急性冠脉综合征患者的护理

笔对34例急性冠脉综合征患进行分析,提出护理要点：按心肌梗死常规护理,加强相关指标的监测。尽早明确诊断;预防并发症,重视不典型表现,注意体温的变化,加强监护;积极做好原发病的防治及护理;加强心理护理及康复指导。     

非ST段抬高的急性冠状动脉综合征的介入治疗进展

急性冠状动脉综合征(ACS)是以冠状动脉粥样硬化斑块破裂或侵蚀,继而发生完全或不完全闭塞性血栓形成为病理基础的一组临床综合征,包括从不稳定性心绞痛(UA)至急性心肌梗死(AMI)的一系列临床病征。现代诊疗策略以初始心电图有无持续性ST段抬高分为ST段抬高的急性冠状动脉综合症和非ST段抬高的急性冠状动脉综合征。对于ST段抬高的ACS,     

Medicamentous management of acute coronary syndrome without ST segment elevation

Recent advances in the recognition and the treatment of acute coronary syndromes (ACS) have lead to an improvement in patient survival and definition of newer guidelines. Current strategies for the treatment of patients with non-ST-elevation ACS include anti-ischemic and antiplatelet medications. While aspirin, beta-blockers, heparin and nitrates are still common practice, the advent of newer anticoagulants (low molecular weight heparins) and antiplatelet agents (glycoprotein llb/IIIa inhibitors and thienopyridines like ticlopidin and clopidogrel) and, possibly, aggressive lipid lowering with statins have added significant benefits to the treatment options with a better prognosis for these patients. Moreover, aggressive medical strategies seem to be justified not only in high-risk patients but also in those that undergo an early invasive approach.     

Fibrinolysis in patients with acute coronary syndrome

The reperfusion therapy including both fibrinolytic therapy and primary percutaneous coronary intervention (PCI) has been established in patients with ST-segment elevation acute myocardial infarction (STEMI). Fibrinolysis has the advantage of universal availability and short time to administration. Because the benefit of fibrinolysis is directly related to the time from symptom onset to treatment as demonstrated in many studies, every effort must be made to minimize any delays between symptom onset and the initiation of a safe and effective reperfusion strategy in patients with STEMI. Although the benefit of fibrinolysis is limited by inadequate reperfusion or reocclusion of the infarct-related artery in a sizable portion of patients, fibrinolysis followed by planned PCI can be one of approaches in patients presenting within 2 or 3 hours from onset of STEMI.     

急性冠脉综合征370例护理体会

对370例急性冠脉综合征患者进行分析，提出护理要点：尽早明确诊断；加强相关指标的监测；预防并发症；加强心理护理及康复指导；积极做好原发病的防治及护理。     

Statin treatment in patients with acute coronary syndrome

In PROVE IT trial, intensive lipid-lowering therapy with statin (80 mg of atorvastatin daily) provides greater protection against cardiovascular events than does a standard regimen (40 mg of pravastatin daily) in patients with acute coronary syndrome (ACS), indicating that such patients benefit from early and continued lowering of LDL cholesterol to levels substantially below current target levels. However, differences between Japanese and Westerns as far as atherogenesis and response to statins are concerned, remain an unsolved problem that requires additional investigation. New guideline for the management of patients with ACS is needed for Japanese patients.     

PCI for the patients with acute coronary syndrome

Numerous clinical trials have been conducted to compare therapeutic efficacy of thrombolysis and that of primary percutaneous coronary intervention (PCI) in the patients with acute coronary syndrome (ACS). Several recent meta-analyses revealed that primary PCI provides better short-term and long-term clinical results for ACS patients than thrombolysis does. However, in order to obtain such benefit of primary-PCI, PCI procedure has to be done by the team of well-trained angioplasters and para-medical staffs with on-site surgical back-up, as indicated by the JCS guideline for ACS treatment.     

Electrocardiographic diagnosis in patients with acute coronary syndrome

Electrocardiographic role in a diagnosis of ischemic heart disease has still important value. As important electrocardiographic findings of myocardial ischemia, there are ST elevation or depression, increase high T wave (hyperacute T wave), negative T wave and negative U wave, but it is particularly important to compare those findings and manifestation. Because the patient can always carry it, event ECG is advantageous in that they can record electrocardiography by themselves when they have some symptom. It is necessary to have attention to what abnormal findings of the electrocardiogram which it is easy to be overlooked such as increase T wave or negative U wave appear in early stage of phase of acute coronary syndrome. When the patient has some symptom that acute coronary syndrome is thought about, it is necessary to record electrocardiograms on several times and to do follow up even if there is no electorcardiographic abnormalities at first recording.     

Managing patients with non-ST-segment elevation acute coronary syndrome

Acute coronary syndromes (ACSs) can be described as ST-segment elevation or non-ST-segment elevation, including unstable angina. Traditionally, ST-segment elevation ACS has been considered to be more serious, but non-ST-segment elevation ACS has higher mortality rates in the longer term. This article discusses diagnosis, including history taking, clinical examination, electrocardiogram and biochemical markers that help to differentiate between types of non-ST-segment elevation ACSs. Risk stratification and treatment strategies are examined, as well as pharmacological treatments. The nurse's role in assessment, treatment, ongoing management and discharge practice is discussed.     

Carbohydrate exchange in patients with acute coronary syndrome

Blood sugar measurement may be important for determining therapeutic tactics in patients in urgent pathological conditions. The role of hyperglycemia in the development of acute myocardial ischemia is under constant study, because the risk of death from myocardial infarction (MI) in patients with diabetes mellitus (DM) is twice higher than in those who do not suffer from DM. Having studied literature data, presented in the article, the authors report preliminary results of their work. Carbohydrate exchange disturbances are found almost in a half (49.1%) of patients with acute coronary syndrome (ACS). In patients with substantial and severe ACS manifestations that were considered to be those of acute myocardial infarction (MI) with ST interval elevation, as well as in patients with a repeated MI, carbohydrate exchange disorder was revealed in 65% and 77% of cases. In 30% of patients with a repeated MI, and in 14% of patients with MI with ST interval elevation, hyperglycemia was transient and disappeared on its own. Evaluation of this group of patients revealed type 2 DM in 44% of cases, which once more confirmed the information that DM patients were more liable to atherothrombosis. In half of the patients DM was newly revealed. This can be explained by the fact that a stressful situation urged revealing of the disease, which otherwise could be concealed. Data that suggest a higher hyperglycemia level in patients who finally could not be saved are of certain importance.     

Impact of gender in patients with acute coronary syndrome

In this article, we review the impact of gender on the pathophysiology, management and outcomes after acute coronary syndrome (ACS). We searched the English-language literature indexed in MEDLINE, Scopus and EBSCOhost Research databases from 1988 through January 2009 using the indexing terms ‘gender’, ‘short- and long-term outcomes’ and ‘acute coronary syndrome’ and ‘myocardial infarction’. Data comparing gender differences in outcomes after ACS showed that females have a higher mortality rate than males. Observational studies showed that guideline-recommended management strategies are used significantly less frequently in females than males. The undertreatment and worse outcome of female patients with ACS are probably multifactorial and have been reported in different ethnicities and cultures. However, there are conflicting data regarding to the impact of gender on early versus long-term outcomes, the benefit of early intervention in low- and high-risk females and the influence of unmeasured selection biases in the use of therapies in the observational data. These gender discrepancy trends warrant close follow-up, as this might reflect changes in primary and secondary prevention in the community. Furthermore, gender discrepancy gives an indication of healthcare quality and whether care is given in an unbiased manner. All high-risk females, and males with ACS, should receive optimal medical management, coronary angiography and revascularization whenever indicated.     

急性冠脉综合征患者临床及冠状动脉造影分析

目的 初步探讨急性冠脉综合征患者的冠脉病变及临床特点。方法 对42例急性冠脉综合征及20例稳定型心绞痛患者的临床资料及选择性冠状动脉造影的结果进行分析。结果 急性冠脉综合征患者中 ,危险因素≥2个者占88.1% ;不稳定型心绞痛组多支病变比率占65.2% ;与稳定型心绞痛组比较 ,不稳定型心绞痛组冠状动脉狭窄程度无显著性差异(p>0.05) ,B型、C型病变的比例在急性心肌梗塞组与不稳定型心绞痛组明显增高(p<0.01)。 结论 急性冠脉综合征的致病过程 ,并不完全取决于冠脉狭窄程度 ,还与粥样斑块病理学稳定性破坏有关     

血浆脑钠素水平测定对无ST段抬高的急性冠状动脉综合征患者预后的预测价值

目的探讨血浆脑钠素(BNP)对无ST段抬高的急性冠状动脉综合征(ACS)患者预后的预测价值。方法对192例无ST段抬高的ACS患者(ACS组),20例性别、年龄相匹配的健康体检者(正常对照组)进行血浆BNP测定,并观察6个月内心血管事件(包括不稳定型心绞痛、急性心肌梗死、心力衰竭、全因死亡)发生情况。结果ACS组血浆BNP(36.45±14.96)ng/L,明显高于正常对照组(11.45±3.95)ng/L(P<0.01);在ACS组内,心肌梗死(AM I)亚组中血浆BNP(43.19±15.26)ng/L,明显高于不稳定型心绞痛(UA)亚组(31.73±12.85)ng/L(P<0.01);正常对照组无1例发生心血管事件;ACS组中,BNP>30 ng/L亚组心血管事件发生率为29.5%,显著高于BNP正常亚组的16.3%(P=0.029),比数比(OR)2.146(95%可信区间为1.07~4.29),血浆BNP>30 ng/L判断心血管事件的阳性预测值为29.5%,阴性预测值为83.6%。结论血浆BNP检测对无ST段抬高的ACS患者预后有较好的判断价值。     

急性冠状动脉综合征患者血浆同型半胱氨酸水平变化的特点

目的　急性冠状动脉综合征患者血浆同型半胱氨酸 (HCY)水平变化的特点。方法　采用高压液相色谱法分别测定 111例急性冠状动脉综合征患者 (急性冠状动脉综合征组 )、84例稳定型心绞痛患者 (稳定型心绞痛组 )和 70例正常人 (正常对照组 )血浆HCY水平。结果　急性冠状动脉综合征组血浆HCY水平明显高于稳定型心绞痛组与正常对照组 ,3组比较有显著性差异 (P <0 .0 0 1) ;高HCY血症所占比例 (4 5 .5 % )明显高于正常对照组 (18.7% ) ,有显著差异 (P <0 .0 0 1) ,较稳定型心绞痛组 (32 .8% )无明显差异 (P >0 .0 5 ) ;急性冠状动脉综合征组中男性患者血浆总HCY水平高于女性患者 (P <0 .0 0 1) ;单支、双支、3支血管有病变者血浆总HCY水平呈逐渐升高趋势 ,但无显著性差异 (P >0 .0 5 )。结论　急性冠状动脉综合征患者血浆总HCY水平明显升高 ,高HCY血症所占比例较大 ,男性患者HCY水平明显高于女性患者     

规律运动与急性冠状动脉综合征患者侧支循环形成的关系

目的 探讨急性冠状动脉综合征（ACS）患者发病前规律运动与冠状动脉侧支循环的关系.方法 选择2012年5-10月入院确诊为ACS并经冠状动脉造影检查为严重冠状动脉病变的239例患者为研究对象,按是否规律运动分为规律运动组102例与无规律运动组137例,收集分析冠状动脉造影及其他相关指标结果,并进行冠状动脉病变Gemini积分和侧支循环Rentmp分级,比较两组间冠状动脉侧支循环情况,同时对其他临床和实验室特征进行比较,采用多元logistic回归分析与侧支循环形成的关联因素.结果 规律运动组侧支循环形成比例[41.2％ （42/102）]高于无规律运动组[24.1％（33/137）],差异有统计学意义（x2=7.929,P=0.005）;规律运动组lg（Gensini评分）为（1.89±0.18）分,非规律运动组为（1.94±0.19）分,差异有统计学意义（t=2.003,P=0.046）;两组左心室射血分数分别为57.0％ （52.0％,60.0％）、50.0％ （45.0％,57.0％）,差异有统计学意义（Z=-5.152,P=0.000）.多因素Logistic回归分析显示,规律运动（OR=3.423,95％ CI：1.790～6.548）、糖尿病（OR=0.451,95％CI：0.212 ～0.962）、B型脑钠肽（OR=2.412,95％ CI：1.271 ～4.578）、非ST段抬高型ACS（OR=2.383,95％ CI：1.185～4.791）、胸痛史（OR =2.207,95％ CI：1.175～4.145）、Gensini评分（OR=1.538,95％ CI：1.141～2.073）是侧支循环建立的影响因素（P均＜0.05）.调整其他影响因素后,与无规律运动比较,规律运动的患者更容易形成冠状动脉侧支循环（OR=3.423,95％ CI：1.790～6.548,P＜0.001）.结论 对于ACS患者,规律运动有利于侧支循环的形成.     

急性冠脉综合征的院前急救与护理干预

急性冠脉综合征(acute coronary syndrome,ACS)是以冠状动脉粥样硬化斑块破溃,继发完全或不完全闭塞性血栓形成为病理基础的一组临床综合征[1],包括不稳定型心绞痛(unstableangina pectoris,UAP)、急性非ST段抬高型心肌梗死(non-ST-seg-ment elevation myocardial infarction,NSTEMI)、急性ST段抬高型心肌梗死(ST-segment elevation myocardion,STEMI)、冠心病猝死(sudden coronary death,SCD)等。该综合征由于导致急性心肌缺血,易致心室颤动而猝死;UAP很易发展为急性心肌梗死(acute myocardial infarction,AMI)。江一清等[2]…     

急性冠状动脉综合征患者经皮冠状动脉介入治疗的护理管理

目的 探讨急性冠状动脉综合征患者经皮冠状动脉介入治疗(PCI)围术期护理风险管理的价值.方法 回顾性分析152例急性冠状动脉综合征患者在PCI围术期开展护理风险管理的情况,再根据患者是否发生不良事件分为发生组38例(出现不良心血管事件)和未发生组114例(未出现不良心血管事件).比较2组一般资料,运用二元Logistic回归分析探讨影响患者出现不良心血管事件的独立因素,再用受试者工作特征(ROC)曲线分析各项独立因素的预测价值.结果 152例患者接受风险管理后,38例(25.00％)出现不良心血管事件.经二元Logistic回归分析,存在高血压病史、体质量指数(BMI)≥24 kg/m2、存在吸烟史、高密度脂蛋白胆固醇(HDL-C)≤0.9 mmol/L、低密度脂蛋白胆固醇(LDL-C)＞ 2.6 mmol/L、白细胞计数≥10×109/L是导致患者出现心脏不良事件的独立因素.经ROC曲线分析显示,白细胞计数、吸烟史、高血压病史、HDL-C、LDL-C、BMI早期预测患者出现心脏不良事件的AUC分别为0.702、0.732、0.667、0.724、0.754、0.706.结论 急性冠状动脉综合征患者在PCI治疗围术期开展护理风险管理效果显著,但仍受到诸多因素影响,故需早期识别、控制危险因素.     

急性冠状动脉综合征患者血浆谷胱甘肽抗氧化系统水平研究

目的研究急性冠状动脉综合征(ACS)患者血浆谷胱甘肽抗氧化系统的改变及临床意义。方法根据有无致动脉粥样硬化危险因素及冠状动脉造影结果将118例患者分为对照组30例、危险组28例及ACS组60例,ACS组又根据发病情况分为不稳定型心绞痛(UAP)组32例和急性心肌梗死(AMI)组28例;根据冠状动脉病变支数分为1支、2支和3支病变组,分别为30例、18例和12例;取静脉血,应用谷胱甘肽还原酶循环法测定血浆还原型谷胱甘肽(GSH)及氧化型谷胱甘肽(GSSG)浓度,根据Nernst方程计算出氧化还原电位(EhGS/GSSG);同期测定血浆高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)浓度。结果①从对照组至危险组,再至ACS组,血浆GSH浓度逐渐下降,ACS组与对照组比较差异有统计学意义(P<0.05),而血浆GSSG浓度和EhGS/GSSG值则逐渐升高,ACS组及危险组与对照组比较差异均有统计学意义(P<0.05);②UAP组与AMI组之间各指标差异均无统计学意义(P>0.05);③随着冠状动脉病变支数的增加,ACS患者谷胱甘肽抗氧化系统水平差异未见统计学意义;④ACS患者血浆GSH浓度与HDL-C水平呈正相关,与LDL-C水平呈负相关,血浆GSSG浓度及EhGS/GSSG值与血脂水平的相关性则相反。结论动脉粥样硬化时机体的抗氧化作用减弱,存在氧化应激,且与高脂血症有一定程度的相关性,提示改善机体的氧化还原状态有可能减慢或阻止动脉粥样硬化的发生与发展。