ImportanceGastrointestinal injury progression induced by antiplatelet therapy in patients after percutaneous coronary intervention (PCI) has not been well studied.ObjectiveTo assess the association of aspirin, clopidogrel, and their combination with gastrointestinal injury progression among patients without high bleeding risk after PCI.Design, Setting, and ParticipantsThis secondary analysis assessed data from the Optimal Antiplatelet Therapy for Prevention of Gastrointestinal Injury Evaluated by ANKON Magnetically Controlled Capsule Endoscopy (OPT-PEACE) double-masked, placebo-controlled, multicenter randomized clinical trial. The OPT-PEACE trial was conducted at 28 centers in China, and recruitment took place from July 13, 2017, to July 13, 2019. The trial included patients with stable coronary artery disease or acute coronary syndromes without ST-segment elevation after PCI. Statistical analysis was conducted from September 13, 2022, to January 23, 2023.InterventionsPatients underwent magnetically controlled capsule endoscopy (MCE) at baseline and after 6 months of dual antiplatelet therapy (DAPT) with aspirin (100 mg/d) plus clopidogrel (75 mg/d). Those with no evidence of gastrointestinal ulcers or bleeding (ie, the intention-to-treat [ITT] cohort) were randomized (1:1:1) to aspirin (100 mg/d) plus matching placebo (aspirin alone), clopidogrel (75 mg/d) plus matching placebo (clopidogrel alone), or DAPT for an additional 6 months. A third MCE was performed 12 months after PCI.Main Outcomes and MeasuresThe primary outcome was the rate of gastric injury progression as assessed with the results of the 3 MCEs (at baseline, 6 months, and 12 months) in the modified intention-to-treat (mITT) population. The key secondary outcome was the rate of small-intestinal injury progression. Gastric or small-intestinal injury progression was defined as a quantitative increase in erosions or ulcers between the second and third MCEs (at 6 and 12 months, respectively).ResultsThis study included the 394 patients in the mITT cohort. Their mean (SD) age was 56.9 (8.7) years, and most were men (296 [75.1%]). A total of 132 patients were randomized to aspirin alone, 132 to clopidogrel alone, and 130 to DAPT. Gastric injury progression occurred in 49 aspirin users (37.1%), 64 clopidogrel users (48.5%), and 69 DAPT users (53.1%) (P = .02), reflecting a lower rate of gastric injury progression among aspirin users vs DAPT users (risk ratio [RR], 0.70 [95% CI, 0.49-0.99]; P = .009). No significant difference was observed between clopidogrel alone and DAPT (48.5% vs 53.1%; P = .46) or between aspirin alone and clopidogrel alone (37.1% vs 48.5%; P = .06). A total of 51 aspirin users (38.6%), 65 clopidogrel users (49.2%), and 71 DAPT users (54.6%) (P = .03) developed progressive small-intestinal injury, reflecting a lower rate of small-intestinal injury among aspirin users vs DAPT users (RR, 0.71 [95% CI, 0.50-0.99]; P = .01). No difference was observed between patients treated with clopidogrel vs DAPT (49.2% vs 54.6%; P = .38) or with aspirin vs clopidogrel (38.6% vs 49.2%; P = .08).Conclusions and RelevanceIn this secondary analysis of a randomized clinical trial, ongoing use of aspirin, clopidogrel, or their combination between 6 and 12 months after PCI was associated with progressive gastric and small-intestinal injury in a substantial proportion of patients, more so with DAPT than with monotherapy. Clopidogrel was at least as likely as aspirin to induce gastrointestinal injury progression. Future research is warranted to determine what impact the findings from MCEs would have on decision-making of antiplatelet therapy.Trial RegistrationClinicalTrials.gov Identifier: NCT03198741

Objective::This study aimed to evaluate the major adverse cardiovascular and cerebrovascular events (MACCEs) and overall safety profile associated with iodixanol in Chinese patients undergoing percutaneous coronary intervention (PCI).Methods::Patients at 30 centers in China registered in the OpenClinic v3.6 database from October 30, 2013, to October 7, 2015, were included in the study. The primary endpoint was in-hospital MACCEs including target lesion revascularization (TLR), stroke, stent thrombosis, cardiac death, and PCI-related myocardial infarction (MI) within 72 h post-PCI. Secondary endpoints were MACCEs from 72 h to 30 d post-PCI and other safety events within 30 d post-PCI.Results::A total of 3,042 patients were enrolled. The incidence of MACCEs within 72 h post-PCI was 2.33% ( n = 71), including cardiac death (0.03%, n = 1) and PCI-related MI (2.30%, n = 70). The incidence of MACCEs from 72 h to 30 d post-PCI was 0.16% ( n = 5), including cardiac death (0.10%, n = 3), PCI-related MI (0.03%, n = 1), and TLR for stent thrombosis (0.03%, n = 1). The incidence of composite angiographic or procedural complications was 2.86% ( n = 87); 233 (7.86%) patients had results suggesting contrast-induced acute kidney injury. Conclusions::These findings indicate that the use of iodixanol in Chinese patients undergoing PCI is associated with a low incidence of MACCEs, confirming its safety in this population.

Key Points Question Are different antiplatelet regimens associated with gastric and small-bowel injury progression among long-term antiplatelet agent users without high gastrointestinal bleeding (GIB) risk? Findings In this secondary analysis of a randomized clinical trial with 394 participants, aspirin, clopidogrel, or their combination were associated with progressive gastric and small-intestinal injury in a substantial proportion of patients after percutaneous coronary intervention, particularly during dual antiplatelet therapy compared with monotherapy. Meaning The findings of this study suggest that continuous antiplatelet use, especially with dual therapy, may increase the risk of GIB, even among patients without high risk.

目的 观察左西孟旦对急性心肌梗死(AMI)合并心源性休克(CS)患者经皮冠状动脉介入治疗(PCI)术后的疗效及预后.方法 选取2019年5月至2021年5月于解放军总医院第七医学中心心脏重症监护病房68例AMI-CS PCI术后患者,按照治疗方案的不同分为观察组和对照组,每组各34例.对照组在常规治疗基础上以2.5～10.0 μg/(kg·min)速度泵入多巴酚丁胺,观察组在对照组基础上加用左西孟旦以0.1～0.2 μg/(kg·min)速度泵入,比较两组治疗前及治疗24 h、72 h后心功能指标[N末端脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)]及血流动力学指标如心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)、每搏输出量(SV)、左心室舒张末期容积(LVEDV)、组织灌注氧代谢变化如氧分压(PaO2)、氧合指数(OI)、中心静脉血氧饱和度(ScvO2)、乳酸(Lac)、乳酸清除率等,记录并比较两组患者住院期间不良反应发生率和28 d生存率.结果 治疗前两组患者一般临床资料比较无明显差异.与治疗前相比,治疗24 h、72 h后两组患者LVEF、SV、MAP、CI、PaO2、OI、ScvO2、乳酸清除率等均较治疗前升高,NT-proBNP、CVP、HR、LVEDV、Lac等均较治疗前下降(P＜0.05),且观察组LVEF、SV、MAP、CI、PaO2、OI、ScvO2、乳酸清除率均高于对照组(P＜0.05),NT-proBNP、CVP、HR、LVEDV、Lac均低于对照组(P＜0.05).治疗期间两组不良反应发生率比较无明显差异(P＞0.05).随访28 d,Kaplan-Meire生存曲线显示,两组生存率未见显著差异(P＞0.05).结论 左西孟旦可稳定AMI-CS PCI术后患者的血流动力学,改善左室功能和组织灌注,且安全性较好,但患者生存率未见明显提高.

Importance:Gastrointestinal injury progression induced by antiplatelet therapy in patients after percutaneous coronary intervention (PCI) has not been well studied. Objective:To assess the association of aspirin, clopidogrel, and their combination with gastrointestinal injury progression among patients without high bleeding risk after PCI. Design, Setting, and Participants:This secondary analysis assessed data from the Optimal Antiplatelet Therapy for Prevention of Gastrointestinal Injury Evaluated by ANKON Magnetically Controlled Capsule Endoscopy (OPT-PEACE) double-masked, placebo-controlled, multicenter randomized clinical trial. The OPT-PEACE trial was conducted at 28 centers in China, and recruitment took place from July 13, 2017, to July 13, 2019. The trial included patients with stable coronary artery disease or acute coronary syndromes without ST-segment elevation after PCI. Statistical analysis was conducted from September 13, 2022, to January 23, 2023. Interventions:Patients underwent magnetically controlled capsule endoscopy (MCE) at baseline and after 6 months of dual antiplatelet therapy (DAPT) with aspirin (100 mg/d) plus clopidogrel (75 mg/d). Those with no evidence of gastrointestinal ulcers or bleeding (ie, the intention-to-treat [ITT] cohort) were randomized (1:1:1) to aspirin (100 mg/d) plus matching placebo (aspirin alone), clopidogrel (75 mg/d) plus matching placebo (clopidogrel alone), or DAPT for an additional 6 months. A third MCE was performed 12 months after PCI. Main Outcomes and Measures:The primary outcome was the rate of gastric injury progression as assessed with the results of the 3 MCEs (at baseline, 6 months, and 12 months) in the modified intention-to-treat (mITT) population. The key secondary outcome was the rate of small-intestinal injury progression. Gastric or small-intestinal injury progression was defined as a quantitative increase in erosions or ulcers between the second and third MCEs (at 6 and 12 months, respectively). Results:This study included the 394 patients in the mITT cohort. Their mean (SD) age was 56.9 (8.7) years, and most were men (296 [75.1%]). A total of 132 patients were randomized to aspirin alone, 132 to clopidogrel alone, and 130 to DAPT. Gastric injury progression occurred in 49 aspirin users (37.1%), 64 clopidogrel users (48.5%), and 69 DAPT users (53.1%) (P = .02), reflecting a lower rate of gastric injury progression among aspirin users vs DAPT users (risk ratio [RR], 0.70 [95% CI, 0.49-0.99]; P = .009). No significant difference was observed between clopidogrel alone and DAPT (48.5% vs 53.1%; P = .46) or between aspirin alone and clopidogrel alone (37.1% vs 48.5%; P = .06). A total of 51 aspirin users (38.6%), 65 clopidogrel users (49.2%), and 71 DAPT users (54.6%) (P = .03) developed progressive small-intestinal injury, reflecting a lower rate of small-intestinal injury among aspirin users vs DAPT users (RR, 0.71 [95% CI, 0.50-0.99]; P = .01). No difference was observed between patients treated with clopidogrel vs DAPT (49.2% vs 54.6%; P = .38) or with aspirin vs clopidogrel (38.6% vs 49.2%; P = .08). Conclusions and Relevance:In this secondary analysis of a randomized clinical trial, ongoing use of aspirin, clopidogrel, or their combination between 6 and 12 months after PCI was associated with progressive gastric and small-intestinal injury in a substantial proportion of patients, more so with DAPT than with monotherapy. Clopidogrel was at least as likely as aspirin to induce gastrointestinal injury progression. Future research is warranted to determine what impact the findings from MCEs would have on decision-making of antiplatelet therapy. Trial Registration:ClinicalTrials.gov Identifier: NCT03198741.

目的 探究一种改良的内皮祖细胞(EPCs)分离培养鉴定方法.除应用传统密度梯度离心法与差速贴壁法分离细胞外,还融合集落挑选法增加所培养EPCs纯度,并观察其生物学特性.方法 密度梯度离心法分离出大鼠骨髓单个核细胞,结合差速贴壁法以及改良后新增的集落挑选法,在培养过程中不断纯化EPCs.通过吞噬试验,免疫荧光检测,流式细胞术鉴定,增殖实验,活力检测,迁移试验和体外成管实验多方面鉴定EPCs.结果 经过改良方法培养的EPCs早期呈现出纺锤形,晚期出现典型的铺路石样集落.(95.7±3.8)％具有吞噬Dil-acLDL和结合FITC-UEA-I能力.免疫荧光发现vWF阳性表达率(96.8±2.8)％,VE-cadherin阳性表达率(97.1±1.4)％.流式结果显示,一次,两次及三次纯化后CD34+和VEGFR2+细胞比例分别为(73.4±2.8)％,(76.8±3.1)％,(80.1±3.4)％,明显高于未纯化细胞(P<0.01).1×105个/ml细胞浓度其增殖和活力最好(P<0.01),并应用于后续实验.所培养细胞具有迁移能力及体外成管能力.结论 此方法操作简单,培养出的EPCs纯度高,状态好,功能完整.为修复受损管壁及治疗缺血相关性疾病提供足够数量以及纯度的细胞基础.

随着强效抗血小板药物的应用,急性冠脉综合征(ACS)患者缺血事件发生率逐渐降低,但相关出血事件发生率则逐渐增加.因此,在平衡ACS治疗的缺血与出血风险时,抗血小板的降阶治疗方案需引起临床上的重视.

Myocardial infarction is still a leading cause of morbidity and mortality worldwide, but its pathogenesis has not been fully understood. In the study, we attempted to explore the effects of E3 ligase tripartite motif 16 (TRIM16) on myocardial ischemia-reperfusion (MI/R) injury in vivo and in vitro, and the underlying mechanisms. We identified that TRIM16 was indeed a potent regulator during MI/R progression in murine models and surprisingly showed a negative correlation with the concentrations of cardiac pro-inflammatory cytokines. Adenoviral vectors encoding GFP or TRIM16 (Ad-TRIM16) were subjected to mice through direct injection into the left ventricular (LV). We found that Ad-TRIM16 significantly reduced the infarct size, and improved the cardiac function and structure compared with the Ad-GFP mice after MI/R operation. More studies indicated that TRIM16 over-expression strongly meliorated nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3) inflammasome and associated inflammatory response in hearts of MI/R-induced mice, which were validated in hypoxia/reoxygenation (H/R)-exposed primary cardiomyocytes in vitro. In particular, MI/R operation led to cardiac pyroptosis by increasing the cleavage of Caspase-1 and Gasdermin D (GSDMD), while being considerably abrogated upon TRIM16 over-expression. Mechanistically, TRIM16 interacted with NLRP3 and promoted the K48-linked polyubiquitination of NLRP3, ultimately promoted its degradation. Together, we identified TRIM16 as a novel E3 ubiquitin ligase for NLRP3, which played an essential role in modulating its expression, and subsequently influenced inflammatory response and pyroptosis in MI/R murine model, confirming that TRIM16 may be a potential therapeutic target for myocardial infarction.

目的 探讨尼可地尔对行PCI的老年非ST段抬高型心肌梗死(NSTEMI)患者冠状动脉灌注的影响.方法 回顾性分析2020年6月～2022年2月于解放军总医院第七医学中心心内科择期行PCI的老年NSTEMI患者180例,依据是否使用尼可地尔分为治疗组88例和对照组92例.比较2组患者治疗后血清肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)峰值、达峰时间、N末端B型钠尿肽前体(NT-proBNP)、PCI术后冠状动脉灌注情况,采用TIMI血流分级和校正的TIMI血流计帧数(CTFC)评价.采用ROC曲线分析发生无复流/慢血流(NR/SF)的预测效能.结果 治疗组治疗后cTnI峰值、CK-MB峰值、NR/SF发生率以及术后CTFC明显低于对照组,cTnI达峰时间和CK-MB达峰时间明显短于对照组(P<0.05,P<0.01).同型半胱氨酸和D-二聚体升高是NSTEMI患者在PCI术后出现NR/SF的危险因素(P<0.05).ROC曲线分析显示,同型半胱氨酸预测PCI术后发生NR/SF的ROC曲线下面积(AUC)为0.665(95％CI:0.556～0.775,P=0.010),D-二聚体的AUC为0.641(95％CI:0.522～0.760,P=0.029).结论 尼可地尔可减轻老年NSTEMI患者缺血性心肌损伤,改善PCI术后冠状动脉灌注;同型半胱氨酸和D-二聚体是NR/SF独立危险因素.

目的 心肌细胞的自噬受到非常精细地调节，本实验探讨ω-3不饱和脂肪酸是否能通过影响自噬改善心肌细胞损伤并深入研究其机制。方法 使用H9C2细胞系以及成年C57BL/6小鼠心肌细胞原代培养，将心肌细胞暴露于血管紧张素Ⅱ和ω-3不饱和脂肪酸环境中，检测心肌细胞结构稳定性和心肌细胞自噬状态，检测指标包括心肌细胞骨架蛋白α-Actinin变化情况变化、细胞自噬流水平变化及细胞自噬相关蛋白变化等。结果 血管紧张素Ⅱ诱导心肌细胞中α-Actinin纤维排列消失，变为散点状结构。ω-3多不饱和脂肪酸使心肌细胞α-Actinin纤维排列结构保持正常。血管紧张素Ⅱ可诱导心肌细胞自噬流明显上调（P＜0.01），而ω-3多不饱和脂肪酸可抑制暴露于血管紧张素Ⅱ的H9c2细胞自噬水平（P＜0.01）。血管紧张素Ⅱ提升细胞LC3Ⅱ/LC3Ⅰ表达，而ω-3多不饱和脂肪酸能够抑制LC3Ⅱ/LC3Ⅰ水平的升高。结论 ω-3多不饱和脂肪酸可通过调节自噬水平来减轻心肌细胞的结构损伤。

目的 探究碎裂QRS波在新战士复检中的发生率、 分布特点及在训练中的预警意义.方法 回顾性分析某部3954例(男性3631例,女性323例)入伍新战士复检心电图,收集静息状态下的常规12导联心电图,筛选出fQRS波,统计fQRS波的发生率及发生部位.依据年龄18～25岁划分为八个组,男兵按兵种分为六组:空军1部、陆军1部、武警、通讯、空军2部、陆军2部,再按fQRS波出现导联分为肢导组、胸导组、胸导+肢导组.结果 fQRS波的整体发生率在性别和年龄上无统计学差异(P>0.05).fQRS发生率在入伍战士各年龄段无统计学差异(P>0.05).六个兵种男兵fQRS波发生率之间存在统计学差异(P<0.05).fQRS波同时发生于胸导和肢导的比例明显大于单纯发生于胸导/肢导的比例,具有显著差异(P<0.05).结论 fQRS波的发生率与运动强度之间具有一定联系,这种不同运动强度造成的fQRS波发生率之间差异可能与心肌损伤有一定关系.

随着对冠状动脉(冠脉)检查手段的不断发展,冠脉微血管病变(CMVD)确诊率逐年增高,该病变可降低患者生活质量,提高心血管事件发生率,其发病机制不尽相同,目前尚无直接评估冠脉微血管病变的检查手段,临床上虽有多种疗法,但效果欠佳.本文对冠脉微血管病变的发病机制、临床评估及治疗进展作一综述.

妊娠期高血压(HDCP)是妊娠期的特发疾病,以妊娠20周后出现高血压、水肿、蛋白尿为主要表现的全身各器官和系统损害的一种妊娠期并发症,严重影响母婴健康,是孕产妇和围生儿患病及死亡的主要原因之一[1,2].降压治疗是HDCP的重要治疗手段,目的是预防子痫、心脑血管意外和胎盘早剥等严重母胎并发症,保证母儿安全,有效改善妊娠结局.我国2015年HDP诊治指南[3]参考了国际指南并结合我国国情建议:收缩压≥160 mmHg和(或)舒张压≥110 mmHg(1 mmHg=0.133 kPa)给予降压药物治疗,目标血压控制在130～155/80～105 mmHg,合并器官功能损伤,应控制130～139/80～89 mmHg,降压过程应平稳,避免过度波动,且血压不应低于130/80 mmHg,以保证子宫-胎盘的血流灌注[4].

目的 探讨心电图T波峰末间期(Tp-Te)、Tp-Te/QT比值对恶性室性心律失常(MVA)的诊断价值.方法 连续入选2017年1月1日至2018年1月1日于保定市第一中心医院西院心电图、脑电图二室行24 h 12导联动态心电图检查的患者412例为研究对象.根据是否发生恶性室性心律失常分为两组:恶性室性心律失常组72例;无恶性室性心律失常组340例.分别测定两组患者Tp-Te间期、QT间期,计算出Tp-Te间期、QTc间期及Tp-Te/QT比值,并对两组患者Tp-Te间期、QTc间期及Tp-Te/QT比值进行统计学分析.结果 恶性室性心律失常组的Tp-Te间期、Tp-Te/QT比值均较非恶性室性心律失常组明显增加(P<0.001).结论 Tp-Te间期、Tp-Te/QT比值增加对于恶性室性心律失常的发生均有预测价值.

BACKGROUND:Gastrointestinal bleeding is the most frequent major complication of antiplatelet therapy. In patients at low bleeding risk, however, clinically overt gastrointestinal bleeding is relatively uncommon. OBJECTIVES:The authors sought to assess the effects of different antiplatelet regimens on gastrointestinal mucosal injury by means of a novel magnetically controlled capsule endoscopy system in patients at low bleeding risk. METHODS:Patients (n = 505) undergoing percutaneous coronary intervention in whom capsule endoscopy demonstrated no ulcerations or bleeding (although erosions were permitted) after 6 months of dual antiplatelet therapy (DAPT) were randomly assigned to aspirin plus placebo (n = 168), clopidogrel plus placebo (n = 169), or aspirin plus clopidogrel (n = 168) for an additional 6 months. The primary endpoint was the incidence of gastrointestinal mucosal injury (erosions, ulceration, or bleeding) at 6-month or 12-month capsule endoscopy. RESULTS:Gastrointestinal mucosal injury through 12 months was less with single antiplatelet therapy (SAPT) than with DAPT (94.3% vs 99.2%; P = 0.02). Aspirin and clopidogrel monotherapy had similar effects. Among 68 patients without any gastrointestinal injury at randomization (including no erosions), SAPT compared with DAPT caused less gastrointestinal injury (68.1% vs 95.2%; P = 0.006), including fewer new ulcers (8.5% vs 38.1%; P = 0.009). Clinical gastrointestinal bleeding from 6 to 12 months was less with SAPT than with DAPT (0.6% vs 5.4%; P = 0.001). CONCLUSIONS:Despite being at low risk of bleeding, nearly all patients receiving antiplatelet therapy developed gastrointestinal injury, although overt bleeding was infrequent. DAPT for 6 months followed by SAPT with aspirin or clopidogrel from 6 to 12 months resulted in less gastrointestinal mucosal injury and clinical bleeding compared with DAPT through 12 months. (OPT-PEACE [Optimal Antiplatelet Therapy for Prevention of Gastrointestinal Injury Evaluated by Ankon Magnetically Controlled Capsule Endoscopy]; NCT03198741).

目的 探讨沙库巴曲缬沙坦联合左束支起搏在心力衰竭中的应用价值.方法 选取2016年6月至2018年6月邯郸市第一医院收治的合并左束支阻滞具有心脏再同步化治疗植入指证的慢性心力衰竭患者30例作为研究对象,随机数字表法分为试验组(15例)和对照组(15例).两组均采取左束支起搏,术后在常规治疗心力衰竭基础上,分别使用沙库巴曲缬沙坦和依那普利,治疗6个月.测定两组术中,术后1、3及6个月电极参数,测量术前和术后6个月的QRS波时限、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、N末端前体脑钠肽(NT-ProB-NP)、可溶性肿瘤生长抑制因子2(sST2).结果 两组的年龄、性别、吸烟史、血压、血糖等基础资料无差异(P均>0.05).两组患者治疗后QRS波时限明显小于治疗前[(108.4±10.0)msvs(158.3±9.5)ms,(106.5±10.3)ms vs(160.2±10.1)ms,P均<0.05],术中测试导线单、双极参数均良好,术后1个月单、双极阻抗均较术中明显下降(P<0.001),起搏阈值及感知参数无变化.术后3至6个月随访单、双极起搏阈值、感知以及阻抗参数均稳定.经治疗后两组较治疗前LVEDD均明显下降[(47.6±4.2)mmvs(58.7±6.1)mm,(50.1±3.5)mmvs(57.8±5.5)mm,P均<0.05],LVEF升高[0.50±0.06vs0.36±0.05,0.44±0.05vs0.36±0.05,P均<0.05)],试验组LVEF升高及LVEDD缩小明显好于对照组(P<0.05).两组治疗后NT-ProBNP、sST2较治疗前下降[(1470±312)μg/Lvs(7050±2015)μg/L,(2641±340)μg/Lvs(6500±1648)μg/L;(0.32±0.33)μg/Lvs(0.67±0.24)μg/L,(0.41±0.24)μg/Lvs(0.66±0.23)μg/L,P均<0.05],试验组优于对照组(P<0.05).结论 沙库巴曲缬沙坦联合左束支起搏治疗慢性心力衰竭优于依那普利联合左束支起搏治疗.

目的 对比探讨新型药物洗脱支架火鹰(Firehawk)支架及XIENCE V依维莫司支架在糖尿病合并急性冠脉综合征(ACS)群体中的有效性及安全性.方法 回顾性分析2017年2月至2019年8月于陆军第八十二集团军医院心脏介入中心接受冠状动脉(冠脉)介入治疗的确诊ACS合并2型糖尿病患者62例.按单一接受不同支架种类分为接受Firehawk支架的Firehawk组(30例)及接受XIENCE V支架的XIENCE V组(32例).对比观察两组患者介入治疗术后12个月内累积心血管不良事件发生情况.结果 XIENCE V组中男性28例,女性4例;年龄37～91岁,平均(59.9±13.1)岁;Firehawk组中男性19例,女性11例.年龄30～79岁,平均(60.4±11.9)岁.两组患者吸烟、高血压及高脂血症情况及实验室检查结果比较,差异均无统计学意义(P>0.05).两组手术成功率均为100.0％;随访中仅XIENCE V组失访1例,总随访率为98.4％.12个月内心绞痛:Firehawk组发生1例(3.33％)和XIENCE V组1例(3.23％),非致死性心肌梗死发生率:Firehawk组1例(3.33％),XIENCE V组0例(0％);心源性死亡发生率:Firehawk组0例(0％),XIENCE V组升主动脉瘤破裂死亡1例(3.23％),累积主要心血管不良事件发生率:6.67％vs.6.45％(P>0.05).结论 应用Firehawk支架治疗糖尿病合并急性冠脉综合征安全有效,在主要心脏不良事件发生率比较无明显差异,安全性及有效性不劣于XIENCE V支架.

近20年来,经皮冠状动脉介入治疗(PCI)有了巨大进步,但慢性完全性闭塞病变(CTO)仍是PCI的最后一个堡垒.随着以美国医生为主的CTO杂交治疗流程图的问世[1],把千差万别的CTO PCI公式化、简单化,在此基础上,结合各地区经验,又相继问世了亚太CTO俱乐部介入治疗流程图[2]、中国冠状动脉慢性完全闭塞病变介入治疗俱乐部PCI流程图[3]以及EuroCTO流程图[4],同时一些新技术、新器具、新理念的应用,CTO病变PCI的成功率及安全性得到非常大的提高[5].本文从哲学角度对CTO开通理念进行探讨.

1 临床资料 患者 男,78岁.因"发作性心前区疼痛6年,加重5 d"于2020年3月25日就诊于解放军总医院第七医学中心.6年来长期口服冠心病二级预防药物,5 d前自觉上述症状加重,经口含硝酸甘油效果欠佳.既往无高血压病、糖尿病、心肌梗死等病史,无烟酒嗜好,无家族性或遗传性疾病史.入院查体:心肺无阳性体征.超声心动图示:主动脉瓣退行性病变,左心室收缩功能正常.