Objective:To analyze the effects of nicorandil and nitroglycerin on coronary circulation in patients with ischemic heart disease.Methods:A total of 112 patients who were diagnosed with ischemic heart disease in our hospital from January 2018 to January 2020 were divided into a nitroglycerin group (56 cases) and a nicorandil group (56 cases) with the random number table. There were 17 males and 39 females in the nicorandil group, with an age of (53.4±5.7) years old, who were treated with nicorandil; there were 19 males and 37 females in the nitroglycerin group, with an age of (52.8±5.4) years old, who were treated with nitroglycerin. The number of attacks per month, the duration of angina pectoris, the start time of ST segment depression, coronary blood flow indexes, cardiac index (CI), and left ventricular ejection fraction (LVEF) were compared between the two groups before and after the treatment, and the incidences of adverse events during the follow-up of the two groups were compared.Results:After the treatment, the numbers of attacks per month and the durations of angina pectoris of the two groups were lower than those before the treatment, the start time of ST segment depression was earlier; the numbers of attacks per month and the duration of angina pectoris of the nicorandil group were (2.1±0.7) times and (5.3±1.3) min, which were lower than those of the nitroglycerin group [(6.6±1.3) times and (7.5±1.4) min], the start time of ST segment depression was higher than that of the nitroglycerin group [(7.2±1.5) min vs.(5.4±1.1) min] (all P<0.05). After the treatment, the values of corrected TIMI frame count (CTFC) and TIMI myocardial perfusion frame count (TMPFC) [left anterior descending branch (LAD), left circumflex artery (LCX), and right coronary artery (RCA)] of the two groups were lower than those before the treatment, and those of the nicorandil group were even lower (all P<0.05). After the treatment, the CI and LVEF of the two groups were higher than those before the treatment, CI and LVEF of the nicorandil group were (3.49±0.61) L/(min·m 2) and (44.34±5.53)%, which were higher than those of the nitroglycerin group [(3.21±0.53) L/(min·m 2) and (38.35±5.21)%] (all P<0.05). The incidence of adverse events in the nicorandil group was lower than that in the nitroglycerin group [28.6% (16/56) vs. 76.8% (43/56)] ( P<0.05). Conclusion:Taking nicorandil in long term can improve coronary circulation and cardiac function of patients with ischemic heart disease, and reduce the incidence of cardiovascular events, recommending for clinical application.

目的:分析探讨光学相干断层成像技术(OCT)对急性心肌梗死(AMI)易损斑块的识别及应用价值.方法:选择某医院收治的AMI患者60例为研究对象,分别于经皮冠状动脉介入治疗(PCI)前、PCI后及PCI术后3个月、6个月、12个月进行OCT检查.分析OCT对易损斑块的识别情况、冠脉血栓类型及罪犯病变的判定情况,评估PCI术后即刻效果和远期效果.结果:该组60例AMI患者,检出易损斑块52例(86.7％),其中,薄纤维帽28例(46.7％),大而软的脂质坏死核心10例(16.7％),破裂区巨噬细胞浸润6例(10.0％),病变处斑块严重钙化或钙化结节向腔内突出4例(6.7％),斑块表面发生侵蚀并出现血小板堆积2例(3.3％);红色血栓42例(70.0％),白色血栓12例(20.0％),混合血栓6例(10.0％);()CT检查发现斑块破裂48例(80.0％),斑块侵蚀8例(13.3％),斑块钙化结节4例(6.7％).该组有6例(10.0％)PCI术后即刻支架膨胀不良,4例(6.7％)支架贴壁不良,出现组织脱垂、支架边缘夹层、支架内即刻血栓各1例(1.7％);术后随访12个月55例中,发生支架内再狭窄6例(10.9％),支架内血栓形成4例(7.3％).结论:OCT检查有助于早期识别AMI患者易损斑块,判断血栓类型及罪犯病变性质,同时有助于评估PCI术后的即刻效果和远期随访.

目的 分析OCT(光学相干断层成像)与IVUS(血管内超声)对ST段抬高型心肌梗死(STEMI)患者急诊PCI(冠状动脉介入治疗)治疗策略的影响.方法 选取本院2016年1月至2018年1月收治的80例STEMI患者,均接受急诊PCI治疗,以入院顺序奇偶性分组,分对照组(在PCI治疗前采用IVUS技术检查,40例)、研究组(在PCI治疗前采用OCT技术检查,40例),术后随访12月,对比两组患者PCI术前冠状动脉斑块检出情况(管腔面积狭窄率、最小管腔面积、冠状动脉最小管腔直径)、支架植入成功率、围术期并发症发生率、住院时间、术后12月内并发症发生率.结果 两组患者PCI术前管腔面积狭窄率、最小管腔面积、冠状动脉最小管腔直径、支架植入成功率(研究组、对照组支架植入成功率分别为95.00％、92.50％)比较,均P>0.05;研究组围术期并发症发生率(5.00％)、术后12月内并发症发生率(5.00％)显著低于对照组(分别为25.00％、27.50％),均P<0.05;研究组住院时间显著短于对照组,P<0.05.结论 STEMI患者在急诊PCI治疗之前,采用OCT技术与IVUS技术均对PCI手术具有一定的指导意义,但OCT技术的安全性较高,可有效缩短患者住院时间,且围术期以及远期并发症较少,值得借鉴.

Objective To evaluate the effect of tiglilo double antiplatelet therapy after percutaneous coronary intervention (PCI) for patients with acute coronary syndrome (ACS).Methods 110 patients with ACS who were admitted to our hospital from January,2017 to October,2018 for PCI were divided into two a control group and a study group,55 cases for each group.The control group received aspirin plus clopidogrel antiplatelet therapy after operation,and the study group was treated with aspirin and tegrillo.The platelet function,inflammatory indicators,and platelet inhibition were observed.Results After the treatment,the levels of sCD40L,MPAR,and PRU,as well as the levels of hs-CRP,ET-1,and MMP-9,were significantly lower and the level of NO was significantly higher in the study group than in the control group (all P ＜ 0.05);After treatment,than that in the control group,while were significantly lower than those in the control group(P ＜ 0.05).The platelet inhibition rates 2,24,and 48 hours after taking medicine were significantly higher in the observation group than in the control group (all P ＜ 0.05).The incidence of adverse events after the treatment in the two groups was 7.27％ in the control group,and was 3.64％ in the study group,with no statistical difference (P ＞ 0.05).Conclusion Tiglilo double antiplatelet therapy after PCI for patients with ACS can effectively improve the platelet aggregation and platelet inhibition rate and significantly reduce the inflammatory reaction in blood vessels,which is helpful to reduce the risk of adverse cardiac events after operation.

目的 分析药物涂层支架置入术患者合并心房颤动(房颤)的三联抗栓治疗的安全性与有效性.方法 临床入选168例栓塞风险评分(CHADS2)≥2分,出血风险评分(HAS-BLED)≥3分的药物涂层支架置入术合并房颤患者,随机分为三联抗栓治疗组(A组)、阿司匹林联合氯吡格雷治疗组(B组)以及华法林联合单一抗血小板聚集类药物治疗组(C组),每组各56例.随访2年,比较3组患者治疗的安全性与有效性.结果 A组出血总发生率比B组及C组高(P＜0.05),而B组与C组出血总发生率无显著差异(P＞0.05).A组主要心脑血管事件总发生率较B组及C组低(P＜0.05),而B组与C组主要心脑血管事件总发生率无显著差异(P＞0.05).结论 药物涂层支架植入术合并房颤患者采用三重抗凝治疗,较双重抗血小板或华法林联合单一抗血小板聚集可以更好防治主要心脑血管事件的发生,但具有一定的出血风险.

目的 研究不同他汀类药物对老年冠心病伴高胆固醇血症患者的疗效和安全性.方法 选取老年冠心病伴高胆固醇血症患者186例,随机分为3组,分别给予阿托伐他汀(20 mg/d)、辛伐他汀(20 mg/d)和瑞舒伐他汀(10 mg/d)治疗,疗程均为12 w.在治疗前后分别检测患者总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),并记录不良反应.结果 治疗后,3组TC、TG、LDL-C均有所改善(P＜0.05),其中瑞舒伐他汀组较其他两组改善程度更为明显(P＜0.05),而阿托伐他汀组与辛伐他汀组间改善程度无统计学差异(P＞0.05).3组不良反应发生率之间无统计学差异(P＞0.05).结论 瑞舒伐他汀对老年冠心病伴高胆固醇血症患者疗效更好,且安全可靠.

目的:观察益心舒胶囊对老年充血性心力衰竭(CHF)患者的临床疗效.方法:448例老年充血性心力衰竭患者随机分为常规组(硝酸酯类药物+利尿剂+地高辛+p受体阻滞剂+AcEI/ARB和益心舒组(对照组治疗药物+益心舒胶囊),随访6个月.观察心功能改善情况并用超声心动图检查测定CHF患者左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、心排出量(CO).结果:观察组心功能改善总有效率87.5%,优于对照组的65.6%(P<0.05).与治疗前相比,观察组左心室射血分数、左心室舒张末期内径、心排出量均有显著改善(P<0.05),而对照组只有左心室射血分数明显改善(P<0.05).结论:益心舒胶囊对改善老年充血性心力衰竭有较好的疗效.