Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention in diabetic patients with severe multivessel disease influenced by the status of insulin requirement？

Several studies have shown that coronary artery bypass graft surgery （CABG） is superior to percutaneous coronary intervention （PCI） in patients with diabetes and multi-vessel disease. Whether this advantage of CABG over PCI is confined to diabetics who require insulin is unknown. We review the published literature comparing CABG with PCI in diabetics including 8 cohorts and 4,786 patients. There was a lower rate for all-cause mortality （Relative risk （RR）： 0.78, 95% confidence interval （CI）： 0.62-0.99）, and for major adverse cardiac and cerebrovascular events （MACCE, RR： 0.59, 95% CI： 0.47-0.75） for CABG compared to PCI. Composite outcome of mortality, myocardial infarction and stoke was similar between CABG and PCI （RR： 0.87, 95% CI： 0.54-1.42）. Visual inspection of the forest plots showed that in most analyses, the point estimates of the RR are similar between the insulin requiring group and non-insulin requiring group. On meta-regression, there was no interaction between status of insulin requirement and revascularization strategies （P 〉 0.05 for all）. The pre- sented data on the still unpublished analysis of the FREEDOM trial showed similar results. Thus, in the current era, CABG is superior to PCI with lower mortality and MACCE rates, but the state of insulin requirement had no effect on the outcomes from the two revascularization strategies.

Diagnostic and prognostic value of minor elevated cardiac troponin levels for percutaneous coronary intervention-related myocardial injury:a prospective,single-center and double-blind study

Cardiac troponin-I （cTnI） and -T （cTnT） are sensitive and specific markers of myocardial injury. However, the role of increased cTnI and cTnT in percutaneous coronary intervention （PCI）-related myocardial injury remains controversial. In this prospective, single-center and double-blind study, we aimed to determine the diagnostic and prognostic value of cTnI as well as cTnT （cTns） in PCI-related myocardial injury in a Chinese population. A total of 1,008 patients with stable angina pectoris and non-ST-segment elevation acute coronary syndrome were recruited. The levels of cTnI and cTnT were examined before and after PCI. All patients were followed up for 26± 9 months to observe the incidence of major adverse cardiac events （MACEs）. Our results showed that post- PCI cTnI and/or cTnT levels were increased to more than the 99^th percentile upper reference limit （URL） in 133 （13.2%） patients, among which 22 （2.2%） were more than 5 × 99^th percentile URL. By univariate analysis, an elevation in cTns after PCI was not an independent predictor of increased MACEs, HR 1.35 （P = 0.33, 95% CI： 0.74-2.46）. In conclusion, our data demonstrate that the incidence of PCI-related myocardial injury is not common in a Chinese population and minor elevated cTns levels may not be a sensitive prognostic marker for MACEs.

Effect of a distal protection device on epicardial blood flow and myocardial perfusion in primary percutaneous coronary intervention

Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated. Methods and Results: Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%). Conclusion: Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.

Initial Experience on Anatomical Snuff Box Approach for Coronary Angiogram &Percutaneous Coronary Intervention in a Tertiary Care Center Nepal

Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Distal puncture of the radial artery through the anatomical snuff box access, however, has recently been shown potential benefit, like comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our aim was to evaluate the safety and feasibility of this new approach. Methods: A cross-sectional observational prospective study of patients underwent invasive diagnostic or therapeutic coronary procedures through the distal trans-radial access and traditional radial access. The primary endpoints were to access difficulties and in-hospital access-site related complications. Results: In 2 months, 190 patients underwent coronary procedures, of which 82 (43%) were selected in both distal transradial & traditional radial group. In 2(2.4%) & 3 (3.6%) cases, distal radial & traditional radial access cannulation was unsuccessful respectively (p >0.05). The mean age was 57.7 ± 10 & 57.2 ± 10 years in successful distal transradial & traditional radial cases respectively. There were no any major vascular complications in distal transradial group while there were 2 vascular complications in traditional radial group (p > 0.05). Conclusions: Distal transradial access is feasible and safe in selected cases, when performed by experienced operators. Larger case series and randomized trials are required to determine its efficacy in reducing vascular complications when comparing to the traditional technique.

Changes in the safety paradigm with percutaneous coronary interventions in the modern era:Lessons learned from the ASCERT registry

In the past,comparative effectiveness trials evaluating percutaneous coronary interventions(PCI),using either balloon angioplasty or bare metal stent(BMS) implantation,versus coronary artery bypass surgery(CABG) found similar survival rates at long-term follow-up with both revascularization strategies.Two major meta-analyses of these trials reported 5-and 6-year comparative effectiveness between PCI and CABG:one included only four trials that compared PCI with BMS implantation versus CABG whereas the largest one also included trials using balloon angioplasty.In these studies,the authors observed no survival differences between groups although a significant survival advantage was seen in diabetics treated with CABG and this benefit was also perceived in elderly patients.In both reports,number of involved vessels,presence of left anterior descending artery stenosis or poor left ventricular ejection fraction were no predictors of poor survival with PCI.Therefore,extent of the coronary artery disease(CAD) was not associated with poor outcome after PCI in the pre-drug eluting stent(DES) era.Recently,the ASCERT(Database Collaboration on the Comparative Effectiveness of Revascularization Strategies) registry found higher mortality rate with PCI in patients ≥ 65 years old in comparison with CABG,and advantages of surgery were seen in all subgroups including those at low risk.In this registry,PCI was accomplished by implantation of the first type of DES designs in 78% of cases.The intriguing observation of high mortality rate with PCI,including for non-diabetics and patients with two-vessel CAD,meaning a lack of clinical benefit with DES implantation,had not been seen previously.The study was not randomized,although its results are largely strengthened by its sample size.In this manuscript,the authors describe other registries and randomized trials reporting similar results supporting the findings of the aforementioned study and explore the reasons for these results,while also searching for potential solutions.

The changes of Hs-CRP and WBC count after percutaneous coronary intervention in different types of coronary heart diseases

Objective： To investigate the regulation of High sensitive C-reactive protein（Hs-CRP） and WBC count in patients with coronary heart disease（CHD） by percutaneous transluminal intervention（PCI） and to discuss the mechanism of inflammatory reaction after coronary stenting. Methods：127 patients who received successful percutaneous transluminal coronary stenting, were divided into groups of stable angina（SAP）, unstable angina（UAP）, and acute myocardial infarction（AMI） according to their clinical types. Another 41 stable angina patients with more than 70% of coronary artery tenosis who did not receive PCI served as control. Serum Hs-CRP levels and WBC count were determined before intervention, 3 days and 7 days post PCI and the data were analyzed statistically by t-test. Results： There showed no difference in clinical baseline characteristics between groups. The serum Hs-CRP level and WBC count was gradually raised in the UAP and AMI group（how about SAP group, andhad no difference in CAG group and SAP group）. After PCI serum HsCRP levels and WBC counts were significantly higher in the SAP group than in the coronary angiography group（CAG） at 3 days and had no difference at 7 days. In the UAP and AMI group, the serum Hs-CRP level at 3 days and 7 days declined obviously, however serum WBC count did not decrease apparently. Conclusion： The serum Hs-CRP level and WBC count elevate transiently after PCI. There are different inflammatory reactions in different types of coronary heart diseases after coronary stenting procedure.

Percutaneous coronary intervention in the elderly:a growing need for a growing population

Persons aged 80 and above are the fastest growing age group in the United States population, having increased 50% since 1990 and predicted to grow another 25% by 2020.

Advances in Periprocedural Anticoagulation for Percutaneous Coronary Interventions

Percutaneous coronary intervention (PCI) is commonly used in the surgical treatment of patients with various types of cardiac diseases. Some patients require long-term anticoagulation in the presence of deep vein thrombosis, atrial fibrillation and mechanical heart valves, and inappropriate anticoagulation during the perioperative period may lead to bleeding events or thrombotic events. In this paper, the importance of anticoagulation in the practical application of percutaneous coronary intervention (PCI) is first introduced, and then the various drug regimens used in the perioperative anticoagulation of percutaneous coronary intervention are explored in detail in the light of current research advances, with a view to providing guidance for clinical practice.

调卫和营宣痹方辅助干预冠心病PCI术后再发心绞痛的临床疗效观察

【目的】观察调卫和营宣痹方与常规西药联合治疗对冠心病经皮冠状动脉介入(PCI)术后再发心绞痛的治疗效果。【方法】将90例冠心病PCI术后再发心绞痛寒凝心脉证患者随机分为对照组和治疗组,每组各45例。对照组给予常规西药治疗,治疗组在对照组的基础上联合调卫和营宣痹方治疗,疗程为12周。观察2组患者治疗前后中医证候积分、心绞痛疗效积分、西雅图心绞痛量表(SAQ)评分以及左心室射血分数(LVEF)、室间隔厚度(IVS)的变化情况,并评定2组患者的临床疗效和用药安全性。【结果】(1)脱落情况方面,研究过程中,对照组和治疗组各有1例患者脱落,最终对照组和治疗组各有44例患者纳入疗效统计。(2)疗效方面,治疗12周后,治疗组的总有效率为93.18%(41/44),对照组为81.82%(36/44),组间比较(χ2检验),治疗组的疗效明显优于对照组(P<0.05)。(3)心绞痛疗效积分方面,治疗后,2组患者的心绞痛发作次数评分、持续时间评分、疼痛程度评分、硝酸甘油使用量评分及总积分均较治疗前明显降低(P<0.05),且治疗组治疗后的各项评分及总积分均明显低于对照组(P<0.05)。(4)SAQ评分方面,治疗后,2组患者SAQ量表的身体活动受限程度(PL)、心绞痛稳定状态(AS)、心绞痛发作情况(AF)、治疗满意程度(TS)、疾病认知程度(DS)评分均较治疗前明显升高(P<0.05),且治疗组治疗后SAQ量表的各项评分均明显高于对照组(P<0.05)。(5)中医证候积分方面,治疗后,2组患者的胸痛、胸闷、气短、乏力、口唇紫暗等证候积分均较治疗前明显降低(P<0.05),且治疗组治疗后的各项中医证候积分均明显低于对照组(P<0.05)。(6)心脏彩超指标方面,治疗后,2组患者的LVEF均较治疗前有所改善(P<0.05),而2组患者的IVS治疗前后均无明显变化(P>0.05);治疗后组间比较,治疗组的LVEF改善幅度明显优于对照组(P<0.05)。(7)安全性方面,治疗过程中,治疗组的不良事件发生率为2.27%(1/44),对照组为18.18%(8/44),组间比较,差异无统计学意义(P>0.05);且2组患者的血、尿、大便常规及肝功能、肾功能、心电图等安全性指标均无明显变化。【结论】在常规西药治疗基础上联合调卫和营宣痹方治疗,能有效缓解冠心病PCI术后再发心绞痛寒凝心脉证患者的临床症状,改善患者的中医证候及左心室射血分数,临床疗效显著。

血尿素氮水平对急性冠状动脉综合征患者PCI术后MACE的预测价值

目的探讨血尿素氮(BUN)水平与急性冠状动脉综合征(ACS)患者接受经皮冠状动脉介入(PCI)治疗后发生主要心血管不良事件(MACE)的关联及预测价值。方法选取2017年4月至2017年11月在首都医科大学附属北京安贞医院心内科首次接受PCI手术的ACS患者。经过36个月的随访,本研究共纳入了487例患者,包括114例发生MACE的受试者和373例没有发生MACE的受试者。利用Cox比例风险回归模型分析BUN与ACS患者PCI术后发生MACE的风险比及其95%CI,并使用受试者工作特征(ROC)曲线下面积(AUC)变化来评估BUN的预测效果。结果调整混杂因素后,Cox比例风险回归分析显示,与低水平BUN组相比,高水平BUN组发生MACE风险增加约4倍(OR=4.722,95%CI 1.716~12.993)。将BUN纳入心血管事件风险的基本预测模型及SCORE模型后,AUC面积显著提高(P<0.001)。结论血BUN可独立于传统危险因素预测ACS患者PCI术后的MACE风险。

1例体外膜肺氧合联合主动脉球囊反搏辅助下行PCI救治心源性休克患者的护理

总结1例体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)联合主动脉内球囊反搏辅助下行冠状动脉介入治疗救治急性心肌梗死伴心源性休克患者的手术护理经验。护理要点如下:采用多学科联合模式,组建“介入+ECMO团队”,规范手术站位及手术流程,做好冠状动脉介入治疗的术中配合及体外膜肺氧合、主动脉内球囊反搏的护理,术后做好转运及交接。患者手术过程顺利,围手术期无并发症发生,该患者经过专业的治疗与护理,术后第4天撤除主动脉内球囊反搏,术后第8天成功撤除体外膜肺氧合,术后第10天转普通病房治疗,术后第15天出院,随访时患者状态良好。

经皮冠状动脉介入治疗(PCI)患者的中医证型分布及预后危险因素:系统评价和meta分析

目的探讨经皮冠状动脉介入治疗(PCI)中医证候分布及相关风险因素,并评估现有研究的报告质量,以期为未来的标准化研究提供指导。方法分别在Pub Med、Cochrane Library和Web of Science等英文数据库,以及中国知网(CNKI)、维普(VIP)和万方数据库等中文数据库中检索PCI相关论文。论文检索的时间跨度从数据库建立至2023年10月1日。使用Stata 12和Python(V 3.9)进行统计分析。采用观察性研究报告规范(STROBE)声明评估纳入研究的报告质量。结果共筛选出1356篇文章,纳入40项横断面研究,涉及10270名参与者。PCI前最常见的中医证候为气滞血瘀证(n=261,36.45%),PCI后1–2周最常见的中医证候为痰瘀互结证(n=109,27.18%),PCI后6个月至1年最常见的中医证候为气虚血瘀证(n=645,37.03%)。吸烟[比值比(OR)=1.15,95%置信区间(CI)(0.83–1.47),I^(2)=24.7%,P=0.257]、寒凝气滞证[OR=4.62,95%CI(1.37–7.86),I^(2)=61.6%,P=0.074]及低密度脂蛋白(LDL)升高[OR=1.38,95%CI(0.92–1.85),I^(2)=12.2%,P=0.286]是再狭窄的风险因素。高血压[OR=7.26,95%CI(3.54–14.88),I^(2)=91.6%,P=0.001]和超重[即身体质量指数(BMI)>23][OR=1.20,95%CI(1.07–1.35),I^(2)=85.3%,P=0.009]是伴发焦虑的显著风险因素。结论本系统评价和meta分析显示,不同中医证型患者PCI术后特点和危险因素不同,未来需要更多相对高质量的研究,以提供更多的支持性证据。

NSTEMI患者PCI术后再入院风险预测模型的建立及验证

目的:探讨急性非ST段抬高型心肌梗死(NSTEMI)患者行直接PCI术后再入院的影响因素,并建立预测模型。方法:选取166例NSTEMI患者为研究对象,依据患者PCI术后1年内是否因心梗及心肌梗死并发症再入院分为再入院组(n=110)和未再入院组(n=56)。分析NSTEMI患者行直接PCI术后再入院的独立影响因素,并构建其风险预测模型列线图,绘制受试者工作特征(ROC)曲线来评估模型区分度,采用Hosmer-Lemeshow对模型进行拟合优度检验,绘制校准曲线评估模型准确度。结果:心率、有无肺炎病史、病变血管数、甘油三酯、B型利钠肽为NSTEMI患者经直接PCI术后再入院的独立预测因素(P<0.05)。构建预测模型列线图,ROC曲线显示,曲线下面积(AUC)为0.773,敏感度为70.9%,特异度为76.8%,Hosmer-Lemeshow拟合优度检验显示,差异无统计学意义(χ^(2)=8.329,P=0.351)。通过模型校准曲线提示列线图模型的实际曲线接近理想曲线。结论:心率、有无肺炎病史、病变血管数、甘油三酯、B型利钠肽为NSTEMI患者直接PCI术后再入院的独立预测因素,以此建立的预测模型列线图可直观、快捷的对该类患者再入院的风险进行评估。

冠状动脉造影微循环阻力指数对急性ST段抬高型心肌梗死患者急诊PCI术后预后的评估价值

目的探究冠状动脉造影微循环阻力指数(coronary angiography-derived index of microcirculatory resistance,caIMR)对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后发生主要心血管不良事件(major adverse cardiovascular events,MACE)的预测价值。方法连续纳入2019年9月~2022年3月在徐州医科大学附属医院诊断为STEMI的患者541例。使用FlashAngio系统(苏州润迈德医疗科技有限公司)计算caIMR。按照住院或随访期间MACE发生与否将患者分为MACE组和非MACE组,MACE定义为全因死亡、心力衰竭再入院、非计划性血运重建。采用COX回归分析、受试者工作特征(receiver operating characteristics,ROC)曲线、Kaplan-Meier生存曲线探究caIMR对STEMI患者急诊PCI术后预后的评估价值。结果随访时间为1年,其中发生MACE 61例(11.28%)。与非MACE组比较,MACE组患者有着更高的caIMR。多因素COX分析表明,caIMR是MACE的独立危险因素。ROC曲线分析结果显示,caIMR预测MACE的曲线下面积0.688,最佳截断值为25.3 U。caIMR加入到临床危险因素模型中后显著增加了模型的判别和重新分类能力;进一步将患者分为低caIMR组(caIMR<25 U,n=377)和高caIMR组(caIMR≥25 U,n=164)。Kaplan-Meier曲线显示caIMR≥25 U患者预后更差。结论caIMR是STEMI患者行PCI术后预后不良的独立危险因素,caIMR≥25 U患者预后更差。

PCI患者术后康复的研究现状与前沿分析

目的:通过文献计量学方法,探讨经皮冠状动脉介入治疗(PCI)患者术后康复的研究现状、热点分析,旨在为临床医生及广大研究者提供相关参考和借鉴。方法:检索Web of Science核心合集数据库,利用文献计量学软件R4.3. 2、VOSviewer 1.6. 18和Excel 2019提取分析文献信息,并绘制可视化知识图谱,从发文年份、国家、机构、期刊和关键词角度,对纳入文献进行分析。结果:最终纳入文献967篇,发文时间截至2023年12月。PCI患者术后康复研究领域的发文量总体呈上升趋势;发文国家及机构较集中,多为国内合作,跨国交流较少;共涉及428种期刊,发文排名前十的期刊均为心血管主题期刊,期刊质量均较高;从关键词聚类可以发现,研究热点主要聚焦在PCI术后的功能锻炼、心脏康复和稳定患者心理状态。结论:本研究通过文献计量学分析发现,PCI术后康复方面的研究已受到全球研究者的关注,并在临床康复治疗中起到显著效果,但在我国目前还处于起步阶段,未来PCI术后康复形式、如何在国内开展PCI术后康复,还需大量研究进一步证实。

全身免疫炎症指数及躯体化症状评分对首发心梗PCI术后发生院内主要不良心血管事件的预测价值

目的·探讨全身免疫炎症指数(systemic immune inflammation index,SII)及躯体化症状评分(somatic symptom scale-China,SSS-CN)对首发急性心肌梗死(acute myocardial infarction,AMI)患者接受经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)后发生院内主要不良心血管事件(major adverse cardiovascular event,MACE)的预测价值。方法·连续纳入2021年9月至2023年9月就诊于安徽省第二人民医院心内科并接受PCI治疗的首发AMI患者305例。根据患者住院期间是否发生MACE相关事件分为MACEs组(n=203)与非MACEs组(n=102)。对2组患者的性别、年龄、实验室检查结果等资料进行描述性统计分析,并根据分析结果对有统计学意义的项目进行二元Logistic回归检验;进一步绘制受试者操作特征(receiver operating characteristic,ROC)曲线,评估SII及SSS-CN预测院内MACE发生的价值。在此基础上联合冠状动脉syntax评分(syntax score,SS),评价三者联合的预测效能,根据最大约登指数确定诊断的最佳cut-off值。结果·共有203例患者发生MACE事件,其中179例(88.1%)患者发生心力衰竭,16例(7.9%)患者发生严重心律失常,4例(2.0%)患者发生休克,2例(1.0%)患者发生再发心肌梗死,2例(1.0%)患者死亡。与非MACE组相比,MACEs组SII及SSS-CN评分显著升高(1925.86 vs 934.23,38.57 vs 23.30;均P<0.05);二元Logistic回归分析结果提示两者均为MACE发生的独立危险因素。ROC曲线显示:当SII≥952时预测效能最佳,敏感度达64.0%,特异度达62.7%(AUC 0.675,95%CI 0.612~0.737);SSS-CN≥28.5分时预测效能最佳,敏感度达80.7%,特异度达77.5%(AUC 0.840,95%CI 0.794~0.886);联合SS后,三者对MACE的预测效能进一步提高(AUC 0.898,95%CI 0.862~0.933)。结论·首发AMI患者的入院SII及SSS-CN分值为此类患者行PCI术后住院期间发生MACE的独立危险因素,早期监测首发AMI患者PCI术后SII变化,或对有明显躯体化症状的患者及时进行SSS-CN评分能帮助识别院内MACE发生的高危患者。

不稳定型心绞痛病人PCI术后负性情绪的潜在类别分析及与MACE的关系

目的:分析不稳定型心绞痛(UAP)病人经皮冠脉介入治疗(PCI)术后负性情绪的潜在类别,并分析其与主要不良心血管事件(MACE)的关系。方法:选取2020年1月—2022年1月我院收治的158例UAP病人,均实施PCI,于术后次日采用汉密尔顿焦虑量表(HAMA-14)、汉密尔顿抑郁量表(HAMD-17)评价其负性情绪,并对焦虑、抑郁情绪进行潜在类别分析;随访6个月,根据MACE发生情况分为发生组和未发生组,分析负性情绪与MACE的关系。结果:焦虑情绪3个潜在类别(C1、C2、C3)的模型拟合效果最优,分别命名为焦虑-害怕组、紧张-失眠组、高水平焦虑组,概率分别为44%、36%、20%;抑郁情绪4个潜在类别(C1′、C2′、C3′、C4′)的模型拟合效果最优,分别命名为失眠组、症状组、焦虑组、低水平抑郁组,概率分别为25%、26%、30%、19%;近期MACE发生率为18.31%;年龄、合并高血压、合并糖尿病、合并高脂血症、高水平焦虑组、症状组、焦虑组均是病人MACE发生的危险因素(P<0.05),术中冠状动脉内注射替罗非班是其保护因素(P<0.05);高水平焦虑组、症状组、焦虑组与病人近期MACE发生均呈正相关(均P<0.001)。结论:UAP病人PCI术后焦虑情绪可分为焦虑-害怕组、紧张-失眠组、高水平焦虑组3类,抑郁情绪可分为失眠组、症状组、焦虑组、低水平抑郁组4类,其中高水平焦虑组、症状组、焦虑组、年龄、合并基础疾病、术中冠脉内注射替罗非班均可影响MACE的发生,且前三者与MACE发生均呈正相关。

本体感觉神经肌肉促进技术理念下呼吸训练护理对心梗PCI术后患者肺功能及运动耐力的影响分析

目的分析在心梗经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)术后患者临床干预中本体感觉神经肌肉促进技术的理念下呼吸训练干预对其肺功能、运动耐力的影响。方法便利选取2022年3月-2023年3月徐州市贾汪区人民医院治疗的92例心梗PCI患者为研究对象,采用随机数表法分为两组,每组46例。对照组行常规呼吸训练,观察组在本体感觉神经促进技术理念下行呼吸训练,比较两组肺功能指标水平、运动耐力水平及生活质量评分。结果观察组术后1周肺功能高于对照组,运动耐力水平低于对照组,差异有统计学意义(P均<0.05)。观察组生活质量评分高于对照组,差异有统计学意义(P<0.05)。结论在心梗PCI术后患者临床干预中,本体感觉神经促进技术理念下实施呼吸训练干预能有效提升患者的肺功能指标水平,增强运动耐力。

Comparative Nursing Study of Patients Undergoing Coronary Intervention Therapy in Different Ways

Purpose: To compare the surgical indicators, perioperative complications and postoperative psychological status of patients with coronary interventional therapy (CIT) by radical artery and femoral artery puncture approaches. Methods: 120 patients with CIT were divided into femoral artery group (FAG) and radial artery group (RAG) according to the operation ways. The interventional operation was performed by the same surgeon team and methods. Data of surgical indicators and perioperative complications were recorded and collected. The psychological questionare survey was made within 48 hours the after surgery by the hospital anxiety and depression scale (HAD), and the results were scored by the psychiatrist. Results: The age, sex, ethnicity, education level, disease type, and combined diseases of the two groups had homogeneity without statistical difference. There was no obvious difference in X-ray exposure time, contrast agent usage and operation time in two ways (P > 0.05). The success rate of one-time catheterization was higher in FAG than in RAG (P Conclusion: CIT via radial artery can reduce the incidence of postoperative complications, postoperative physical discomfort and psychological problems such as anxiety and depression of patients.

冠心病病人PCI术后1年出血危险因素的模型构建和验证

目的:基于LASSO-Logistic回归分析冠心病病人经皮冠状动脉介入(PCI)术后1年出血的危险因素,并建立Nomogram预测模型,以便临床采取及时、有效的干预方案。方法:选取2021年1月—12月在我院行PCI术的226例冠心病病人为研究对象,依据PCI术后1年是否出血分为出血组、未出血组。采用LASSO-Logistic回归筛选PCI术后1年出血的危险因素,进一步构建Nomogram预测模型。利用受试者工作特征(ROC)曲线、校准曲线验证Nomogram预测模型的价值。结果:PCI术后1年226例冠心病病人出血发生率为11.95%;年龄≥60岁、有消化道病史、慢性肾功能不全、使用血管闭合器、球囊扩张次数、支架术后抗血小板药物停药模式(PARIS)评分、支架术后双重抗血小板治疗病人出血并发症预测(PRECISE-DAPT)评分为PCI术后1年出血的危险因素(P<0.05);Nomogram预测模型预测PCI术后1年出血的ROC曲线下面积为0.959。结论:年龄≥60岁、有消化道病史、慢性肾功能不全、使用血管闭合器、球囊扩张次数、PARIS评分、PRECISE-DAPT评分为冠心病病人PCI术后1年出血的危险因素,基于LASSO-Logistic回归分析建立的Nomogram预测模型对PCI术后1年出血具有一定预测价值,临床应筛查高危人群并实施严格观察,制定合理治疗措施,以降低出血风险。