急诊冠脉介入治疗血栓抽吸改善急诊冠脉介入治疗后血流的疗效

Effect of thrombus aspiration on improvement of blood flow during emergency PCI

目的:探讨急性ST段抬高性心肌梗死(STEMI)患者行急诊冠脉介入治疗(PCI)时血栓抽吸预防无复流现象的疗效。方法:60例急性STEMI行急诊PCI患者被随机分为血栓抽吸+替罗非班治疗组(血栓抽吸组30例)和常规经皮冠状动脉介入+替罗非班治疗组(常规PCI组,30例),观察两组PCI术前后心肌梗死血栓溶解(TI-MI)积分、肌酸激酶同工酶(CK-MB)峰值及达到其峰值时间、TIMI血流、心肌灌注分级(MPG)、左心室射血分数(LVEF)以及主要心血管不良事件(MACE)发生率等的变化及进行组间比较。结果:与常规PCI组治疗后相比,血栓抽吸组治疗后血栓积分[(1.82±0.78)分比(1.02±0.55)分]明显下降(P<0.001),球囊扩张次数[(3.06±0.83)次比(1.68±0.95)次]、靶血管平均植入支架数[(1.95±1.32)个比(1.16±0.83)个]明显减少(P<0.001,<0.01),支架直接植入率(0比36.6%)、术后ST段回落>50%率(50%比76.7%)、术后3个月LVEF[(55.3±12.7)%比(62.6±13.8)%]明显升高(P<0.05),CK-MB达到峰值时间更早[(13.18±3.28)h比(10.35±2.72)h]、峰值更小[(358.6±231.9)U/L比(253.2±156.5)U/L],TIMI血流[(2.25±0.83)级比(2.83±0.67)级]、MPG明显改善[(2.23±0.76)级比(2.77±0.61)级],P均<0.05;两组MACE发生率及出血并发症差异无显著性(P>0.05)。结论:PCI血栓抽吸可减少血栓,改善冠状动脉血流、心肌灌注和左室收缩功能,有较好的安全性。

Objective： To explore efficacy of thrombus aspiration on improvement of blood stream in patients with a- cute ST elevation myocardial infarction （STEMI） during emergency percutaneous coronary intervention （PCI）. Methods： A total of 60 acute STEMI patients undergoing emergency PCI were randomly divided into thrombus aspi- ration ± tirofiban group （thrombus aspiration group, n=30） and routine PCI ± tirofiban group （routine PCI group, n = 30）. Changes of thrombolysis in myocardial infarction （TIMI） score, peak value of creatine kinase- MB （CK - MB） and time to its peak, TIMI blood flow, myocardial perfusiongrade （MPG）, left ventricular ejection fraction （LVEF） and incidence rate of major adverse cardiovascular events （MACE） were observed and compared before and after PCI and between two groups. Results： Compared with routine PCI group after treatment, there were sig- nificant decrease in thrombus score [ （1.82 ± 0.78） scores vs. （1.02 ± 0.55） scores, P（0. 001], number of balloon dilation [ （3.06± 0.83） times vs. （1.68 ± 0.95） times, P〈0. 0001] and mean number of implanted stents in tar- get vessels [ （1.95 ± 1.32） vs. （1.16 ± 0.83）, P〈0.01], and significant increase in direct implantation rate of stent （0 vs. 36.6%）, rate of ST segment regression 〉50% after PCI （50% vs. 76.7%） and LVEF after three months [ （55.3 ± 12.7）% vs. （62.6 ± 13.8）%], P〈0.05 all; and there were also significant decrease in time to peak of CK -MB[ （13.18±3.28） hvs. （10.35±2.72） hi, peak value of CK-MB [ （358.6±231.9） U/L vs. （253.2±156.5） U/L], and significant increase in TIMI blood flow [ （2.25 ± 0.83） grades vs. （2.83±0.67）] grades and MPG [ （2.23± 0.76） grades vs. （2.77 ± 0.61） grades ] in thrombus aspiration group, P〈0.05 all. There were no significant difference in incidence rates of MACE and bleeding complications between two groups （P〉0.05）. Conclusion： Thrombus aspiration during PCI can effectively decrease thrombus, improve coronary artery blood flow, myocardial perfusion and left ventricular systolic function, and it possesses good safety.