急性心肌梗死介入治疗中应用抽吸导管对心肌再灌注的影响

Effects of aspiration cathter on myocardial reperfusion in patients with acute myocardial infarction treated by primarypercutaneous coronary intervention

目的:分析在急性ST段抬高型心肌梗死(STEMI)急诊行经皮冠状动脉介入治疗(PCI)中应用抽吸导管对心肌再灌注影响。方法:首次STEMI行PCI患者80例,随机分为试验组(41例,应用抽吸导管后再行PCI),对照组(39例,直接行PCI)。比较2组术后即刻计算校正TIMI计帧数和心肌Blush分级、术中慢复流现象、心电图90minST段下降率。在术后24h、1周时应用心肌声学造影计算灌注对比积分指数(CSI)、室壁运动积分指数(WMSI)。结果:PCI后试验组的校正TIMI计帧数明显低于对照组,Blush分级≥2级获得率高于对照组,慢复流现象减少;再通后90min心电图相关导联ST段下降率试验组明显大于对照组(P<0.05)。同时在研究的每一个时点,试验组CSI、WMSI较对照组明显降低(P<0.05)。结论:在STEMI急诊行PCI中应用抽吸导管可改善梗死相关血管前向血流情况,改善心肌再灌注,减少无复流现象。

Objective：To investigate the effects of aspiration catheter on myocardial reperfusion in patients with STEMI treated by primary percutaneous coronary intervention（PCI）. Method：Eighty patients with primary STEMI who underwent primary PCI were randomized into two groups. Fourty-one patients in experimental group were treated with aspiration catheter, Tirty nine patients in control group were treated routinely without aspiration catheter, corrected TIMI frame count （CTFC） and myocardial blush grade after PCI , the rate of descendent level of ST-segment, slow flow phenomeon were compared. Meanwhile, contrast score index （CSI） , regional wall motion score index （WMSI） with myocardial contrast endocardiography at 24h and 1 week were compared. Result： While lower TIMI frames and higher percentage of blush grade ≥2 of IRAs were observed in the experimental group. The slow-reflow phenomean were much less in the experimental group（P〈0.05）, and faster ST-segment resolution in the experimental group after PCI were also observed （P〈0.05）. Meanwhile, CSI, regional WMSI with myocardial contrast endocardiography at 24h and 1 week were lower in the experimental group. Conclusion： Application of aspiration catheter could improve coronary flow and myocardial reperfusion.