AMI患者PCI术后BNP相关分析及应用研究

目的:观察PCI术对AMI患者血浆中BNP的水平变化,探讨PCI对AMI患者预后的影响.方法:采用快速荧光免疫测定法对50例AMI患者PCI治疗前、治疗后7d内每日同一时间取静脉血进行BNP的测定和50例对照组血浆BNP水平进行检测.结果:AMI患者血浆BNP在行PCI术后与对照组比较有显著性差异(P<0.05),PCI治疗后呈明显下降趋势.结论:AMI患者经PCI治疗血浆BNP水平变化说明PCI术对改善AMI患者的预后有重要意义.     

直接和延迟PCI对AMI患者血浆BNP影响的对比研究

目的:探讨通过序列地测定急性心肌梗死(AMI)患者经皮冠脉介入(PCI)前后血浆 BNP浓度,探讨了直接和延迟PCI对AMI患者心功能转归的影响.方法:顺序选入2005-12-2006-11月就诊于河北医科大学第三医院心内科的ST段抬高型心肌梗死(STEMI)患者45名.采用酶联免疫吸附法(ELISA)分别检测入院即时、术后7d和30d时的血浆脑利钠肽(BNP)浓度.结果:直接PCI组和延迟PCI组血浆BNP浓度在术前无显著性差异,PCI术后7d、30d的血浆BNP浓度与治疗前比较均有显著下降(P<0.05),术后30d下降更为显著(P<0.01);两组间比较PCI术后7d(183.4±56.2pg/mL vs 243.7±85.2pg/mL P<0.05)和30d(108.3±36.7pg/mL vs 139.4±76.8pg/mL P<0.05)均有显著性差异,前者均低于后者.结论:AMI患者接受PCI治疗后,血浆BNP浓度逐渐下降,直接PCI较延迟PCI治疗血浆BNP浓度下降显著,直接PCI治疗对住院期间AMI患者心功能的改善优于延迟PCI治疗.     

冠脉急诊PCI术与溶栓治疗对老年急性心肌梗死患者的临床疗效观察

目的:研究急诊冠状动脉介入治疗(PCI)与静脉溶栓治疗对老年急性心肌梗死患者的近期疗效观察.方法:78例≥60岁的ST段抬高的急性心肌梗死患者,43例接受急诊PCI治疗.35例接受静脉溶栓治疗.比较两种治疗方法对患者的临床近期效果.结果:溶栓组梗死相关血管(IRA)再通率为68.5%,直接PcI组IRA再通率为97.6%;6个月时左室射血分数(LVEF)溶栓组为(40.5±5.8)%.直接PCI组为(51.6±6.5)%.出血并发症、住院期间病死率、再发心绞痛和主要心脏事件发生率,溶栓组明显高于直接PcI组.溶栓组平均住院时间为9.5d,PCI组平均住院时间为21.5d.结论:对老年AMI患者,急诊PCI治疗更能尽快、及时有效地开通梗死相关动脉,挽救濒死心肌,改善左室功能,降低病死率.     

Ⅰ期运动康复训练对急性ST段抬高心肌梗死急诊PCI术后患者心功能及预后的影响研究

目的：分析Ⅰ期运动康复训练对急性ST段抬高心肌梗死（ST-segment elevation myocardial infarction, STEMI）患者PCI术后心功能及预后的影响。方法：以75例STEMI患者为研究对象,随机分为观察组（n=35）与对照组（n=40）,对照组术后行常规康复,观察组接受Ⅰ期运动康复训练。比较两组患者心功能指标、运动能力及主要心血管不良事件（major adverse cardiac events, MACE）的发生情况。结果：观察组与对照组离院时血浆NT-pro BNP、cTNI与hs-CRP水平无统计学差异（P>0.05）。观察组术后6个月LVEF水平高于对照组（P<0.05）,观察组术后1个月与术后6个月显著高于对照组（P<0.05）。观察组术后1个月及术后6个月MACE发生率分别为5.7%与8.6%,均低于对照组但无统计学差异（P>0.05）。结论：Ⅰ期运动康复训可改善STEMI患者预后,具备较高的应用价值。     

急性心肌梗塞急诊介入治疗的临床观察

目的 :通过分析急诊经皮冠状动脉介入治疗 (PCI)对急性心肌梗死的急诊介入治疗方法 ,探讨急诊PCI对急性心肌梗塞的治疗策略。方法 :入选 2 0 0 1.6 .2 3～ 2 0 0 2 .5 .10日入院的ST段抬高的急性心肌梗塞 ,发病时间在 12h内 ,行急诊冠状动脉造影的急诊PCI。结果 :入选急性心肌梗死患者 4 4例行急诊冠状动脉造影 ,男 34例 ,女 10例 ,年龄 (6 0 .1± 11.3岁 )。行急诊PCI的有 4 3例 ,IRA前向血流达到TIMI3级为 90 .9%。单支、双支及三支病变分别占 2 2 .7%、2 9.8%、4 0 .9% ,左主干三支病变占 6 .8%。其中左主干 +三支病变组死亡一例 ,其余 4 2例均放入支架无IRA的急性或亚急性再闭塞 ,住院期间无心肌缺血再发 ,无复流现象 4例 ,约占 9.1%。结论 :急性PCI是开通梗死相关血管的最佳方法 ,应积极开展。     

Effect of a distal protection device on epicardial blood flow and myocardial perfusion in primary percutaneous coronary intervention

Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated. Methods and Results: Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%). Conclusion: Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.     

Renal insufficiency is an independent predictor of in-hospital mortality for patients with acute myocardial infarction receiving primary percutaneous coronary intervention

Objective:To investigate the relationship between renal function and clinical outcomes among patients with acute ST-segment elevation myocardial infarction (ASTEMI), who were treated with emergency percutaneous coronary intervention (PCI). Methods: 420 patients hospitalized in Peking University First Hospital, diagnosed with ASTEMI treated with emergency (PCI) from January 2001 to June 2011 were enrolled in this study. Estimated glomerular filtration rate (eGFR) was used as a measure of renal function. We compared the clinical parameters and outcomes between ASTEMI patients combined renal insufficiency and the patients with normal renal function. Results:There was a significant increase in the concentrations of fibrinogen and D-Dimer (P<0.05) and a much higher morbidity of diabetes mellitus in the group of patients with chronic kidney disease (CKD; eGFR<60 ml/(min·1.73 m2)) (P<0.01). CKD (eGFR<60 ml/(min·1.73 m2)) was an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI receiving PCI therapy rapidly (P=0.032, odds ratio (OR) 4.159, 95% confidence interval (CI) 1.127-15.346). Conclusions:Renal insufficiency is an independent predictor of in-hospital mortality for patients hospitalized with ASTEMI treated with primary PCI.     

Early reperfusion strategy for acute myocardial infarction: a need for clinical implementation

Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction (STEMI) care, and it is time-dependent. Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in practice. We need to improve upon the problems of low reperfusion rate, non-standardized treatment, and economic burden in STEMI care. This article briefly reviews the current status of reperfusion strategy in STEMI care, and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.     

灯盏花素治疗冠心病的疗效观察

目的：探讨灯盏花素治疗冠心病的疗效机理．方法：用灯盏花素治疗冠心病伴高粘滞血症患者４０例，与用复方丹参注射液治疗的同样患者４０例进行对比，两组疗程均１５天．对血清脂质过氧化物（ＬＰＤ）含量、超氧化物歧化酶活性（ＳＯＤ）、血脂、血液流变学指标进行检测．结果：患者症状、心电图、血脂、血流变、ＬＰＯ、ＳＯＤ，治疗组较对照组改善明显．（ｐ＜０．０５）．结论：灯盏花素降低冠心病者血液的高粘滞状态，提高抗氧化能力，有效改善其症状．