Do changes in intracoronary pressure aid coronary spasm diagnosis using the spasm provocation test?

BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.METHODS Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure.During each SPT,the pressure wire was advanced into the distal portion of the right coronary artery(RCA)and left anterior descending coronary artery,and the ratio of intracoronary pressure to aortic pressure(Pd/Pa)was monitored.Coronary spasm was defined as an arterial narrowing of>90%in response to the administration of acetylcholine(ACh),with chest symptoms and/or ischemic electrocardiographic changes.ACh was administered to the RCA at low,moderate,or high doses of 20,50,or 80μg,respectively,and to the left coronary artery(LCA)at low,moderate,or high doses of 50,100,or 200μg,respectively.Coronary arteries with coronary spasms at low doses of ACh were defined as group L,and those with coronary spasms at moderate or high doses were defined as group MH.Those who did not occur coronary spasms at any ACh dose were designated as group N.RESULTS Among the 132 coronary arteries assessed using a pressure wire,there were 49 in group N,25 in group L,and 58 in group MH.Baseline Pd/Pa was the lowest in group L(P=0.001).The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N(P<0.001).A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95,with a sensitivity of 0.600(15/25)and a specificity of 0.713(76/107)and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was−0.04,with a sensitivity of 0.741(43/58)and a specificity of 0.694(34/49).CONCLUSION These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasms.

Evaluation of Clinical Outcomes of ses Stent in Patients with Coronary Artery Disease After Intracoronary Stenting in Small Vessels

Background:Limited data are available for sirolimus-eluting stent(SES,Cypher)implantation in patients with coronary artery disease in small vessels.The clinical longtermoutcomes of SES in patients with coronary artery disease after intracoronary stenting in small vessels has not been yet evaluated.

Risk factors and outcomes of acute kidney injury after intracoronary stent implantation

Acute kidney injury following percutaneous coronary intervention （PCI） is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury （AKI） in patients after intracoronary stent implantation are still unknown. A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine. Those were excluded from the study if they had incomplete clinical data. The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI. The parameters of the patients included： 1） pre-operative ones： age, gender, hypertension, diabetes mellitus, cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate （eGFR）, hyperuricemia, proteinuria, emergency operation, hydration, medications （ACEI/ARBs, statins）; 2） intraoperative ones： dose of contrast media, operative time, hypotension; and 3） postoperative one： hypotension. The parameters were analyzed with univariate analysis and multivariate logistical regression analysis. Of the 325 patients, 51（15.7%） developed AKI. Hospital day and in-hospital mortality were increased significantly in the AKI-group. Univariate analysis showed that age, pre-operative parameters （left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration）, emergency operation, intraoperative parameters （operative time, hypotension） and postoperative hypotension were significantly different. However, multivariate logistic regression analysis revealed that increased age （OR=0.253, 95%CI=0.088-0.727）, pre-operative proteinuria （OR=5.351, 95%CI=2.128-13.459）, pre-operative left ventricular insufficiency （OR=8.704, 95%CI=3.170-23.898）, eGFR〈60 ml/min/1.73 m2 （OR=6.677, 95%CI=1.167-38.193）, prolonged operative time, intraoperative hypotension （OR=25.245, 95%CI=1.001-1.034） were independent risk factors ofAKl. AKI is a common complication and associated with ominous outcome following intracoronary stent implantation. Increased age, pre-operative proteinuria, pre-operative left ventricular insufficiency, pre-operative low estimated glomerular filtration rate, prolonged operative time, intraoperative hypotension were the significant risk factors ofAKl.

INTRACORONARY STENT PLACEMENT IN THE RECOVERY PERIOD AFTER ACUTE MYOCARDIAL INFARCTION

Angiography and intracoronary arena was performed in 16 patients in therecovery period after acute myocardial infarction in our hospital fromNovember 1995 to October 1997.The group comprised 16 men.mean age was52.7±11.8 years.Six had postinfarction angina,ten had postinfarction heartfailure.The infart-related vessel was single in 15 cases.8 in LAD.5 inRCA.2 in LCX,infact-related veasel was double in 1 case,LAD+RCA.MeanLesion length was 19.5±5.3mm and average diameter stenosis beforeprocedure was 92.5±5.1%.Nineteen intracoronary atents were implanted.10in LAD.7 in RCA,2 in LCX.Three patients received 2 stents,respectively.The procedure succese rate was 100%.After the stente implanting,averagediameter stenosis decreased to 0-10%.postinfarct angina disappeared,In thepostinfart heartfailure group,the diameter of left atrial and left vertricularon the UCG were reduced,enjection fraction increased significantly.Ourresults indicate that intracoronary stent in the recovery period aftermyocadial infarction provides a benefial effcct in increasing coronary bloodflow.preventing left ventricular function and reducing mortality Ascompared with sngioplasty.coronary stent placement has a higher clinicalsuccses rate and reduces the incidence of reetenosis.

Does the intracoronary pressure differ according to two types(diffuse or focal)of coronary spasm?

BACKGROUND Several reports show that two types of coronary vasospasm(diffuse and focal spasm)are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina(VSA).It is unclear whether intracoronary pressure differs between the two spasm types.AIM To investigate such relationships using a pressure wire during the spasm provocation test(SPT)in patients with VSA.METHODS Eighty-seven patients with VSA(average age:67 years;50 men,37 women)underwent SPT.During the SPT,a pressure wire was advanced into the distal portion of the right coronary artery and left anterior descending coronary artery,and the ratio of the intracoronary pressure to the aortic pressure(Pd/Pa)was continuously monitored.An SPT was performed using acetylcholine(ACh),and the presence of coronary spasm was defined as the presence of>90%arterial narrowing in response to an ACh infusion,with the usual chest symptoms and/or ischemic ECG changes.Focal spasm was defined as total or subtotal spasm within one segment of the AHA classification,while diffuse spasm was defined as>90%spasm with two or more segments.RESULTS Among 87 patients,the frequencies of metabolic syndrome and having coronary atherosclerosis were higher in the focal group(n=33)than in the diffuse spasm group(n=54,P<0.05).In the vessel analyses,in these 134 spastic segments,diffuse and focal spasms were detected in 100 and 34 vessels,respectively.The Pd/Pa at baseline was similar in both groups(diffuse:0.96±0.05,focal:0.95±0.05,P=0.35);however,the Pd/Pa during coronary spasm was lower in focal spastic vessels(0.66±0.20)than in diffuse spastic vessels(0.76±0.11,P<0.01),and the reduction in Pd/Pa during an SPT was also lower in focal spastic vessels(-0.29±0.20)than in diffuse spastic vessels(-0.18±0.11,P<0.01).The presence of focal spasm was a significant factor responsible for reduction in Pd/Pa during SPT.CONCLUSION These findings suggest that focal spasm may be more severe than diffuse spasm,judging from the intracoronary pressure during coronary spasm.

A CLINICAL ANALYSIS OF 24 PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH PTCA AND INTRACORONARY STENT IMPLANTATION

The data of 24 cases(18men,6women) with AMI treated with directPTCA and intracoronary stant implantation were analyzed.The infart-related vessels were 13 LADs,4LCXs,7KCAs:The successful rate washigh(95.8%).The mean stenoses before and after performation were 95.6±5.4%,8.3±0.2%.18 stems were implanted in 16 cases.Lesscomplication happened during the procedure.There was a higher TIMI Ⅲflow patency rate in PTCA and intracoronary stent implantation than indrug thrombolysis (92% vs 40%).Stent implantation had a significanteffect on myocardial reperfution by enhancing the successful rate ofPTCA and reducing the stenosis significantly.

Intracoronary brachytherapy for the treatment of recurrent drugeluting stent in-stent restenosis:A systematic review and metaanalysis

BACKGROUND We performed a meta-analysis on observational studies since randomized control trials are not available.We studied intracoronary brachytherapy(ICBT)and recurrent drug eluting stent in-stent restenosis(DES-ISR)to evaluate the procedural success,target lesion revascularization(TLR),incidence of myocardial infarction(MI)and all-cause mortality at 2 years follow-up.AIM To perform meta-analysis for patients undergoing ICBT for recurrent DES-ISR.METHODS We performed a systematic search of the PubMed/MEDLINE,Cochrane and DARE databases to identify relevant articles.Studies were excluded if intracoronary brachytherapy was used as a treatment modality for initial ISR and studies with bare metal stents.We used a random-effect model with DerSimonian&Laird method to calculate summary estimates.Heterogeneity was assessed using I2 statistics.RESULTS A total of 6 observational studies were included in the final analysis.Procedural angiographic success following intra-coronary brachytherapy was 99.8%.Incidence of MI at 1-year was 2%and 4.1%at 2-years,respectively.The incidence of TLR 14.1%at 1-year and 22.7%at 2-years,respectively.All-cause mortality at 1-and 2-year follow-up was 3%and 7.5%,respectively.CONCLUSION Given the observational nature of the studies included in the analysis,heterogeneity was significantly higher for outcomes.While there are no randomized controlled trials or definitive guidelines available for recurrent ISR associated with DES,this analysis suggests that brachytherapy might be the alternative approach for recurrent DES-ISR.Randomized controlled trials are required to confirm results from this study.

Comparison of the curative effect of intracoronary retrograde thrombolysis and thrombus aspiration combined with stent implantation on STEMI patients

Objective:To evaluate the short-term and long-term curative effects of precise intracoronary retrograde thrombolysis combined with stent implantation,thrombus aspiration combined with stent implantation,and traditional stent implantation in patients with acute ST-segment elevation myocardial infarction.Methods:From January 2018 to October 2019,184 patients diagnosed with acute ST-segment elevation myocardial infarction and infarction-related arterial blood flow TIMI 0 grade in the First Affiliated Hospital of Hainan Medical College and percutaneous coronary intervention(PCI)were selected.According to different surgical methods,patients were divided into intracoronary retrograde thrombolysis combined with stent implantation group(thrombolysis group,n=57 cases),thrombus aspiration combined with stent implantation group(aspiration group,n=57 cases)),traditional stent implantation group(traditional group,n=70 cases).Compare the incidence of no-reflow phenomenon after percutaneous coronary intervention,the rate of 1 hour ST_segment fall≥50%in the ECG after PCI,and the main adverse cardiovascular events(MACE)during hospitalization;compare the left ventricular end-diastolic diameter(LVEDD)、left ventricular ejection fraction(LVEF)and major adverse cardiovascular events at 1 year after PCI.Results:1.The short-term effects:The incidence of no-reflow phenomenon in the thrombolytic group was lower than that of the aspiration group and the traditional group,and the rate of 1hSTR≥50%was higher than that of the aspiration group and the traditional group,the difference was statistically significant(P<0.05).2.The long-term effects:1 year after percutaneous coronary intervention,the LVEDD of the thrombolytic group was lower than that of the aspiration group and the traditional group,while the LVEF was higher than the aspiration group and the traditional group,and the incidence of major adverse cardiovascular events in the thrombolytic group at was lowest,both the difference was statistically significant(P<0.05).Conclusion:The application of intracoronary retrograde thrombolysis combined with stent implantation in STEMI patients can reduce the occurrence of no-reflow,improve long-term cardiac function,and reduce the occurrence of major adverse cardiovascular events for short-term and long-term.

对比冠状动脉内注射替奈普酶与替罗非班对急性ST段抬高型心肌梗死的有效性及安全性

目的观察对比冠状动脉内靶向应用替奈普酶和替罗非班对急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)的有效性及安全性。方法回顾性分析2021年8月-2023年8月南京医科大学附属明基医院接受直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的STEMI患者46例,根据治疗方案分为观察组(冠状动脉内注射替奈普酶)21例,对照组(冠状动脉内注射替罗非班)25例。比较两组支架个数、心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级、TIMI血栓分级、校正的TIMI血流帧数计数(CTFC)、手术后2 hST段回落幅度(STR)≥50%百分比、术后N-末端B型脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、术后72 h左室射血分数、住院期间出血事件和心血管不良事件发生率。结果有效性方面,给药后观察组TIMI血栓分级、CTFC均优于对照组(P<0.05),观察组术后左室射血分数、术后NT-proBNP均优于对照组(P<0.05),两组支架个数、TIMI血流分级、术后2 hSTR≥50%占比差异均无统计学意义(P>0.05);安全性方面,两组住院期间出血事件、心血管不良事件发生率差异均无统计学意义(P>0.05)。结论STEMI患者,PCI联合冠状动脉内注射替奈普酶和替罗非班均安全、有效,且替奈普酶优于替罗非班。

终末期肝病模型-XI评分对急性心肌梗死冠状动脉支架植入术后患者预后的预测价值

目的 探讨终末期肝病模型-XI(MELD-XI)评分对急性心肌梗死患者冠状动脉支架植入术后的预后的预测价值。方法 回顾性收集2021年1月至2022年12月于内蒙古医科大学附属医院收治的急性心肌梗死患者226例,根据入院时MELD-XI评分,将患者分为高MELD-XI评分组和低MELD-XI评分组,每组各113例。比较两组患者近、远期预后。结果 与低MELD-XI评分组比较,高MELD-XI评分组患者左室射血分数(LVEF)显著降低[(51.67±7.91)%vs.(60.91±5.91)%],(P<0.001);N末端脑钠肽前体(NT-proBNP)显著增高(822.87±462.38) vs.(701.84±338.21)ng/L,(P=0.026)。与低MELD-XI评分组比较,高MELD-XI评分组患者不良结局事件的发生率显著增高(16.81%vs. 6.19%,P=0.012)。MELD-XI评分对急性心肌梗死冠状动脉支架植入术后不良结局事件具有一定的预测价值,曲线下面积为0.732,95%CI:0.671~0.798,(P<0.001)。结论 MELD-XI对于预测急性心肌梗死患者预后具有一定的参考价值。

冠状动脉注射尿激酶原与瑞替普酶对急性心肌梗死患者炎症因子及出血事件的影响

目的 探究冠状动脉注射尿激酶原与瑞替普酶对急性心肌梗死(AMI)患者炎症因子及出血事件的影响。方法 选取四川大学华西医院营山医院2021年9月至2023年9月AMI患者94例,根据随机数字表法分为观察组、对照组,各47例。对照组给予冠状动脉注射瑞替普酶,观察组给予冠状动脉注射尿激酶原。对比两组患者心肌灌注情况、炎症因子、出血事件及不良心血管事件。结果 治疗后,观察组血流分级(TIMI)1级、2级及3级的患者比例为17.02%(8/47)、17.02%(8/47)、65.96%(31/47),对照组TIMI1级、2级及3级的患者比例为8.51%(4/47)、19.15%(9/47)、72.34%(34/47),两组比较差异无统计学意义(U=0.842,P=0.400)。治疗后,观察组高敏C反应蛋白、白细胞介素-6及肿瘤坏死因子-α水平[分别为(2.93±1.01) mg·L^(-1)、(10.43±4.16) ng·L^(-1)、(112.67±21.36) ng·L^(-1)],与对照组[分别为(3.19±1.22) mg·L^(-1)、(11.67±4.54) ng·L^(-1)、(119.48±22.32) ng·L^(-1)]比较差异均无统计学意义(t=1.125、1.381、1.511,均P>0.05);治疗后,观察组轻度出血及不良心血管事件发生率分别为6.38%(3/47)、8.51%(4/47)均低于对照组的21.28%(10/47)、23.40%(11/47)(χ^(2)=4.374、3.887,均P<0.05),但中度出血事件发生率观察组为2.13%(1/47),对照组为6.38%(3/47),两组比较差异无统计学意义(χ^(2)=0.261,P=0.609)。结论 冠状动脉注射尿激酶原与瑞替普酶对AMI患者的心肌灌注效果相当,炎症改善作用相当,尿激酶原相较于瑞替普酶安全性更高。

急性STEMI患者直接PCI时经球囊尾部于冠状动脉内注射小剂量尿激酶原的疗效

目的探讨直接经皮冠状动脉介入术(percutaneous coronary intervention,PCI)时,经球囊尾部于冠状动脉内注射小剂量尿激酶原对急性重度血栓负荷ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的临床疗效。方法纳入2022年6月至2023年7月就诊于天津市宝坻区人民医院胸痛中心、发病时间<12 h、直接PCI时梗死相关动脉为重度血栓负荷(血栓积分≥4分)的急性STEMI患者122例,采用随机数字表法将患者分为经球囊尾部于冠状动脉内注射尿激酶原+替罗非班组(研究组,61例)和单纯经球囊尾部于冠状动脉内注射替罗非班组(对照组,61例)。比较两组临床资料。结果①两组年龄、性别、吸烟史、高血压病史、糖尿病病史、冠心病家族史、陈旧性心肌梗死病史、高脂血症病史、心功能分级、术前TIMI血流分级、TMPG血流分级、术前化验(肌酸激酶同工酶、超敏肌钙蛋白T、CRP、D-二聚体、B型脑钠肽、肌酐、血红蛋白)、梗死相关动脉、病变血管支数、症状至再灌注时间和血栓负荷等差异均无统计学意义(P>0.05)。②PCI后两组TIMI血流分级、TMPG血流分级、主要心血管不良事件及出血率差异均无统计学意义(P>0.05)。③术后研究组2 h心电图ST段回降率≤50%占比、超敏肌钙蛋白T峰值浓度、肌酸激酶同工酶峰值浓度、术后24 h B型脑钠肽均低于对照组,术后1周左心室射血分数高于对照组,差异均有统计学意义(P<0.05)。结论经球囊尾部于冠状动脉内注射小剂量尿激酶原能够减少重度血栓负荷急性STEMI患者的心肌损害,改善心脏功能,并且不增加患者住院期间出血风险。

冠状动脉内溶栓在急性心肌梗死冠状动脉高血栓负荷患者中的应用效果探讨

目的探究冠状动脉内溶栓在急性心肌梗死冠状动脉高血栓负荷患者中的应用效果。方法选取200例急性心肌梗死冠状动脉高血栓负荷患者,随机分为观察组(常规治疗+冠状动脉内溶栓治疗)、对照组(常规治疗),各100例。比较两组治疗效果、心功能指标[左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)]改善情况、临床症状评分及术后冠状动脉心肌梗死溶栓治疗实验(TIMI)血流分级。结果观察组总有效率97%高于对照组的80%(P<0.05)。观察组治疗后LVEDD(50.14±3.21)mm、LVESD(45.58±4.06)mm均较对照组的(55.36±3.48)、(50.36±4.69)mm更小,LVEF(55.81±4.41)%较对照组的(50.23±3.56)%更高(P<0.05)。观察组治疗后胸痛评分(4.42±0.74)分、呼吸困难评分(4.57±0.51)分较对照组的(3.15±0.45)、(3.30±0.33)分明显更高(P<0.05)。观察组术后冠状动脉TIMI血流分级情况优于对照组(P<0.05)。结论冠状动脉内溶栓应用在急性心肌梗死冠状动脉高血栓负荷患者中可以获得更加显著的治疗效果,有利于改善心功能,减轻临床症状。

系统免疫炎症指数对冠状动脉支架植入术后的心肌梗死患者并发支架内血栓的预测价值

目的探讨系统免疫炎症指数对冠状动脉支架植入术后的心肌梗死患者并发支架内血栓的预测价值。方法回顾性收集联勤保障部队第九四○医院于2021年1月至2022年6月收治的因心肌梗死行冠状动脉支架植入术患者462例,对其随访1年,根据患者是否发生支架内血栓,分为支架内血栓组(n=54)和对照组(n=408)。观察两组患者的临床特征,使用ROC曲线分析系统免疫炎症指数对冠状动脉支架植入术后的心肌梗死患者并发支架内血栓的预测价值。结果两组患者年龄、糖尿病、支架数目、药物依从性和系统免疫炎症指数等方面比较,有统计学差异(P<0.05)。系统免疫炎症指数对支架内血栓具有较好的预测价值,曲线下面积为0.786(95%CI:0.725~0.846,P=0.000),最佳诊断界值为653,此时敏感性和特异性分别为0.704和0.686。多因素回归分析显示糖尿病、未规律服药、支架数目≥2和系统免疫炎症指数≥653,是冠状动脉支架植入术后支架内血栓形成的独立危险因素(P<0.05)。与对照组比较,支架内血栓组患者再发心肌梗死发生率显著增高(33.33%vs.13.24%,P=0.000);死亡率显著增高(11.11%vs.2.70%,P=0.002)。结论系统免疫炎症指数对冠状动脉支架植入术后的心肌梗死患者并发支架内血栓具有一定预测价值。

急性心肌梗塞时原发冠状动脉内支架植入术疗效研究

目的：研究急性心肌梗塞（ＡＭＩ）时原发冠状动脉内支架植入术的临床疗效。方法：以标准方法对３０例ＡＭＩ患者行心肌梗塞相关动脉原发冠状动脉内支架植入术。手术成功标准为残余狭窄＜３０％、心肌梗塞溶栓治疗临床试验（ＴＩＭＩ）２或３级血流，且围术期无心脏事件（死亡、冠状动脉再梗塞和心力衰竭）发生。用二维超声心动图测定左心室射血分数。记录随访期心脏事件发生情况。结果：手术成功率为９３．３％，心肌梗塞相关动脉残余狭窄程度为（５．２±６．４）％。住院期间心脏事件发生率为６．７％。随访期中（平均７．１±２．５个月），左心室射血分数较入院时测值显著增高（０．５６±０．０９比０．４７±０．０８，Ｐ＜０．０１），２９例存活者中２８例无心脏事件发生。１２例行冠状动脉造影复查（平均３．１个月），均示心肌梗塞相关动脉通畅，且残余狭窄程度无显著变化［（４．６±７．５）％和（６．２±９．４）％］。结论：ＡＭＩ时原发冠状动脉内支架植入术安全可行，且有益于患者的临床预后。

血府逐瘀浓缩丸防治43例冠心病冠脉内支架植入术后再狭窄的临床研究

目的 :探讨血府逐瘀浓缩丸防治冠心病冠脉内支架植入术后再狭窄的临床疗效。方法 :将 84例冠脉内支架植入术成功的冠心病患者随机分为西药常规治疗加血府逐瘀浓缩丸组 (治疗组 ,43例 )和西药常规治疗组 (对照组 ,41例 ) ,疗程均为 6个月。追踪观察患者有无心绞痛复发 ,以及患者的血瘀症状和血瘀证候积分的变化 ,并通过心电图活动平板运动试验、运动 -静息心肌断层显像追踪、冠状动脉造影复查评价再狭窄的发生。结果 :治疗组患者在随访中各项血瘀症状均有明显改善 (P <0 0 1 ) ,6个月后血瘀证候积分值明显下降 (P <0 0 1 ) ,且与对照组比较有显著性差异 (P <0 0 1 ) ;治疗组心绞痛复发率显著低于对照组 (P <0 0 5 ) ;84例患者总冠脉造影复查率为 61 9% ,治疗组再狭窄率为 2 5 8% ,对照组再狭窄率为3 2 1 % (P >0 0 5 )。结论 :血府逐瘀浓缩丸防治冠脉内支架植入术后再狭窄有一定作用 ,值得进一步扩大临床研究。

心区交感神经阻滞治疗急性心肌梗死支架置入术后重度心力衰竭的观察

目的观察高位硬膜外阻滞（心区交感神经阻滞）对急性心肌梗死冠状动脉内支架置入术后重度心力衰竭（心衰）的疗效。方法高位硬膜外阻滞T1～T5交感神经，间隔2h于管内注射0．5％利多卡因3～5ml，并辅助常规药物治疗，疗程4周，观察8例患者治疗前后的症状、Killip分级及心脏彩超检查心功能参数的变化，测量左心房收缩末期内径（LAD）、左心室舒张末期内径（LVEDd）、左心室射血分数（LVEF）及短轴缩短率（FS）。结果治疗后呼吸困难明显减轻，治疗前后的心功能Killip分级分别为（3．7±0.4）和（2．0±0．5）（P〈0．01），LVEDd分别为（64．7±4．2）和（56．7±4．3）mm（P〈0．01），LVEF分别为（40．4±2．1）％和（56．5±5．2）％（P〈0．01）。结论心区交感神经阻滞对常规方法治疗无效或疗效欠佳的急性心肌梗死冠状动脉内支架置入术后心衰疗效好，可改善心功能。

血管内放射抑制猪冠状动脉球囊损伤后新生内膜形成及血管重塑

目的：观察血管内放射治疗再狭窄的有效性及相关问题，并进一步应用于临床。方法：小型猪１２ 头，体重２０ ～３０ ｋｇ 。实验组（ ｎ ＝ ７） ，在动物麻醉后，切开右股动脉，插入动脉鞘管，对冠状动脉前降支和（ 或） 回旋支的近中段进行球囊扩张术，保留０－０１４″的导丝，插入４ Ｆ ＵＳＣＩＰｒｏｂｉｎｇ Ｃａｔｈｅｔｅｒ ，并覆盖目标血管段，将带有１９２Ｉｒ 线源（ 活性长度３０ｍ ｍ ，直径０－５ ｍ ｍ ，放射活度在３５０ ～４１９ ｍＣｉ） 的导丝（ 长２８０ ｍ ｍ ，直径０－８９ ｍ ｍ） 定位在目标血管段，进行血管内放射治疗（２０ Ｇｙ） 。对照组（ ｎ ＝ ５） ，未进行治疗。术后３０ 天处死动物，快速取心脏，用中性福尔马林对冠状动脉进行原位灌注，切片行苏木素伊红、马宋三色和维尔霍夫范吉狲染色，计算机图像分析系统分析形态学及组织学的变化。结果：１ 个月后损伤处内弹力膜断裂、中膜撕裂，并有内膜增殖及管腔狭窄。放射治疗后３０ 天明显减少了血管内膜厚度（６７－３ ％ ，Ｐ＜ ０－０１） 、新生内膜面积（６７－６ ％ ，Ｐ＜ ０－０１） 和狭窄面积百分比［ 对照组：（４４－７ ±２０－７） ％ ， 实验组：（１６－６ ±１１－５） ％ ，Ｐ ＜０－０１］ ?

护理延伸服务对经皮冠状动脉内支架植入术患者自我管理行为的影响

目的探讨护理延伸服务对经皮冠状动脉内支架植入术(coronary stent implantation,CASI)患者自我管理行为的影响。方法采用便利抽样法选择湖北医药学院附属太和医院心内科2011年1-12月出院的CASI患者255例,按出院单双日分为对照组119例和干预组136例。对照组采用常规出院宣教,干预组实施6个月多途径、多方式的护理延伸服务,调查两组患者出院后自我管理行为的差异。结果出院6个月时,干预组CASI患者自我管理行为的指标得分率总水平为81.02%、临床医嘱行为为84.18%、生活改良行为为81.29%、应急处理行为为78.23%,与对照组各对应项目间的差异均有统计学意义(均P<0.05)。结论提供护理延伸服务,可以提升CASI患者出院后的自我管理行为水平以及生活质量。

经桡动脉和股动脉路径行冠状动脉造影和支架置入术患者辐射剂量分析

目的评价经桡动脉和股动脉路径行冠状动脉造影和支架置入术患者的辐射剂量,为临床介入路径选择提供参考。方法回顾性分析190例(43股动脉,147桡动脉)冠状动脉造影(CAG)样本和54例(17股动脉,37桡动脉)冠脉造影和支架置入术(CAG+IS)样本。分别按穿刺路径分为股动脉组和桡动脉组,对不同路径下的辐射剂量进行对比分析。结果股动脉和桡动脉组在CAG中平均剂量面积乘积(DAP)和累积剂量(CD)无明显差异(P>0.05)。CAG中2例CD远高于其他样本,排除2例异常样本后,桡动脉组平均剂量面积乘积(DAP)23.93Gy·cm2,平均累积剂量(CD)358.85 mGy,股动脉组平均DAP 27.06Gy·cm2,平均CD 369.57mGy,仍无明显差异(P=0.734,P=0.834)。CAG+IS中桡动脉组平均DAP 82.64Gy·cm2,平均CD1 286.41mGy,股动脉组平均DAP 78.11Gy·cm2,平均CD 1 267.76mGy,DAP和CD均无明显差异(P=0.705,P=0.919)。结论经桡动脉路径行冠状动脉造影和支架置入术的辐射剂量与经股动脉路径比较无差异。