血栓抽吸术对高危非ST段抬高型急性冠状动脉综合征介入疗效的影响

Effects of thrombus aspiration on non-ST element acute coronary syndrome patients undergoing percutane-otls coronary intervention

目的评价血栓抽吸术对高危非ST段抬高型急性冠状动脉综合征（NSTEACS）患者介入疗效的影响。方法78例行急诊经皮冠状动脉介入治疗（PCI）的高危NSTEACS患者按随机数字表法分为研究组和对照组，各39例。研究组先行冠状动脉内血栓抽吸术，再行PCI；对照组直接行PCI。观察术后心肌灌注分级、血清心肌肌钙蛋白T（cTnT）和术后1个月左心室射血分数（LVEF）的差异。结果研究组与对照组相比，心肌灌注率0／1级为7．7％（3／39）比28．2％（11／39）（P〈0．05）；2级为23．1％（9／39）比30．8％（12／39）（P〉0．05）；3级为69．2％（27／39）比41．0％（16／39）（P〈0．05）。研究组和对照组血清cTnT分别为（4．7±1．3）μg／L和（9．3±3．1）μg／L，研究组低于对照组（P〈0．05）；LVEF分别为（55±15）％和（40±10）％，研究组高于对照组（P〈0．05）。结论高危NSTEACS患者行早期PCI前进行血栓抽吸术可改善心肌灌注，减少心肌坏死，改善术后心脏功能。

Objective To assess the effects of thrombus aspiration during percutaneous coronary interven- tion （PCI） on high risk non-ST element acute coronary syndrome （NSTEACS）. Methods A total of 78 patients with NSTEACS were randomly assigned to the thrombus-aspiration group and the conventional PCI group. In the thrombus-aspiration group, patients had thrombus-aspiration before urgent PCI; in the conventional PCI group, pa- tients underwent urgent PCI routinely. The endpoints included angiographic evidence of myocardial perfusion （ myo- cardial blush grade）, the peak volume of cardiac troponin T （cTnT） and left ventricular ejection fraction （LVEF） one month later. Results In the thrombus-aspiration group and the conventional-PCI group, patients with blush grades 0/1 were 7.7% （3/39） vs 28.2% （ 11/39）, P 〈 0.05, grades 2 were 23.1% （9/39） vs 30.8% （ 12/39, P 〉 0.05 ） and grades 3 were 69.2% （27/39） vs 41.0% （ 16/39）, P 〈 0.05. The peak volume of cTnT [ （4.7±1.3）μg/Lvs （9.3±3.1）μg/L,P〈0.05] and LVEF one month later [（55±15） % vs （40±10） % （P〈 0.05） ] between the thrombus-aspiration group and the conventional PCI group were observed. Conclusion Thrombus aspiration during urgent PCI in patients with high risk NSTEACS shows an optimistic effect on myocardial perfusion, myocardial necrosis and heart function.