ObjectiveTo investigate the feasibility and effectiveness of using ultrasound to evaluate the internal mammary artery (IMA) and explore the related factors affecting the quality of IMA.MethodsFrom July 2020 to January 2021, for patients who underwent coronary artery bypass grafting at the Department of Cardiovascular Surgery, Fuwai Hospital, ultrasound was applied to measure bilateral IMA at the parasternal second intercostal space. There were 62 males and 18 females with an average age of 59.9±8.3 years. The clinical data of the patients were recorded and analyzed.ResultsA total of 160 IMA were measured. The IMA was detected in 99.4% (159/160), and the one that was not measured was proved to be occluded by enhanced CT. A total of 157 (98.1%) IMA intima were smooth, 2 (1.3%) were found to have uneven intimal thickening and less smooth, and only 1 (0.6%) was occluded. The intravascular diameter, peak systolic flow rate, peak diastolic flow rate, and blood flow rate of the left second intercostal IMA were 1.9±0.3 mm, 66.8±17.7 cm/s, 6.4 (0.0, 9.7) cm/s, 19.7±9.4 mL/min; and those of the right one were 2.1±0.3 mm, 69.7±18.5 cm/s, 6.0 (0.0, 9.2) cm/s and 22.8±11.5 mL/min, respectively. IMA vessel diameter and blood flow were greater on the right than those on the left side in the same individual (P<0.01). In univariate analysis, sex and body surface area were the factors that influenced the size of the IMA vessel among different individuals, and by linear regression analysis, the size of the IMA vessel was only related to body surface area among different individuals. On univariate analysis, diabetes mellitus was the only factor affecting IMA blood flow, with a mean reduction in blood flow of 18.4% (left) and 21.7% (right) in the diabetic group (P<0.05).ConclusionPreoperative evaluation of the IMA using ultrasound over the parasternal second intercostal space is easy, noninvasive, and has a high success rate. The internal diameter of the IMA is positively correlated with body surface area, and blood flow is significantly reduced in patients with diabetes.
【摘要】 目的 研究合并2型糖尿病的冠心病患者冠狀動脈病變程度與血清視黃醇結合蛋白4（retinol-binding protein 4，RBP4）水平的相關性。 方法 2008年10月-2010年4月選擇性冠狀動脈造影確診的冠心病患者共120例，分為單純冠心病組（A組）60例和冠心病合并糖尿病組（B組）60例，檢測血糖、血脂、胰島素以及脂聯素、RBP4水平；根據冠狀動脈造影結果，以Gensini評分評判冠狀動脈病變程度。 結果 B組空腹血糖、胰島素、RBP4均顯著高于A組（Plt;0.05）；冠狀動脈病變程度更重（Plt;0.05）。相關性分析顯示RBP4水平與低密度脂蛋白膽固醇、胰島素抵抗和冠狀動脈病變積分呈正相關（r=0.312、0.322、0.314，Plt;0.05）。與脂聯素水平呈負相關（r=-0.362，Plt;0.01）。 結論 冠心病合并2型糖尿病患者RBP4明顯升高，且與冠狀動脈狹窄程度呈正相關。【Abstract】 Objective To explore the relationship between the level of serum retinol-binding protein 4 (RBP4) and the extent of coronary lesions in coronary heart disease (CHD) patients accompanied with type 2 diabetes mellitus (T2DM). Methods A total of 120 patients with CHD diagnosed by coronary arteriongraphy between October 2008 and April 2010 were enrolled. The patients were divided into two groups: CHD group (60 patients); CHD accompanied with T2DM group (60 patients). The levels of serum insulin, adiponectin and RBP4 were measured. All the patients underwent coronary angiography and the extent of coronary lesions was assessed quantitatively based on the Gensini′s scoring system. Results The levels of serum insulin, plasma RBP4 and the extent of coronary artery stenosis in CHD accompanied with T2DM group were significantly higher than those in CHD group (Plt;0.05). Correlation analysis showed that the level of RBP4 was positively correlated with LDL-C, insulin resistance index and the coronary artery narrow degree（r=0.312, 0.322, 0.314; Plt;0.05); and negatively correlated with adiponectin (r=-0.362, Plt;0.01). Conclusion The significant elevated plasma RBP4 in CHD patients accompanied with T2DM is positively correlated with the extent of coronary artery lesion.
ObjectiveTo explore and discuss the risk factors of early onset coronary heart disease in Tibetan residents.
MethodsWe selected Tibetan residents with coronary heart disease who were hospitalized in the Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region between January 2011 and May 2013, and then divided them into two groups by age (early onset and late onset coronary heart disease groups). Univariate analysis was performed between two groups by gender, family history, smoking, drinking, hypertension, diabetes, levels of blood lipid, respectively. The factors with significant differences were extracted for logistic regression. Data analysis was performed using SPSS 16.0 software.
ResultsA total of 64 Tibetan residents with coronary heart disease were included, of which, 22 cases were in the early onset groups and 42 cases the late onset group. The results of univariate analysis showed that, significant differences were found in gender, family history, and levels of HDL-C and LDL-C (all P < 0.05). Besides, the results of logistic regression showed that, family history (OR=3.374, P < 0.05), high triglycerides level (OR=2.369, P < 0.05), low HDL-C level (OR=0.014, P < 0.05) and high level of LDL-C (OR=3.008, P < 0.05) were independent risk factors of early onset coronary heart disease in Tibetan residents.
ConclusionPositive family history, high triglycerides level, low HDL-C level and high level of LDL-C are independent risk factors of early onset coronary heart disease in Tibetan residents.
Objective To investigate the effect of coronary artery bypass grafting (CABG) on patients with coronary heart disease and giant left ventricular dimension but without aneurysm. Methods The clinic data of 51 consecutive patients with coronary heart disease accompanied by enlarged left ventricle dimension without aneurysm, including 50 males and 1 female, undergoing CABG between January 2004 and December 2006 in Nanjing First Hospital of Nanjing Medical University was retrospectively reviewed. The patients were at the age of 54-61 years with an age of 57.5±3.2 years. All patients received CABG, combined with aortic valve replacement in 7, mitral valve replacement in 16, mitral valvoplasty in 17 and tricuspid valvoplasty in 7. After surgery, perioperative complications and mortality were closely observed and followup for a period of 37 months was carried out. Results The number of distal anastomoses per patient was 2.0-4.0(3.8±1.1). Four patients died perioperatively (7.8%), among whom 2 died from malignant ventricular fibrillation, 1 from acute kidney failure and 1 from stroke caused by severe low cardiac output syndrome. All other patients were discharged from hospital with good recovery. After operation, 5 patients had atrial fibrillation and 11 had ventricular fibrillation, but all of those patients survived after proper treatment. The followup period for 47 patients was 37-49 months (43±11months), with a followup rate of 100%. No death occurred during the follow-up. Ultrasound cardiography in the followup period showed that there was a decreased left ventricular enddiastolic dimension (59±2 mm vs. 68±5 mm; t=7.320, Plt;0.05) and an improved left ventricular ejection fraction (45%±17% vs. 34%±15%; t=4.770, Plt;0.05) compared with those before operation with statistical significance. Conclusion CABG is an effective surgical procedure in the treatment of coronary heart disease with giant left ventricular dimension but without aneurysm.
ObjectiveTo systematically review the efficacy and safety of triple antiplatelet therapy (TAT:aspirin, clopidogrel and cilostazol) for patients with coronary heart diseases after percutaneous coronary intervention.
MethodsSuch databases as The Cochrane Library (Issue 2, 2014), PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were electronically searched for relevant randomized controlled trials (RCTs) on the efficacy and safety of TAT for patients with coronary heart diseases after percutaneous coronary intervention from inception to February 2014. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software.
ResultsA total of 15 RCTs involved 6 980 patients were included. The results of meta-analysis showed that:a) the DAT group (DAT:aspirin and clopidogrel) and the TAT group were similar in non-fatal myocardial infarction (OR=0.72, 95%CI 0.47 to 1.10, P=0.05), stroke (OR=0.66, 95%CI 0.38 to 1.16, P=0.15), and hemorrhage (OR=1.03, 95%CI 0.74 to 1.44, P=0.85) with no significant difference; b) the TAT group was superior to the DAT group in reducing the incidences of the major cardiovascular and cerebrovascular events (MACCE) (OR=0.50, 95%CI 0.39 to 0.65, P < 0.000 01), cardiac death (OR=0.53, 95%CI 0.33 to 0.84, P=0.007), stent thrombosis (OR=0.52, 95% CI 0.27 to 0.99, P=0.05), target vessel revascularization (OR=0.63, 95%CI 0.51 to 0.76, P < 0.000 01), and target lesion revascularization (OR=0.44, 95%CI 0.28 to 0.70, P=0.000 6); and c) no significant difference was found between the two groups in the incidences of thrombocytopenia, leucopenia, and liver damage. The DAT group was superior to the TAT group in gastrointestinal reaction, palpitations, headache, and skin rashes between the two groups, with significant differences.
ConclusionTAT therapy has good efficacy and safety in the treatment of patients with coronary heart diseases after percutaneous coronary intervention.
ObjectiveTo investigate the clinical efficacy of off-pump coronary artery bypass grafting, and summarize the experience of nursing care in the treatment.
MethodsWe retrospectively analyzed the clinical data of 25 patients undergoing off-pump coronary artery bypass surgery between January 2010 and December 2012. The therapeutic effect of the surgical method and the care management measures were summarized and analyzed.
ResultsAll the operations were successful without any deaths. The Mean operation time was (209.85±38.41) miniutes; Blood infusion volume averaged (1 311.23±423.70) mL; Drainage volume was (491.98±142.46) mL; The mean ICU monitoring time was (4.22±1.23) days; Hospitalization lasted for (10.10±1.89) days; And the mean number of bypass was 4.00±0.51. Two patients had high temperature and coughing after surgery, and were cured through intravenous dripping and atomization sputum suction. Two had slight injury infection and were controlled with antibiotics. Two could not endure the pain which was relieved by sauteralgyl. One patient with thoracic pain due to neural stimulation was relieved by glycerin trinitrate.
ConclusionThe off-pump coronary artery bypass surgery is advantageous in having less trauma, less bleeding, shorter hospital stay and lower hospital costs. The preoperative, intraoperative and postoperative care should be prepared to ensure the smooth implementation of the surgery and improve therapeutic effect.
Objective To evaluate the efficacy and safety of safflower yellow pigment lyophilized power amp; dripping solution in the treatment of patients with angina, by using parenteral solution of Dan-shen root extraction as control, we designed the nonferiority clinical trial phase Ⅲ. Method 784 patients with stable angina pectoris Ⅰ, Ⅱ, Ⅲ degree and occurred more than twice per week were selected. They were randomly, stratified and blindly assigned into 5 parallel groups including one control. They were treated by using safflower yellow pigment lyophilized power (SYPLP) 80 mg + 0.9% NS 250ml, intravenously guttae, daily (trial group 1); SYPLP 160 mg + 0.9% NS 250 ml, intravenously guttae, daily (trial group 2); safflower yellow pigment lyophilized dripping solution (SYPLDS) 200 ml (160 mg), intravenously guttae, daily (trial group 3); SYPLDS 100 ml (80 mg), intravenously guttae, daily (trial group 4) and parenteral solution of Dan-shen root extraction 20 ml + 0.9% NS 250 ml, intravenously guttae, daily (control group) respectively. Efficacy and safety were evaluated after 14 days of continuous treatment. Results The angina efficacy (per-protocol population, PP): The notable effective rates of trial groups 1 to 4 and control group were 53.27%，69.44%，70.09%，55.09% and 26.00% respectively, and the effective rates were 88.79%，92.59%，93.46%，89.81% and 73.00% respectively。There was significant differences between trial group 1 and 2, trial group 3 and 4. All trial groups showed significant different effect when compared with control (P＜0.05). The effect of trial group 2 was better than those of trial group 1, and trial group 3 better than trial group 4, the four trial groups better than control group. The intention-to-treat (ITT) analysis result was almost the same to PP analysis, but trial group 3 showed no significant difference to trial group 4. In trial group 2, 3 and 4, each occurred one adverse effect, while the number was 10 in control group.Conclusion SYPLP amp; SYPLDS have certain effect on angina. They are more effective than parenteral solution of Dan-shen root extraction. No toxic side effect has been found in clinic tests.
Objective To evaluate the clinic outcomes of coronary artery bypass grafting （CABG） on patients of coronary artery disease complicated with chronic obstructive pulmonary disease（COPD）. Methods The data of 27 patients of coronary artery diseases complicated with COPD who had received CABG from Jan. 1998 to Dec. 2004, were retrospectively summarized. 18 patients received off-pump CABG （off-pump group）,and 9 cases received on- pump CABG （on-pump group）. All patients accepted the evaluation about clinical respiratory complications, oxygenation index （PaO2/FiO2）, related respiratory function index, plasma intercellular adhesion molecule 1 （ICAM-1） and the amount of neutrophil in pulmono-alveolar perfusion fluid at the different time point including the start of CPB （for off-pump group, the measurement accepted at the start of operation）, end of CPB （end of operation for off-pump group）, and at 2, 6, 12, and 24h after operation. Results There was no operation-related death in two groups. One died of respiratory failure 14 days after operation in the hospital in off-pump group, there were more respiratory complications in on-pump group than that in off-pump group, and PaO2/FiO2 in on-pump group was higher than that in off-pump group at CPB 30min （at the start of operation）, but lower than that in off-pump group postoperative at 6 h, 12 h（P〈0. 05）, the concentration of plasma ICAM-1 had obvious difference between two groups from CPB 30 min （at the start of operation） to post-operative 24 h （P 〈 0. 05）. The neutrophils in bronchoalveolar lavage in on-pump group was higher than that in off-pump group from CPB 30 min （at the start of operation） to 24 h after operation （P〈0. 05）. Conclusion Off-pump CABG seems more suitable than on-pump CABG for coronary artery disease patients with COPD due to less damage on oxygen-exchange capability and less respiratory complication.
Objective To evaluate the effectiveness and safety of simvastatin 40 mg daily use in treatment of coronary heart disease. Methods The study was designed as before-after study in the same patients. One hundred and sixty seven patients with coronary heart disease were prescribed simvastatin 40 mg daily for 3 and 6 months. Total cholestero (TC), low-density lipoproteins cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerldes (TG), ALT and creatine kinase (CK) in serum before therapy and at the end of 3 months and 6 months treatment were dectected. Continuous data were analyzed by standard difference of blocked randomization and described by mean±SD. Dunnet-t test was used for multiple comparison of trial and control groups. Statistical difference was set up at P＜0.05. Success rate was assessed by chi square test at the end of 3 and 6 months treatment. Results Simvastatin 40 mg/d significantly decreased the level of TC (P＜0.000 5), LDL-C (P＜0.000 5), TG (P＜0.05), and could elevate HDL-C (P＜0.05). There were 39.5% of patients whose LDL-C reduced below 70 mg/dl. One patient whose CK raised 5.6 times of upper line of normal range and 4 patients whose ALT raised more than 2 times of upper line of normal range withdrew. The reliability of simvastatin 40 mg/d was relatively good. Conclusions Simvastatin 40 mg/d could significantly improve the lipid profile, and is relatively reliable in treatment of coronary heart disease.
Objective To compare the clinical early results of on-pump and off-pump coronary artery bypass grafting re-operations (re-CABG)and introduce our experience. Methods From April 2000 to June 2006, 21 cases with coronary artery diease of re-CABG were performed in this hospital. 10 patients received off-pump CABG (off-pump group), and 11 underwent CABG re-operations with cardiopulmonary bypass CABG(on-pump group). There were no significant difference regarding gender, age, weight, diabetes, hypertension, left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) between two groups before operation. On-pump CABG procedures were performed on hypothermia cardiopulmonary bypass. Standard methods were used to finish off-pump CABG. Flow meters were utilized to measure the flow of grafts in both groups. Results No one in off-pump group needed to conver to on-pump CABG. There was no operative or late mortality. The operation time, respiratory support time, the volume of chest tube drainage, blood transfusion and postoperative hospital stay were less in off-pump group than those in on-pump group after operation. Early death occurred in 1 patient in on-pump group. The number of distal anastomosis were more in on-pump group than that in off-pump group. Conclusions Both off-pump CABG and on-pump CABG can be applied to CABG re-operations and achieved similar completeness of revascularization, similar early surgical results.
