Diver C.E.抽吸导管对急性心肌梗死患者心肌再灌注的影响

Effect of Diver C.E.aspiration thrombectomy catheter on myocardial reperfusion in patients with acute myocardial infarction

目的评价急性心肌梗死急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中应用Diver C.E.血栓抽吸导管对改善心肌组织灌注及临床预后的作用。方法 72例急性心肌梗死患者按电脑随机数字法分为Diver C.E.+PCI组(36例)和传统PCI治疗组(36例),对两组之间的冠状动脉造影结果[心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级、TIMI心肌灌注(TIMI myocardial perfusion,TMP)血流]、心电图ST段回落百分比(sumSTR)和临床结果(肌酸激酶和肌酸激酶同工酶峰值、术后1周左心室射血分数、12个月主要心血管事件)进行分析比较。结果 Diver C.E.+PCI组与单纯PCI组比较,TIMI分级及TMP分级均明显改善,差异有统计学意义(均P<0.01);肌酸激酶[(1486.6±73.7)U/L vs.(1835.9±84.5)U/L,P<0.01]和肌酸激酶同工酶[(129.6±26.5)U/L vs.(246.8±29.3)U/L,P<0.01]峰值明显降低;ST段回落幅度大(66.6%±29.3%vs.41.8%±33.6%,P<0.01);近期左心室射血分数增高(57.9%±4.8%vs.52.3%±4.7%,P<0.01);左心室舒张末期内径减少[(48.6±5.8)mm vs.(56.6±5.3)mm,P<0.01];两组住院期间均无主要心血管事件发生。结论在急性心肌梗死急诊PCI治疗中应用Diver C.E.血栓抽吸导管安全可行,有效的清除冠状动脉内血栓,改善心肌组织灌注及术后心脏功能,并且不增加主要心血管事件的发生率。

Objectives To assess the effect of the Diver C.E. aspiration thrombectomy catheter on improving the myocardial repeffusion and clinical prognosis in patients with acute myocardial infarction （AMI） who underwent primary pereutaneous coronary intervention （PCI）. Methods A total of 72 patients were assigned to the thrombus aspiration group （n=36） and the conventional PC I group （n=36）.We assessed angiographic results [thrombolysis in myocardial infarction （TIMI） flow grade, TIMI myocardial perfusion （TMP） flow grade ] and electrocardiographie signs （sum-STR） of myocardial reperfusion, as well as clinical outcome（peak values of ereafine kinase and MB isoenzyme of creatine kinase, left ventricular ejection fi＇aetion in one week after PCI,elinica] outcomes up to 12 months after PCI）. Results Compared with PCI group, TIMI flow grades and TMP grades were significantly improved （P〈0.01）; peak serum ereatine kinase and isoenzyme of creatine kinase [ （129.6±26.5） U/L vs.（246.8±29.3） U/L,P〈0.01 ] were lower; ST segment resolution（66.6%±29.3% vs. 41.8%＋33.6% ,P〈0.01）was faster; left ventrieular ejection fraction （57.9%± 4.8 % vs. 52.3%±4.7% ,P〈0.01 ） was better and left ventricular end diastolic dimension [ （48.6±5.8）mm vs. （56.6±5.3）mm,P〈0.01 ] decreased in thrombus aspiration group. There were no major adverse cardiovascular events in two groups. Conclusions In AMI patients treated with primary PCI, application of Diver C.E. aspiration thrombeetomy catheter is safe and effective,which could lower thrombosis burden, improve distal myoeardium perfusion and cardiac function after procedure, do not increase the incidence of major adverse cardiovascular events.