血管内窥镜评价急性心肌梗塞患者的介入治疗

Angioscopic Evaluation of Interventional Treatments in Acute Myocardial Infarction

目的：探讨介入治疗后出现的血栓形态与介入治疗方法的关系。 方法：应用血管内窥镜观察经介入治疗后３１ 例急性心肌梗塞（ＡＭＩ）患者经皮冠状动脉腔内再通术（ＰＴＣＲ）组１４例，经皮冠状动脉腔内成形术（ＰＴＣＡ）组１０ 例，支架置入组１５ 例（其中８例行ＰＴＣＡ后支架置入）冠状动脉血栓形态。 结果：在支架置入组均为附壁血栓，无一例是管腔内血栓；而在ＰＴＣＲ组和ＰＴＣＡ组中管腔内血栓分别占８６％ 和９０％ ，比支架置入组管腔内血栓有意义地增多（Ｐ＜ ０．００１）。 结论：３种ＡＭＩ介入治疗中，支架植入术在降低急性冠状动脉闭塞及再狭窄等并发症的发生率方面，优于ＰＴＣＲ和ＰＴＣＡ。

Objective:To investigate the morphology of thrombus formed soon after intracoronary intervention for acute myocardial infarction (AMI). Methods:Coronary angioscopy was performed in 31 patients immediately after coronary interventions including primary stenting(15 cases),percutaneous transluminal coronary angioplasty(PTCA)(10 cases),percutaneous transluminal coronary recanalization(PTCR)(14 cases)to look at the newly formed thrombus. Results:Lining thrombi were observed in all the patients(15/15,100%)in the stenting group and protruding thrombi were found in 12/14,86% and 9/10,90% of the patients in PTCR and PTCA group,respectively.The difference was statistically significant( p <0 001). Conclusion:The incidence of acute coronary occlusion and late restenosis is lower after primary stenting than that after PTCA and PTCR in AMI.Different characters of thrombi formed following the procedures.