急性冠脉综合征抗凝与抗血小板治疗

近年来，人们已知急性冠脉综合征(ACS)发病机制是不稳定斑块即易损斑块的破裂，由易损斑块的破裂引起血小板聚集并激活血凝系统，形成血栓。根据血栓是否自溶，是否完全阻塞血管而在临床上形成急性冠脉综合征中的不稳定性心绞痛(UA)、非ST段抬高心肌梗死(NSTEMI)和ST段抬高心肌梗死(STEMI)。所以，在临床治疗上，抗凝和抗血小板治疗则成为急性冠脉综合征治疗中最重要措施之一。     

术前戒烟干预对患者术后戒烟的影响

目的评估麻醉医师术前戒烟干预对患者术后戒烟影响的有效性及安全性。方法选择当前吸烟男性择期手术患者182例,年龄18~79岁,ASAⅠ~Ⅲ级,按1∶1比例及手术大小分层随机分为对照组和干预组,每组91例。在术前访视时实施戒烟干预,措施为:吸烟对麻醉影响宣教、戒烟宣传资料(包括吸烟危害文字部分、吸烟所致器官损害图片、北京朝阳医院戒烟门诊热线电话及微信公众号),记录麻醉方式、手术时间、PACU治疗时间和术中术后并发症发生情况,术后30d电话随访戒烟率、吸烟下降率、戒烟门诊或戒烟热线随访率。结果在182例患者中,失访16例,最后纳入分析166例。术后30d两组戒烟率差异无统计学意义;术后30d干预组自报吸烟下降率(36.9%)明显高于对照组(22.0%);在术后30d自报戒烟患者中,干预组术前呼气末CO值为轻度吸烟者占83.3%,对照组占40.0%(P0.05);两组术中术后并发症发生率差异无统计学意义。结论麻醉医师术前实施戒烟干预具有安全性,可使患者术后30d吸烟量下降,并提高轻度吸烟患者术后30d戒烟率。     

急性冠脉综合征患者抑郁状态调查

目的了解急性冠脉综合征患者是否存在抑郁症状及其程度,以便为临床心理护理提供依据。方法采用抑郁 自评量表对85例急性冠脉综合征患者进行问卷调查。结果57.65%患者存在不同程度的抑郁症状;年龄<60岁 组较≥60岁组抑郁发生率高(P<0.05);抑郁发生与性别和病情无相关性。结论急性冠脉综合征患者的抑郁发 生率偏高,临床医护人员应给予足够的重视,采用多种措施缓解患者的抑郁症状,以维持患者的心理健康。     

13例急性冠脉综合征患者急救与护理体会

本文回顾性总结我科收治的13例急性冠脉综合征患者的护理,我们的体会是早期明确诊断、医护严密配合救治以及密切病情观察,对减少并发症的发生,提高患者抢救成功率十分重要.     

急性冠脉综合征院前急救及护理

目的:探讨急性冠脉综合征患者的院前急救及护理措施,提高抢救成功率及患者生存质量.方法:对36例急性冠脉综合征患者进行院前急救护理干预,给予及早、迅速、有效的救护.结果:除1例急性大面积心肌梗死病人,在送往医院途中突发呼吸、心搏骤停,经抢救无效死亡;其余35例病人接受急救护理,送往心内科住院治疗;其中1例死亡,33例均取得了满意的疗效.结论:对急性冠脉综合征患者应迅速、及早、正确、有效的进行院前急救护理干预,及早缓解病痛,同时为入院后的进一步介入治疗和冠脉内支架术赢得了宝贵的时间,提高了患者的生存率.     

强化戒烟教育对青年冠心病患者PCI术后远期疗效的影响

目的调查青年冠心病患者经皮冠状动脉介入术(PCI)后的强化戒烟教育对远期疗效的影响。方法对2010年1月至2012年6月成功接受PCI治疗且术前长期吸烟的192例(实验组)青年冠心病患者进行强化戒烟教育;2007~2009年收治的172例患者(对照组)接受常规健康教育和随访。比较两组出院后戒烟状况及临床主要心脑不良事件(MACCE)的发生情况。结果实验组出院后1、3、6、12、24个月复吸率显著低于对照组(P0.05,P0.01),随访期间实验组MACCE发生率显著低于对照组(P0.05)。结论 PCI术后强化戒烟教育能降低青年冠心病患者复吸率及远期MACCE的发生率。     

Outcome of poor initial TIMI flow in patients presenting with acute coronary syndrome

Objectives. We explored the predictors and outcome of poor, versus good, initial TIMI flow in patients with acute coronary syndrome (ACS). Design. We performed post-hoc analysis of a randomized trial of patients presenting with ACS who received 2 comparative stents. Poor initial TIMI flow was defined as baseline TIMI flow grade 0/1 at the initial coronary angiography. The primary endpoint was major adverse cardiac events (MACE): a composite of cardiac death, non-fatal myocardial infarction or ischemia-driven target lesion revascularization. Stent thrombosis (ST) was adjudicated according to the criteria of definite ST described by the Academic Research Consortium. Propensity score-matched analysis was performed. We report data after 5-year follow-up. Results. Of 827 patients enrolled, 279 (33.7%) had initial TIMI 0/1 flow. Median follow-up duration was 5.0 years. Presentation by ST-elevation myocardial infarction and target vessel other than left anterior descending artery predicted initial TIMI 0/1 flow. MACE rate was comparable between the 2 subgroups (14% versus 15.9%, in patients with poor versus good initial TIMI flow, respectively, p?=?.46). Individual endpoints were comparable (p?>?.05 for all). Definite ST was more frequent in patients with initial TIMI 0/1 flow (3.6% versus 1.5%, respectively, p?=?.048). This was driven by more frequent early events (30 days) (p?=?.036); late/very late events were comparable (p?=?1.0). Conclusions. Predictors of poor initial TIMI flow included presentation by ST-elevation myocardial infarction, and target vessel other than left anterior descending artery. Definite ST occurred more in patients with poor, versus good, initial TIMI flow, mainly driven by difference in early events.     

赋能教育对PCI术后患者运动康复的影响

目的 探讨赋能教育对经皮冠状动脉介入治疗(PCI)术后患者运动康复的影响.方法 选取PC1治疗患者73例,按照收治病区分为干预组36例和对照组37例.对照组进行常规健康教育;干预组进行赋能教育,分3个阶段、8次进行.比较两组干预前、干预1个月后、干预3个月后有氧运动耐力、运动自我效能及运动依从性.结果 干预1个月、3个...     

手指康复操训练对经桡动脉行冠脉造影患者肢体并发症的影响

目的减轻经桡动脉行冠脉造影患者术后术侧肢体的肿胀、疼痛程度。方法将196例择期经桡动脉行冠脉造影的住院患者分为对照组99例与干预组97例。对照组术后予常规护理,干预组在对照组基础上进行手指康复操锻炼。观察两组手掌周径、疼痛程度、出血情况。结果干预组手掌周径(术后4、12 h)显著小于对照组,疼痛程度显著轻于对照组(P0.05,P0.01);两组出血程度比较,差异无统计学意义(P0.05)。结论手指康复操锻炼可缓解经桡动脉行冠状动脉介入术患者术后术侧手部肿胀程度及疼痛感,不会增加穿刺点出血发生率。     

急性冠脉综合征患者家庭-社区-医院协同化救治的效果

目的 探讨家庭-社区-医院协同化救治急性冠脉综合征方案的实施及效果.方法 将124例急性ST段抬高型心肌梗死患者分为干预组63例和对照组61例,分别实施家庭-社区-医院协同化救治和常规救治方案,比较两组入院方式、院前时间、院内救治时间及临床结局.结果 两组入院方式、症状出现-首次医疗接触时间、入院-首次心电图时间、决定...     

Different prognostic importance of elevated troponin I after percutaneous coronary intervention in acute coronary syndrome and stable angina pectoris

Objectives. To investigate the prognostic importance of cardiac troponin I (cTnI) elevation after percutaneous coronary intervention (PCI) in different clinical settings. Design. The study includes 238 patients presenting with acute coronary syndrome (ACS) and 194 patients with stable angina pectoris (SAP). The composite end point of death or hospitalization due to non-fatal myocardial infarction, repeated revascularization or unstable angina, was determined during one year of follow-up. Results. cTnI elevation after PCI was more frequent in ACS patients than SAP patients. ACS patients with cTnI elevation after PCI had significantly higher number of events than patients with unchanged cTnI status after PCI. SAP patients had generally lower event rate than ACS patients. The event rate was also significantly higher among ACS patients than SAP patients at comparable degrees of cTnI elevation after PCI. There was no difference in events among SAP patients with or without cTnI elevation after PCI. Conclusion. cTnI elevation after PCI predicts adverse outcome after one year in patients with ACS, but not in patients with SAP.