。结论对有缺血表现的心肌桥患者,介入治疗是相对安全的,能够达到比较满意的临床效果。     

帕金森病患者甲襞微循环改变与血浆同型半胱氨酸、内皮素水平的关系

目的 探讨帕金森病患者微循环改变与血浆同型半胱氨酸(Hcy)和内皮素(ET-1)水平的关系.方法 对57例帕金森病患者和40例健康对照组的甲襞微循环、血浆Hcy和ET-1进行检测.结果 帕金森病患者甲襞微循环袢周状态积分、管袢流态积分、管袢形态积分和总积分值均显著高于对照组,分别为(0.70±0.29)分vs(0.52±0.36)分,(0.89±0.35)分vs(0.67±0.28)分,(0.96±0.33)分vs(0.73±0.31)分,(2.51±0.97)分vs(1.92±0.75)分(P＜0.05或P＜0.01);血浆Hcy和ET-1水平显著高于对照组,分别为(14.86±3.48)μmol/L vs(10.87±3.26)μmol/L,(85.04±18.51)ng/L vs(54.28±14.12)ng/L(均P＜0.01),且甲襞微循环总积分与血浆Hey、ET-1水平呈正相关(R=0.971,0.972;均P＜0.01).结论 帕金森病患者微循环障碍与血浆Hcy和ET-1水平有密切关系.