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Objective Study on cytochrome P450 (CYP) 2C19 gene single nucleotide polymorphism and the clinical prognosis of coronary heart disease (CHD) patients with percutaneous coronary intervention (PCI) after long-term use of clopidogrel.Methods A total of 150 cases of CHD patients was chosen prospectively between January 2013 and June 2014 who were hospitalized and PCI.All patients accepted dual antiplatelet therapy.Platelet aggregation rate and platelet aggregation inhibition rate were detected before taking the medicine and after PCI,which were used to classify the patients into clopidogrel-resistance groups (CR) and non-clopidogrel-resistance group (NCR).CYP2C19 gene single nucleotide polymorphism type was determined.The patients in CR group accepted clinical intervention countermeasures and NCR group was used as control,and postoperative recurrence angina and bleeding at the one year of operation were observed.Results About 24.67％ of patients with CHD with clopidogrel treatment,platelet aggregation rate cannot recover to normal.The correlation analysis showed CYP2C19* 2 carriers had a significantly higher platelet aggregation rate.Comprehensive analysis found that CYP2C19 * 2,long-term smoking,increased platelet count,and diabetes were the independent risk factors that platelet aggregation rate cannot recover to normal.No significant differences were found in primary end point,secondary end points,and bleeding events between CR group after clinical intervention countermeasures and NCR group.Conclusions CYP2C19 * 2,long-term smoking,increased platelet count,and diabetes are the independent risk factors that platelet aggregation rate cannot be developed to standard.Patients with clopidogrel resistance,the clinical intervention countermeasures to strengthen antiplatelet therapy can improve high platelet reactivity after PCI in CHD patients,and does not increase the risk of bleeding.
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Objective To investigate the clinical application of pulse indicator continuous cardiac output (PICCO) target oriented role monitoring technique on hemodynamics in patients with intractable heart failure.Methods Eighteen patients with intractable heart failure were selected as control group and received regular treatment including internal medicine under monitoring by central venous pressure.Another 18 patients with refractory heart failure were selected as PICCO group and given the internal medicine under PICCO monitoring.Intrathoracic blood volume index(ITBVI),global end diastolic volume index(GEDVI),extravascular lung water index (EVLWI),cardiac index (CFI),N-terminal B type natriuretic peptide precursor(NT-proBNP) and left ventricular ejection fraction(LVEF) were recorded.The data including mortality rate,ventilation time,intensive care time,APACHE Ⅱ score and the re-hospitalization rate were also record at 28th day.Results Compared with before treatment,ITBVI,GEDVI,EVLWI in PICCO group were (1 282.6 ± 196.4) ml/m2,(1 026.8 ±92.1) ml/m2,(12.9 ± 5.5) ml/kg respectively,significant different from that before treatment ((907.4±78.3) ml/m2,t =8.75,P =0.001; (715.2 ±61.8) ml/m2,t =6.48,P =0.003; (6.5 ± 1.2)ml/kg),t =2.94,P =0.033) and they are all back to normal level.The indices of CFI,NT-proBNP,LVEF in PICCO group were improved than before treatment (CFI:(3.1 ±0.5) L/min vs.(4.8 ± 1.3) L/min,t =2.56,P=0.042) ;NT-proBNP:(6 438.3 ±249.5) ng/L vs.(1 371.6 ±87.5) ng/L,t =5.12,P =0.019) ;LVEF:(26.9±3.1)％ vs.(54.3 ±2.5)％,t =2.62,P =0.040)).Mortality at 28th D in PICCO group was 16.7％,lower than that of control group (33.3％,x2 =4.99,P =0.026).The indices of assisted ventilation time,intensive care time,APACHE score of lⅡ and the rehospitalization ratein PICCO group were better than that of the control group ((8.5 ±2.3) dvs.(3.2±0.8) d,t=24.31,P＜0.05;(14.9±2.3) dvs.(8.3 ±2.0)d,t=12.26,P=0.002;(23.4±1.3) vs.(14.7±1.6),t=9.52,P=0.011;38.9％ vs.11.1％; t=5.79,P =0.020).Conclusion PICCO provides effective guidance for intractable heart failure patients hemodynamic monitoring of goal orientation.
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Objective To explore the causes,clinical manifestations,diagnosis and treatment method of femoral artery pseudoaneurysms (IFPSA) after ultrasound-guided percutaneous coronary intervention.Methods Ultrasound-guided repair by compression was applied to all cases,of which the failed cases were treated with ultrasound-guided thrombin injection.Results IFPSA was confirmed by ultrasound imaging in 39 cases,18 of which were cured by compression repair,with the average compression duration of (36.78 ± 1.71 )min.Another 21 cases were cured by the thrombin injection,after compression repair failed,with average time for thrombosis (0.33 ± 0.06 )min.All the patients were re-evaluated by ultrasound 24 h after treatment,confirming the successful closure of the pseudoaneurysms.No recurrence of pseudoaneurysm was observed during a half-year post-operative follow-up.Conclusion Ultrasound-guided compression repair and ultrasound-guided thrombin injection into the cavity are safe and effective treatments for femoral arterial pseudoaneurysms after coronary intervention.