血栓抽吸治疗急性ST抬高型心肌梗死神经内分泌变化的临床研究

Study on neuroendocrine change in patients with ST segment elevation in acute myocardial infarction using thrombectomy

目的探讨应用血栓抽吸装置GuardWire PlusTM行血栓抽吸治疗急性ST抬高型心肌梗死(STEMI)神经内分泌变化及其临床价值。方法将2004年9月至2006年9月在我院行急诊PCI的72例急性STEMI患者分为两组,A组(38例):血栓抽吸后支架植入组;B组(34例):直接PCI组。于手术当天、术后第1、2、3、5日分别测定外周血中内皮素(ET)、血浆肾素活性(PRA)、醛固酮(ALD)、血管紧张素Ⅱ(AngⅡ)、去甲肾上腺素(NE)、肾上腺素(E)水平。术后1周与3个月测定左室射血分数(LVEF),评价心功能。结果两组病例均成功地置入支架,术前两组患者的神经内分泌因子水平无显著差异(P>0.05),ET、PRA、AngII、ALD、E等神经内分泌因子于术后第1、2日A组下降较B组明显(P<0.05),两组间NE下降无明显差异(P>0.05)。术后3个月A组的LVEF明显高于B组(P<0.05)。结论血栓抽吸治疗急性STEMI较直接PCI能够明显改善恶化的神经内分泌变化,对心功能可能有潜在的保护作用。

Objective To study neuroendocrine change and clinical value of percutaneous thrombectomy system （GuardWire Plus^TM）in treatment of patients with ST-elevation acute myocardial infarction （STEMI）. Methods 72 patients with STEMI underwent percutaneous coronary intervention（PCI）were divided into A group （38 patients）with direct stent placement after thrombectomy and B group （34 patients） with prim,ry PCI. The plasma levels of ET, PRA, ALD, Ang Ⅱ , NE, E were measured on the day of operation and the first, second, third and fifth days after PCI. Left ventricular ejection fraction（LVEF） was measured by echocardiography at one week and three months after PCI. Results The stents were successfully implanted in two groups. All the neuroendocrine factors have no difference between the two groups before operation. The first and second day after PCI, the levels of ET, PRA, ALD, Ang Ⅱ and E were significantly lower in A gronp than those in B group （P 〈 0.05）. NE showed no difference after PCI （P 〉 0.05）. Conclusions Deteriorated neuroendocrine changes are significantly improved with thrombectomy, providing potential benefits on heart function. （J Intervent Radiol, 2007, 16： 443-445 ）