Comparative effectiveness of coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) in elderly patients with diabetes

Objective: To compare the relative effectiveness of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) among elderly patients with diabetes regarding acute myocardial infarction (AMI), stroke, repeat revascularization, and all-cause mortality.

Methods: A retrospective cohort study was conducted using the 2006–2008 5% national sample of Medicare claims data. Elderly (≥65 years) beneficiaries with at least two claims of diabetes separated by ≥30 days and who had at least one inpatient claim for multi-vessel CABG or PCI between 1 July 2006 and 30 June 2008 were identified. The date of beneficiary’s first CABG or PCI was defined as the index date. All patients were followed from the index date to 31 December 2008 for outcomes. CABG and PCI patients were 1:1 matched on propensity scores and index dates. Cox proportional hazards models were used to compare postoperative outcomes between patients undergoing CABG versus PCI.

Results: The matched sample consisted of 4430 patients (2215 in each group). The Cox proportional hazards models showed that, compared to patients undergoing PCI, CABG was associated with a lower risk of postoperative AMI (hazard ratio [HR]: 0.494; 95% CI: 0.396–0.616; p?<?.0001), repeat revascularization (HR: 0.194; 95% CI: 0.149–0.252; p?<?.0001), the composite outcome (HR: 0.523; 95% CI: 0.460–0.595; p?<?.0001), and all-cause mortality (HR: 0.775; 95% CI: 0.658–0.914; p?=?.0024); postoperative risk of stroke was not significantly different between the two groups (HR: 0.965; 95% CI: 0.812–1.148; p?=?.691).

Conclusions: CABG appears to be the preferred revascularization strategy for elderly patients with diabetes and coronary heart disease. However, this result should be interpreted considering study limitations, for example, several patient clinical variables and physician-related factors which may affect procedure outcomes are not available in the data. Clinical decisions should be individualized considering all patient- and physician-related factors.     

药物洗脱支架应用于ST段抬高型心肌梗死急诊冠状动脉介入治疗临床分析

目的观察药物洗脱支架应用于急诊冠状动脉介入治疗ST段抬高性型心肌梗死的疗效和安全性。方法选择我院急诊住院的22例ST段抬高性急性心肌梗死患者,男18例,女4例,年龄40—79岁,平均年龄为（60．3±11．7）岁。发病至手术时间为1．5～11h,平均（4．4±2．78）h,在发病12h内急诊行经皮冠状动脉介入（percutaneous coronary interverjtion）治疗,将22例患者植入Firebird和ENDEAVOR支架,并对临床资料,住院期间的心脏事件发生率进行分析,同时对比观察分析两组不同的药物洗脱支架的病变特征,术后住院期间和随访期间再梗死,、死亡等心血管不良事件。结果全部患者造影证实PCI即刻恢复TIM13级血流达到95．7％,4．3％恢复TIM12级血流,改善了ST段抬高型心肌梗死患者的房室传导功能,并发症发生率低。其中两组药物洗脱支架患者住院期间心脏不良事件发生率无显著性差异。住院期间无急性或亚急性血栓形成,在长达两年的随访中,22位病人并未出现心源性死亡,无再发新梗死。结论药物洗脱支架（Firebird支架和ENDEAVOR支架）在急诊冠状动脉介入治疗ST段抬高型心肌梗死中是安全有效的。     

Rationale for administering beta-blocker therapy to patients undergoing coronary artery bypass surgery: a systematic review

Introduction: Secondary preventative therapies are essential for patients undergoing coronary artery bypass graft (CABG) surgery to optimize perioperative and long-term outcomes. Beta-blockers are commonly used to treat patients with coronary artery disease and congestive heart failure (CHF), but their role for CABG patients remains unclear. The goal of this systematic review was to evaluate the rationale for administering beta-blockers to the CABG population and to assess their efficacy before and after coronary surgical revascularization.

Areas covered: A systematic literature review was performed to retrieve relevant articles from the PubMed database published between 1985 and 2017.

Expert opinion: Outside of the surgical field, strong evidence supports the use of beta-blockers for patients with a history of previous myocardial infarction (MI) or CHF. For the CABG population, studies have suggested that perioperative beta-blocker therapy is beneficial, with an associated reduction in mortality, particularly among those with a history of previous MI or CHF. Beta-blocker administration has also clearly been shown to lower the rate of new-onset postoperative atrial fibrillation after CABG. Among the different types of beta-blockers, perioperative carvedilol appears to be the most beneficial. In the absence of contraindications, nearly all CABG patients are candidates for perioperative beta-blocker therapy.     

冠状动脉旁路移植术后桥血管闭塞致心绞痛复发患者行自体冠状动脉介入治疗观察

目的 探讨冠状动脉旁路移植术(CABG)后因桥血管闭塞致心绞痛复发的冠心病患者行自体冠状动脉介入(PCI)治疗的疗效.方法 对10例实施介入治疗的CABG术后因桥血管闭塞致心绞痛复发患者的临床资料、造影结果、介入治疗结果进行回顾性分析.结果 10例桥血管闭塞的CABG术后患者接受了PCI治疗,其中9例患者为慢性完全闭塞病变(CTO),1例患者为左主干病变.10例患者均成功完成自体冠状动脉血运重建,术后均无心绞痛复发.结论 自体冠状动脉病变行PCI治疗CABG术后心绞痛复发是可行的、安全有效的.     

替罗非班对糖尿病并ST段抬高急性心肌梗死急诊PCI术后心肌灌注的影响

目的:探讨急诊经皮冠状动脉介入治疗(PCI)术应用国产替罗非班对糖尿病(DM)并ST段抬高急性心肌梗死(STEMI)患者心肌灌注的影响。方法:79例首发STEMI且有DM并接受急诊PCI治疗的患者,随机分为替罗非班组(n=38)和常规治疗组(n=41),替罗非班组患者诊断后即刻给予替罗非班氯化钠注射液10μg.kg-1于3 min内推注完毕,术后替罗非班0.15μg.kg-1.min-1滴注24～36 h,其余治疗同常规治疗组。比较两组患者心肌灌注分级(TMPG)、测定两组术后肌酸激酶(CK)及心肌型肌酸激酶同工酶(CK-MB)峰值水平和出血并发症。结果:两组基础临床情况和造影特征无明显差异。替罗非班组心肌灌注良好获得率明显增高;替罗非班组术后CK及CK-MB峰值水平明显减低;替罗非班组轻度出血发生率有高于对照组趋势,但无严重出血或血小板减少症。结论:国产替罗非班能改善DM并STEMI患者心肌灌注指标,减少心肌损伤,不增加出血及血小板减少症并发症的发生率。     

右优势型右冠脉PPCI时低血压状态的原因及对策

目的分析总结经冠脉造影证实的右优势型右冠脉急性闭塞导致急性下壁心肌梗死的患者行直接经皮冠状动脉介入（PPC）I治疗手术时低血压状态的原因及对策。方法选择112例经冠脉造影证实的右优势型右冠脉急性闭塞导致急性下壁心肌梗死的患者,当患者在PPCI治疗术中开通冠脉病变血管时出现低血压状态时,先给予静脉快速补充生理盐水治疗,若血压不能恢复正常,再酌情使用阿托品、多巴胺及临时起搏治疗。结果全组有103例病例在PPCI手术中出现低血压状态,有59例通过单纯静脉快速补充生理盐水治疗后得以纠正。结论在右优势型右冠脉急性闭塞导致急性下壁心肌梗死的患者进行PPCI手术出现低血压状态时,可以先尝试使用静脉快速补充生理盐水的治疗方法来纠正。     

雷帕霉素药物洗脱支架在STEMI合并糖尿病患者急诊PCI中的应用

目的 探讨雷帕霉素药物洗脱支架在急性ST段抬高型心肌梗死（STEMI）合并糖尿病患者急诊经皮冠状动脉介入（PCI）中应用的安全性与有效性.方法 选取本院2010年7月～2013年7月收治的STEMI合并2型糖尿病行雷帕霉素药物洗脱支架置入术患者（79例）作为试验组,选取同期收治的STEMI合并2型糖尿病行金属裸支架置入术患者（43例）作为对照组,对比两组患者术后12个月不良心血管事件发生率及术后即刻、24 h、48 h、72 h血小板聚集情况.结果 试验组患者术后12个月死亡、再梗死、再次靶血管重建等主要不良心血管事件发生率均明显低于对照组,差异有统计学意义（P＜0.05）.两组患者术前即刻、术后即刻及术后24 h血小板聚集情况差异无统计学意义（P＞0.05）,试验组患者术后48、72 h血小板聚集情况明显优于对照组,差异有统计学意义（P＜0.05）.两组患者术后24 h、术后1个月等近期再狭窄发生率差异无统计学意义（P＞0.05）,试验组患者术后6、12个月再狭窄发生率（8.86％、11.39％）明显低于对照组（25.58％、32.56％）,差异有统计学意义（P＜0.05）.结论 STEMI合并糖尿病患者行急诊PCI术后置入支架能在一定程度上改善心肌再灌注情况,且雷帕霉素药物洗脱支架相较于金属裸支架具有更好的远期疗效,其远期不良心血管事件发生率明显偏低,心肌组织水平再灌注情况优势明显,有助于改善患者术后的生活水平.     

Heparin responsiveness during off-pump coronary artery bypass graft surgery: predictors and clinical implications

Aim:To evaluate the clinical impact of reduced heparin responsiveness (HR(reduced)) on the incidence of myocardial infarction (MI) following off-pump coronary artery bypass graft surgery (OPCAB), and to identify the predictors of HR(reduced).Methods:A total of 199 patients scheduled for elective OPCAB were prospectively enrolled. During anastomosis, 150 U/kg of heparin was injected to achieve an activated clotting time (ACT) of ≥ 300 s, and the heparin sensitivity index (HSI) was calculated. HSIs below 1.0 were considered reduced (HR(reduced)). The relationships between the HSI and postoperative MI, cardiac enzyme levels and preoperative risk factors of HR(reduced) were investigated.Results:There was no significant relationship between the HSI and cardiac enzyme levels after OPCAB. The incidence of MI after OPCAB was not higher in HR(reduced) patients. HR(reduced) occurred more frequently in patients with low plasma albumin concentrations and high platelet counts.Conclusion:HR(reduced) was not associated with adverse ischemic outcomes during the perioperative period in OPCAB patients, which seemed to be attributable to a tight prospective protocol for obtaining a target ACT regardless of the presence of HR(reduced).     

冠状动脉移植术和介入术后患者监护拔牙的临床观察

目的探讨对经冠脉血管重建(CABG)与冠脉介入术(PCI)患者安全实施拔牙手术的途径和方法。方法设定2病种在牙科手术和围手术期的安全基线,确定可施行手术观察组的入组条件。对每一拔牙手术需求患者进行术前评估,对其中较重病种给予药物治疗干预,根据评估的结果决定是否入组进行监护手术,依据各病种病情特点确定术后观察和随访原则。结果 CABG患者44例次,评估后符合入组条件41例次,安全施行拔牙手术39例次,占入组患者95.12%;PCI患者267例次,79例做安放支架前患心肌梗死,评估入组患者245例次,安全实施手术240例次,占入组患者97.95%。结论本研究制定的方法和路径对CABG和PCI患者实施拔牙手术安全可靠。     

抑肽酶与冠脉搭桥术围术期心梗相关性的初步观察

目的:观察冠状动脉搭桥手术(CABG)患者术中应用抑肽酶是否引起围术期心肌缺血甚至心肌梗死。方法:11例择期冠状动脉搭桥术者,均浅低温体外循环(CPB),预充抑肽酶500万KIU。6例灌注4∶1冷含血心脏停搏液(10～15℃),5例单次灌注4℃组氨酸-色氨酸-α酮戊二酸(HTK)液。于麻醉诱导后、CPB停机前、术后2h、第1天、第2天分别采取外周血,用酶联免疫法测定血清磷酸肌酸激酶同工酶(CK-MB)含量。并观察记录异常心电图及胸痛主诉。结果:CPB中至术后第一天CK-MB均显著升高,第二天均恢复正常。5例于术后第一、二天有短暂不典型的ST抬高,全体无胸痛主诉。1例死于呼吸衰竭,其余痊愈出院。结论:未能观察到CABG患者应用大剂量抑肽酶增加围术期心肌梗死的危险。     

药物洗脱支架与裸金属支架治疗无保护左主干病变的效果比较

目的：比较药物洗脱支架(DES)和裸金属支架(BMS)在无保护左主干(LMCA)病变中的疗效。方法连续入选了294例无保护LMCA病变患者,其中165例接受DES治疗,129例接受BMS治疗。主要终点是术后5年的主要心脏不良事件(MACE),包括心性死亡、心肌梗死(MI)和靶病变血运重建(TLR)。结果在PSM后的人群中,DES组5年的MACE(P=0.022)、心性死亡(P=0.045)、MI(P=0.049)的发生率均低于BMS组,两组TLR和支架内血栓发生率比较差异无统计学意义(P跃0.05)。 Kaplan-Meier法分析显示,DES组和BMS组的无MACE生存率(80.6%和68.2%,P=0.023)、总体生存率(93.0%和85.3%,P=0.045)、无TLR生存率(84.5%和72.1%,P=0.014)及无MI生存率(89.9%和80.6%,P=0.029)比较差异均有统计学意义。结论在无保护LMCA病变患者中,置入DES组患者的MACE发生率低于BMS组；DES组心性死亡和MI的获益高于BMS组,而TLR的长期获益相当。     

罗格列酮对2型糖尿病患者冠脉支架内再狭窄的预防作用

目的 探讨罗格列酮对2型糖尿病患者行冠脉成形及支架植入术后支架内再狭窄的预防作用。方法 选择行冠脉成形及支架植入术的2型糖尿病患者60例。在原有降糖药物治疗的基础上，研究组(n=31)加服罗格列酮；对照组(n=29)用药方案不变。术后随访6mo，观察患者死亡、急性心肌梗死及再次血管重建术等心血管事件的发生情况，在随访结束时行活动平板检查，结果 阳性的再次行选择性冠脉造影术。结果2组患者随访期间均无死亡、急性心肌梗死等心血管事件发生。6mo内研究组9例再次心绞痛发作，5例活动平板试验阳性，其中5例(16．1％)冠脉支架内再狭窄；而对照组18例再次心绞痛发作，其中15例活动平板阳性，15例(48．4％)冠脉造影术证实支架内再狭窄，2组再狭窄对比有显著差异(P=0．013)。结论 对于2型糖尿病合并冠心病行冠脉成形及支架植入术患者，罗格列酮能有效降低支架内再狭窄。     

冠状动脉旁路移植术后再发心绞痛介入血运重建与药物治疗的比较研究

目的 观察冠状动脉介入治疗和单纯药物治疗对冠状动脉旁路移植术后再发心绞痛患者预后的影响.方法 回顾性分析冠状动脉旁路移植术后因再发心绞痛行冠状动脉造影检查的患者的临床资料,依据是否对桥血管和原发冠状动脉病变进行介入性血运重建分为介入治疗组(129例)和单纯药物治疗组(133例).随访1年后的主要心血管事件发生率.主要终点为主要不良心血管事件(MACE)发生情况,包括心源性死亡、非致命性心肌梗死、靶病变/靶血管血运重建等;次要终点:非靶血管血运重建和心绞痛复发情况.观察心功能和因心血管疾病再住院率.结果 随访1年,2组患者共成功随访245例,其中介入治疗组124例、药物治疗组121例.1年后MACE发生率:介入治疗组、药物治疗组分别为9.7％ (12/124)、23.1％(28/121),差异有统计学意义(P＜0.05).介入治疗组和药物治疗组心绞痛复发率为14.5％(18/124)和27.3％ (33/121),差异有统计学意义(P＜0.05).因心血管疾病再住院率介入治疗组和药物治疗组分别为10.5 (13/124)和21.5％ (26/121),差异有统计学意义(P＜0.01).介入治疗组左心室射血分数为(64±11)％,明显高于药物治疗组[(58±8)％](P＜0.05).结论 经皮冠状动脉介入治疗对冠状动脉旁路移植术后桥血管和原发冠状动脉病变安全有效,中期预后优于单纯药物治疗.     

中重度缺血性二尖瓣反流患者行二尖瓣置换同期冠状动脉旁路移植术的临床研究

目的：探讨二尖瓣置换（mitral valve replacement,MVR）同期冠状动脉旁路移植术（coronary artery bypass grafting,CABG）治疗中重度缺血性二尖瓣反流（ischemic mitral regurgitation,IMR）的效果。方法2010年7月—2013年1月,16例冠状动脉粥样硬化性心脏病（coronary artery disease,CAD）合并中重度 IMR 的患者接受了 CABG 联合 MVR 术。其中男性8例,女性8例;平均年龄（63．4±7．6）岁。术前经胸超声心动图示中度二尖瓣反流2例,中重度8例,重度 6例。比较患者术前及术后经胸超声心动图资料。结果院内死亡1例。术后复查超声心动图示二尖瓣无反流10例,轻度反流5例,轻中度反流1 例。左心室舒张末内径（left ventricular end-diastolic diameter,LVEDD）从（60±13）mm 下降到术后12个月随访时的（47±12）mm（P ＜0．05）。结论二尖瓣置换同期冠状动脉旁路移植术治疗中重度缺血性二尖瓣反流的近期效果满意,并能明显改善左心室功能。     

杂交冠状动脉血运重建术与CABG治疗多支冠状动脉疾病中远期随访的Meta分析

目的 系统评价杂交冠状动脉血运重建术（HCR）与冠状动脉旁路移植术（CABG）治疗多支冠状动脉疾病 中远期疗效与并发症。方法 系统检索Embase、PubMed、Web of Science、Cochrane Central Registry of Controlled Trials （Central）、万方数据、中国知网,筛选符合纳入标准的文献,并计算每项研究中的比值比（odds ratio,OR）和95%置信 区间（95%CI）,采用RevMan 5.3软件进行Meta分析。结果 9篇文献纳入研究,累计研究对象4 030例,其中1 142例 接受HCR治疗,2 888例接受传统CABG治疗。Meta分析结果显示：（1）中远期随访中HCR组术后全因病死率（OR= 0.72,95%CI：0.54～0.96）和主要心脑血管事件（MACCE,OR=0.54,95%CI：0.35～0.82）均低于CABG组。而在血运重 建（OR=0.90,95%CI：0.61～1.34）及心肌梗死或心绞痛发生率（OR=0.51,95%CI：0.18～1.41）方面差异无统计学意义。 （2）中期随访中 HCR 组的 MACCE 发生率低于 CABG 组（OR=0.31,95%CI：0.15～0.66）,而全因病死率（OR=0.79, 95%CI：0.52～1.22）、血运重建（OR=0.77,95%CI：0.30～1.96）以及心肌梗死或心绞痛发生率（OR=0.71,95%CI：0.05～ 9.46）等差异无统计学意义。（3）远期随访中HCR组术后全因病死率（OR=0.67,95%CI：0.46～0.98）及心肌梗死或心绞 痛发生率（OR=0.32,95%CI：0.15～0.68）均低于 CABG 组。而在 MACCE（OR=0.72,95%CI：0.43～1.21）与血运重建 （OR=0.93,95%CI：0.60～1.45）方面差异无统计学意义。结论 HCR相比CABG可降低多支冠状动脉病变患者的中 期MACCE和远期全因病死率、心肌梗死或心绞痛发生率。     

冠心病合并2型糖尿病患者血糖、血脂水平与冠状动脉病变的关系

目的 探讨冠心病（CAD）合并2型糖尿病（T2DM）患者的血糖、血脂水平与冠状动脉病变之间的关系.方法 收集我院2007年1月至2009年12月期间住院行冠状动脉造影检查明确诊断为CAD患者328例,其中T2DM患者96例（糖尿病组）,非T2DM患者232例（非糖尿病组）.比较分析两组患者的空腹血糖（FBG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、甘油三脂（TG）水平以及冠状动脉病变特点.结果 （1）糖尿病组患者FBG、TC、LDL-C以及TG水平分别为（7.2±1.1）mmol/L、（5.6±0.8）mmol/L、（3.1±0.5）mmol/L、（2.6±0.5）mmol/L,高于非糖尿病组（P＜0.05）.HDL-C水平为[0.9±0.2）mmol/L,低于非糖尿病组（P＜0.05）.（2）糖尿病组患者中冠状动脉重度狭窄者占65.6%,冠状动脉多支病变者占69.8%,明显高于非糖尿病组（P＜0.05）.（3）FBG≥6.1 mmol/L以及LDL-C≥2.6 mmol/L的CAD合并T2DM患者中冠状动脉重度狭窄者分别占73.3%、70.9%,多支病变者分别占80.0%、76.4%,高于对照组（P＜0.05）.结论 冠心病合并2型糖尿病患者冠状动脉狭窄程度重、病变分布广泛.FBG及LDL-C升高与糖尿病合并冠心病患者冠脉病变密切相关.     

心理护理在冠状动脉搭桥术患者中的应用

目的：探讨心理干预对冠状动脉搭桥术患者的影响。方法选择2014年1月-2015年1月医院行冠状动脉搭桥术治疗的冠心病患者60例,随机分为观察组与对照组各30例。对照组予常规护理,观察组在对照组基础上增加心理护理干预。比较2组临床护理质量及效果。结果观察组心理焦虑、抑郁发生率明显低于对照组,住院时间短于对照组,问卷调查满意度高于对照组,差异有统计学意义（P ﹤0.05）。结论对冠状动脉搭桥术患者进行围术期心理干预可改善患者心理状况,提高手术成功率,值得临床推广应用。     

前列地尔对冠心病合并糖尿病患者介入治疗后造影剂肾病的影响简

目的 探讨前列地尔对防治冠心病合并糖尿病患者经皮冠状动脉介入治疗（PCI）后造影剂肾病的有效性.方法 将158例冠心病合并糖尿病患者随机分为常规治疗组（81例）和前列地尔组（77例）.常规治疗组（对照组）常规给予抗血小板聚集、降血脂及水化等治疗;前列地尔组（治疗组）PCI术开始前30 min给予前列地尔脂微球载体制剂10 μg经100 ml生理盐水稀释后经静脉滴入,术后连续静脉注射3 d;然后分别测定并比较两组患者造影后24 h、72 h的血肌酐（Scr）、尿素氮（BUN）、肾小球滤过率（GFR）和造影剂肾病（CIN）的发生率.结果 两组患者术后72 h治疗组BUN及Scr增加值和增加百分比明显低于对照组（P＜0.05）,GFR下降值和下降比率以及CIN的发生率亦明显低于对照组（P＜0.05）.结论 应用前列地尔可能对于冠心病合并糖尿病患者PCI术后造影剂肾病的发生具有一定的预防保护作用.     

Clinical pharmacy specialist implementation of lisinopril therapy in patients with coronary artery disease and diabetes mellitus

STUDY OBJECTIVE: As the results of the Heart Outcomes Prevention Evaluation trial suggested that patients with both coronary artery disease (CAD) and diabetes mellitus would benefit from angiotensin-converting enzyme (ACE) inhibitor therapy, our objective was to increase the percentage of patients with both of these conditions receiving the goal dosage (20 mg/day) or highest tolerated dosage of the ACE inhibitor lisinopril through intervention of a clinical pharmacy service. STUDY DESIGN: Prospective study with historic comparison (control group). SETTING: Clinical Pharmacy Cardiac Risk Service. PATIENTS: Hospitalized patients with CAD and type 2 diabetes mellitus. MEASUREMENTS AND MAIN RESULTS: At hospital discharge, lisinopril 5 mg/day was started in eligible patients; the drug was titrated to a goal dosage of 20 mg/day or the highest tolerated dosage. Potassium level, serum creatinine level, and blood pressure were monitored at baseline, at each dosage titration, and 2 weeks after the goal or highest tolerated dosage was reached. The group receiving usual care (control group) consisted of 95 patients; the treatment group had 101 patients. At baseline, 19 patients (20%) in the control group were receiving the goal dosage of lisinopril, 34 (36%) were taking a suboptimal dosage, 16 (17%) were excluded from treatment, and 26 (27%) were eligible but were not receiving lisinopril therapy. After 9 months, ACE inhibitor dosages had changed minimally in the control group. In the treatment group, at baseline, 37 patients (36%) were at their goal dosage and therefore titration was not necessary; 15 (15%) were receiving a suboptimal dosage, 35 (35%) were excluded from treatment, and 14 (14%) were eligible but not receiving therapy. After the titration period, 55 (54%) treatment group patients were at the goal dosage, 11 (11%) were taking a suboptimal dosage, and 35 (35%) were not candidates for ACE inhibitor therapy. The most common reasons for exclusion were renal insufficiency, cough, and baseline hypotension. Changes in potassium level, serum creatinine level, and blood pressure were not significant during the study. CONCLUSION: The clinical pharmacy service more than doubled the number of patients with CAD and diabetes who achieved the goal dosage of an ACE inhibitor, a drug class that has been shown to decrease morbidity and mortality in this patient population.     

经桡动脉途径行冠状动脉介入治疗心肌梗死的临床效果观察

目的：探讨经桡动脉途径行冠状动脉介入治疗（ PCI ）急性心肌梗死的临床效果。方法将2011年1月至2014年1月收治的236例急性心肌梗死患者随机分为观察组（ n ＝129）和对照组（ n ＝107）,对照组经股动脉行PCI,观察组经桡动脉行PCI,比较2组患者治疗效果、并发症发生率及心血管事件（ CE）发生率。结果2组患者造影和PCI资料比较差异无统计学意义（ P ＞0#．05）;观察组卧床时间、住院时间、围术期TIMI小出血发生率、血管并发症发生率分别为（4．11±1．73）h、（3．14±0．57）d、5．43％和21．71％,均低于对照组（ P ＜0．05）;2组患者围术期TIMI大出血发生率、住院期间CE发生率及术后1年、2年CE发生率比较差异无统计学意义（ P ＞0．05）。结论经桡动脉行PCI治疗心肌梗死的临床疗效与经股动脉相当,但经桡动脉行PCI并发症发生率较低,且术后卧床时间较短,值得临床重视。