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目的应用^99mTc-甲氧异晴(MIBI)心肌灌注断层显像判断经皮冠状动脉腔内成形术(PTCA)及支架置入术的疗效。方法54例冠心病患者在PTCA/支架术前、术后分别行运动+静息或静息+硝酸甘油介入心肌灌注断层显像检查。结果PTCA/支架置入术后,患者的缺血心肌节段及不可逆灌注缺损节段减少,即术前分别为2.64±0.43及3.64±0.47,术后分别为1.54±0.29及2.34±0.40。结论成功的PTCA/支架置入术治疗能明显改善冠心病心肌缺血。核素心肌灌注断层显像对PTCA术的疗效评价准确可靠,为一种有价值的无创性方法。 相似文献
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目的探讨99Tcm MIBI对判断经皮冠状动脉腔内成形术(PTCA)及支架置入术后的疗效及测定再狭窄以及估测预后的临床价值。方法对31例确诊冠状动脉性心脏病(CAD)患者PTCA及支架置入术前、术后行99Tcm MIBI静息门控断层心肌灌注显像(GSPECT)进行研究。患者均于PTCA前和PTCA后1个月行GSPECT,其中21例于PTCA后3个月再行GSPECT。经SPECT计算机处理获得舒张末期容积(EDV)、收缩末期容积(ESV)、左室射血分数(LVEF)等心功能参数。结果①PTCA术后1个月有48.1%的异常节段血流灌注较前改善,术前后的心功能参数均无显著差异(P>0.05)。②PTCA后3个月行静息GSPECT,再狭窄率14.3%(3/21)。结论静息99Tcm MIBIGSPECT可以较好的评价PTCA术的疗效,并可判定PTCA术后冠脉是否发生再狭窄。 相似文献
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目的 探讨术前应用负荷剂量瑞舒伐他汀(20 mg)对老年冠心病患者经皮冠状动脉介入治疗(PCI)术后的影响.方法 将99例择期行PCI术的老年(年龄≥60岁)不稳定型心绞痛(UAP)患者分为观察组(51例)和对照组(48例).两组均予给予瑞舒伐他汀10 mg/d治疗,观察组在PCI术前12 h给予瑞舒伐他汀20 mg口服.记录住院期间和随访期间 30d内的主要不良心脏事件(MACE)发生率及瑞舒伐他汀的肝毒性和肌毒性的发生情况.结果随访30d内,共17例患者发生MACE,占17.2%.其中观察组5例,占9.8%;对照组12例,占25%;两组MACE发生率差异有统计学意义(P< 0.05).两组均无肝毒性和肌毒性事件发生.结论 术前早期应用负荷剂量瑞舒伐他汀(20 mg)对老年冠心病PCI术后患者是安全有效的. 相似文献
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99mTc-MIBI门控心肌断层显像在冠状动脉支架术后的临床价值 总被引:1,自引:0,他引:1
目的:探讨99mTc-甲氧基异丁基异腈(MIBI)门控心肌断层显像(G-MPI)在冠状动脉支架术后疗效评价、判断再狭窄以及预后评估的临床价值。方法:78例患者,冠状动脉支架术后3~12个月内均行G-MPI,其中31例有术前对照。33例复查冠状动脉造影(CAG)。随访13~24个月。结果:①31例复查G-MPI24例心肌灌注有改善,改善率为77.4%。②31例术后静息G-MPI所测左室射血分数(LVEF)较术前由(42.6±8.6)%上升至(49.7%±6.4)%,P<0.05;舒张末期容积(EDV)和收缩末期容积(ESV)分别由(158.2±55.3)ml、(92.6±44.9)ml明显下降到(133.9±39.9)ml、(71.2±28.7)ml,P均<0.01。③33例复查CAG患者,G-MPI对再狭窄诊断的敏感性、特异性、准确性为82.3%、85.0%、84.8%。④随访心脏事件发生率术后G-MPI灌注改善组(1.9%)与异常组(28.6%)之间有极显著差异(P<0.01)。结论:G-MPI对冠心病血运重建术后疗效评价、判断再狭窄以及预后评估具有重要的临床价值。 相似文献
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经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)、经皮冠状动脉腔内成形术(Percutaneous transluminal coronary angioplasty,PTCA)和(或)支架植入术已成为且前冠心病诊断的金标准及常用治疗方法,我科自2003年9月至2005年6月对75例老年冠心病患者实施了冠状动脉造影、PTCA或支架植入术。探讨老年患者冠状动脉造影、PTCA及冠状动脉内支架植入术护理方法,回顾分析实施冠状动脉介入诊断和治疗的75例患者的临床护理资料,现报告如下。 相似文献
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经皮冠状动脉介入治疗术(PCI)后老年冠心病患者172例,按照所在社区分为对照组(78例)和观察组(94例)。对照组出院后转社区医疗组织管理,医院不再提供后续健康干预治疗;观察组出院后由医院协同社区共同健康管理1年,比较两组患者遵医服药率、再住院率、平均再住院天数、平均再住院费用及心脏事件发生率,及生活质量综合评定问卷(GQOLI-74)、焦虑自评量表(SAS)、抑郁自评量表(SDS)评分。结果显示,观察组患者再住院例数、平均再住院天数、平均再住院费用及SAS、SDS评分均明显降低(P〈0.01或〈0.05),遵医服药率及躯体健康度、心理健康度、社会功能维系度方面好于对照组(P〈0.05),但在心脏事件发生率及物质生活维系度改善方面差异则无统计学意义(P〉0.05)。提示,医院、社区协同健康管理模式是老年PCI术后患者降低再住院率、减轻医疗负担、提高生存质量切实有效的管理措施。 相似文献
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目的探讨心肌灌注显像(MPI)在经皮冠状动脉介入治疗(PCI)术前后的应用价值。方法 32例行PCI患者,分别于术前2个月及术后6个月内行心肌灌注断层显像,术后6个月内均再次行冠脉造影检查。应用配对t检验对比分析两次MPI与CAG结果。结果 PCI术后MPI显示28例患者心肌灌注可逆性缺损或固定性缺损节段数减少。与CAG对比分析,PCI术前后两次MPI敏感性/特异性分别为83.8/73.0%,86.5/81.1%。结论对于心肌血运状况的评价,心肌灌注显像无论在PCI术前还是术后均为必要而有效的诊断手段。 相似文献
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目的:探讨糖尿病(DM)合并冠心病(CHD)和单纯CHD患者在经皮腔内冠状动脉成形术(PTCA)前、后QT间期离散度(QTd、QTcd)的变化。方法:对选择性冠状动脉造影(CAG)阳性的196例单纯CHD与58例DM合并CHD患者进行PTCA,对PTCA术前和术后QTd、QTcd进行比较分析。结果:DM组与非DM组比较,PTCA术前QTd、QTcd显著增加(P<0.01);术后24h、7d、30d的QTd、QTcd无显著差异。结论:DM是影响CHD患者QTd、QTcd延长的因素之一;但PTCA是DM合并CHD患者降低QTd、QTcd安全、有效的方法。 相似文献
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目的 观察冠心病病人经皮冠状动脉介入治疗(PCI)术后睡眠质量及影响因素,并探讨护理干预提高病人睡眠质量的有效途径.方法 将PCI术后病人104例作为研究对象,随机分为实验组和对照组,各52例.实验组PCI术后全程给予干预护理,对照组给予常规护理.采用自编睡眠质量影响因素调查表和匹兹堡睡眠指数量表(PSQI),对住院病人睡眠质量和影响因素进行调查.结果 两组影响睡眠质量比较集中的因素依次为身体不适、焦虑、环境、医源性因素及生活习惯,两组间差异无统计学意义(χ2=0.04~0.22,P>0.05).实验组PSQI总分、主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能的分数均低于对照组,两组间差异有显著性(t=3.987~38.722,P<0.01).实验组并发症的发生率低于对照组,住院天数短于对照组,差异有显著性(χ2=2.66,t=8.90,P<0.01).实验组的满意度为96%(50/52),对照组为77%(40/52),两组比较差异有显著性(χ2=8.25,P<0.01).结论 有效的护理干预能改善PCI术后病人的睡眠质量,有利于疾病的康复. 相似文献
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PTCA及血管内支架术中冠脉循环血小板功能的变化 总被引:11,自引:4,他引:7
目的 探讨经皮腔内冠脉成形术(PTCA)及冠脉内支架术对冠脉循环中血小板功能的影响。方法 29例冠心病患者分成冠脉造影组(8例)和PTCA加支架组(21例),分别于术前及术后即刻采集冠状静脉窦血,采用比浊法测定血小板最大聚集率(MPAR),放免法测定血小板α-颗粒膜蛋白(GMP-140)及血栓素B2(TXB2)的浓度。并对PTCA及支架术中不同时间点血小板功能指标的变化情况进行了观察。结果 冠脉造影前后血小板功能指标无显著变化;PTCA及支架组在球囊预扩张即刻各血小板功能指标均轻度增高;支架后即刻显著升高(P<0.05),支架后10min有下降趋势。结论 冠脉造影对冠脉循环血小板功能无显著影响;PTCA及支架术中能使血小板功能激活。 相似文献
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为探讨心肌声学造影(MCE)在经皮冠状动脉成形术(PTCA)中的应用价值,对14例冠心病人于PTCA术前后经冠状动脉完成MCE,观察心肌影象增强计分,心肌灰阶峰值强度(PI)和心肌节段半径缩短率(D%)等指标的变化。结果:心绞痛病人20个心肌节段术前有7个节段MCE计为1分者,术后仍为1分,术前13个节段为0.5分者术后有8个节段升级为三分,PI及△D%均有相应改善(P<0.01);7例心肌梗塞病人共分析了16个心肌节段,术前有12个节段MCE计分为0者,术后有9个节段的MCE计分升级,PI及△D%也得到改善,提示有存活心肌。联合观察3项指标可从心肌灌注水平评价PTCA效果。 相似文献
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磁化支架防治犬PTCA术后冠状动脉再狭窄 总被引:12,自引:0,他引:12
目的 探讨磁化支架对 (PTCA,Percutaneoustranslum inal coronary angioplasty)术后冠状动脉再狭窄的防治作用 .方法 2 0只健康杂种犬 ,超大球囊反复扩张损伤靶血管 (前降支或旋支中段 )制备 PTCA术后冠状动脉狭窄模型 (大于 5 0 % )后随机分成对照组和实验组各 10只 ,对照组靶血管置入普通 Palmaz支架 ,实验组靶血管置入磁化 Palmaz支架 .手术前、后不用抗血小板药和抗凝药 ,术后 6 mo冠状动脉造影并处死犬 ,切取靶血管 3cm进行组织病理学检查 .结果 冠状动脉造影示冠状动脉再狭窄率对照组 30 % ,实验组 0 ;组织病理学检查靶血管平均内膜厚度 [对照组 (2 .98±0 .5 6 ) m m,实验组 (1.13± 0 .4 1) mm ]有显著差异 ,P<0 .0 5 .结论 磁化支架对犬 PTCA术后冠状动脉再狭窄有显著的防治作用 . 相似文献
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目的:探讨经皮腔内冠状动脉成形术(PTCA)治疗冠状动脉粥栏硬化性心脏病(冠心病)的疗效。方法:回顾分析应用PTCA治疗的223例冠心病患者,并记录住院和随访期间的心脏事件。结果:共扩张267支血管,左前降支126支,左回顾支47支,右冠状动脉94支。非完全闭塞性病变222坂,成功率98.20%(218/222);完全闭塞性病变45支,成功率77.78%(33/45),明显低于非完全闭塞组(P〈0 相似文献
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目的 运用定量组织速度成像技术(quantitative tissue velocity imaging,QTVI)分析冠心病患者治疗前后左室壁及二尖瓣环的运动速度指标,评价其在冠心病诊断及治疗方面的应用.方法 用二维超声及QTVI技术检测冠状动脉造影(coronary angiography,CAG)患者72例,CAG术前、术后测量左室前壁、下壁、侧壁、室间隔基底部及中间部8个位点的VS、VE、VA、舒张早期心室充盈速度最大值E峰与舒张晚期心室充盈速度最大值A峰的比值(E/A)及收缩期峰值速度(MV)、射血分数(EF)值,根据CAG结果将患者分为无狭窄组及冠心病组.结果 病变组较无狭窄组各指标均较低且有显著性差异(P<0.05),病变组在经皮冠状动脉腔内成形术 支架(PTCA stent)治疗前后EF值及MV值均有所提高,且MV与EF有相关性(r=0.84,P<0.01).结论 QTVI技术是一种较客观、定量、实时评价心肌缺血的指标. 相似文献
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负荷MR心肌灌注成像检测冠心病心肌缺血与冠状动脉造影及99mTc-SPECT对比的初步研究 总被引:2,自引:0,他引:2
目的 探讨负荷MR首过心肌灌注成像检测冠心病的临床价值.方法 33例经冠状动脉造影确诊的冠心病患者,男22例,女11例,平均年龄58.32岁.其中15例常规行静息-负荷99m^Tc-SPECT心肌灌注显像.采用IR-turboFLASH序列行静息-负荷MR首过心肌灌注成像及延迟期心肌灌注成像,目测定性分析心肌灌注图像,将分析结果与冠脉造影及99m^Tc-SPECT进行比较,计算其敏感性和特异性.结果 28例(28/33)191段心肌灌注减低,其中92段(92/191)可逆性灌注减低,99段(99/191)固定灌注减低;51支冠状动脉主干或其主要分支狭窄,MR首过心肌灌注成像42支狭窄冠脉供血区心肌灌注减低.以冠脉造影为参考标准,MR首过心肌灌注成像检测狭窄50%以上冠状动脉病变的敏感性及特异性分别为:82.35%和91.67%.MR首过心肌灌注成像与99m^TC-MIBI SPECT具有很好的一致性,两者符合率为:92.5%.以99m^TC-MIBI SPECT为参考标准,MR首过心肌灌注成像检测冠心病的敏感性及特异性分别为:94.74%、92.55%.结论 负荷MR首过心肌灌注成像能有效检测冠心病心肌缺血;MR首过心肌灌注成像定性评价冠心病心肌缺血具有较高的临床实用价值. 相似文献
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Objective To assess the immediate and late clinical outcome of left anterior descending artery ostial lesions treated with percutaneous coronary intervention.Methods Seventeen patients (6 females and 11 males) treated with percutaneous coronary intervention for ostial left anterior descending artery stenoses have had clinical follow-ups over 12 months. Clinical events were defined as an occurrence of death, myocardial infarction, recurrent angina, and reguiring repeat revascularization (either by angioplasty or by surgery). A matched population treated with coronary bypass surgery was selected based on the similarities in age, left ventricular ejection fraction and the number of diseased vessels. Kaplan-Meier event-free survival curves were generated and the matched comparison was done using the Chi-square test (Mc Neimar method).Results In the catheter-based angioplasty group, the patients’ mean age was 63±8 years. One patient was treated with directional atherectomy plus balloon, 6 with rotational atherectomy plus balloon, 7 with stent and 3 with rotational atherectomy plus stent. Glycoprotein Ⅱb/Ⅲa antagonist was used in 4 cases. Initial procedural success without major complications was achieved in all cases. The mean reference diameter was 2.90±0.48 mm. The minimum lumen diameter increased from 1.05±0.30 mm to 2.40±0.45 mm, and the diameter stenosis decreased from 64%±7% to 8%±13%. During the follow-up period, adverse events reguiring repeat revascularization occurred in 8 patients. The event-free probability was 0.42±0.14 in a two-year period. In a matched population treated with bypass surgery (single mammary graft), only one event occurred, and the difference in event-free survival in two-year period between the two patient groups was significant.Conclusions Percutaneous coronary intervention for left coronary descending artery ostial lesion is technically feasible and safe, leading to an optimal early success rate, but has a higher risk of late restenosis and greater need for repeat revascularization than coronary bypass surgery. 相似文献
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西京医院冠心病介入治疗537例 总被引:1,自引:1,他引:0
目的 总结西京医院冠心病介入治疗的成功率及并发症发生率 .方法 回顾性分析 1998- 12前所有冠心病介入治疗病历完整患者的临床资料 .结果 在 5 37例患者中 ,6 9.3%为不稳定性心绞痛 ,2 0 .3%射血分数≤ 40 .0 % ,6 4.6 %为多支病变 .治疗血管 6 71支、病变 76 9处 ,B,C型病变77.9% .介入治疗病例成功率为 89.2 % .病变成功率 89.1% ,严重并发症发生率为 3.4% (死亡 1.9% ,Q波心梗 2 .0 % ,急症冠脉搭桥术 0 .2 % ) .普遍应用支架前后对比 ,病例成功率提高 (91.0 % vs80 .0 % ,P<0 .0 1) ,严重并发症发生率下降 (2 .6 % vs 6 .4% ,P<0 .0 5 ) .结论 我院病例病情严重 ,介入治疗成功率和并发症发生率与国外文献报道相似 .支架提高了介入治疗的安全性 相似文献
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Long-term outcomes of drug-eluting versus bare-metal stent implantation in patients with chronic total coronary artery occlusions 总被引:3,自引:0,他引:3
HAN Ya-ling ZHANG Jian LI Yi WANG Shou-li JInG Quan-min YI Xian-hua MA Ying-yan LUAN Bo WANG Geng WANG Bin 《中华医学杂志(英文版)》2009,122(6):643-647
Background There are limited data on the efficacy of drug-eluting stents (DES) for treatment of chronic total occlusions (CTO). The aim of the study was to evaluate the long-term clinical outcomes of DES implantation for CTO compared with bare-metal stent (BMS) implantation.
Methods Between June 1995 and December 2006, a total of 1184 patients with successful recanalization of at least one de novo CTO lesion were consecutively registered, including 660 (55.7%) who underwent DES and 524 (44.3%) who underwent BMS implantation. All patients were followed up for up to 5 years for occurrence of major adverse cardiac events (MACE). Long-term survival rates were estimated with the Kaplan-Meier method.
Results Baseline clinical and angiographic characteristics were comparable between the two groups except that patients in the DES group received longer dual antiplatelet therapy ((7.4±2.5) months vs (1.7±0.8) months, P 〈0.001). Average follow-up periods were (4.7±0.89) and (3.2±1.3) years for the BMS and DES groups, respectively. There was no significant difference in 5-year survival rates between the two groups (90.3% for DES group vs 89.6% for BMS group, Log-rank P=0.38), but the 5-year target vessel revascularization (TVR)-free survival rate in the DES group was significantly higher than that in the BMS group (81.6% vs 73.5%, Log-rank P 〈0.001). The cumulative MACE-free survival in the DES group was also significantly higher than that in the BMS group (80.6% vs 71.5%, Log-rank P〈0.001). The rates of readmission caused by cardiovascular disease (27.0% vs 37.8%, P 〈0.001) and the need for bypass surgery were significantly lower in the DES group (1.5% vs 3.4%, P 〈0.05). By multivariable analysis, DES implantation could significantly lower the long-term MACE risk of PCI for CTO patients (HR: 0.492; 95% Cl 0.396-0.656, P 〈0.001). Left ventricular ejection fraction 〈50% and elderly (〉65 years) were identified as independent predictors of long-term MACE during follow-up.
Conclusion This study demonstrates the long-term (up to 5 years) efficacy of DES for treatment of CTO, which is superior to BMS implantation in reducing the rates of TVR and MACE, as well as the need of re-admission and bypass surgery. 相似文献
Methods Between June 1995 and December 2006, a total of 1184 patients with successful recanalization of at least one de novo CTO lesion were consecutively registered, including 660 (55.7%) who underwent DES and 524 (44.3%) who underwent BMS implantation. All patients were followed up for up to 5 years for occurrence of major adverse cardiac events (MACE). Long-term survival rates were estimated with the Kaplan-Meier method.
Results Baseline clinical and angiographic characteristics were comparable between the two groups except that patients in the DES group received longer dual antiplatelet therapy ((7.4±2.5) months vs (1.7±0.8) months, P 〈0.001). Average follow-up periods were (4.7±0.89) and (3.2±1.3) years for the BMS and DES groups, respectively. There was no significant difference in 5-year survival rates between the two groups (90.3% for DES group vs 89.6% for BMS group, Log-rank P=0.38), but the 5-year target vessel revascularization (TVR)-free survival rate in the DES group was significantly higher than that in the BMS group (81.6% vs 73.5%, Log-rank P 〈0.001). The cumulative MACE-free survival in the DES group was also significantly higher than that in the BMS group (80.6% vs 71.5%, Log-rank P〈0.001). The rates of readmission caused by cardiovascular disease (27.0% vs 37.8%, P 〈0.001) and the need for bypass surgery were significantly lower in the DES group (1.5% vs 3.4%, P 〈0.05). By multivariable analysis, DES implantation could significantly lower the long-term MACE risk of PCI for CTO patients (HR: 0.492; 95% Cl 0.396-0.656, P 〈0.001). Left ventricular ejection fraction 〈50% and elderly (〉65 years) were identified as independent predictors of long-term MACE during follow-up.
Conclusion This study demonstrates the long-term (up to 5 years) efficacy of DES for treatment of CTO, which is superior to BMS implantation in reducing the rates of TVR and MACE, as well as the need of re-admission and bypass surgery. 相似文献
20.
择期经皮腔内冠状动脉成形术对心率变异性的影响 总被引:2,自引:1,他引:1
目的该文选择成功地行择其经皮腔空冠状动脉成形术的首次急性心肌梗死患者,进行心率变异检查,以了解择期PTCA对心率变异性的影响.方法所有患者均于PTCA术前1,2 d及术后1周、3个月进行24 h Hdter记录.HRV检查方法包括长时程24h时域分析(重取SDNN)和短时程5 min频域分析(采取LFnorm、HFnorm和LF/HF).结果PTCA术后1周与术前相比无明显变化.PTCA术后3个月与术前相比有显著差异,其中SDNN、HFnorm和LFnorm有明显增高(P<0.05),LF/HF有明显降低(P<0.05).结论AML接受择期PTCA有益于患者心率变异性的恢复,术后一周改善不显著,至术后3个月有显著,至术后3个月有显著改善. 相似文献