心肌呈色分级评价急性心肌梗死超声血管成形术的疗效

Therapeutic efficacy of ultrasonic angioplasty in acute myocardial infarction evaluated by myocardial blush grade

目的 以心肌呈色分级 (Blush分级 )评估急性心肌梗死超声血管成形术后的心肌灌注状况。方法 3 0例急性心肌梗死患者纳入研究 ,其中超声组 15例 ,PTCA组 15例。比较两组间的基础临床状况、冠状动脉造影情况 ,病变血管手术后均行TIMI分级、TIMI计帧和心肌Blush分级。结果 3 0例AMI患者均有一支有大量血栓的IRA ,两组间的基础临床状况、术前造影情况和术终TIMI血流均无明显差异 (P >0 0 5 )。超声组术终远端微血管栓塞、无再流现象、血管内血栓影的发生率明显低于PTCA组 (分别为 6 67%、0 %、0 %和 3 3 3 3 %、2 0 %、2 6 67%,P均 <0 0 5 ) ,TIMI帧数明显低于PTCA组 ( 18 7± 4 6和 2 9 7± 8 9,P <0 0 5 ) ,Blush 3级获得率高于PTCA组 ,超声组术后 2、2 4hST段回落幅度大于PTCA组 ,但残余狭窄高于PTCA组 [( 3 8 5 3± 10 6) %vs ( 18 8± 5 4) %,P <0 0 5 ]。结论 急性心肌梗死应用超声血管成形术 ,可开放IRA 。

Objective To evaluate the effects of myocardial reperfusion after treatment with ultrasonic angioplasty for acute myocardial infarction (AMI) using myocardial blush grade. Methods A total of 30 AMI patients were divided into ultrasonic angioplasty group and percutaneous transluminal coronary angioplasty (PTCA) group. The basic clinical parameters and the angiographic results in the two groups were compared. Thrombolysis in myocardial infarction (TIMI) grading, TIMI frame count, and myocardial blush grading were performed in all cases after percutaneous coronary intervention (PCI). Peak serum CK MB time and ST segment on ECG were observed. Results At least one infarct related artery (IRA) with massive thrombosis was found in all the 30 patients. There was no significant difference in basic clinical parameters, angiographic results before PCI, and TIMI3 flows achieved in IRAs after PCI between the two groups ( P >0.05). Less distal embolization (6 67% vs 33 33%, P <0.05), no reflow (0% vs 20%, P <0 05), incidence of images of thrombi (0% vs 26.67%, P <0.05), and better TIMI frame count [(18.7±4.6) vs (29.7±8.9), P <0.05] were achieved in ultrasonic angioplasty group. In ultrasonic angioplasty group, however, myocardial blush grade 3 was significantly higher than that in PTCA group after the operation, and the rate of residual stenosis was also higher [(38.53±10.6)% vs (18.8±5.4)%, P <0.05]. At 2 and 24 h after the treatment, the depressed amplitude of ST segment in ultrasonic angioplasty group was higher than that in PTCA group. CK MB peak values migrating forward were found in all the patients. Conclusion Ultrasonic angioplasty, which can open IRA, restore TIMI blood flow, and improve distal coronary reperfusion, can be used as an effective approach for acute myocardial infarction.