【摘要】 目的 探讨降低冠状动脉支架植入术后拔管所致血管迷走神经反射（vasovagal reflexs，VVR）的护理干预措施及效果。 方法 将2011年1-3月冠状动脉支架植入患者120例随机分为两组，对照组58例，试验组62例，对照组按常规方法拔管，试验组除常规方法外根据患者不同情况予针对性护理干预。 结果 120例患者中共发生VVR 10例，其中对照组发生8例，试验组发生2例。两组比较差异有统计学意义（Plt;0.05）。 结论 冠状动脉支架植入手术患者实施针对性的护理干预可有效降低血管迷走神经反射的发生，提高手术成功率。【Abstract】 Objective To investigate the nursing intervention measures and effects on reducing the vasovagal reflexs (VVRs) after the coronary stent extubation. Methods The clinical data of 120 patients who underwent coronary stenting between January and March 2011 were retrospectively analyzed. Patients were randomly divided into control group (n=58) treated with conventional coronary stent extubation and experiment group (n=62) treated with conventional coronary stent extubation and professional nursing intervention care. Results In 120 patients, VVRs occurred in 10 including 8 in the control group and 2 in the experiment group. The difference between the two groups was significant (Plt;0.05). Conclusion The coronary stent implantation with specific nursing interventions can effectively reduce the vascular vagal reflex, and leads to a higher success rate of the surgery.
Objective To discuss the clinical effect and value of stent placement combined with mechanical aspiration thrombectomy for acute iliofemoral venous thrombosis with iliac vein occlusion. Methods From October 2004 to December 2011， interventional treatment were performed in 273 patients with acute iliofemoral venous thrombosis and iliac vein occlusion， including left side of 235 cases and right side of 38 cases. Antegrade femoral vein under local anesthesia， an 8-14F catheter was inserted into iliofemoral vein with the guidance of guide wire to aspirate thrombus directly， 53 patients used 18-24F large lumen sheath to aspirate thrombus. As for the femoralpopliteal vein thrombus， a “cross sheath” was inserted to affected iliac vein with the help of guide wire capture technique， a guide wire was introd-uced to popliteal vein， then a Fogarty balloon catheter was inserted and extracted thrombus to iliac vein， mechanical aspiration thrombectomy was performed again. After iliofemoral vein thrombus were removed completely， percutaneous transluminal angioplasty （PTA） and stenting were performed for stenosis or occlusion displayed by venography. Results Thrombus removal were completely cleared （degreeⅢ） in 219 cases （80.22%）， partly cleared （degreeⅡ） in 49 cases （17.95%）， and minimal cleared （degreeⅠ） in 5 cases （1.83%）. The effect of stent placement：were cured in 235 cases （86.08%）， excellent in 29 cases （10.62%）， mild in 2 cases （2.57%）， and invalid in 7 cases （0.73%）. Total effective rate was 99.27% （271/273）， the average days in hospital was 7.5 days. Tumescence and pain of affected limb disappeared or relieved after interventional therapy for 1-2 days. The followe up effect：3-6 months， 7-12 months， 13-24 months， and 25-36 months after treatment of iliac vein patency were 94.87%，93.73%，87.08%，and 84.13% respectively. Conclusion Mechanical aspiration thrombectomy combined with stent placement for acute lower extremity deep venous thrombosis and iliac vein obstruction is an effective and safe treatment for its notable therapeutic effect and the short hospitalization time.
ObjectiveTo investigate the factors related to recurrent coronary events in patients after coronary artery stent implantation. MethodsWe retrospectively studied the patients performing coronary angiography (CAG) who were admitted to the Department of Cardiology of the Second Affiliated Hospital of Guangzhou Medical University between January 2012 and June 2013. All of the enrolled patients had received CAG in our hospital, with complete coronary angiogram and clinical data. The patients were divided into two groups according to the coronary angiogram and clinical data: coronary event group and non-coronary event group. SPSS 16.0 software was employed for statistical analysis, and multivariate analysis was performed using binary logistic regression model to analyze the risk factors. ResultsA total of 115 patients were included, of which 50 patients had recurrent coronary events. Both the serum total bilirubin and unconjugated bilirubin in patients with coronary events were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05 or P < 0.01). The serum total bilirubin at baseline and the serum total bilirubin and unconjugated bilirubin at the time of CAG reexamination were significantly lower in patients with revasculization due to the progression of coronary artery lesions compared with the patients without coronary events (P < 0.05 or P < 0.01). The serum unconjugated bilirubin in patients with in-stent restenosis were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05). The results of logistic regression analysis showed that multi-vessel coronary artery disease (two-vessel coronary artery disease: OR=10.094, 95%CI 2.498 to 40.798, P=0.001; three-vessel coronary artery disease: OR=16.047, 95%CI 4.121 to 62.481, P=0.000) and low serum unconjugated bilirubin (OR=0.873, 95%CI 0.773 to 0.987, P=0.03) were independent risk factors of recurrent coronary events. ConclusionMulti-vessel coronary artery disease and low serum unconjugated bilirubin are independent risk factors of recurrent coronary events in patients after coronary artery stent implantation.
ObjectiveTo systematically review the long-term efficacy of coronary artery bypass grafting (CABG) versus drug-eluting stent implantation (DES-PCI) for patients with multivessel coronary artery disease. MethodsWe searched The Cochrane Library (Issue 2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP to collect randomized controlled trials (RCTs) about CABG versus DES-PCI for patients with coronary multivessel disease from the inception to October 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.2 software. ResultsA total of seven RCTs, involving 5 723 patients were included. The results of meta-analysis showed that: compared with the DES-PCI group, the CABG group had lower 1-year incidence of target vessel revascularization (OR=0.39, 95%CI 0.31 to 0.48, P<0.000 01), 5-year mortality (OR=0.78, 95%CI 0.65 to 0.94, P=0.008), and 5-year incidence of myocardial infarction (OR=0.46, 95%CI 0.37 to 0.58, P<0.000 01). However, 1-year, 2-year and 5-year incidences of stroke in the CABG group were significantly higher than that in the DES-PCI group (all P values <0.05). ConclusionThe available evidence suggests that CABG is superior to DES-PCI for patients with multivessel coronary artery disease in long-term effects, but CABG could increase the incidence of stroke. Due to the quantity and quality of the included studies, the above conclusions still need to be verified by more high-quality RCTs.
Objective To systematically evaluate efficacy and safety of endoscopic pneumatic dilation and endoscopic stent placement in treatment of achalasia. Methods Eligible studies comparing the pneumatic dilation and the stent placement in treatment of achalasia were identified by an electronic search of MedLine, Embase, ISI Web of Science, the Cochrane Database, China Biology Medicine and Wanfang databases from inception to December 2015. Two reviewers independently screened the literatures, extracted data, and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. Results A total of 4 randomized controlled trials including 343 patients with achalasia (176 cases in the pneumatic dilation group, 167 cases in the stent placement group) were subjected to the final analysis. The results of meta-analysis showed that the postoperative short term symptom relief rate had no significant difference between the pneumatic dilation group and the stent placement group 〔RR=1.03, 95%CI (0.95, 1.12),P=0.53〕, the postoperative 2-year symptom relief rate of the stent placement group was significantly higher than that of the pneumatic dilation group 〔RR=0.77, 95%CI (0.64, 0.92),P=0.005〕, but the complications rate of the stent placement group was significantly higher as compared with the pneumatic dilation group 〔RR=0.52, 95%CI (0.40, 0.69),P<0.000 01〕 too. Conclusions Although this meta-analysis has some shortcomings, preliminary results show that short term effects of pneumatic dilation and stent placement in treatment of achalasia are effective, long term effect of stent placement in treatment of achalasia is better as compared with pneumatic dilation, but it’s complications rate is higher. So in clinical diagnosis and treatment, effect, risk, patient’s physical condition, and demand should be considered together; during treatment, we should pay attention to adverse reactions and prepare adequately in order to reducing complications. When complications occur, we should take timely symptomatic treatment.
Objective To explore the influence of applying the fast-track surgery (FTS) to optimize the process in the perioperative period of cardiac intervention on the rehabilitation of patients with radial artery stenting surgery. Methods A total of 190 patients with radial artery stenting surgery in the Department of Cardiology, West China Hospital from June 2017 to May 2018 were enrolled. They were randomized into a control group (n=95) and a FTS group (n=95) by random umber table. There were 60 males and 35 females aged 35-88 (65.2±9.6) years in the control group as well as 62 males and 33 females aged 34-86 (61.5±11.3) years in the FTS group. Patients in the control group received routine perioperative care, but patients in the FTS group received individual precision interventions by applying the FTS concept to optimize the process of perioperative care, including individual care management before being admitted into hospital, during hospital, and after discharge from hospital. Duration of hospital stay, satisfaction scores, number of comorbidities after surgery, disease self-management ability, and readmission rates were compared between the two groups. Results Compared to the control group, the FTS group had significantly shorter duration of hospital stay, less comorbidities, higher satisfaction scores and disease self-management ability, and lower readmission rate to hospital (P<0.05). Conclusion Applying FTS into the perioperative period of cardiac interventions to optimize its process can help patients recover from radial artery stenting surgery, increase patients’ self-management abilities, shorten duration of hospital stay and decrease comorbidities and cardiac adverse events.
ObjectiveTo analyze the short-term and long-term efficacy of staged coronary artery bypass grafting (CABG) and carotid artery stenting (CAS) compared with CABG alone in patients with coronary heart disease with preoperative history of stroke and carotid stenosis. MethodsWe reviewed the clinical data of 55 patients (48 males, 7 females, aged 67.62±7.06 years) with coronary heart disease and carotid stenosis who had a history of stroke and underwent CABG+CAS or CABG alone in Zhongshan Hospital from 2008 to 2017. There were 13 patients in the staged CABG+CAS group and 42 patients in the CABG alone group. The differences in the incidence of perioperative adverse events and long-term survival between the two groups were studied, and univariate and multivariate analyses were carried out to determine the independent risk factors of long-term adverse events. Results Perioperative adverse events occurred in 1 (7.69%) patient of the staged CABG+CAS group, and 4 (9.52%) patients of the CABG alone group (P=0.84). During the follow-up period (67.84±37.99 months), the long-term survival rate of patients in the staged CABG+CAS group was significantly higher than that in the CABG alone group (P=0.02). The risk of long-term adverse events in the staged CABG+CAS group was 0.22 times higher than that in the CABG alone group (95%CI 0.05-0.92, P=0.04). ConclusionStaged CABG+CAS can significantly improve the long-term survival prognosis without increasing the perioperative risk. It is a safe and effective treatment, but prospective randomized studies are still needed to further confirm this finding.
Objective To investigate the correlation between D-dimer level within 2 hours on admission and early in-hospital major adverse events (MAEs) in patients with acute type A aortic dissection undergoing arch replacement and the frozen elephant trunk (FET) implantation. Methods The patients with acute type A aortic dissection undergoing arch replacement and the FET implantation, who hospitalized in our hospital from September 2017 to December 2022, were included in this retrospective study. Grouping based on the occurrence of in-hospital major adverse events (MAEs) after total arch replacement and FET implantation, with no in-hospital MAEs as a control group and in-hospital MAEs as an observation group. The perioperative data were compared between the two groups. Univariate and multivariate analyses were used to investigate the risk factors for MAEs (in-hospital mortality, gastrointestinal bleeding, paraplegia, acute kidney failure, reopening the chest, low cardiac output syndrome, cerebrovascular accident, respiratory insufficiency, multiple organ dysfunctionsyndrome, gastrointestinal bleeding, and severe infection). Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the prediction area under the ROC curve (AUC). Results Finally 218 patients were collected, including 157 males and 61 females with an average age of 51.54±9.79 years. There were 152 patients in the control group and 66 patients in the observation group. In-hospital mortality was 2.8% (6/218). The level of D-dimer, lactic acid, cardiopulmonary bypass time, aortic cross-clamping time, ventilator-assisted time and ICU stay in the observation group were higher or longer than those in the control group (P=0.013). Multivariate logistic analysis showed that D-dimer (OR=1.077, 95%CI 1.020-1.137, P＜0.05) was an independent risk factor for MAEs in hospital. The level of D-dimer within 2 hours admission predicted that the AUC of MAEs in hospital was 0.83 (95%CI 0.736-0.870, P＜0.05), and the optimal critical point was 2.2 μg/mL, with sensitivity and specificity of 84.8% and 73.0%, respectively. Conclusion Increased D-dimer levels at admission are associated with early in-hospital MAEs in the patients with acute type A aortic dissection undergoing arch replacement and FET. These results may help clinicians optimize the risk evaluation and perioperative clinical management to reduce early adverse events.