蚓激酶合并阿司匹林对冠脉术后患者预后的观察

目的观察蚓激酶合并阿司匹林对冠脉介入术后患者预后的观察。方法选择冠脉术后患者共120例。随机分为对照组60例,蚓激酶组60例。随访6～12月。结果对照组随访期间无症状生存为69%。蚓激酶治疗组随访期间无症状生存为93%。结论蚓激酶治疗组无症状生存明显高于对照组,明显降低心血管事件。     

蚓激酶对短暂性脑缺血患者纤维蛋白原及血黏度的影响

随着社会的不断发展进步，人民群众的生活水平日益提高，一些缺血性血管疾病如短暂性脑缺血（TIA）、脑梗死、冠心病等疾病的发病率也在逐渐升高。而缺血性疾病的发生和患者的纤维蛋白原及血黏度水平有着密切的关系，本研究观察口服蚓激酶患者的纤维蛋白原及血黏度变化的情况，希望对缺血性疾病的治疗有所参考。     

疏血通对冠脉支架介入后凝血功能及血黏滞度的影响

目的探讨疏血通注射液对冠脉支架介入后（PCI）后血液凝血功能、纤溶活性、血液黏度的疗效观察。方法选择2009—2012年冠脉支架介入治疗患者226例,随机分为治疗组116例,对照组110例,2组均给予常规治疗,治疗组术后立即应用疏血通静点,对照组术后立即应用替罗非斑静脉泵入,术后第2天、第6天测血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、国际标准化比值（INR）,比较2组疗效及不良反应。结果2组介入治疗后均未出现早期血栓形成所致的心血管事件,但治疗组凝血酶时间延长,纤维蛋白原降低,血液黏度降低,其他各项检查指标均优于对照组,差异有统计学意义（P〈0．05）。结论应用疏血通后通过对其凝血功能、血液粘滞度的检测,其在PCI术后可有效改善内皮功能和纤溶活性,从而可预防冠脉PCI术后支架内血栓形成,避免PCI术后心脏时间的发生。     

纤维蛋白原对PCI治疗后的急性冠脉综合征患者预后评估价值探讨

目的 探讨纤维蛋白原对PCI治疗后的急性冠脉综合征(ACS)患者预后评估价值.方法 收集首次诊断为ACS且接受PCI治疗患者的一般资料和病例资料,并随访3年,记录患者是否发生远期主要心血管不良事件(MACE),分析纤维蛋白原与患者发生MACE的相关性.结果 有26例患者术后3年内发生MACE,根据标准挑选了52例患者作为对照,归为非MACE组;MACE组患者纤维蛋白原水平明显高于非MACE组患者,差异有统计学意义(P<0.05),其他项目差异无统计学意义(P>0.05).结论 纤维蛋白原的浓度对于行PCI治疗的ACS患者预后有评估价值,当其浓度接近或者高于(3.4±0.9)g/L时,患者术后发生MACE的可能性较大.     

蚓激酶胶囊联合阿托伐他汀对颈动脉粥样斑块及纤维蛋白原水平的影响

目的观察蚓激酶胶囊联合阿托伐他汀对颈动脉粥样斑块及纤维蛋白原水平的影响。方法选择151例颈动脉粥样斑块患者并采用随机数字表法分为三组,蚓激酶胶囊组（48例）在常规治疗的基础上加蚓激酶胶囊2粒,每天3次（均为饭前30min）;阿托伐他汀组（50例）在常规治疗基础上加阿托伐他汀20mg,每晚1次;联合治疗组（53例）在常规治疗基础上,应用蚓激酶胶囊2粒,每天3次;阿托伐他汀20mg,每晚1次。患者均连续服药6个月,并均于服药前和服药后6个月接受颈部血管彩色多普勒超声检查,及纤维蛋白原指标检测。观察比较各组用药前后斑块的数据及纤维蛋白原的数据。结果三组患者用药后颈动脉粥样硬化斑块有不同程度逆转。蚓激酶组与阿托伐他汀组差异无统计学意义（P〉0．05）,但联合治疗组患者颈动脉粥样硬化斑块减轻较其余两组更明显（t=1．677,P〈0．05）。用药三组纤维蛋白原指标均有下降（均P〈0．05）,但联合治疗组下降程度更明显（t=1．799,P〈0．05）。结论蚓激酶胶囊和阿托伐他汀均对颈动脉粥样硬化斑块有明显的抑制作用,均有降低纤维蛋白原作用,且两药联合效果更佳。     

阿托伐他汀对急性冠脉综合征患者血浆纤维蛋白原的影响

目的：研究阿托伐他汀对急性冠脉综合征（ACS）患者血浆纤维蛋白原（Fib）的影响。方法：急性冠脉综合征患者112例，随机单盲分为阿托伐他汀组56例，常规治疗组56例，另外随机选择40例正常人做对照组。采用血凝仪法测定Fib含量。结果：急性冠脉综合征患者血浆Fib水平明显升高，明显高于正常对照组（P〈0．01）；阿托伐他汀组和常规治疗组两组治疗前Fib水平比较无显著性差异（P〉0．05）。阿托伐他汀组治疗后Fib水平较前明显降低，而常规治疗组治疗后Fib水平无明显变化，两组比较有显著性差异（P〈0．01）。结论：阿托伐他汀可通过降低Fib水平改善急性冠脉综合征患者血液流变学状态，从而改善心肌供血，抑制冠心病的发生发展过程。     

纤维蛋白原对急性冠脉综合征的预测价值

为探讨血浆纤维蛋白原(Fg)对急性冠脉综合征(ACS)的预测价值，应用Clauss凝固法测定664例因胸痛而接受冠状动脉造影患者的血浆Fg水平，并与其相关因素进行统计学分析。结果表明，冠心病患者中有高血压者Fg水平(4．315&;#177;1．446)g／L较无高血压者(4．003+1．393)g／L高0．3g／L(P&;lt;0．05)。经多元逐步回归分析发现，高血压是影响Fg水平的独立因素(P&;lt;0．05)。Fg水平与年龄呈正相关，r=0．110(P&;lt;0．05)，经多元逐步回归分析，仍有意义(P&;lt;0．05)。ACS患者血浆Fg水平(4．402&;#177;1．445g／I．)高于非冠心病者(4．036&;#177;1．792g／L)(P&;lt;0．05)，同时亦高于稳定性心绞痛者(P&;lt;0．05)。三支病变者血浆Fg水平(4．302&;#177;1．366g／L)高于单支病变者(4．072&;#177;1．255g／L)，P&;lt;0．05。结论：血浆Fg水平与患者年龄、高血压密切相关，对ACS及冠脉病变严重程度有一定预测价值。     

蚓激酶肠溶胶囊对TIA患者血黏度及纤维蛋白原影响的临床观察

目的观察蚓激酶对TIA患者血液流变及纤维蛋白原的影响。方法68例TIA患者随机分为治疗组和对照组,分别予以常规治疗及加用蚓激酶肠溶胶囊进行治疗,观察3个月后,统计患者各项相关指标及复发情况。结果治疗组的纤维蛋白原及中切血黏度较对照组降低幅度更大,而且治疗组的复发次数明显低于对照组。结论蚓激酶肠溶胶囊能够显著改善TIA患者的血黏度及血浆纤维蛋白原水平,显著降低TIA的复发率。     

冠脉介入治疗前后内皮素、C反应蛋白、纤维蛋白原的变化

为观察急性心肌梗死 ( AMI)患者介入治疗前后内皮素 ( ET1)、C反应蛋白 ( CRP)、纤维蛋白原 ( Fg)的变化 ,对经静脉溶栓后 3 4例 AMI患者于发病后 3周行延迟 PCI治疗。结果显示 ,介入前观察组 ET1、CRP、Fg与对照组相比有显著差异 ( P<0 .0 5 ) ,介入后血液中 ET1、CRP、Fg水平较介入前显著升高 ( P <0 .0 5 ) ,但与对照组相比无显著差异 ( P>0 .0 5 )     

血浆纤维蛋白原与急性冠脉综合征关系探讨

目的:探讨血浆纤维蛋白原水平与急性冠脉综合征间的关系。方法:检测90例诊断为冠心痛的住院病人血浆纤维蛋白原水平。其中稳定性心绞痛30例,不稳定性心绞痛30例,急性心肌梗死30例。结果:不稳定性心绞痛与急性心肌梗死病人血浆纤维蛋白原水平明显高于稳定性心绞痛病人(P<0.05)。结论:血浆纤维蛋白原参与了急性冠脉综合征形成,升高的血浆纤维蛋白原水平可能是急性冠脉综合征发生的预测因子。     

Berberine ameliorates inflammation in patients with acute coronary syndrome following percutaneous coronary intervention

1. Inflammation is central to the pathogenesis of acute coronary syndrome (ACS) and is associated with adverse clinical outcomes after percutaneous coronary intervention (PCI). Recent in vitro work has demonstrated the anti‐inflammatory effect of berberine, a primary component of the traditional Chinese medicine ‘umbellatine’. In the present study, we further tested whether berberine had any beneficial effects on ACS patients following PCI. 2.In all, 130 ACS patients undergoing PCI were recruited to the present study. Sixty‐one patients were treated with berberine (300 mg, t.i.d., for 30 days) in addition to standard therapy, whereas the remaining patients received standard therapy alone. Circulating inflammatory markers were measured by ELISA, whereas serum lipid profiles were measured by routine chemical assays. 3.In the berberine‐treated group, matrix metalloproteinase (MMP)‐9, intercellular adhesion molecule (ICAM)‐1, vascular cell adhesion molecule (VCAM)‐1, C‐reactive protein, interleukin‐6 and monocyte chemoattractant protein‐1 were significantly reduced relative to baseline values. Furthermore, the changes in MMP‐9, ICAM‐1 and VCAM‐1 from baseline to after 1 month of treatment differed significantly between the two patient groups. There was a tendency for berberine to induce a slightly greater reduction in low‐density lipoprotein cholesterol and triglycerides than standard therapy alone, without affecting high‐density lipoprotein cholesterol, but the differences failed to reach statistical significance. No severe adverse effects of berberine were observed. 4.The results of the present study provide the first clinical evidence of the anti‐inflammatory action of berberine in ACS patients following PCI. Berberine may become adjunct therapy to further improve clinical outcomes via its anti‐inflammatory effect in ACS patients.     

Pharmacological antithrombotic adjuncts to percutaneous coronary intervention

Stent thrombosis is the major cause of early adverse events during percutaneous coronary intervention. Its incidence has fallen considerably in recent years, principally due to the introduction of effective antithrombotic therapies. The selection of an appropriate antithrombotic regimen is critical in achieving a balance between reducing ischaemic events and minimising bleeding complications in patients undergoing percutaneous coronary intervention. In this article, evidence for the role of antiplatelet and anticoagulant therapies is discussed, including the thienopyridines, glycoprotein IIb/IIIa receptor antagonists, direct thrombin inhibitors and pentasaccharides.     

Bivalirudin during percutaneous coronary intervention in acute coronary syndromes

Introduction: Anticoagulant therapy is critical to prevent ischemic recurrences and complications in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Unfractionated heparin (UFH), an injectable anticoagulant has several limitations: lack of predictability of its biological efficacy, platelets activation, heparin-induced thrombopenia and bleedings. Bivalirudin, a synthetic direct thrombin inhibitor has biological properties that promised better clinical outcome in ACS patients undergoing PCI.

Areas covered: The present review aimed to summarize two decades of randomized clinical trials that compared bivalirudin to UFH in ACS patients treated with PCI. Early trials highlighted a reduction of bleedings with bivalirudin compared to UFH in combination with glycoprotein inhibitors (GPI). Recent studies questioned this reduction given that GPI are less and less used during PCI. Further, trials raised concerns about the risk of stent thrombosis in patients treated with bivalirudin. In light of this data, bivalirudin has been downgraded in international guidelines and appears as a second line anticoagulant agent after UFH.

Expert opinion: The highly questioned reduction of bleedings under bivalirudin and the potential risk of stent thrombosis are unwarranted. Based on clinical trials, UFH has no equivalent in terms of anticoagulation in ACS patients undergoing PCI.     

基层医院高龄患者冠心病介入治疗体会

目的:评价高龄(≥75岁)冠心病(CAD)患者在基层医院直接经皮冠状动脉介入治疗(PC I)的安全性及疗效。方法:回顾分析2006年1月—2009年12月年龄≥75岁的82例CAD患者行PC I治疗的临床病变特点、手术成功率、手术并发症及近中期临床疗效。结果:PC I的成功率为95.0%,靶病变成功率为96.9%,未出现严重并发症。结论:基层医院对高龄老年CAD患者行PC I治疗成功率高,手术相关并发症少,安全有效。充分的术前准备、全面的评估、权衡利弊及谨慎的操作和适应证的严格掌握是保证安全有效的前提。     

冠心病患者PCI术后康复治疗的意义探讨

目的观察康复治疗对冠心病PCI术后患者生理、心理恢复的影响。方法平均将64例PCI术后患者随机分为两组：康复治疗组、对照组。观察术后2周及3个月时两组6min步行试验时的距离及心绞痛诱发情况。同时调查患者的生活质量满意度。并作统计学分析。结果两组间6min步行试验距离、满意度均有显著差异,诱发心绞痛的情况也有不同。结论康复治疗有助于进一步提高生活质量及运动耐量、减少心绞痛的发生。     

The early percutaneous coronary intervention in elderly patients with acute coronary syndrome

It is challenging to undo early percutaneous intervention (PCI) in the elderly with acute coronary syndrome (ACS). Fifteen patients older than 65 years with ACS within 24 hours of the event were admitted from April 4, 2004 to December 12, 2005. All the patients had early percutaneous coronary intervention and were followed up for 6–12 months by telephone or in the out-patient department. Nine of the 15 patients exhibited acute myocardial infarction (AMI). Six exhibited unstable angina (UA). All the patients had early PCI. The average door-to-balloon time was 78 minutes (40–110 minutes). The average PCI time was 99 minutes (68–120 minutes). Nineteen of 36 lesions in the fifteen angioplasty patients were treated and 20 stents were implanted in total. All the procedures were considered successful. Neither deaths nor recurrent angina occurred in the 6–12 months of follow-up. It was shown that early PCI might be an effective and safe method to treat elderly patients with ACS.     

冠心病介入治疗质量控制体系建设和展望

二十一世纪以来我国冠心病介入治疗进入加速发展阶段,2009 年正式开展全国冠心病介入诊疗医疗质量控制有关工作,国家质控中心的主要工作包括与各省级质控中心建立密切联系,不断完善质控网站建设和质控方法;进行质控数据收集、分析和质控报告撰写、发布;开展质控检查,并开展与冠心病介入治疗质控相关的其他工作,如介入培训和准入工作。质控体系的正常运转使我国的冠脉介入质控工作初见成效,以数据形式准确掌握不同地区以及全国冠脉介入开展的情况,质控系统的建立和常规质控工作保证了我国冠脉介入治疗水平的稳步提高。未来需进一步完善质控技术和管理队伍建设,逐步建立和完善质控评估体系,将冠心病介入诊疗质控与冠心病诊疗质量管理相结合,在一定范围内以特定方式发布医疗质量评估、排名的结果,从而使冠心病介入治疗水平得到进一步提高。     

The role of eptifibatide in patients undergoing percutaneous coronary intervention

Glycoprotein (GP) IIb/IIIa receptor antagonists inhibit the binding of ligands to activated platelet GP IIb/IIIa receptors and, therefore, prevent the formation of platelet thrombi. They have been extensively studied in patients undergoing percutaneous coronary intervention (PCI). Eptifibatide, one of the approved GP IIb/IIIa inhibitors, is a small heptapeptide that is highly selective and rapidly dissociates from its receptor after cessation of therapy. In clinical studies, concomitant administration of eptifibatide in patients undergoing elective PCI reduced thrombotic complications in the IMPACT-II (Integrilin to Minimize Platelet Aggregation and Prevent Coronary Thrombosis II) and ESPRIT (Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy) trials. In the PURSUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) trial, which included 10,948 patients with non-ST-elevation acute coronary syndromes, eptifibatide significantly reduced the primary end point of death and non-fatal myocardial infarction at 30 days compared with placebo. In patients with ST-segment elevation myocardial infarction (STEMI), eptifibatide has been studied as adjunct to primary PCI and improved epicardial flow and tissue reperfusion. Studies are now evaluating eptifibatide in high-risk patients with non-ST elevation acute coronary syndromes (NSTE-ACS) and a planned early invasive strategy in the EARLY-ACS (Eptifibatide Administration prior to Diagnostic Catherization and Revascularization to Limit Myocardial Necrosis in Acute Coronary Syndrome) trial and in patients with primary PCI for STEMI in comparison to abciximab in the EVA-AMI (Eptifibatide versus Abciximab in Primary PCI for Acute Myocardial Infarction) trial. After the completion of these trials, the value of eptifibatide in patients undergoing PCI in different indications can be determined.     

伊伐布雷定联合比索洛尔对冠心病PCI术后患者心脏康复的影响

目的：研究伊伐布雷定联合比索洛尔对冠心病经皮冠状动脉介入（PCI）术后患者心脏康复的影响。方法：选取于某院行PCI术的冠心病患者84例,随机分为观察组（n=42）及对照组（n=42）,观察组在常规冠心病二级预防治疗的基础上给予比索洛尔1.25 mg联合伊伐布雷定治疗,对照组在常规冠心病二级预防治疗的基础上仅给予比索洛尔5~10 mg口服。分别于治疗前、治疗4周及治疗12周时监测两组患者的6 min步行实验的距离、6 min步行实验的心率及血氧饱和度、左室射血分数、左室收缩末期内径、左室舒张末期内径、左室间隔厚度及左心室壁厚度。结果：观察组与对照组比较,在治疗12周时,6 min步行试验的距离、LVEF及左室正常舒张功能的比例明显增加,LVEDD、LVESD及6 min步行实验时的心室率明显降低,差异均具有统计学意义（P<0.05）;与治疗前相比,在治疗4周及12周时,观察组的6 min步行试验的距离、LVEF及左室正常舒张功能的比例明显增加,LVEDD、LVESD及6 min步行实验时的心室率明显降低,差异均具有统计学意义（P<0.05）;研究期间,观察组不良反应发生率低于对照组,但无统计学差异（P>0.05）。结论：伊伐布雷定联合比索洛尔对冠心病PCI术后患者的心脏康复的长期效果优于单纯比索洛尔治疗,不增加不良反应,是一种安全有效的治疗方案。