主动脉内球囊反搏术联合血栓抽吸治疗大面积ST段抬高型急性心肌梗死患者的疗效

Effect of application of intra-aortic balloon pump counterpulsation combined with thrombus aspiration on clinical prognosis of ST-segment elevation myocardial infarction patients with emergent percutaneous coronary intervention

目的评价主动脉内气囊反搏术(IABP)联合血栓抽吸对急诊经皮冠状动脉介入(PCI)治疗的急性大面积ST段抬高型心肌梗死(STEMI)患者临床预后的影响。方法发病12 h内的急性大面积STEMI患者120例随机分为试验组和对照组各60例,均给予规范的药物治疗并急诊冠脉造影,试验组应用IABP联合冠脉内血栓抽吸,对照组单纯血栓抽吸后行PCI术。评价梗死相关血管PCI术后冠脉血流(TIMI)分级,心肌组织灌注(TMP)分级、无复流或慢血流发生率、IABP并发症及术后4 w心功能、主要不良心脏事件的发生情况。结果试验组PCI术后TIMI 3级血流发生率、TMP明显高于对照组;慢血流、无复流发生率明显低于对照组;术后4 w左心室射血分数(LVEF)明显高于对照组,左心室舒张末期内径、主要不良心脏事件的发生率小于对照组(均<0.05)。结论急性大面积STEMI患者急诊PCI前应用IABP联合血栓抽吸能改善梗死相关血管的急性心肌梗死溶栓(TIMI)血流,增加冠脉灌注,改善心功能,减少主要不良心脏事件的发生率,临床应用安全有效。

Objective To evaluate the effect of application of intra-aortic balloon pump（IABP） counterpulsation combined with thrombus aspiration catheter therapy on patients with acute ST-segment elevation myocardial infarction（STEMI） for emergent percutaneous coronary interventional（PCI）.Methods 120 STEMI patients were randomized into test and control groups,60 cases in each group.All patients′ onset of STEMI was in 12 hours,all patients were performed thrombus aspiration catheter therapy and emergent PCI.The patients in test group received IABP support treatment and thrombus aspiration before PCI,while the ones in control group received PCI after thrombus aspiration.Thrombolysis in acute myocardial infarction（TIMI） grade and TIMI myocardial perfusions（TMP） were studied before and after PCI.The major adverse cardiac events（MACE） and heart function at 4 weeks were studied.Results TIMI flow rate,TMP,the occurrence of MACE at 4 weeks,left ventricle ejection fraction（LVEF） were significantly different between two groups.Conclusions Application of IABP combined with thrombus aspiration catheter therapy on patients with STEMI for emergent PCI are safe and effective,which can reduce the occasion of MACE,and improve LVEF.