经桡动脉血栓抽吸术在急诊经皮冠状动脉介入中的临床应用评价

Clinical application of arterial thrombectomy in acute percutaneous coronary intervention through the radial artery

目的:评价经桡动脉急性心肌梗死急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗,使用血栓抽吸导管的有效性及安全性。方法:选择梗死相关血管前向血流心肌梗死溶栓试验血流0级的急性ST段抬高性心肌梗死患者48例,按电脑数字随机法分为血栓抽吸加PCI治疗组(血栓抽吸组)24例和标准PCI治疗组(对照组)24例。比较两组术后心肌梗死溶栓试验(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%)、住院期间血清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、6个月主要心血管事件(MACE)包括急性心肌梗死、再次血运重建或心源性死亡等。结果:两组基础资料情况和冠状动脉造影特征比较,差异无统计学意义(P>0.05)。血栓抽吸组与对照组比较,TIMI分级及TMP分级均明显改善,差异有统计学意义(均P<0.01);肌酸激酶和肌酸激酶同工酶峰值明显降低;ST段回落幅度大;左心室射血分数增高;左心室舒张末期内径减少;治疗6个月内两组均未发生主要心血管事件。结论:在急性心肌梗死急诊PCI治疗中应用ZEEK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。

Objective：To evaluate the safety and effectiveness of ZEEK aspiration thrombectomy catheter in the operation of thrombectomy via radial artery in primary percutaneous coronary intervention（PCI）for patients with acute myocardial infarction.Methods：A total of 48 patients（tested as level 0 in the trial of infarct-related artery blood flow myocardial infarction） with primary ST-elevation myocardial infarction who underwent primary PCI were randomized into two groups：treatment group（24 cases,treated with thrombus aspiration catheter） and control group（24 cases,routinely treated without thrombus aspiration catheter）.The detection index were assessed：flow classification of thrombolysis in myocardial infarction（TIMI）,TIMI myocardial perfusion（TMP）,the regression rate of ST segment,the peak value of creatine kinase（CK） and creatine kinase isozyme（CKMB）,left ventricular ejection fraction（LVEF） within postoperative 1 week,major cardiovascular events（MACE） within 6 months including acute myocardial infarction,repeat revascularization,cardiac death,etc.Results：The flow classification of TIMI and TMP,the regression rate of ST segment and LVEF were all significantly improved in treatment group compared with that in control group（P0.01）.The peak value of CK,CKMB and Left ventricular end-diastolic inner diameter were significantly decreased in treatment group compared with that in control group.No MACE occurred in the two groups within six months.Conclusion：The application of ZEEK aspiration thrombectomy catheter is safe and feasible in AMI patients with primary PCI,which is effective for removing intracoronary thrombus,improving distal myocardium perfusion and postoperative cardiac function,and doesn＇t increase in incidence of MACE.