冠心病合并左心功能不全患者冠状动脉介入治疗预后影响因素分析

【目的】探讨经皮冠状动脉介入治疗（PCI）对冠心病合并左心功能不全患者预后的相关因素。【方法】选择2007年5月至2012年5月本院收治的416例冠心病合并左心功能不全患者,根据其是否行PCI治疗将其分为观察组（n=264）和对照组（n=152）,收集其临床资料,包括年龄、性别、高血压病史、糖尿病病史、心功能指标、病变血管情况等资料,并进行2年随访,比较PCI治疗与普通药物治疗对患者预后的影响,logistic回归分析影响冠心病并左心功能不全患者PCI治疗后预后的相关因素。【结果】术后经2年随访共有134例（32．2％）患者死亡,其中观察组63例,对照组71例,观察组患者病死率均显著低于对照组患者,猝死及急性心力衰竭是患者死亡的主要原因。年龄、糖尿病史、高血压病史、心绞痛、LVEF、病变血管支数均与冠心痛合并左心功能不全患者预后相关。【结论】冠心病合并左心功能不全患者行PCI治疗可显著减少患者病死率。年龄、合并糖尿病、高血压病史,有心绞痛症状,LVEF、病变血管支数是决定其预后的重要因素。     

老年冠心病患者PCI术后常见并发症观察及相关干预措施

[目的]探讨老年冠心病患者经皮冠状动脉介入治疗(PCI)术后常见并发症及相关干预措施.[方法]选择2012年6月至2014年6月本院收治的202例经皮冠状动脉造影确诊的冠心病老年患者为研究对象,其中男116例,女86例,观察患者PCI术后出现的并发症并给予及时有效的干预措施.[结果]术后108例患者出现并发症,其中腰部酸痛不适最多为94例(46.53%),穿刺部位血肿10例(4.95%),尿潴留9例(4.46%),血管迷走神经反射7例(3.47%),造影剂反应4例(1.98%).其中出现2个及以上并发症患者16例(7.92%),所有术后出现并发症的患者均及时给予相关的干预措施,均好转.[结论]PCI术后及时有效的干预措施对降低冠心病PCI术后并发症的发生有重要作用,对改善患者预后有重要意义.     

局部松解弹力绷带减少冠脉介入术后患者皮肤损伤的临床观察

经股动脉穿刺行冠脉介入诊断和治疗的患者228例,采用局部松解弹力绷带处理手术后穿刺口,皮肤完好率为96.9%。采用局部松解弹力绷带处理冠脉术后穿刺血管,显著降低了穿刺皮肤并发症。     

15例逆行导引钢丝技术治疗慢性完全闭塞病变的围手术期护理

总结了15例冠状动脉慢性完全闭塞病变行逆行导引钢丝技术的术后护理.主要采取以下护理措施:密切观察病情变化,积极预防术后并发症,包括冠状动脉穿孔、血管并发症、胃肠道反应、时比剂肾病及放射性损伤等,并做好出院指导.本组住院期间无不良心血管事件发生,患者均好转出院.     

冠状动脉三支病变患者不同血运重建策略的预后比较

[目的]比较冠状动脉三支病变患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)和冠状动脉旁路移植术(coronary artery bypass grafting,CABG)的预后。[方法]回顾性分析了首次行血运重建治疗的冠状动脉三支病变患者233例,其中PCI组160例,CABG组73例,比较两组患者2年的不良心脑血管事件(包括全因死亡;全因死亡和非致死性卒中/心肌梗死联合终点;再次血运重建术)。[结果]CABG组的2年再次血运重建率低于PCI组,但由于术后院内死亡率较高导致CABG组2年全因死亡发生率高于PCI组(P﹤0.05),2年主要不良心脑血管事件发生率(major adverse cardiac and cerebrovascular events,MACCE)、2年全因死亡和非致死性卒中/心肌梗死联合终点发生率两组间差异无统计学意义(P﹥0.05)。[结论]冠状动脉三支病变患者2年联合终点事件发生率两组间并无差异,但PCI组的2年再次血运重建率仍高于CABG组。     

浅谈经皮冠状动脉成形术(PTCA)在临床应用中的护理问题及防护

本文通过对医院心脑血管内科在临床上运用经皮冠状动脉成形术过程中出现的并发症及相应的护理问题的整理和总结,为今后在临床上运用经皮冠状动脉成形术提供依据和指导方法,以便经皮冠状动脉成形术在心血管疾病方面的运用更加的安全有效。     

Cost Determinants of Percutaneous and Surgical Interventions for Treatment of Intermittent Claudication from the Perspective of the Hospital

Purpose To identify pretreatment predictors of procedural costs in percutaneous and surgical interventions for intermittent claudication due to aortoiliac and/or femoropopliteal disease. Methods A retrospective study was conducted in 97 consecutive patients who underwent percutaneous or surgical interventions over 15 months at a tertiary care center. Nineteen clinical predictive variables were collected at baseline. Procedural costs (outcome) were assessed from the perspective of the hospital by direct calculation, not based on ratios of costs-to-charges. A multivariable regression model was built to identify significant cost predictors. Follow-up information was obtained to provide multidimensional assessment of clinical outcome, including technical success (arteriographic score) and clinical result (changes in ankle-brachial pressure index; cumulative patency, mortality, and complication rates). Results The linear regression model shows that procedural costs per patient are 25% lower in percutaneous patients (versus surgical), 42% lower for patients without rest pain than for those with, 28% lower if treated lesions are unilateral (versus bilateral), 12% lower if the treated lesion is stenotic rather than occlusive, 34% higher in sedentary patients, and 11% higher in patients with a history of cardiac disease. After a mean clinical follow-up >2 years, between-group differences between percutaneous and surgical patients were small and of limited significance in all dimensions of clinical outcome. Conclusion Predictors of clinical outcome are different from predictors of costs, and one should include both types of variables in the decision-making process. The choice of percutaneous versus surgical strategy, the presence of rest pain, and the bilaterality of the culprit lesions were the main pretreatment determinants of procedural costs. When possible choices of treatment strategy overlap, percutaneous treatment should provide an acceptable result that is less expensive (although not equal to surgery).     

Complications of lower-limb percutaneous transluminal angioplasty: A prospective analysis of 410 procedures on 295 consecutive patients

> Purpose: To evaluate complications and their predictors in percutaneous transluminal angioplasty (PTA) of lower-limb arteries. Methods: Complications in 410 angioplasty procedures in 295 consecutive patients (192 claudicants and 103 suffering from chronic critical ischemia) were prospectively analyzed. Results: The total complication rate was 10.5% (43/410). There were 21 major complications (5%), eight of which required surgical treatment, including four hematomas, two arteriovenous fistulae, and two pseudoaneurysms at the puncture site, two retroperitoneal hematomas, and 11 thrombotic/thromboembolic complications. There were significantly more complications with treatment of occlusions compared with stenoses (18% vs 7%, p= 0.002). Women had significantly more bleeding complications than men (15% vs 6%, p= 0.032). The 30-day mortality rate in patients with critical ischemia was 10%. Conclusion: In lower-limb PTA a few target lesion- and patient-related determinants of complications could be identified. In patients with critical ischemia, the 30-day mortality was rather high and mainly due to associated coronary and cerebrovascular diseases.     

Interventional therapeutic techniques in Budd-Chiari syndrome

Purpose To analyze the results obtained with percutaneous therapeutic procedures in patients with Budd-Chiari syndrome (BCHS). Methods Between August 1991 and April 1993, seven patients with BCHS were treated in our hospital. Three presented with a congenital web; in another three cases the hepatic veins and/or the inferior vena cava (IVC) were compromised after major hepatic surgery; one patient presented with a severe stenosis of the intrahepatic IVC due to hepatomegaly. Results One of the patients with congenital web has required several new dilatations due to restenosis; one patient required a transjugular intrahepatic portosystemic shunt procedure while awaiting a liver transplantation. The two postsurgical patients with stenosed hepatic veins did not require any new procedure after the placement of metallic endoprostheses. However, the patient with liver transplantation presented IVC restenosis after balloon angioplasty that required the deployment of metallic endoprostheses. In the patient with hepatomegaly a self-expandable prosthesis was placed in the intrahepatic portion of the IVC before (4 months) a liver transplantation. Conclusion Interventional therapeutic techniques offer a wide variety of possibilities for the treatment of patients with BCHS. For IVC stenoses, the results obtained with balloon angioplasty are at least as good as those obtained with surgery.