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.

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.

目的 比较替格瑞洛片与氯吡格雷片在临床住院急性冠状动脉综合征患者使用中的出血风险。方法 选择2016年1月—2016年11月于我院心血管内科住院的264例急性冠状动脉综合征患者。将患者随机分为两组,替格瑞洛组(A组)131例,氯吡格雷组(B组)133例。对两组患者出血情况进行比较。结果 住院期间两组患者均无严重心血管不良事件(MACE),均未见黑便及需要输血的严重出血。轻微出血患者数,A组:17例占13.0%(17/131),B组:3例占2.3%(3/133),A组轻微出血风险高于B组,差异有统计学意义(P＜0.01)。结论 替格瑞洛轻微出血风险发生率高于氯吡格雷,均未见MACE发生及严重出血病例,临床使用中需注意此问题,并建议更多的临床研究出现。

Objective To compare the risk of bleeding between Clopidogrel and Ticagrelor in inpatients with acute coronary syndrome. Methods 264 patients with acute coronary syndrome who were admitted to our hospital from January 2016 to October 2016 were selected. The patients were divided into two groups randomly, 131 cases with taking Ticagrelor tablets and 133 cases with taking Clopidogrel tablets. The risk of bleeding of the two groups were compared. Results There were no serious adverse cardiovascular events (MACE) between two groups. Severe bleeding events were not obsereved in Ticagrelor and Clopidogrel group. The number of cases with mild bleeding were 17 in Ticagrelor group(13%) and 3 in Clopidogrel group (2.3%). The incidence of minor bleeding risk in Ticagrelor group was significantly higher than the Clopidogrel group(P<0.01). Conclusion The incidence of minor bleeding risk in Ticagrelor group was higher than Clopidogrel.There was no MACE occurrence and serious bleeding among two groups. We need to pay more attention to this problem in clinical use, and more clinical research should be proposed.

目的 探讨焦虑障碍与冠心病经皮冠状动脉介入治疗(PCI)患者术后发生对比剂肾病(CIN)的相关性及机制,为早期发现CIN高危人群及其预防提供理论依据。方法 入选2014年6月—2016年12月于天津市第四中心医院心内科住院确诊冠心病并接受PCI患者,进行综合医院焦虑/抑郁情绪测定表(HAD)及汉密尔顿焦虑量表(HAMA)评价,依据量表的评分标准,最终纳入研究共120例,其中焦虑障碍组60例,非焦虑障碍组60例。观察2组患者PCI术前及术后72 h肌酐(SCr)、肌酐清除率(Ccr)、肿瘤坏死因子-α(TNF-α)、可溶性细胞间黏附分子-1(sICAM-1)、C反应蛋白(CRP)、白细胞介素-18(IL-18)的变化情况,并记录CIN的发生率。结果 2组患者PCI术前Scr、Ccr水平差异无统计学意义(P>0.05);2组患者PCI术后Scr水平均较术前升高,Ccr水平较术前降低(P<0.01)。PCI术后,焦虑障碍组Scr水平高于非焦虑障碍组,Ccr水平低于非焦虑障碍组(P<0.05)。2组患者PCI术前sICAM-1、CRP、IL-18、TNF-α差异无统计学意义(P>0.05);2组患者PCI术后sICAM-1、CRP、IL-18、TNF-α水平较术前均升高(P<0.01);PCI术后焦虑障碍组sICAM-1、CRP、IL-18、TNF-α水平高于非焦虑障碍组,差异有统计学意义(P<0.05)。PCI术前,焦虑障碍组HAD、HAMA评分高于非焦虑障碍组,差异有统计学意义(P<0.01);非焦虑障碍组患者PCI术后较术前HAD、HAMA评分差异无统计学意义(P>0.05);焦虑障碍组PCI术后HAD、HAMA评分高于术前,差异有统计学意义(P<0.01);PCI术后,焦虑障碍组HAD、HAMA评分高于非焦虑障碍组,差异有统计学意义(P<0.01)。结论 焦虑障碍可能是冠心病患者PCI术后发生对比剂肾病的危险因素之一。

目的 观察ST段抬高型急性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中应用不同转运模式的应用疗效。方法 选取我院80例行急诊PCI的STEMI患者,有31例患者的12导联心电图由救护车上的急救人员通过手机微信传输到指定的东莞市大朗医院胸痛中心微信群(远程早期干预组),有49例患者自行来院就诊(传统就诊组),比较两组患者的临床疗效。结果 远程早期干预组患者的D-to-B时间低于传统就诊组(P<0.01),D-to-B达标率高于传统就诊组(P<0.01);远程早期干预组患者住院费用、平均住院天数、住院期间病死率及心力衰竭发生率均低于传统就诊组(P<0.05)。结论 相比较传统就诊模式,远程转运模式能显著提高STEMI患者PCI术的治疗效果,并有效改善其预后情况,临床效益较好,值得实践推广。

目的 采用二维斑点追踪技术(2D-STI)检测冠状动脉左前降支供血区心肌纵向应变,探讨其评估缺血心肌局部收缩功能的价值。方法 使用2D-STI检测不同狭窄程度(＜50%、50%~75%、＞75%)及未见明确狭窄的左前降支供血区心肌纵向应变参数:心内膜下、心外膜下及区域心肌收缩期纵向应变峰值-LS-endo、LS-epi、LS-Territorial,计算收缩期心肌跨壁纵向应变(LS-mural)。观察PCI术后供血区心肌纵向应变的变化。结果 各组内LS-endo均高于对应的LS-epi(均P<0.01)。随着左前降支狭窄程度增加,LS-endo、LS-epi、LS-Territorial、LS-mural逐渐减低(均P<0.01)。术后LS-endo、LS-epi、LS-Territorial逐渐增高,LS-mural先增高后缓慢减低再增高。结论 2D-STI可定量检测不同层次的心肌纵向应变,反映心肌局部收缩功能,为早期识别缺血心肌、评价PCI术后疗效提供参考依据。

Objective To detect myocardial longitudinal strain in the area supplied by left anterior descending coronary artery (LAD) via two dimensional speckle tracking image (2D-STI), and to investigate its estimated value of myocardial systolic function of ischemic myocardium. Methods Detection of myocardial longitudinal strain parameters in the area supplied by the LAD with different stenosis degree(＜50%、50%~75%、＞75%) and no definite stenosis via 2D-STI:subendocardial longitudianl strain (LS-endo), subepicardial longitudianl strain (LS-epi) and territorial longitudianl strain (LS-Territorial). Calculate transmural longitudinal strain (LS-mural) in the systole.Then observe the changes of myocardial longitudinal strain in the blood supply area after percutaneous coronary interventional therapy (PCI). Results LS-endo, LS-epi, LS-Territorial and LS-mural gradually decrease with the increase of LAD stenosis (all P<0.01). After operation, LS-endo, LS-epi and LS-Territorial increase progressively (all P<0.01). LS-mural increases first and then decreases and finally increases slowly. Conclusion Layer-specific quantification of myocardial longitudinal strain by 2D-STI may reveal the regional myocardial systolic function. It is useful to identify the ischemic myocardium in the early stage and evaluate the treatment effect of PCI.

心肌梗死模型在心肌梗死病理发生机制、新药研发研究中占有重要地位。目前冠状动脉结扎法制作大鼠心肌梗死模型,模型稳定,操作简单,造价便宜,效果可靠,为最主要的心肌梗死造模方法,制作方法及具体操作中存在各自的优势和不足,影响着模型的进一步推广,有待继续进行改进和深入研究。

目的 对经皮冠状动脉介入(PCI)治疗术前高敏C反应蛋白(hs-CRP)水平进行测定,探究其与患者术后发生造影剂肾病相关性。方法 选取2011年4月—2013年5月在我院进行PCI手术疗的患者120例为实验对象。根据术前hs-CRP值分为3组:A组(hs-CRP<1 mg/L,n=56),B组(hs-CRP 1～3 mg/L,n=40)和C组(hs-CRP>3 mg/L,n=24)。观察各组术后造影剂肾病的发生情况以及探究其两者之间的相关性。结果 A、B、C组患者术后CIN的发生率分别为8.93%、22.5%和50.0%,经过统计学比较,差异有统计学意义(P<0.05)。患者术前hs-CRP水平年龄在75岁以上、男性、糖尿病、贫血、水化治疗均与CIN显著独立相关。C组MACE发生率均高于A组、B组(P<0.05)。结论 接受PCI手术治疗的患者,其术前hs-CRP水平与其术后CIN的发生具有一定的相关性,患者术前hs-CRP水平越高,术后更可能发生CIN,hs-CRP的水平可作为辅助CIN诊断的指标。

      目的   探讨在冠状动脉造影术后患者中应用风险防范护理干预对血管并发症的控制效果。方法   选择2022年1月—2023年6月于我院接受治疗的85例冠状动脉造影术后患者。按照随机数字表法分组，其中对照组42例给予常规护理干预，观察组43例给予风险防范护理干预，比较两组干预前后的心理状态、治疗依从性、血管并发症。结果   干预后，观察组正性情绪（PA）评分高于对照组PA评分（t=3.821，P＜0.001），观察组负性情绪（NA）评分低于对照组NA评分（t=5.380，P＜0.001）。与对照组比，观察组治疗依从性更好（Z=2.268，P=0.023）。观察组血管并发症总发生率低于对照组（9.30% vs 30.95%，χ ² =6.224，P=0.013）。结论   采用风险防范护理干预，能够改善冠状动脉造影术后患者的心理状态，提高治疗依从性，并降低血管并发症总发生率。

       Objective  To explore the effect of  risk prevention nursing intervention on controlling vascular complications in patients after coronary angiography．Methods  Eighty-five patients after coronary angiography in our hospital were selected from January 2022 to June 2023．They were grouped according to the random number table．And 42 cases were divided into the control group for routine nursing intervention，and 43 cases in the observation group were given risk prevention nursing intervention．Psychological status，treatment compliance and vascular complications of the two groups were observed．Results  After the intervention，the postive affect score of the observation group was higher than that of the control group（t=3.821，P＜0.001），and the negative affect score of the observation group（21.25±3.31）was lower than the score of the control group（25.35±3.70）（t=5.380，P＜0.001）．Compared with the control group the compliance of observation group was higher（Z=2.268，P=0.023）．The overall incidence of vascular complications in the observation group was lower than that in the control group（9.30% vs 30.95%，χ2=6.224，P=0.013）．Conclusions  Risk prevention nursing intervention can improve the psychological status of patients after coronary angiography，improve treatment compliance，and reduce the overall incidence of vascular complications．