急性ST段抬高型心肌梗死急诊介入术中血栓抽吸疗效观察

Effect of suck by catheter during percutaneous coronary intervention in patients with acute myocardial infarction

目的评价血栓抽吸导管在急性ST段抬高的心肌梗死(STEMI)介入术中应用疗效。方法 2010年9月至2012年9月行急诊经皮冠状动脉介入术的患者76例,其中应用抽吸导管及冠状动脉介入治疗(PCI)组(40例)和,另常规PCI对照组(36例)。观察2组的造影结果、术后效果及心肌梗死溶栓试验(TIMI)血流分级。结果研究组发病距血管再通时间、ST段回落>70%和术后达心肌梗死溶栓试验(TIMI)3级血流情况[分别为(5.3±2.5)h、26(65.0)、37(92.5)]明显好于对照组[分别为(6.1±3.1)h、18(50.0)、28(77.7)],梗死相关血管(IRA)无复流或慢血流发生率明显低于对照组[2(5.0)VS5(13.9)],差异均有统计学意义(均P<0.05)。研究组cTnT峰值及CK-MB峰值明显低于对照组[研究组与对照组分别为(8.5±3.6)ug/L、(128.0±74.5)U/L及(11.2±3.9)ug/L、(168.3±80.2)U/L],左心室射血分数(LVEF)明显大于对照组[研究组与对照组分别为(56.2±12.5)%及(44.3±11.2)%],住院期间主要不良心血管事件(MACE,包括死亡、再梗死、再次靶血管重建)的发生率少于对照组,差异均有统计学意义(均P<0.05)。结论急诊介入术中血栓抽吸治疗安全可靠,增加心肌的血流灌注,有可能改善术后心脏功能,并且不增加血管不良事件的发生率。

Objective To evaluate the suck effect by catheter during percutaneous coronary intervention（PCI） in patients with acute myocardial infarction（AMI）.Methods A total of 76 AMI patients were enrolled from September 2011 to September 2010.There were 40 patients received PCI and suck by catheter（suck＋PCI group）,another 36 patients received routine PCI（routine PCI control group）.Results The coronary angiography,clinical effect and thrombolysis in myocardial infarction trial（TIMI） of the two groups were compared and analyzed.Results Compared with routine PCI control group,ratio of ST segment resolution70%（65.0%vs.50.0%）was significantly higher,TIMI blood flow grades after suck site（92.5% vs 77.7%） significantly improved in suck＋PCI group.There were lower peakserum cTnT CK-MB,LVEF,no-reflow in IRA after PCI,MACE rates in study group were Superior to those in the control group.（P0.05）.Conclusion Thrombus suction is safe and effective method for treatment of acute myocardial infarction with thrombus.Which can lower thrombosis burden,improve distal myocardium perfusion and cardiac function after the procedure.And dose not increase the incidence of blood vessel event.