急性冠脉综合征患者接受经皮冠状动脉介入治疗前后抗凝策略

急性冠脉综合征(ACS)是一组由急性心肌缺血引起的临床综合征,包括不稳定型心绞痛(UA)、非ST段抬高型心肌梗死(NSTEMI)和ST段抬高型心肌梗死(STEMI)。目前抗血小板治疗和抗凝治疗是ACS患者抗栓治疗的两大重要组成部分。强力抗血小板及抗凝药物的出现,在很大程度上减少了ACS患者缺血事件的发生率,但经皮冠状动脉介入治疗(PCI)围手术期抗血小板及抗凝治疗的联合应用增加了出血风险,而出血风险又增加发生死亡、心肌梗死(MI)或卒中的风险,其原因可能与输血和/或停用抗凝抗血小板药物有关。因此,权衡抗栓效应及出血风险可进一步改善ACS患者临床疗效。本文就ACS患者有关接受PCI前后的抗凝治疗策略的一些大型临床试验及抗凝药物在当今早期侵入性冠状动脉治疗时代中的应用现状作一综述。

冠心病PCI术后合并房颤患者的抗栓治疗研究

探讨接受PCI术的房颤患者的抗栓治疗现况及临床预后。方法 选择2016年1月~2020年12月在某医院诊断为PCI术后1年合并房颤的285例患者,根据出院时不同的抗栓方案分为四组,分析各组的临床资料及每年实际抗栓情况,采用二元Logistic回归法分析有抗凝指征的患者使用口服抗凝剂的相关因素及COX回归法分析患者临床预后出现MACEs的影响因素。结果 出院后患者使用单一口服抗凝药的比例在逐年上升;二元Logistic分析显示,抗凝药的使用与既往有陈旧性心肌梗死、HAS-BLED评分≥3分呈负相关,与既往有缺血性脑卒中史、持续性房颤呈正相关;COX回归显示,患者年龄≥75岁与MACEs的发生风险增加相关;与阵发性房颤相比,持续性房颤与MACEs的发生风险增加相关;与出院后使用OAC相比,出院后使用SAPT也与MACEs的发生风险增加相关。结论 临床实践中,PCI术后一年合并房颤患者出院时实际抗栓治疗方案与最新指南所推荐的抗栓治疗方案仍有一定差距。既往有陈旧性心肌梗死、HAS-BLED评分≥3分是影响有抗凝指征患者不规范使用抗凝药的独立危险因素。随访过程中,患者为高龄、持续性房颤以及出院后行单一抗血小板药物治疗与发生MACEs的风险增加相关。

血小板GPⅡb基因多态性与PCI术后血小板功能变化

目的探讨血小板膜糖蛋白(GP)Ⅱb HPA-3基因多态性与急性冠脉综合征(ACS)经皮冠状动脉介入治疗(PCI)前后血小板功能变化的关系。方法选择行PCI的ACS患者120例测定GPⅡb HPA-3基因型,测定各基因型PCI术前、术后即刻、术后24h三个时间段血浆GMP-140、vWF和PAI-1浓度。对不同基因型PCI前后血小板功能指标进行对比。结果经Logistic回归分析校正各因素后发现:GPⅡbHPA-3bb基因型是心肌梗死的独立危险因素。GMP-140在bb基因型组PCI术后即刻、术后24h较aa、ab基因型均增高(P<0.01)。vWF三种基因组差异无统计学意义。PAI-1bb在基因组PCI术后即刻比aa、ab基因型存在更明显的PAI-1活化(P<0.01)。结论血小板GPⅡb HPA-3bb基因型可能是心肌梗死的独立危险因素,并且该基因型ACS患者在PCI术后存在更迅速、更显著的血小板活化,提示bb基因型可能是PCI后血栓负荷过重和术后心血管事件的危险因素。

Family care and subjective well-being of coronary heart disease patients after percutaneous coronary intervention:Mediating effects of coping strategies

Objectives To analyze the correlations between family care,coping strategies and the subject well-being(SWB)of patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods From November 2019 to October 2020,264 CHD patients who had undergone PCI were enrolled in this questionnaire survey.The research tools applied included General Information Questionnaire,the Adaptation,Partnership,Growth,Affection and Resolve,Medical Coping Modes Questionnaire,and the General Well-being Schedule.SPSS 24.0 and Amos 23.0 software packages were used for statistical analysis.Results The mean scores for family care,confrontation,avoidance,acceptance-resignation and SWB,were 7.59±2.24,20.03±3.78,16.49±2.70,10.42±2.01,and 73.31±11.63,respectively.Subgroup analysis showed that the path coefficient between family care and subjective well-being was higher in males than females.Family care was directly related to coping strategies.The coping strategies were directly related to SWB,while family care showed an indirect association with SWB via coping strategies.Conclusions Family care can improve CHD patients’SWB post-PCI,and coping strategies are important for the link between family care and SWB.Also,men received more family care than women.Based on a patient's characteristics,healthcare providers can promote patients’positive coping strategies,increase their perceived family care,and improve the patient's SWB.

Effects of multidisciplinary exercise management on patients after percutaneous coronary intervention:A randomized controlled study

Objectives To explore the effectiveness of the mobile app-based multidisciplinary exercise management on patients who receive percutaneous coronary intervention(PCI).Methods From January to October 2020,54 patients after PCI were randomly assigned to the intervention group(n=27)and the control group(n=27).The intervention group received the mobile app-based multidisciplinary exercise management,whereas the control group received routine care.The patients after PCI began to take intervention one month after the operation,and the intervention lasted for two months.Before and after the intervention,6-Minute Walking Distance was used to evaluate the patient’s exercise tolerance,and the patient’s exercise compliance was evaluated according to the patient’s exercise status recorded by the mobile app.The cognitive questionnaire on knowledge about PCI treatment for Coronary Heart Disease,the Self-efficacy for Chronic Disease Scale and the Perceived Social Support Scale were used to evaluate patients’disease-related cognition,self-efficacy and perception of social support.This study was registered on Clinical Trials.gov with registration number ChiCTR2000028930.Results Totally 51 patients after PCI who completed this study(25 patients in the intervention group and 26 patients in the control group)were included in the analysis.After 2 months of intervention,the exercise compliance of patients in the intervention group was better than that in the control group.And 6-Minute Walking Distance(469.36±57.48 vs.432.81±67.09),and the scores of knowledge of PCI treatment for coronary heart disease(52.64±9.82 vs.42.42±8.54),Self-efficacy for Chronic Disease Scale(42.40±8.04 vs.36.88±7.73)and Perceived Social Support Scale(74.04±5.73 vs.66.69±6.86)in the intervention group were higher than those in the control group with statistical significance(P<0.05).Conclusions The multidisciplinary exercise management based on the mobile app can effectively improve exercise tolerance,exercise compliance,disease-related cognition,self-efficacy,and perception of social support during exercise training for patients after PCI.

Retrospective analysis of exercise capacity in patients with coronary artery disease after percutaneous coronary intervention or coronary artery bypass graft

Objectives:To describe the current state of exercise capacity as well as to identify its predictors in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in the mainland of China.Methods:A retrospective study design was employed.We evaluated 230 CAD patients following PCI or CABG in a cardiac rehabilitation center from January 2019 to October 2019.The patients were referred to undergo incremental cardiopulmonary exercise testing with a cycle ergometer.The Zung Self-Rating Anxiety Scale and the Zung Self-Rating Depression Scale were used to evaluate patients' mental health.Statistical analysis was performed using the chi-square test,Fisher's exact test,t-test,Mann-Whitney U test,and binary logistic regression.Results:Among the 230 patients,223 patients demonstrated reduced exercise capacity.Resutlts of the logistic regression analysis showed that anxiety (OR =1.13,95% CI 1.01-1.32,P =0.029) was an independent risk factor for reduced exercise capacity in patients following the PCI or CABG.Conclusions:Exercise capacity of Chinese CAD patients after PCI or CABG was relatively poor.Alleviating symptoms of anxiety and making exercise prescriptions according to the results of the cardiopulmonary exercise test should be considered during the intervention to improve CAD patients' exercise capacity.

Coronary arteriography under acupuncture anesthesia:a case report

Acupuncture anesthesia is a technique by partially or completely replacing anesthetics with acupuncture in surgery based on the traditional acupuncture analgesia mechanism.It emerged in the 1950s,went viral in the 1970s and then gradually fell into decline.In the recent years,this technique has regained attention and further research.Acupuncture anesthesia can be classified as either pure acupuncture anesthesia or acupuncture-medication combined anesthesia.To expand the application of this technique,a patient with non-ST elevation acute coronary syndrome in urgent need of percutaneous coronary intervention (PCI) received pure acupuncture anesthesia because of an allergy to lidocaine,and the operation went successfully.This is the first time that pure acupuncture anesthesia and coronary arteriography were combined,which is of great significance in further study and development of acupuncture anesthesia.