Research Progress on the Depression Status and Nursing Intervention in Patients after Percutaneous Coronary Intervention

Percutaneous coronary intervention(PCI)is an effective treatment method for myocardial ischemic necrosis.Postoperative depression caused by PCI stress will adversely affect the prognosis of patients.This article reviews the current status and influencing factors of postoperative depression after PCI and summarizes the corresponding nursing interventions,to provide a literature reference to implement effective nursing interventions for depressed patients after clinical PCI.

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.

Application of the interventional limb raising management strategy(ILRMS) at radial vascular access sites in coronary angiography and percutaneous coronary intervention:A randomized trial

Purpose:To compare the effectiveness of the interventional limb raising management strategy(ILRMS)to elastic bandage compression at radial vascular access sites following coronary angiographies(CAGs)and percutaneous coronary interventions(PCIs).Methods:Patients with ischemic coronary heart disease whose condition was stable over three months were enrolled in this clinical study(n=590;aged 25e80).All participants had just undergone CAG and PCI.Patients were randomized into either the ILRMS group(n=360)or standard post-intervention care with an elastic bandage(n=230).Overall comfort and wrist pain was assessed and the degree of index finger swelling and oxygen saturation was measured on the affected arm.All variables were measured prior to postintervention treatment and again at six hours after CAG and PCI.Results:We found that patients receiving ILRMS had significantly lower wrist pain scores and swelling around the index finger compared to the elastic bandage group(p<0.05).Oxygen saturation of the index finger was not statistically significant(p>0.05).We also found that 19.57%of the elastic bandage patients were comfortable,while ILRMS patients were significantly more comfortable(93.06%;p<0.05).Conclusions:We find that ILRMS alleviates swelling and pain of the wrist more effectively than current practices and improves the degree of overall comfort of patients who undergo CAG and PCI.

The effect of the application of cold on hematoma, ecchymosis, and pain at the catheter site in patients undergoing percutaneous coronary intervention

Objective: This study was conducted to determine the effect of the application of cold on hematoma,ecchymosis,and pain in patients undergoing percutaneous coronary intervention.Methods: It is a quasi-experimental study with a control group.A total of 200 patients (100 in the control group and 100 in the experimental group) were included in the research.In the experimental group,a cold pack was applied to the bottom of the sandbag for the first 15 min after withdrawing the femoral arterial catheter.Both groups were assessed and followed up at the first 15th minute and 4th,48th and 72 nd h.Results: After the femoral arterial catheter was withdrawn,ecchymosis and hematoma were smaller and pain was less in the experimental group at the catheter entry site compared to the control group,and the difference was statistically significant (P < 0.01).Conclusion: It was determined that the application of cold reduced the formation of hematomas,ecchymoses and pain in patients after the withdrawal of the femoral arterial catheter.

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.

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.

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.

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。

早期心脏康复护理对急诊PCI术后患者心功能及生活质量的影响

目的探讨早期心脏康复护理在急诊经皮冠状动脉介入治疗术(PCI)术后患者中的应用效果。方法选取2020年4月至2021年2月在商丘市第一人民医院接受经桡动脉行急诊PCI治疗的急性心肌梗死(AMI)患者139例为研究对象,并将其分为对照组(70例)、干预组(69例)。给予对照组常规护理,干预组在此基础上接受早期心脏康复护理干预。比较两组患者心功能及生活质量评分。结果接受早期心脏康复护理干预的急诊PCI术后患者心功能评估(左心室射血分数、左心室舒张末期内径、心输出量、每搏心输出量)结果与对照组比较,差异无统计学意义(P>0.05)。接受早期心脏康复护理干预的急诊PCI术后患者,出院1个月后生活质量4个维度(一般健康状况、生理职能、社会功能、生理机能)评分均高于对照组(P<0.05)。结论早期心脏康复护理干预能提高急诊PCI术后患者生活质量,建议临床推广应用。

量表指导下调整护理策略对PCI患者的影响

目的探讨经皮冠状动脉介入治疗(PCI)患者采用量表指导下调整护理策略的影响。方法选取2020年1月至2022年11月接收的PCI患者102例,以随机数字表法分成干预组和对照组,每组51例。对照组给予常规护理,干预组给予量表指导下调整护理策略,比较2组生活质量、舒适度、并发症。结果干预后2组世界卫生组织生存质量测定量表简表评分升高(P<0.05),干预组较对照组升高(P<0.05);2组干预后舒适状况量表评分升高(P<0.05),干预组较对照组升高(P<0.05);干预组并发症发生率较对照组降低(P<0.05)。结论PCI患者给予量表指导下调整护理策略能够提高生活质量、舒适度,减少并发症发生。

THR、MHR和NHR对冠状动脉狭窄程度和行PCI的预测价值

目的 探讨总胆固醇与高密度脂蛋白胆固醇比值(THR)、单核细胞与高密度脂蛋白胆固醇比值(MHR)和中性粒细胞与高密度脂蛋白胆固醇比值(NHR)对患者冠状动脉狭窄程度和行经皮冠状动脉介入(PCI)治疗的预测价值。方法 回顾性选取2021年6月至2023年6月在新疆医科大学第一附属医院行冠状动脉造影的患者,严格纳入排除标准筛选,共纳入6 281例患者,分为PCI组和non-PCI组,收集所有患者的临床资料、实验室检查结果及介入治疗资料。采用Pearson相关性分析评估THR、MHR和NHR与冠状动脉狭窄程度之间的关联。使用二元Logistic逐步回归和受试者工作特征(ROC)曲线评估THR、MHR和NHR单一指标和联合指标对冠心病患者行PCI治疗的影响因素和预测价值。结果 与Non-PCI组比较,PCI组年龄偏大,男性占比、患糖尿病占比、THR、MHR、NHR、Gensini评分高于Non-PCI组,既往支架植入比例少于Non-PCI组(P<0.05)。Pearson相关分析结果显示,THR(r=0.351,P<0.001)、MHR(r=0.192,P<0.001)和NHR(r=0.236,P<0.001)水平与冠状动脉狭窄程度的Gensini评分均存在显著正相关关系。多因素Logistic回归结果显示,年龄>50岁、男性、患糖尿病、THR、MHR、NHR是冠心病患者行PCI独立危险因素,既往支架植入史是冠心病患者行PCI的保护因素。ROC曲线结果显示,THR、MHR和NHR三者联合曲线下面积(AUC)最大(AUC=0.809,95%CI:0.798~0.820)。结论 THR、MHR和NHR与冠状动脉狭窄程度具有相关性,对评估冠心病行PCI治疗有较强的临床应用价值。

急性心肌梗死PCI术后病人便秘预防与管理的最佳证据总结

目的:检索并总结国内外急性心肌梗死(AMI)病人经皮冠状动脉介入治疗(PCI)术后便秘预防与管理的相关证据,为临床实践提供依据。方法:根据“6S”模型系统检索国内外数据库及相关专业网站,检索时限为2018年1月1日—2023年5月31日,文献类型包括临床决策、推荐实践、指南、专家共识、系统评价、证据总结等,对文献进行质量评价,提取证据并进行总结。结果:共纳入16篇文献,包括4篇指南、3篇专家共识、1篇推荐实践、1篇临床决策、7篇随机对照试验研究。提取包括专业护理团队、评估时机和内容、基础管理、药物护理及中医护理技术5个方面,共38条最佳证据。结论:本研究汇总了急性心肌梗死PCI术后病人便秘预防和管理的最佳证据,医护人员可结合具体临床情境有针对性地选择、应用证据,减少便秘和心脏不良事件的发生。

PCI术后病人主要不良心血管事件风险感知的质性研究

目的:了解经皮冠状动脉介入治疗(PCI)后病人主要不良心血管事件(MACE)发生风险感知,以期为改善该人群的健康行为和疾病预后提供借鉴。方法:基于描述性现象学研究方法,对18例PCI病人进行半结构式深入访谈,采用Colaizzi 7步法分析、提炼主题。结果:共归纳出个体感知疾病威胁、感知健康行为益处、感知行为转变障碍和感知风险驱动力4个主题,其中个体感知疾病威胁包括对健康状况的不确定性、易感性认知匮乏和低严重性感知;感知健康行为益处包括维持良好身体状况、缓解精神压力和减轻家庭负担;感知行为转变障碍包括疾病控制感弱、消极思维占据主导和外界错误信息误导;感知风险驱动力包括负性事件促发、健康知识增长和感知社会支持。结论:PCI术后病人对MACE风险感知水平不一,普遍存在低严重性感知,建议通过提升病人风险意识、减少行为改变障碍,增强感知效益和健康行为驱动力,以应对MACE发生风险。

中青年冠心病PCI术后患者出院准备度现状及影响因素

目的调查中青年冠心病患者经皮冠状动脉介入治疗(PCI)术后患者出院准备度的现状及影响因素。方法选取郑州大学第一附属医院心内科于2023年5—10月收治的210例接受PCI术治疗的中青年冠心病患者进行问卷调查,问卷内容由6个调查表构成:一般资料调查表、疾病资料调查表、出院准备度量表、出院指导质量量表、自我效能量表、社会支持评定量表。结果中青年冠心病PCI术后患者出院准备度总得分为(92.07±11.85)分。出院准备度总分与出院指导质量总分呈正相关(r=0.901,P<0.05);出院准备度总分与自我效能总分呈正相关(r=0.632,P<0.05);出院准备度总分与社会支持评定总分呈正相关(r=0.686,P<0.05)。多重线性回归分析显示,影响中青年冠心病PCI术后患者出院准备度的影响因素有年龄、受教育程度、婚姻状况、家庭人均收入、疾病发病情况、出院指导质量、自我效能、社会支持,能解释回归方程82.5%的变异。结论中青年冠心病PCI术后患者出院准备度处于中等水平。中青年冠心病PCI术后患者出院准备度受年龄、受教育程度、家庭人均收入、疾病发病情况、出院指导质量、自我效能、社会支持影响,患者出院准备度影响患者康复及健康结局,医护人员制定有针对性的干预措施,可提高患者治疗效果和生活质量。

基于IMB模型的延续性护理对冠心病PCI术后患者的康复效果观察

目的:观察基于信息-动机-行为技巧(IMB)模型的延续性护理对冠心病(CHD)经皮冠状动脉介入术(PCI)术后患者的康复效果。方法:选取2019年1月—2023年1月武汉科技大学附属天佑医院行PCI治疗的84例CHD患者作为研究对象,根据入院顺序分为对照组(n=42)和观察组(n=42)。对照组患者出院后给予常规延续性护理干预,观察组患者出院后给予基于IMB模型的延续性护理干预,干预时间为6个月。分别采用修订版健康促进生活方式量表-Ⅱ(HPLP-Ⅱ)、CHD自我管理行为量表、西雅图心绞痛问卷(SAQ)评估两组患者护理干预前后健康促进生活方式、自我管理行为、生存质量的变化。结果:干预后,两组患者各项评分比较,观察组患者健康促进生活方式各项评分均高于对照组,差异均有统计学意义(t=6.732、4.536、6.125、5.032、3.942、6.592,P<0.05);观察组患者自我管理行为各项评分均高于对照组,差异均有统计学意义(t=7.153、7.721、7.362、6.305、5.269、7.029、6.704,P<0.05);观察组患者生存质量各项评分均高于对照组,差异均有统计学意义(t=5.371、6.172、6.353、5.923、6.441,P<0.05)。结论:基于IMB模型的延续性护理可明显改善CHD患者PCI术后的健康促进生活方式、自我管理行为、生存质量。

基于时机理论的心脏康复护理对PCI后心肌梗死患者的影响

目的:探讨基于时机理论的心脏康复护理(TBCRN)对经皮冠状动脉介入术(PCI)后心肌梗死(MI)患者的影响。方法:选取2020年2月—2023年2月盐城市中医院收治的102例MI患者。根据随机数表法将其分为观察组及对照组,各51例。对照组采用常规护理,观察组采用TBCRN。比较两组护理前后心脏功能、应对方式、生活质量及不良心血管事件。结果:护理后,观察组心肌做功指数、左心室舒张末期内径(LVEDD)均降低,左心室射血分数(LVEF)上升,观察组心肌做功指数及LVEDD均低于对照组,LVEF高于对照组,差异有统计学意义(P<0.05)。护理后,两组应对方式问卷(CSQ)评分升高,观察组CSQ评分高于对照组,差异有统计学意义(P<0.05)。护理后,两组疾病认知程度、治疗满意度、心绞痛发作情况、心绞痛稳定性、躯体受限程度评分均升高,观察组疾病认知程度、治疗满意度、心绞痛发作情况、心绞痛稳定性、躯体受限程度评分均高于对照组,差异有统计学意义(P<0.05)。两组不良心血管事件发生率比较,差异无统计学意义(P>0.05)。结论:TBCRN可显著改善MI患者心脏功能、应对方式及生活质量。

基于VOSviewer的冠心病病人PCI术后心脏康复相关研究的可视化分析

目的:分析我国冠心病经皮冠状动脉介入治疗(PCI)术后心脏康复研究现状及热点。方法:检索中国知网、万方数据库、维普数据库建库至2023年7月31日收录的冠心病PCI术后心脏康复相关文献,对年发文量、核心作者、期刊、发文机构、关键词等进行文献计量学分析,并应用VOSviewer 1.6.18软件进行可视化分析。结果:最终纳入539篇文献,年发文量总体呈现上升趋势;核心作者149人;载文量最多的期刊是《中西医结合心脑血管病杂志》;发文量最多的机构是广州中医药大学;第一作者地域分布广泛;研究热点为冠心病、心脏康复、经皮冠状动脉介入术、生活质量、心功能。结论:我国冠心病PCI术后心脏康复相关研究不断深入,总体处于分散状态,研究质量有待提高,今后应加强作者间、机构间、地域间的深度交流,开展多中心、多样本、高质量的研究。