冠心病患者冠状动脉旁路移植术不同术式的临床疗效比较

目的对比研究冠心病患者体外循环冠状动脉旁路移植术和非体外循环冠状动脉旁路移植术的手术效果。方法106例择期行冠状动脉旁路移植术患者分为两组,体外循环冠状动脉旁路移植术组59例,非体外循环冠状动脉旁路移植术组47例,对两组相关指标进行对比分析。结果两组在平均搭桥支数、平均动脉桥支数、死亡率以及术后并发症的发生率方面无明显差异(P>0.05);而非体外循环冠状动脉旁路移植术组术后呼吸机支持时间、ICU天数、平均住院天数以及胸腔引流量和输血量均低于体外循环冠状动脉旁路移植术组(P<0.05)。结论非体外循环冠状动脉旁路移植术和体外循环冠状动脉旁路移植术均是冠心病外科治疗有效的方法;与体外循环冠状动脉旁路移植术相比,非体外循环冠状动脉旁路移植术在缩短呼吸机支持时间、减少胸腔引流量、输血量和平均住院天数等方面具有一定的优势。     

非体外循环和体外循环高龄冠状动脉旁路移植术临床分析比较

目的:比较75岁以上老年患者行非体外循环冠状动脉旁路移植术(Off-pump CABG)与体外循环冠状动脉旁路移植术(On-pump CABG)的临床效果。方法:59例75岁以上老年患者,Off-pump CABG组(10例);On-pump CABG组(49例)。结果:Off-pump组手术时间、引流量600mL、呼吸机辅助时间20h、正性肌力药物使用时间36h指标均少于或低于On-pump组(P0.05,或P0.01)。On-pump组死亡2例,死于多脏器功能衰竭和恶性心律失常。Off-pump组无死亡。结论:对75岁以上的老年冠心病患者行冠状动脉旁路移植术是安全可行的。2组比较,Off-pump组手术有时间短、引流量少、呼吸机辅助时间短及正性肌力药物使用时间短等优点。     

拔管时间对冠状动脉旁路移植术后谵妄的影响

评价拔管时间对体外循环冠状动脉旁路移植患者术后谵妄的影响。方法：回顾性分析阜外医院外科SICU自2020年1月至2021年4月行单纯体外循环冠状动脉旁路移植术的患者信息。包括基本情况、基础疾病、术前超声EF值、术前血肌酐值,术中转机时间及阻断时间,术后呼吸机使用时间,拔管时间、ICU停留时间以及术后谵妄发生率。结果：共495例患者纳入研究,其中夜间拔管组54例,对照组441例。夜间拔管组患者年龄、转机时间、阻断时间及呼吸机使用时间均小于对照组,具有统计学差异。夜间拔管组20例发生术后谵妄（37.0%）,而对照组85例发生谵妄（20.5%）,卡方值9.082,p=0.004。多因素logistic回归分析结果夜间拔管为冠状动脉旁路移植术后谵妄的独立危险因素,OR:4.155, 95%CI:2.118 – 8.151, P=0.001。结论：夜间拔管增加冠状动脉旁路移植术后患者谵妄的发生率     

非体外循环和体外循环冠状动脉旁路移植术的对比研究

96例冠状动脉旁路移植术(CABG)患者,按照术式的不同分为非体外循环冠状动脉旁路移植术(OPCAB)组46例和常规体外循环冠状动脉旁路移植术(CCABG)组50例.两组患者均于术前1 d及术后4 h、24 h、72 h、5 d、7 d空腹采集静脉血,检测血清cTnI、CK-MB及血脂水平;观察并比较两组患者术后呼吸机辅助时间和围手术期并发症发生率以及ICU停留时间、术后住院时间.发现术后4、24 h,CCABG组cTnI和CK-MB水平均明显高于OPCAB组;术后72 h,两组cTnI水平亦有明显差异;两组术后血脂水平无明显差异.提示OPCAB对心肌的损伤程度低于CCABG;OPCAB可减少呼吸机辅助时间、ICU停留时间、住院时间,可降低肾功能不全、呼吸功能不全的发生率.     

体外循环与非体外循环冠状动脉旁路移植术后移植血管通畅率比较

目的比较体外循环冠状动脉旁路移植术(CCABG)与非体外循环冠状动脉旁路移植患者术(OPCAB)术后移植血管通畅率。方法选取2007年8月—2012年8月我院收治的行冠状动脉旁路移植术患者372例,按照手术方式不同将其分为CCABG组176例和OPCAB组196例,比较两组移植血管数量、手术时间、呼吸机辅助时间、24 h引流量及输血量、肾功能不全发生率、神经系统并发症、肺部并发症、住院时间等,以及移植血管通畅率。结果 CCABG组呼吸机辅助时间长于OPCAB组,住院时间短于OPCAB组,术后引流量、术后输血量均大于OPCAB组,肾功能不全发生率、神经系统并发症、肺部并发症发生率均高于OPCAB组(P0.05)。术后2周、3个月以及1年,两组移植血管〔包括左乳内动脉(LIMA)和大隐静脉(GSV)〕通畅率比较,差异无统计学意义(P0.05)。结论CCABG和OPCAB术后移植血管通畅率差异不明显,应根据患者具体情况选择适合的方式。     

右美托咪啶对体外循环下冠状动脉旁路移植术患者术后恢复的影响

目的观察右美托咪啶对全麻低温体外循环下冠状动脉旁路移植术患者术后恢复的影响。方法择期行全麻低温体外循环下冠状动脉旁路移植术患者80例。随机分为右美托咪啶组(D组)和对照组(P组),每组40例。患者在麻醉诱导中心静脉置管后,D组患者静脉泵注右美托咪啶4ug/(kg·h)持续15 min后调节剂量为0.7 ug/(kg·h)直到手术结束。P组同时间注射等容量生理盐水。记录2组患者术后初醒时间,气管插管留置时间,ICU停留时间,术后住院时间,术前及术后第五天心脏超声心功能(EF值),和住院总费用。结果 D组患者术后初醒时间明显早于P组,气管插管留置时间明显短于P组,且均有统计学差异(P<0.05)。两组患者术后ICU停留时间和术后住院时间没有统计学差异(p>0.05)。两组患者术前心脏超声心动图EF值没有统计学差异(p>0.05),术后第五天心脏超声心动图与术前相比,P组EF值明显下降,且有统计学差异(P<0.05),而D组术后EF值虽较术前下降,但没有统计学差异(p>0.05)。两组患者住院费用没有统计学差异(p>0.05)。结论右美托咪啶应用于全麻低温体外循环下冠状动脉旁路移植术,能加快患者术后苏醒,并缩短气管插管留置时间。     

3D打印技术在不停跳冠状动脉旁路移植术中的应用

目的:观察借助3D打印技术辅助行不停跳冠状动脉(冠脉)旁路移植术的手术效果。方法:将36例冠脉多支病变患者分为观察组(20例)和对照组(16例),观察组借助3D打印技术打印出1∶1冠脉模型用于辅助不停跳冠脉旁路移植术。对照组采用常规不停跳冠脉旁路移植术。比较两组患者围术期情况及术后随访结果。结果:两组患者手术顺利,均康复出院。手术时间[观察组(146.60±7.51) min∶对照组(156.00±7.70) min,P0.05],术后引流量[观察组(81.65±12.05) ml∶对照组(92.63±18.60) ml,P0.05],ICU监护治疗时间[观察组(51.08±4.26) h∶对照组(54.21±4.88) h,P0.05],术后住院天数[观察组(6.46±0.65) d∶对照组(6.55±0.84) d,P0.05],下肢大隐静脉切口长度[观察组(30.08±3.15) cm∶对照组(33.68±2.58) cm,P0.05]。观察组及对照组均全部一次关胸,胸部切口及大隐静脉切口愈合佳。观察组术中、术后未输注红细胞,对照组输注红细胞2例,大隐静脉切口愈合不良1例。结论:借助3D打印技术进行不停跳冠脉旁路移植的效果较好,且手术时间较短,术后患者心功能及切口恢复较好。     

非ST段抬高急性冠脉综合征患者血清单核细胞/高密度脂蛋白比值与GRACE评分和SYNTAX评分相关性

目的探讨血清单核细胞/高密度脂蛋白(HDL)比值(MHR)与非ST段抬高急性冠脉综合征(NSTE-ACS)患者全球急性冠状动脉事件注册(GRACE)评分和SYNTAX评分的关系。方法纳入2018年因胸痛在心血管内科住院治疗,并行冠状动脉造影检查证实为NSTE-ACS患者236例。根据患者入院时GRACE评分,将患者分为GRACE评分低危、中危和高危组。入院后抽取患者的血常规及血脂生化检查,比较三组之间的MHR值,采用多因素Logistic回归分析MHR值与GRACE评分的关系。对所有患者进行冠状动脉造影检查,根据患者的冠状动脉病变特点,采用SYNTAX评分,将患者分为SYNTAX评分低危、中危及高危组,比较三组之间的MHR值。结果与低危及中危组相比,GRACE评分高危组患者的MHR水平明显升高(P0.05)。MHR与GRACE评分呈线性正相关(r=0.783,P0.05),多因素Logistic回归分析显示高MHR值是GRACE评分高危的独立预测因子。SYNTAX评分高危组患者的MHR值与中危组及低危组相比无明显差异(P0.05)。结论高MHR水平与NSTE-ACS患者GRACE评分的危险分组独立且显著相关,有助于判断NSTE-ACS患者的危险分层及短期预后。     

体外循环与非体外循环冠状动脉旁路移植术治疗冠状动脉粥样硬化性心脏病的临床效果

目的分析体外循环冠状动脉旁路移植术(CABG)与非体外循环冠状动脉旁路移植术(OPCAB)治疗冠状动脉粥样硬化性心脏病(冠心病)的临床疗效。方法选取2010年5月—2012年5月我院收治的冠心病患者40例,根据手术方式不同将患者分为CABG组和OPCAB组,各20例。记录两组患者手术时间、旁路移植支数、术后苏醒时间以及住院费用等。结果 CABG组手术时间、术后苏醒时间长于OPCAB组,旁路移植支数、住院费用多于OPCAB组(P0.05)。结论与CABG相比,OPCAB临床效果良好,可减少手术时间和术后苏醒时间,医疗费用相对较低,具有一定的优越性,值得临床推广运用。     

GRACE、CHA2DS2-VASc评分对冠状动脉支架置入病人术后不良事件的预测价值

目的探讨全球急性冠状动脉事件注册(GRACE)、CHA2DS2-VASc评分对冠状动脉支架置入病人术后不良事件的预测价值。方法选取我院2012年10月—2015年10月行冠状动脉支架置入术病人879例,根据危险程度分为3组,其中低危组379例,中危组283例,重危组217例,均行GRACE、CHA2DS2-VASc评分。分析术后不良事件,其中心血管不良事件包括心搏骤停,心源性休克,室性心动过速及室性心律失常等高危心律失常,急性左心衰竭,非心血管不良事件为血栓。结果心血管不良事件,低危组、中危组、高危组GRACE评分预测价值高于CHA2DS2-VASc评分(P 0.05);非心血管不良事件,低危组、中危组、高危组CHA2DS2-VASc评分预测价值高于GRACE评分(P 0.05)。GRACE评分预测价值低危组中危组重危组(P 0.05);CHA2DS2-VASc评分低危组中危组重危组(P 0.05)。结论 GRACE评分对冠状动脉支架置入病人术后心血管不良事件的预测价值较高。CHA2DS2-VASc评分对冠状动脉支架置入病人术后非心血管不良事件的预测价值较高。     

Percutaneous coronary intervention of bifurcation coronary disease

Bifurcation coronary artery disease is a frequent problem faced by interventional cardiologists and it affects approximately 15-20% of patients undergoing percutaneous coronary intervention (PCI). The application of drug-eluting stents (DES) technology to prevent restenosis after PCI represents one of the success stories in cardiology, but DES have not resolved the bifurcation PCI challenge. Bifurcation PCI remains associated with higher procedural failure and worse outcomes compared with PCI of non-bifurcated lesions even in DES era. A dependable strategy for PCI of bifurcation lesions has yet to be established, which is likely due to the paucity of studies evaluating the anatomical intricacies of the bifurcation as well as the lack of large scale randomized therapeutic trials. Further, bifurcation has many anatomical variants and it is unlike that one technique will fit all. Currently, we are left with the option of a tailor-made strategy for each patient and bifurcation anatomy and make the most of the limited evidence available to support our therapeutic decisions. In this review, we attempted to describe the current understanding of bifurcation anatomy and corresponding PCI strategies.     

Pseudoaneurysm of coronary artery following rupture of coronary artery during coronary angioplasty.

Rupture of the coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We describe a case of coronary artery rupture during PTCA resulting in the formation of a coronary artery pseudoaneurysm. The pseudoaneurysm was successfully treated by percutaneous spring-coil embolization of the coronary artery.     

Atherosclerosis of coronary arteries, coronary heart disease and sudden coronary death

Correlation between the severity of coronary atherosclerosis, thrombosis and sudden cardiac death was examined in 721 autopsied cases. Severe coronary atherosclerosis with stenosis was found in most of them; however a similar grade of atherosclerosis was discovered in patients with ischaemic heart disease not dying suddenly. Acute coronary thrombosis in the studied subjects was diagnosed post mortem in about 20 percent of those who died suddenly. Other studies indicate frequencies between 4-93%. There was no consistent time dependence.     

冠状动脉256排CT与冠状动脉造影对冠心病的诊断比较

目的冠状动脉256排CT成像技术与冠状动脉造影检查对冠状动脉粥样硬化性心脏病的诊断比较。方法选取2013年5月至2014年5月内蒙古兴安盟人民医院心血管内科疑似冠心病患者50例,其中男性29例,女性21例,年龄37~68岁。先行冠状动脉256排CT扫描及图像后处理,后行冠状动脉造影检查,将两结果进行对比分析。结果以冠状动脉狭窄≥50%者为阳性。冠状动脉256排CT诊断冠心病灵敏度为40.00%,特异度98.18%,阳性预测值88.89%,阴性预测值81.82%,正确指数38.18%,符合率82.67%,KAPPA值46.28%。结论冠状动脉造影诊断冠心病准确性优于冠状动脉CT。冠状动脉CT可对冠心病患者进行初筛诊断。     

Clinical trials of coronary revascularization: coronary angioplasty vs. coronary bypass grafting

In the absence of diabetes mellitus, rates of survival and of survival free of myocardial infarction (MI) are almost identical among patients with multivessel disease assigned to percutaneous transluminal coronary angioplasty (PTCA) versus those assigned to coronary artery bypass grafting (CABG) after 6.5 to 8 year follow-up period. Additional revascularization occurs 2.5 to 4.5 times more frequently in PTCA-treated than in CABG-treated patients and prevalence of angina is no longer statistically different between the two treatment groups. The excess health care costs of bypass surgery, which are important early after revascularization, almost disappear 5 to 8 years later. In patients with single vessel disease, survival free of MI is also comparable in both treatment groups at 5 years. Additional revasculariztion occurs two to four times more often in PTCA-treated than in CABG-treated patients and prevalence of angina does not differ between the two treatment groups. Thus, in nondiabetic patients with multivessel disease, the choice of a revascularization strategy rests on the patient's and treating physician's preference between the invasive nature of bypass surgery and the risk of recurrent procedures. In patients with single vessel disease, these long-term data suggest that bypass surgery is at least as safe and effective as coronary angioplasty and therefore may be a treatment option in selected cases.     

Percutaneous transluminal coronary angioplasty of coronary artery embolism

A 35-yr-old woman with known valvular heart disease presented with acute myocardial infarction. Angiography demonstrated a totally occluded distal left anterior descending coronary artery. Though initially successful, angioplasty ultimately failed to maintain arterial patency, leaving a more distal total occlusion after several balloon inflations. In spite of this, PTCA possibly provided a more localized infarction via a peripheral mobilization of the embolus.     

Detecting of coronary dissection by coronary magnetic resonance

A 75-year-old man, who had a history of coronary dissection after percutaneous coronary intervention in left anterior descending coronary artery, underwent coronary magnetic resonance. Magnetic resonance demonstrated coronary dissection in the distal portion of the left anterior descending artery. Both the true lumen with thick vessel wall and the false lumen with thin vessel wall were demonstrated in the cross-sectional images using T1-weighed black blood technique and T2-weighed black blood technique. Soft plaque was located at the twelve o'clock in the true lumen. Invasive coronary angiogram showed long coronary dissection from middle to distal portion of left anterior descending coronary artery. Magnetic resonance was thought to be useful to detect and follow up the coronary dissection noninvasively.     

经桡动脉穿刺冠状动脉复杂病变的介入治疗

目的　探讨复杂冠状动脉病变经桡动脉穿刺途径行介入治疗的成功率和并发症。方法　 184例复杂冠状动脉病变的冠心病心绞痛患者中 ,经桡动脉穿刺组 4 6例 ,对照组为经股动脉穿刺者 138例 ,观察两组手术成功率、术后并发症等情况。结果　经桡动脉组手术成功率为 92 .2 % ,与经股动脉组 (94 .9% )相比无明显差异 (P>0 .0 5 )。但术后与穿刺有关的并发症发生率 ,经桡动脉组明显少于经股动脉组 (10 .8% vs 2 8.3% ,P<0 .0 5 ) ;术后卧床时间也明显短于经股动脉穿刺组 (P<0 .0 1)。而经桡动脉组从穿刺开始至指引导管放置成功所需的时间长于经股动脉组(P<0 .0 5 )。结论　经选择的冠状动脉复杂病变经桡动脉途径介入治疗具有较高的成功率。经桡动脉途径术后与穿刺有关的并发症发生率低。     

Results of coronary revascularization in occluded coronary arteries

In a total of 82 patients (age 37-71 years) with an occluded left anterior descending artery (LAD) the results of coronary revascularization were evaluated 7 months postoperatively on average. In all patients the indications for revascularization was given by clinical symptoms (angina pectoris) or by prognostic reasons. In patients with multivessel disease. In patients with anterior wall infarction viable myocardium was proven by thallium-scintigram at rest and during exercise. 29 patients were evaluated by coronary angiography postoperatively, in 19 patients the angiograms of the left ventricle could be assessed quantitatively. Total patency rate was 76%, for the LAD 69%, for the circumflex artery 73% and for the right coronary artery 83%. The relatively low patency rate for the LAD was caused by an increased collateral flow to the occluded LAD and therefore by a significantly lower bypass flowrate measured during surgery. Angina pectoris improved markedly, 55% of patients had angina pectoris class III or IV versus 10% postoperatively. These changes were observed in all patients irrespectively of patency rate or occluded grafts to the LAD. Left ventricular volumes and ejection fraction did not change on average after revascularization. Only end-diastolic volume increased significantly in patients with an occluded graft to the LAD. There was a tendency of the end-systolic volume to decrease postoperatively in patients with complete revascularization or at least an open graft to the LAD. The results show a similar clinical improvement in these patients with occluded LAD as shown after "usual" revascularization in other patients. Preoperative coronary angiograms are helpful in judging the postoperative outcome of grafts to the occluded LAD.