直接介入治疗中影响血栓抽吸效果的因素分析

Analysis of the factor of effective thrombus aspiration on patients in primary percutaneous coronary intervention

目的 分析能够改善前向血流,进行有效血栓抽吸的影响因素.方法 采用单中心回顾性研究,入选2008年1月至2008年12月期间因急性心肌梗死在北京安贞医院住院行直接介入治疗术并于术中应用了血栓抽吸导管的患者共226例,将抽吸后TIMI血流改善＞1者178例为有效组,而无明显改善者48例患者作为对照组,将两组ST段回落率、直接支架率;发生无复流/慢血流比率;冠脉内应用替罗非班率;术后冠状动脉TIMI 3级血流率进行比较,并对影响抽吸有效性的因素进行logistic分析.结果 有效组吸烟史、糖尿病史、术前TIMI 0级血流比例、PCI术后无复流/慢血流、冠脉内应用替罗非班比例均显著低于对照组,而术后TIMI 3级血流比例、直接支架置入率则显著高于对照组,两组之间差异具有统计学意义.多因素分析结果显示吸烟史（OR=1.551,95%CI：1.018～2.154,P=0.012）、糖尿病史（OR=1. 132,95%CI：0.276～3.562,P=0.044）、术前TIMI0级血流（OR=0.544,95%CI：0.368～1.911,P=0.035）是血栓抽吸有效的独立影响因素.结论 直接PCI中有效的血栓抽吸能够显著提高术后TIMI 3级血流率,重视影响抽吸有效性的因素,尽早控制,改善预后.

Objective To find the factors lowering the rate of effective thrombus aspiration in patients with ST- segment elevation acute myocardial infarction （STEMI） treated with primary percutaneous coronary intervention （ PCI）. Method From January to December 2008, a total of 226 AMI patients from Beijing Anzhen Hospital, treated with primary PCI to aspirate the thrombus from the infraeted coronary artery via a cannula, were enrolled in a single center retrospective study. The criterion of successful thrombectomy （ device success） was defined as the coronary blood flow of involved vessel after PCI resumed to greater than T1MI grade 1. One hundred seventy-eight patients were assigned to effective thrombus aspiration group, and 48 patients without improvement in coronary blood flow of involved vessel after PCI to control group. Data collected after PCI including the normalization of the elevated ST segment, the use of direct stent, ratio of no-flow/slow flow, intra-coronary administration of Tirofiban and the rate of thrombelysis in myocardial infarction （TIMI） flow grade 3 were analyzed with logistic analysis soas to find out the factors affecting the efficacy of thrombus aspiration. Results There were no significant differences in data before PCI between two groups （P 〉 0.05）. Compared with the control group, the factors studied such as smoke, diabetes, the rate of pre-PCI TIMI flow grade 0, the post-PCI ratio of no-reflow/slow flow, and the intra-coronary administration of Tirofiban were fewer significantly in the effective thrombus aspiration group. And the rate of post-PCI TIMI flow grade 3, and the rate of direct stent were higher in the effective thrombus aspiration gn）up. Logistic analysis showed that smoke （ OR = 1. 551,95% CI ： 1. 018 - 2. 154, P = 0.012）, diabetes （ OR = L. 132,95% CI：0.276 - 3. 562, P = 0. 044）, and pre-PCI TIMI flow grade 0 OR = 0. 544,95%CI：0, 368 - 1.911, P = 0.035） were independent factors of effective thrombus aspiration. Conclusions Effeetive thrombus aspiration may improved the coronary blood flow to TIMI flow grade 3 after PCI and reduce the impaimaent of myocardial perfusion, and the factnrs affecting the efficacy of thrombus aspiration should be paid more attention to and should be minimized to achieve the better clinical outcomes.