摘要：Background Low diastolic blood pressure (DBP) was reported to be associated with reduced coronary blood flow,subclinical myocardial damage,and cardiovascular events. The aim of this study was to explore the impact of low DBP on clinical outcomes in patients with ST-elevation myocardial infarction(STEMI)undergo-ing percutaneous coronary intervention(PCI). Methods A total of 1232 patients with STEMI were retrospec-tively enrolled and divided into two groups according to admission DBP level:≥70 mm Hg(n=817)and<70 mm Hg (n=415). The relationship between DBP and in-hospital and 1-year adverse events was evaluated. Results In-hospital death occurred in 2.4％of patients. The in-hospital mortality(5.3％vs. 1.0％,P<0.001)and major adverse clinical events(11.1％vs. 7.5％,P=0.033)were significantly higher in patients with a low DBP. DBP<70 mm Hg was associated with in-hospital death(adjusted odds rate=3.31,95％CI:1.36-8.07,P=0.009). Additional significant indicators included eGFR<60 mL/min/1.73 m2 and intra aorta balloon pump(IABP)treat-ment. Seventy-seven(6.3％)patients died in the one-year follow-up. DBP<70 mm Hg was associated with in-creased risk of 1-year death(8.9％vs. 4.8％,Log-rank=9.9 ,P=0.002). Conclusion Low DBP was associat-ed with increased risk of in-hospital and 1-year adverse prognosis in patients with STEMI undergoing PCI, which could be a tool for risk assessment.

摘要：Background Septal Surfing Technology (SST) is one of the most important techniques for collateral channels (CCs) crossing in retrograde chronic total occlusion (CTO) of percutaneous coronary intervention (PCI).We examined this technique's usefulness in retrograde CTO-PCI cases.Methods We retrospective analyzed 728 consecutive CTO-PCI cases from January 2014 to September 2016.One hundred and forty-two patients who had undergone retrograde PCIs using septal collateral channels (CCs) were collected.Univariate and multivariate analyses were conducted to identify independent predictors for SST CCs crossing success.Results The CCs crossing success rate was 89.4％ during retrograde PCI.Three factors were figured out as independent predictors,including CCs tortuosity (OR 0.164,95％CI:0.041-0.657;P=0.011),diameter of distal CTO lesion (2.035,95％CI:1.011-4.099;P=0.047) and LAD-CTO (OR 0.244,95％CI:0.067-0.894;P=0.033).There were complications of CCs injury in 23.2％ cases and 2.1％ cases had cardiac tamponade without any in-hospital death.Conclusion SST is an effective method in collateral crossing during retrograde CTO-PCI.It has high successful rate regard less of the Wemer Collateral Class of interventional collaterals,especially in invisible collaterals.This technology is feasible in daily practice of retrograde PCI.

摘要：To summarize a case of late pregnancy complicated with acute Stanford type A aortic dissection who underwent multidisciplinary treatment perioperative nursing experience in emergency surgery.The patient was 37 weeks of intrauterine pregnancy and suffered from sudden chest pain.The emergency admission was diagnosed with aortic dissection(Stanford A type),and the condition was dangerous and life-threatening.After preoperative multidisciplinary combined systematic comprehensive disease assessment and comprehensive surgical emergency plan was formulated,do a good job of effective psychological counseling and operation cooperation education,nursing cooperation during intraoperative anesthesia and nursing focus of multidisciplinary combined surgical treat-ment,postoperative prevention of massive bleeding,puerperium infection and a series of effective nursing mea-sures,no perioperative period occurred nursing complications.The newborn survived,the patient recovered and was discharged from the hospital,and returned to the hospital for re-examination with normal indicators and good physical condition.

摘要：Background Coronary slow flow (CSF) during primary percutaneous coronary intervention (PCI) is closely related to the prognosis of patients with acute myocardial infarction (AMI).Whether Enhanced External CounterPulsation (EECP) could improve the phenomenon and enhance cardiac function in these patients has not been studied.Methods Seventy-eight AMI patients undergoing primary PCI were enrolled and divided into 2 groups,EECP group and sham group.In EECP group,the patients were treated with EECP for 30 min after coronary artery stent implantation;and in sham group,the patients after coronary artery stent implantation were treated with cuffs wrapped for 30 min.Hemodynamics and corrected TIMI Frame Count (cTFC) were recorded at different time points in both groups.CRP,HCY,NT-proBNP and Killip class were also detected before operation and after treatment.Results In EECP group,compared to pre-and post-EECP treatment,the systolic blood pressure (SBP) was much lower (P ＜0.05),diastolic blood pressure (DBP) and mean arterial blood pressure (MBP) were much higher (P ＜0.05).The heart rate (HR) was not changed during EECP treatment (P ＞0.05).In sham group,SBP,DBP,MBP and HR were not significantly changed during these period (P ＞0.05).In EECP group,the cTFC of patients with CSF decreased significantly after treatment (P ＜0.05);and there was no difference in sham group (P ＞0.05).Compared with pre-EECP treatment,CRP and HCY were increased in post-EECP treatment of both groups (P ＜0.05),while,they were much lower in EECP group (P ＜0.05).The expression of NT-proBNP was decreased after treatment in both groups (P ＜0.05),and it was much lower in EECP group than in sham group (P ＜0.05).The Killip class was much lower after treatment than before operation in EECP group (P ＜0.05),and there was no change in sham group (P＞0.05).Conclusions The results suggest that EECP is helpful in a short time to the improvement of CSF and recovery of cardiac function in AMI patients during primary PCI,and that CRP and HCY may be involved in this process.

摘要：Background Heart failure is a common condition in elderly patients.With further population aging,incidence of heart failure is constantly increasing.When heart failure occurs in this group of patients,clinical symptoms may vary vastly,rendering difficulty for the treatment process and leading to poor efficacy and prognosis.To gain better understanding on clinical symptoms and signs of heart failure in elderly patients,to provide prevention and treatment against heart failure for elderly patients in terms of nursing care and to improve success rate of salvage treatment as well as nursing quality.Methods Retrospective analysis was performed in 141 patients with heart failure who were treated in our hospital during January 2005 and December 2009.Those aged ＞ 60 years were assigned to elderly group while those aged ＜ 60 years were assigned to non elderly group.These two groups were compared in terms of clinical symptoms,signs and physical and laboratory examinations.Results Clinical symptoms and signs of heart failure tended to be atypical in elderly patients.Symptoms including cough,sputum,increased heart rate and mental disorder were frequent,and a substantial proportion of patients had pulmonary congestion and edema.Conclusions Prevention and specific nursing measures should be aggressively taken based on the features of heart failure in elderly patients.Frequency of inspection particularly observation on atypical symptoms should be increased to provide intensive monitoring.

摘要：Background Data are limited regarding the risk of contrast-induced nephropathy (CIN) for patients after the second contrast exposure.Objective To examine the risk of CIN after the second contrast exposure in patients of acute coronary syndrome (ACS) with chronic kidney disease (CKD).Methods Patients of ACS scheduled for a second elective PCI.Patients were required to have an estimated creatinine clearance (CrC1) between 15 and 60 ml/min.The value of serum creatinin (sCr) prior to the second contrast exposure must not be ≥ 25％ or ≥ 88.4 μmol/L compared to baseline.CIN was defined as an increase of sCr ≥ 25％ from baseline within 48-72h after the second contrast exposure.The primary end-point was risk of developing CIN.Results Thirty-nine patients completed the study.The average of interval between contrast exposures was 116 ± 64 h,contrast volume was 266 ± 100 mL and length of hospitalization was 8.3 ± 4.7 days.The incidence of CIN in the overall study population was 10.3％.There was not change significantly in average sCr and CrC1 after the second contrast exposure (sCr 1.52 ± 0.62 vs.1.54 ± 0.60 mg/dL baseline,P =0.75; CrC1 (40.68 ± 14.46 vs.39.16 ± 12.10mL/min baseline,P =0.26).None of the patient was death in 30 days.One (2.6％) of the patients who developed CIN required dialysis in-hospital.Conclusion Our findings suggest that patients with prior renal dysfunction are not increased risk of developing CIN after the second contrast exposure.This cohort may be benefit from sufficient prophylaxis.

摘要：Background Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is an acute heart disease caused by incomplete occlusion of related coronary arteries with unstable atherosclerotic plaques.Lead aVR ST-segment elevation and cTnI positive are closely correlated to the prognosis of NSTE-ACS patients.However,there are few studies applying the two predictors to early risk stratification in NSTE-ACS patients.Method Two hundred and five cases of NSTE-ACS patients followed up for 6 months after discharge were reviewed.All patients were divided into four groups:Group A-cTnI negative combined with aVR-non-ST-segment elevation group (100 cases);Group B-cTnI negative combined with aVR-ST-segment elevation group (31 cases);Group C-cTnI positive combined with aVR-non-ST-segment elevation group (43 cases);Group D-cTnI positive combined with aVR-ST-segment elevation group (31 cases).There was no significant difference in gender,age,old myocardial infarction,previous PCI history,hypertension,and diabetes between aVR-ST elevation group and no aVR-ST elevation group.The morbidity of left main or three-vessel coronary artery disease as well as adverse cardiovascular events in the four groups were observed and analyzed.Results (i) The morbidity of left main or three-vessel coronary artery disease was highest in Group D (87.1％),and was markedly higher in Group B (41.9％) than that in Group A (7％) or Group C (9.3％);(ii) The incidence of adverse cardiovascular events was highest in Group D (77.4％),and was much higher in B (35.5％) as compared with that tin Group A (1％) or group C (7％).Conclusion Electrocardiographic lead aVR ST-segment elevation combined with cTnI positive has an important clinical value in predicting the prognosis of the patients with NSTE-ACS.

摘要：Objectives To compare the different effects of late successful reperfusion with PCI on left ventricular function and its relationship with viable myocardium after acute anterior wall myocardial infarction in patients with or without diabetes. Methods A total of 125 consecutive subjects with acute anterior wall myocardial infarction were selected, and divided into diabetes mellitus (DM) group (n=43) and Non-DM group (n=82) according to WHO diabetes diagnosis criteria. All patients received successful PCI at 12±8 days from onset. Ischemic viable myocardium was detected with low-dose dobutamine echocardiography, and left ventricular function and wall motion abnormality were also assessed with echocardiography before PCI. The data of clinical manifestations and angiograms before and after PCI were analyzed. Levels of creatinine kinase-MB (CK-MB), and troponin T (TnT) before PCI, 6 hours and 24 hours after PCI were assessed. All patients received clinic and echocardiography follow-up for 6 months. Results Higher rate of TIMI 2 flow, and lower rate of TIMI 3 flow in DM group were demonstrated immediately after PCI, and the rate of serum CK-MB and/or TnT levels were higher in DM group, compared with Non-DM group(P <0.05). 63% of DM patients and 56% of non-DM patients had viable myocardium before PCI(P >0.05). There were no significant differences of left ventricular ejection fraction (LVEF), left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI), and wall motion score (WMS) between two groups at baseline before PCI(P > 0.05). After six months, WMS was decreased and LVEF was increased in Non-DM group, but the WMS and the LVEF did not changed, and the LVEDVI was increased in DM group compared with baseline; the LVEDVI, LVESVI, LVEF, and WMS were significantly different between two groups (P <0. 05 or P <0.01). Conclusions Compared with non-diabetics, delayed successful revascularization with PCI in diabetics patient with acute myocardial infarction has less benefitial effect on the improvement of late phase left ventricular function, and it may be because the insufficient reperfusion or reperfusion injury to myocardium but not the viable myocardium contributing to the poor result.

摘要：Background Dilated cardiomyopathy (DCM) is a primary cardiomyopathy characterized by the enlargement of left ventricle or biventricular and left ventricular systolic dysfunction, without any obvious stenosis of coronary arteries. However, it remains unclear that whether the diameter of coronary artery is different from those of normal population, because few studies directly assessed the diameter of the coronary artery in patients with DCM. The study aimed to evaluate the diameter of coronary arteries in DCM patients and its influence on prognosis for DCM patients. Methods Fifty-seven DCM patients and fifty-nine patients presenting with atypical chest pain and normal coronary angiography were enrolled in the study. A coronary angiography image analysis system was used to measure the diameters at 5 mm from the opening of the left main coronary artery (LM), left anterior descending (LAD) and left circumflex coronary (LCX) arteries, and the right coronary artery (RCA) of both groups. Follow-up study through telephone over a period of 2 years was performed. Spearman rank correlation and logistic regression were used to evaluate the correlations of the diameter of coronary arteries with the risk of nonfatal heart failure event. Results Diameters of the LM, LAD, LCX, and RCA in DCM group were significantly larger than those of the control group (P ＜ 0.001). During a follow-up of 2 years, the nonfatal heart failure event occurred in 9 patients of DCM group, but not in control group. Spearman rank correlation analysis showed diameters of the LM, LAD, and LCX were correlated with the risk of nonfatal heart failure event, respectively (P ＜ 0.05). While the diameter of RCA showed no correlation with the risk of nonfatal heart failure event (P = 0.583). Whereas logistic regression analysis showed there were no correlation between diameters of the LM, LAD, LCX, and RCA and the risk of nonfatal heart failure event (P ＞ 0.05). Conclusions The coronary arteries of DCM patients show a larger diameter without any obvious stenosis, which may not correlate with the risk of heart failure event.

摘要：Objectives To assess the efficiency and safety of dual-wire balloon angioplasty side branch combined stenting the main branch in the treatment of coronary bifurcation lesions. Methods This study included thirty-six patients with 41 coronary bifurcation lesions. Selective dual-wire balloon angioplasty was performed in side branch and/or in main branch, and implantation of stents was performed in main branch only. Clinical outcome and major adverse cardiac events were observed inhospital and follow-up. Results Success rate of side branch dilatation before main branch stenting was 100%; main branch direct stenting performed in 4 cases; success main branch dilatation performed in the other 37 cases; kissing technique was performed successfully in 5 cases, which side branch was jailed after main branch stenting with TIMI grade 0-2 flow. No Q-wave myocardial infarction, acute revascularization and death occurred during in-hospital.Clinical follow-up was available in all patients. No Q-wave myocardial infarction, revascularization and death occurred, angina pectoris recurred in three patients,released by strengthen drug treatment. Conclusions Dual-wire balloon angioplasty side branch combined stenting the main branch is simple, safe and effective for the treatment of coronary bifurcation lesions.

摘要：Background Ultrasound-guided temporary pacemaker implantation has been proven safe and efficient.However,few studies have focused on elder and critical patients.Methods Twelve elder and critical patients underwent temporary cardiac pacing through the jugular vein or subclavian vein,with bedside ultrasound images to assist the placement of electrode within the right ventricle.Results Ultrasound-guided temporary cardiac pacemaker insertion was successful in all of the 12 patients.Electrodes were sent into the right ventricle correctly with the help of ultrasound imaging.In all cases,temporary pacemaker functioned well without procedure-related complications.Conclusion Temporary cardiac pacing guided by ultrasound is safe and effective in elder and critical patients,which is worth of promoting,especially in intensive care unit.

摘要：The patients having received CABG are more likely to suffer from cardiac dysfunction and hemodynamic instability.Floating catheter provides a full set of hemodynamic parameters in an accurate manner.Methods From January 6,2018,to December 29,2018,101 patients receiving CABG in our department were selected.Among them,53 patients indwelt with Swan-Ganz balloon floating catheters.The correct application of indwelling Swan-Ganz balloon floating catheter was analyzed targeting 53 patients receiving CABG to standardize nursing and prevent complications.Results Of the 53 patients recruited,48 cases recovered,3 cases had clinical death,and 2 cases were automatically discharged.There are 16 cases subject to complications and adverse reactions.In 4 cases with catheter obstruction in SICU where CVP could be measured,floating catheters were removed in time within 24 hours after catheterization in 3 cases and ld22h in 1 case.In 2 cases,catheter obstruction happened in SICU after CO measurement and before CVP measurement,where catheter obstruction was observed ld8h after catheterization,and floating catheters were removed within 2d22h in all cases.There were 3 cases who had capillary hemorrhage at puncture sites,where compression hemostasis with cigarette coils and gauze blocks was performed in all cases,followed by 3M TegadermTM transparent film dressing for sterile covering at the puncture site.4 cases suffered from transient premature ventricular contraction (PVC),which was alleviated without malignant arrhythmia after immediate suspension of operation.In addition,2 cases were subject to balloon catheters in the right ventricle and 1 case had balloon catheter in pulmonary artery,where CO,CI,SVR and other values except for the pulmonary capillary wedge pressure (PCWP) could be measured in all cases.Balloon rupture,pulmonary embolism,pulmonary hemorrhage,and pulmonary artery rupture,catheter knotting and catheter rupture or phlebitis and complications of catheter-related bloodstream infection (CRBI)were not found in the 53 patients.Conclusions The application of Swan-Ganz balloon floating catheter can provide hemodynamic monitoring data and guidance for monitoring the treatment of patients receiving CABG.Scientific application and management of pulmonary artery floating catheters and effective nursing can prevent complications and adverse reactions.

摘要：Background Aortic dissection occurs at a low incidence,but is associated with high mortality.It is generally acute onset,complicated and is often misdiagnosed; therefore is a macro vascular disease that poses major threat on patients' lives.Timely diagnosis and management are essential,so we investigated the diagnostic value of multi-slice spiral CT in aortic dissection.Methods clinical data from 21 patients with confirmed aortic dissection were retrospectively analyzed.All patients had undergone plain and contrasted multi-slice spiral CT scans.Results true lumen and pseudo cavity were clearly revealed in all 21 patients,of which 17 showed intimal flap,four showed intimal calcification and inward displacement,while 2 had thrombosis in the pseudo cavity.As for classification among these21 patients,9 had type Ⅰ aortic dissection,including two patients with innominate artery involvement,1 with celiac trunk involvement and 2 with left renal artery involvement; 2 had type Ⅱ aortic dissection,including 1 patient with innominate artery involvement; Another ten patients had type Ⅲ aortic dissection,including 2 patients with left subclavian artery involvement and 1 with celiac trunk involvement.Nineteen out of 21 patients had clearly revealed initial rapture.Conclusion multi-slice spiral CT is characterized by rapidness,non-invasiveness and accuracy.It provides clear visualization of the location and scope of aortic dissection,location of the rupture as well as the valves,which makes it a first-choice imaging approach for the diagnosis of aortic dissection.

摘要：Background Metabolic Syndrome(MS)is a group of conditions included hypertension,hyperlipidemia,central obesity,impaired glucose tolerance and insulin resistance,which may contribute to risk factors for atherosclerosis syndrome.Insulin resistance is the core mechanism? While the underlying mechanism is not clear.This article aims to study the correlation of carotid atheroselerosis with C-reactive protein and adiponectin in metabolic syndrome(MS)patients.Methods According to bilateral carotid artery atherosclerosis echocardiography,226 patients with metabolic syndrome were randomized to three groups,of which were non-carotid atherosclerosis plaque group(MS-1 group,n =94),carotid artery atherosclerosis plaque group(MS-2 group,n = 132),and normal control group(n = 36).Determination of serum insulin,high sensitivity C-reactive protein,adiponectin and bilateral carotid artery atherosclerosis ultrasonography and other indicators,semi-quantitative estimates of the extent and severity of plaque.Results ①In two MS groups,carotid artery atherosclerosis,intima-media thickness(IMT),insulin resistance index(HOMA-IR)and high sensitive C-reactive protein(hs-CRP)were significantly higher than the control group(P < 0.01),while adiponectin was lower than the control group(P < 0.01); When MS-2 group was compared to MS-1 group,there were significant differences(P < 0.01).②IMT was positively correlated with HOMA-IR and hs-CRP(P < 0.01)while negatively correlated with adiponectin(P < 0.01).Conclusions C-reactive protein and adiponectin in MS patients were correlated with carotid atherosclerosis and insulin resistance,which may be used as the assessment of MS patients.

摘要：To assess five-year results after successful percutaneous mechanical mitral commissurotomy (PMMC).Methods Thirty-four selected patients with rheumatic mitral stenosis underwent PMMC successfully in Guangdong cardiovascular institute between February 2001 and August 2002. Serial echocardiograms were performed in all patients at baseline, discharge and annually thereafter. Results Five-year follow-up rate was 97. 1%. Five-year survival rate was 100%. Before and after PMMC and at follow-up, mean mitral valve area by two-dimensional echocardiography was (0. 87 ± 0. 15 ) cm2, (2. 11 ± 0. 38 ) cm2 and (1.81 ± 0. 36) cm2, respectively (P＜ 0. 01 ). Five-year mitral resteno sis rate was 6. 1%. Conclusion PMMC can achieve excellent and sustained long-term results in selected patients with mitral echocardiographic score exceeding or being equal to 9.