年轻冠心病介入治疗术后心血管康复管理行为发展轨迹及影响因素分析

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目的:探讨年轻冠心病经皮冠状动脉介入治疗(PCI)术后患者康复管理行为的发展轨迹及其异质性亚组,并分析基线心理社会因素及临床特征对轨迹归属的影响,为制定精准化心脏康复管理策略提供依据。方法:采用回顾性研究设计,选取2022年1月至2025年3月在郑州大学第五附属医院心血管内科行首次PCI治疗的265例年轻冠心病患者(年龄22~45岁)为研究对象。于术后1个月(基线)、3个月、6个月、12个月采用冠心病PCI术后康复管理行为问卷进行纵向随访评估;基线时同时完成一般自我效能感量表、社会支持评定量表及医院焦虑抑郁量表测评。应用潜类别增长模型识别康复管理行为的发展轨迹,采用多元Logistic回归分析影响轨迹归属的因素。结果:年轻冠心病PCI术后患者术后1个月康复管理行为总分为(68.5±14.2)分,3个月升至(70.3±13.8)分,之后持续下降,12个月降至(63.2±18.1)分,各时间点差异有统计学意义(P<0.001)。潜类别增长模型识别出3种行为发展轨迹:持续高行为组(75例,28.3%),行为始终维持高水平且无显著下降;中度下降组(120例,45.3%),行为早期尚可但逐渐下降;持续低行为组(70例,26.4%),行为起点低且下降速度最快。Pearson相关分析显示,基线康复管理行为总分与自我效能、社会支持呈正相关(r=0.523,0.452,均P<0.01),与焦虑、抑郁呈负相关(r=-0.381,-0.346,均P<0.01)。多因素Logistic回归分析表明,文化程度高中及以下(OR=2.15,95%CI 1.12~4.13)、合并糖尿病(OR=2.33,95%CI 1.10~4.95)、左心室射血分数<50%(OR=2.80,95%CI 1.15~6.82)及焦虑得分升高(OR=1.12,95%CI 1.01~1.24)是未维持高水平康复行为的独立危险因素(均P<0.05);自我效能得分高(OR=0.92,95%CI 0.88~0.96)及社会支持得分高(OR=0.95,95%CI 0.91~0.99)为独立保护因素(均P<0.05)。结论:年轻冠心病PCI术后患者康复管理行为整体呈先升后降趋势,且存在3种异质性发展轨迹,仅不足三成患者可长期维持高水平依从。低文化程度、合并糖尿病、心功能不全及高焦虑水平者更易归属行为低下或下降轨迹,而高自我效能、高社会支持则有助于行为维持。临床应建立基于轨迹分层的随访管理体系,对持续低行为组及中度下降组早期识别并实施针对性强化干预。
论著

经皮冠状动脉介入治疗后恐动症患者不良心理健康状态的影响因素分析

Analysis of the influencing factors of adverse psychological health status in patients with kinesiophobia after percutaneous coronary intervention

:1712-1723
 
       目的   识别经皮冠状动脉介入治疗(PCI)后恐动症患者抑郁、焦虑和压力的影响因素。方法   采用横断面研究,纳入780例行PCI术后恐动症患者。应用系列量表评估恐动症患者的不良心理健康状况、生活质量、自我感受负担、社会支持和运动自我效能,并通过问卷收集了患者的社会人口学数据。线性回归和Logistic回归用于识别抑郁、焦虑和压力等不良心理状态的影响因素,应用中介分析探索潜在的中介机制。结果  271例(34.7%)、304例(39.0%)和153例(19.6%)恐动症患者存在不同程度的抑郁、焦虑和压力。恐动症患者的抑郁、焦虑和压力水平呈正相关。线性回归和Logistic分析结果表明,较高的家庭月收入与较高的抑郁水平相关(线性回归:β为0.908和1.937;Logistic:OR2.05和5.47),社会支持程度与抑郁水平呈负相关(线性回归:β=-0.079;Logistic:OR=0.93)。单身/离异/寡居患者的焦虑水平显著高于已婚患者(线性回归:β=1.613;Logistic:OR=2.28)。与家庭月收入低于5 000元者相比,家庭月收入为5 000~10 000元之间的患者的压力水平较高(线性回归:β=1.065;Logistic:OR=3.14)。此外,自我感受负担较重的患者具有更高的压力水平(线性回归:β=0.077;Logistic:OR=1.05)。中介分析结果表明,焦虑和压力是社会支持/自我感受负担与抑郁之间关联的潜在中介因子。结论  PCI术后恐动症患者广泛存在心理健康问题,其家庭月收入、年龄、婚姻状况、生活方式和病史等因素对患者的不良心理健康状态具有显著影响。医务人员应关注这些患者的心理健康状况及影响因素,制定综合管理策略以改善其预后。
       Objective  To identify the risk factors associated with depression,anxiety  and  stress in  patients with kinesiophobia after percutaneous coronary intervention(PCI).Methods  In this cross-sectional study,780 patients who developed kinesiophobia after undergoing PCI were enrolled.A series of scales were used to assess the psychological health status,quality of life,self-perceived burden,social support,and exercise self-efficacy of patients with kinesiophobia,and socio-demographic data of the patients were collected through a questionnaire.Linear regression analyses and Logistic regression analyses were used to identify risk factors of adverse psychological outcomes,including depression,anxiety,and stress.Furthermore,mediation analysis was employed to explore the potential mediating mechanisms.Results  Among the 780 patients with kinesiophobia,271(34.7%),304(39.0%)and 153(19.6%)were found to have varying degrees of depression,anxiety,and stress,respectively.The levels of depression,anxiety and stress in patients with kinesiophobia were positively correlated with each other.The results of both linear regression and Logistic regression analyses indicated that higher levels of family monthly income were associated with higher levels of depression(linear:β=0.908 and 1.937;Logistic:OR=2.05 and 5.47),while the degree of social support was negatively correlated with depression levels(linear:β=-0.079;Logistic:OR=0.93).For patients who were single,divorced or widowed,their levels of anxiety were significantly higher than those of married patients(linear:β=1.613;Logistic:OR=2.28).Compared to patients with a monthly household income of less than 5 000 yuan,those with a monthly income between 5 000 and 10 000 yuan reported higher levels of stress(linear:β=1.065;Logistic:OR=3.14).Additionally,patients who perceived a higher personal burden also experienced greater stress(linear:β=0.077;Logistic:OR=1.05).Mediation analysis indicated that anxiety and stress were potential mediating factors in the relationship between social support/self-perceived burden and depression.Conclusions  This study  reported the widespread psychological health issues among patients with kinesiophobia after PCI and the interactions between these issues.Factors such as monthly household income,age,marital status,lifestyle and medical  history were found to  be significantly associated with these negative psychological outcomes.Clinicians and nurses should focus on the psychological health and influencing factors of these patients and develop comprehensive management strategies to improve their prognosis.
论著

基于思维导图的绿色通道急救干预对急性心梗患者介入治疗的效果

The effect of green channel emergency nursing based on mind mapping on PCI of acute myocardial infarction patients

:1677-1683
 
       目的   探讨基于思维导图的绿色通道急救干预对急性心肌梗死患者介入治疗的效果。方法   对天津市人民医院2022年1月—2024年12月收治的80例AMI患者进行研究,依照收治时间进行分组,将2022年1月—2023年6月采取常规急救流程干预的40例患者分为常规组,将2023年7月—2024年12月的采取基于思维导图的绿色通道急救干预的40例患者分为思维导图组。比较两组患者急救效率、急救前后生命体征(心率、舒张压、收缩压)、心肌损伤指标[磷酸肌酸激酶(CK-MB)及肌钙蛋白Ⅰ(cTnI)],最后比较两组患者干预满意度。结果   对比急救效率发现,思维导图组的预检时间、会诊时间、导管室激活时间、急诊送至PCI手术时间均短于常规组(P<0.05);对比急救前后生命体征发现,与急救前对比,急救后两组的心率、舒张压、收缩压均降低(P<0.05),急救前后两组心率、舒张压、收缩压比较差异无统计学意义(P>0.05);对比急救前后心肌损伤指标发现,急救前两组CK-MB、cTnI比较差异无统计学意义(P>0.05),急救后,思维导图组CK-MB、cTnI低于常规组与急救前(P<0.05);对比干预满意度发现,思维导图组干预满意度为100.00%,高于常规组的85.00%(P<0.05)。结论  基于思维导图的绿色通道急救干预可提升AMI患者的急救效率,稳定患者生命体征,减轻心肌损伤的同时,提升患者干预满意度。
       Objective  To explore the effect of green channel emergency nursing based on mind mapping on percutaneous coronary intervention(PCI) of patients with acute myocardial infarction(AMI).Methods  A study was conducted on 80 AMI patients admitted to Tianjin People’s Hospital from January 2022 to December 2024.The patients were divided into two groups based on their admission time.The 40 patients who received routine emergency nursing interventions from January 2021 to June 2023 were assigned to the conventional group,while the 40 patients who  received green channel emergency nursing based on mind mapping from July 2023 to November 2024 were assigned to the mind mapping group.The emergency treatment efficacy,vital signs(heart rate,diastolic blood pressure,systolic bloodpressure),myocardial injury indicators(phosphocreatine kinase[CK-MB],and troponin I[cTn1])between two groups of patients before and after emergency treatment were compared.Results  The pre-examination time,consultation time,catheterization room activation time and emergency room to PCI operation time of mind mapping group were all shorter than those of conventional group(P<0.05).Compared with the vital signs before and after emergency treatment,we found that the heart rate,diastolic pressure and systolic blood pressure of the two groups decreased after emergency treatment(P<0.05),and there was no significant difference between the heart rate,diastolic pressure and systolic blood pressure of the two groups before and after emergency treatment(P>0.05).Comparing the myocardial injury indicators before and after emergency treatment,there was no significant difference in CK-MB and cTn1 between the two groups before emergency treatmentP>0.05).After emergency treatment,CK-MB and cTn1 in the mind map group were lower than those in the conventional group and before emergency treatment(P<0.05).Comparing the intervention satisfaction,it was found that the mind mapping group of 100.00% was higher than the conventional group of 85.00%(P<0.05).Conclusions  Green channel emergency nursing based on mind mapping can improve the efficiency of emergency treatment for AMI patients,stabilize their vital signs,reduce myocardial injury,improve patient intervention satisfaction.
论著

急性缺血性脑卒中介入治疗优化护理路径的构建及应用

Development and application of an optimized nursing pathway for endovascular therapy in acute ischemic stroke

:1563-1568
 
       目的   探讨优化护理路径在急性缺血性脑卒中介入手术中的应用及效果。方法   采用随机对照研究,纳入2024年1月—2025年1月收治的112例急性缺血性脑卒中取栓患者,观察组(56例)实施优化介入护理路径,对照组(56例)采用常规护理。结果   观察组患者的满意度评分、医护满意度评分均优于对照组(P<0.05);观察组的术前等待时间、患者自进入介入室至股动脉穿刺时间、手术时间、住院费用、并发症发生率、差错事故发生率也优于对照组(P<0.05)。结论   通过标准化术前准备、术中多学科协作及术后康复衔接,优化护理路径可显著提升急性缺血性脑卒中治疗时效性(缩短急性脑卒中患者从进入医院到开始静脉溶栓给药的时间至黄金时间窗内),改善患者神经功能预后。
       Objective  To explore the application and efficacy of an optimized nursing pathway in endovascular therapy for acute ischemic stroke(AIS).Methods  A randomized controlled trial was conducted,enrolling 112 AIS patients undergoing mechanical thrombectomy from January 2024 to January 2025.Patients were randomly assigned to either the observation groupn=56),which received the optimized interventional nursing pathway,or the control group(n=56),which  received  routine nursing care.Results  Patient satisfaction score,medical staff satisfaction score,and postoperative favorable  recovery  rate in observation group were better than those of control group(P<0.05).Additionally,the observation group  showed  significant improvements in preoperative waiting time,time from entering the operation room to femoral artery puncture,surgical duration,hospitalization costs,complication incidence rate,and medical error incidence rate(P<0.05).Conclusions  By standardizing preoperative preparations,implementing intraoperative multidisciplinary collaboration,and enhancing postoperative  rehabilitation coordination,the optimized nursing pathway significantly improved the timeliness of thrombectomy treatment(shortening door-to-needle time to reach the golden time window)and enhanced neurological functional prognosis in AIS patients,demonstrating substantial clinical applicability.
论著

同轴微导管PVA栓塞介入治疗动脉性下消化道出血的研究

Study of coaxial microcatheter PVA embolization in the treatment of arterial lower gastrointestinal hemorrhage

:869-874
 
目的 研究同轴微导管聚乙烯醇颗粒(PVA)栓塞治疗动脉性下消化道出血患者的应用效果。方法 本研究为前瞻性研究,选择河南科技大学第一附属医院2022年1月—2023年6月收治的118例动脉性下消化道出血患者为研究对象,以计算机随机分组法将其分为常规组和试验组,各59例。两组均行数字减影血管造影检查明确出血情况,常规组予以内镜下注射止血治疗,试验组经同轴微导管PVA栓塞进行止血治疗,比较两组患者的治疗效果及预后情况。结果 在不同治疗方案下,试验组的技术成功率、临床成功率分别为89.83%(53/59)、84.75%(50/59),均高于常规组[71.19%(42/59)、64.41%(38/59)](χ2=11.071、10.911,P<0.05);试验组的止血时间、凝血酶原时间(PT)、凝血酶时间(TT)分别为(50.25±10.37)min、(10.25±2.31)s、(16.33±4.47)s,均低于常规组[(55.36±10.72)min、(12.44±3.61)s、(19.35±4.23)s](t=2.632、3.925、3.769,P<0.05);试验组治疗后的动脉搏动指数(PI)、阻力指数(RI)分别为(1.12±0.33)(0.51±0.21),均低于常规组[(1.65±0.41)(0.73±0.22)](t=7.735、5.556,P<0.05);试验组治疗7、14、30 d后的再出血率分别为5.08%(3/59)、8.47%(5/59)、10.17%(6/59),均低于常规组[20.34%(12/59)、25.42%(15/59)、28.81%(17/59)](χ2=10.495、10.207、11.071,P<0.05);试验组的并发症发生率8.47%(5/59)低于常规组22.03%(13/59),差异均具有统计学意义(χ2=7.113,P<0.05)。结论 与常规内镜下止血相比,同轴微导管PVA栓塞可显著提升动脉性下消化道出血患者的止血成功率,对缩短患者止血时间、促进凝血系统恢复、降低再出血风险及相关并发症发生风险均有积极意义。
Objective To study the effect of coaxial microcatheter PVA embolization in the treatment of patients with arterial lower gastrointestinal bleeding.Methods This study is a prospective study,118 patients with arterial lower gastrointestinal bleeding admitted between January 2022 and June 2023 were selected as the study subjects.They were randomly divided into a conventional group(59 cases)and an experimental group(59 cases)using computer randomization.Both groups underwent digital subtraction angiography examination to determine the bleeding situation.The conventional group received conventional endoscopic hemostasis treatment,while the experimental group received coaxial microcatheter PVA embolization for hemostasis treatment.The treatment efficacy and prognosis were compared between two groups.Results Under different treatment plans,the technical success rate and clinical success rate of the experimental group were 89.83%(53/59)and 84.75%(50/59),respectively,which were higher than those of the conventional group [71.19%(42/59)and 64.41%(38/59)](χ2=11.071、10.911,P<0.05).The hemostatic time,PT,and TT of the experimental group were(50.25±10.37)min,(10.25±2.31)seconds,and(16.33±4.47)seconds,respectively,which were shorter than those of the conventional group [(55.36±10.72)min,(12.44±3.61)seconds,and(19.35±4.23)seconds](t=2.632、3.925、3.769,P<0.05).The arterial PI and RI of the experimental group after treatment were(1.12±0.33) and(0.51±0.21),lower than those of the conventional group [(1.65±0.41)and(0.73±0.22)](t=7.735、5.556,P<0.05).The rebleeding rates of the experimental group after 7 days,14 days and 30 days of treatment were 5.08%(3/59),8.47%(5/59) and 10.17%(6/59),respectively,which were lower than those of the conventional group [20.34%(12/59),25.42%(15/59) and 28.81%(17/59)](χ2=10.495,10.207,11.071,P<0.05).The incidence of complications in the experimental group was 8.47%(5/59),which was lower than that in the conventional group 22.03%(13/59)(χ2=7.113,P<0.05).Conclusions Compared with conventional endoscopic hemostasis,coaxial microcatheter PVA embolization can significantly improve the success rate of hemostasis in patients with arterial lower gastrointestinal bleeding,shorten the hemostasis time,promote coagulation system recovery,reduce the risk of rebleeding and related complications,with a positive significance.
论著

GuideLiner®延长导管在复杂经皮冠状动脉介入治疗中的临床经验

Clinical efficacy and safety of GuideLiner® guide extension catheter application during complex coronary percutaneous coronary intervention procedure

:28-32
 
目的 总结GuideLiner®延长导管在复杂经皮冠状动脉介入治疗(PCI)中的初步经验,探讨其有效性及安全性。方法 选择2015年3月—2017年3月因冠心病于广州市第一人民医院行PCI的患者13例,因复杂病变需要更强支撑力而使用GuideLiner®延长导管完成手术,总结手术成功率、并发症以及6个月随访主要不良心脏事件的发生情况。结果 13例患者在GuideLiner®延长导管应用下均成功完成手术。使用延长导管的目的2例手术为辅助球囊通过,7例为辅助支架通过,4例为辅助支架及球囊通过。全部患者均未发生术中及住院期间死亡、急性心肌梗死,未发生急性支架内血栓形成、目标冠脉夹层或穿孔、心包填塞等并发症,6 个月随访均无不良心脏事件发生。结论 应用延长导管可提高支撑力,有效辅助球囊和/或支架到达冠状动脉病变部位,提高手术成功率,安全性较高。
Objective To evaluate the clinical efficacy and safety of GuideLiner® guide extension catheter during complex coronary percutaneous coronary intervention(PCI) procedures. Methods Thirteen patients with coronary heart diseases performed PCI procedures were included in this study from March 2015 to March 2017. GuideLiner® guide extension catheters were used in these complex cases. The PCI success rate,incidence of complications and 6-month follow up data were observed. Results Benefited from the stronger support produced by GuideLiner®, PCI success rate was 100%. The guide extension catheters were used for the delivery of balloons in 2 cases, while 7 cases for stents, and 4 cases for both balloons and stents. No death were observed during the procedure or in hospital, and there were no dissection or acute myocardial infarction. During 6 months of follow-up,there was no major adverse cardiac events (MACE). Conclusion GuideLiner® guide extension catheter may improve procedure success rate by ensuring the delivery of balloons and stents in complex PCI.
论著

CT扫描结合MRI在原发性肝癌诊断与介入治疗预后评估中的临床意义

Clinical significance of CT combined with MRI scans in diagnosis of primary liver cancer and prognosis evaluation after interventional therapy

:58-61
 
目的 分析CT+MRI在原发性肝癌诊断与介入治疗预后评估中的临床意义。方法 选定本院2019年1月—2021年1月住院治疗的150例原发性肝癌患者,入院后均接受介入治疗,分别予以CT、MRI检查,将手术病理检查结果作为本次研究的金标准,比较CT、MRI、CT+MRI诊断效能,Kappa检验CT、MRI、CT+MRI与金标准的一致性,比较CT、MRI、CT+MRI介入术后病灶检出率。结果 CT+MRI诊断准确率(98.67%)、特异度(75.00%)、灵敏度(99.32%)均高于CT(86.00%、25.00%、87.67%)、MRI(90.67%、91.78%、50.00%),P<0.05(差异均有统计学意义),CT+MRI与金标准的一致性较好(Kappa值为0.779),CT、MRI与金标准的一致性一般(Kappa值为0.527、0.596)。CT+MRI介入术后病灶总检出率(12.00%)高于CT(2.00%)、MRI(4.00%),P<0.05(差异有统计学意义)。结论 CT+MRI可提高原发性肝癌患者介入术后病灶检出率,弥补了单一CT、MRI检查的不足。
Objective To evaluate the clinical significance of CT + MRI scans in diagnosis of primary liver cancer and prognosis evaluation after interventional therapy. Methods A total of 150 cases of patients with primary liver cancer admitted to our hospital from January 2019 to January 2021 were selected. They all received interventional treatment, and were examined by CT and MRI. The results of pathological examination were taken as the gold standard in this study to compare the diagnostic efficacy of CT, MRI and CT+MRI.Kappa value was used to compare the consistency of CT, MRI, CT+MRI scans with gold standard, and compared the detection rate of lesions after CT, MRI and CT+MRI interventional surgery. Results The diagnostic accuracy (98.67%), specificity (75.00%) and sensitivity (99.32%) of CT + MRI scans were higher than those of CT (86.00%, 25.00%, 87.67%) and MRI scans (90.67%, 91.78%, 50.00%),P<0.05 (which differences were statistically significant). The consistency of CT + MRI scans with gold standard was good (kappa value was 0.779), but the consistency of CT/MRI scans with gold standard were not satisfying (kappa value were 0.527, 0.596). The total detection rate of lesions after CT + MRI interventional surgery (12.00%) was higher than that of CT (2.00%) and MRI (4.00%, which P<0.05). Conclusion CT + MRI scans can improve the detection rate of lesions in patients with primary liver cancer after interventional therapy, and make up for the deficiency of only CT or MRI scans.
临床诊疗

冠心病介入治疗中出现心血管迷走神经反射的原因及防治措施

:131-134
 
目的 对冠心病治疗过程中出现迷走神经反射的原因进行分析探讨,并进行高效防治措施的总结。方法 本研究采用现况研究进行调查。本研究以在本院2021年1月—2021年3月就诊并临床诊断为冠心病的患者作为研究对象,经过纳入、排除标准筛选,共挑选出240名患者作为研究对象。根据文献分析得知拔鞘管可能是影响冠心病介入治疗过程中出现迷走神经反射的重要原因,因此将研究对象分为2组,实验组130人,对照组110人。对2组患者进行冠状动脉腔内血管成形术+支架置入术。实验组在患者进行鞘管拔出时进行局部麻醉;对照组则按照常规方法对鞘管进行拔出,分析2组患者迷走神经发生反射的几率,运用统计学软件进行数据分析对比。结果 根据数据分析结果可知,2组患者出现迷走神经反射的几率并不相同,通过差异性分析可知2组数据的差异具有统计学意义,且观察组发生率低于对照组(P<0.05)。结论 建议在临床上对冠心病进行介入治疗时,拔除鞘管的过程应该加入合理的干预,以减少患者出现迷走神经反射的几率,增强患者预后。
论著

直接经皮冠状动脉介入治疗急性ST段抬高型心肌梗死患者的性别差异

Sex difference in acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

:71-76
 
目的 分析广州北部区域某胸痛中心不同性别的急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗的结果。方法 纳入广州市花都区人民医院2016年12月—2020年1月期间接受直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者。按照不同的性别,评估患者的危险因素、治疗时限性和主要心血管不良事件情况。结果 入选389名患者,73名(18.8%)为女性。和男性患者对比,女性患者年龄更大(69.3±10.8岁vs 55.8±13.1 岁,P<0.05),具有更高比例的2型糖尿病(26.0% vs 17.7%,P<0.05)、高血压病(58.9.0% vs 43.0%,P<0.05)病史。女性患者的症状-首次医疗接触时间和总缺血时间均长于男性患者(分别为229.2 min vs 174.5 min,P<0.05;424.9 min vs 317.4 min,P<0.05),PCI术中出现慢血流/无复流的比例更高(26.0% vs 16.5%,P<0.05)。女性患者主要住院心血管事件风险更高(11.0% vs 4.4%, P<0.05),其中院内死亡率(4.1% vs 1.6%, P<0.05)。女性患者在院期间发生心衰及心源性休克的比例更高(分别为34.2% vs 21.2%,P<0.05; 30.1% vs 18.7%,P<0.05)。结论 在行急诊介入治疗的急性ST段抬高型心肌梗死患者中,女性患者预后差于男性,具有更高的心血管事件风险,死亡率更高。
Objective We investigated sex-based outcomes after primary percutaneous coronary intervention (PPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) in a chest pain center of northern Guangzhou. Methods From December 2016 to January 2020, consecutive STEMI patients who underwent PPCI in Guangzhou Huadu District People's Hospital were recruited. Risk factors, time variables, and major cardiovascular adverse events (MACE) were assessed according to gender. Results A total of 389 patients were enrolled,with 73(18.8%)women. Compared to men, women patients presented higher risk profiles with old age(69.3±10.8 years vs 55.8±13.1 years,P<0.05),diabetes (26.0% vs 17.7%,P<0.05), hypertension (58.9.0% vs 43.0%,P<0.05).Women had longer symptom onset to first medical contact time and total ischemic time than men had(229.2min vs 174.5min,P<0.05;424.9min vs 317.4min,P<0.05).During PCI procedure,women presented higher ratio of slow flow/no reflow(26.0% vs 16.5%,P<0.05).Women had increased major adverse events(11.0% vs 4.4%, P<0.05), and higher in-hospital mortality(4.1% vs 1.6%, P<0.05).Women presented more heart failure incidence (34.2% vs 21.2%,P<0.05),and cardiac shock incidence(30.1% vs 18.7%,P<0.05). Conclusion Women with acute STEMI who underwent PPCI had worse outcomes compared to men.They had higher MACE and in-hospital mortality.
论著

GuideLiner®延长导管在复杂经皮冠状动脉介入治疗中的临床经验

Clinical efficacy and safety of GuideLiner® guide extension catheter application during complex coronary percutaneous coronary intervention procedure

:-
 
目的 总结GuideLiner®延长导管在复杂经皮冠状动脉介入治疗(PCI)中的初步经验,探讨其有效性及安全性。方法 选择2015年3月—2017年3月因冠心病于广州市第一人民医院行PCI的患者13例,因复杂病变需要更强支撑力而使用GuideLiner®延长导管完成手术,总结手术成功率、并发症以及6个月随访主要不良心脏事件的发生情况。结果 13例患者在GuideLiner®延长导管应用下均成功完成手术。使用延长导管的目的2例手术为辅助球囊通过,7例为辅助支架通过,4例为辅助支架及球囊通过。全部患者均未发生术中及住院期间死亡、急性心肌梗死,未发生急性支架内血栓形成、目标冠脉夹层或穿孔、心包填塞等并发症,6 个月随访均无不良心脏事件发生。结论 应用延长导管可提高支撑力,有效辅助球囊和/或支架到达冠状动脉病变部位,提高手术成功率,安全性较高。
Objective To evaluate the clinical efficacy and safety of GuideLiner® guide extension catheter during complex coronary percutaneous coronary intervention(PCI) procedures. Methods Thirteen patients with coronary heart diseases performed PCI procedures were included in this study from March 2015 to March 2017. GuideLiner® guide extension catheters were used in these complex cases. The PCI success rate,incidence of complications and 6-month follow up data were observed. Results Benefited from the stronger support produced by GuideLiner®, PCI success rate was 100%. The guide extension catheters were used for the delivery of balloons in 2 cases, while 7 cases for stents, and 4 cases for both balloons and stents. No death were observed during the procedure or in hospital, and there were no dissection or acute myocardial infarction. During 6 months of follow-up,there was no major adverse cardiac events (MACE). Conclusion GuideLiner® guide extension catheter may improve procedure success rate by ensuring the delivery of balloons and stents in complex PCI.
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