经皮冠状动脉介入术联合经皮血栓吸除术治疗急性心肌梗死的临床评价

The efficacy of percutaneons coronary intervention combined percutaneous thrombectomy on coronary thrombotic lesions in patients with acute myocardial infarction

目的评价经皮冠状动脉介入术(PCI)联合经皮血栓吸除术治疗急性心肌梗死(AMI)的疗效。方法 56例 AMI 患者随机分为 PCI组(n=28)和 PCI 联合血栓吸除术组(n=28)。于 PCI术后24小时、1周行实时心肌声学造影(RT-MCE),记录各组灌注对比积分指数(CSI)、室壁运动积分指数(WMSI)、透壁性对比缺损长度(CDL)和严重室壁运动异常长度(WML)。采用免疫散射比浊法测定血浆超敏 C-反应蛋白(hs-CRP)水平,酶联免疫吸附法测定血浆 N-末端脑利钠肽(NT-ProBNP)和基质金属蛋白酶-9(MMP-9)水平。结果各时间点 PCI 联合血栓吸除术组 CSI、WMSI、CDL 和 WML明显低于 PCI 组(P<0.05)。术后1周 PCI 联合血栓吸除术组血浆 hs-CPR 和 NT-ProBNP 水平低于对照组[(4.56±1.98)mg/L 比(5.96±2.03)mg/L,P<0.05;(544.7±185.3)pmol/L 比(897.6±215.9)pmol/L,P<0.01],血浆 MMP-9无明显升高[(672.7±175.9)μg/L 比(609.6±196.5)μg/L,P>0.05]。结论与 PCI 组相比,PCI 联合经皮血栓吸除术可明显减少术后无再流的发生,改善微循环和心脏功能,是治疗 AMI 的有效方法。

Objective To evaluate the efficacy of pereutaneous coronary intervention （PCI） combined pereutaneous thrombectomy on coronary thrombotic lesions in patients with acute myocardial infarction （AMI）. Methods PCI were performed in 56 patients with AMI and positive coronary thrombus shown by angiography and these patients were randomly divided into PCI therapy group （ n = 28 ） and PCI combined pereutaneous thrombectomy group（ n = 28 ）. Real-time myocardial contrast echocardiography （ RTMCE） was performed at 24h and 1 week after PCI. Contrast score index （CSI）, regional wall motion score index （WMSI）, endocardial length of contrast defect （CDL）, and wall motion abnormality （WML） were calculated. The plasma level of hs-CRP was measured by immunonephelometry. The plasma concentration of N-terminal proB-type natriuretic peptide （NT-proBNP） and matrix metalloproteinase-9 （MMP-9） were detected by enzyme-linked immunosorbent assay（ELISA）. Results CSI,WMSI, CDL and WML at 24 hours and 1 week post procedure as well as the levels of hs-CPR and NT-proBNP at 1 week pest procedure [ （4. 56 ± 1.98 ） mg/L vs. （5.96 ± 2. 03 ） rag/L, P 〈 0. 05 ; （544. 7 ±185. 3 ） pmol/L vs. （ 897. 6 ± 215.9） pmol/L, P 〈 0. 01 ] were significantly lower in PCI combined pereutaneous thrombectomy group than those in PCI group in various time points. There were no differences in the plasma level of MMP-9 between the two groups [（672.7±175.9） μg/L vs. （609.6 ± 196.5）μg/L,P 〉0.05]at 1 week after PCI. Conclnsions PCI combined pereutaneous thrombectomy can significantly reduce no-reflow phenomenon, improve microcireulation and myocardial dysfunction. Thus PCI combined percutaneous thrombectomy is a feasible therapy in patients with AMI.