血栓抽吸导管联合山莨菪碱在老年急性心肌梗死介入治疗中应用

Treatment of thrombus aspiration catheter combined with intracoronary anisodamine in elderly patients with acute myocardial infarction

目的探讨血栓抽吸导管联合山莨菪碱在老年急性心肌梗死(AMI)患者介入治疗的可行性及临床疗效。方法邯郸市中心医院行急诊经皮冠状动脉介入治疗(PCI)的患者80例,随机分为两组,观察组(血栓抽吸导管联合山莨菪碱组)40例和对照组40例,观察术后校正的心肌梗死溶栓试验(TIMI)血流计帧数(CTFC)、TIMI心肌灌注分级(TMPG),术后1个月左心室舒张末内径(LVEDD)和左心室射血分数(LVEF),住院期间及术后1个月内主要不良心血管事件(MACE)发生率。结果与对照组比较,观察组术后CTFC明显减少(31.4±5.8)帧vs(22.9±7.3)帧(P<0.05),术后TMPG 3级比例增高(87.5%vs 62.5%,P<0.05);观察组LVEF和LVEDD均好于对照组(58.62±7.13)%vs(45.38±5.28)%;(47.52±3.12)mm vs(57.56±2.68)mm(均P<0.05);术后1个月观察组MACE发生率明显低于对照组(P<0.05)。结论应用血栓抽吸导管联合山莨菪碱可显著增加老年AMI术后心肌组织灌注,改善心功能,减少不良心血管事件发生率。

Objective To investigate the feasibility and clinical efficacy of thrombus aspiration catheter combined with anisodamine in elderly patients with acute myocardial infarction（AMI）during percutaneous coronary intervention（PCI）.Methods Eighty patients who underwent emergent PCI in Handan Central Hospital were randomly divided into two groups,the observation group（thrombus aspiration catheter combined with anisodamine group）40cases and the control group 40cases.Observation was performed on the corrected Thrombolysis in Myocardial Infarction trial（TIMI）flow frame count（CTFC）,TIMI myocardial perfusion grade（TMPG）,left ventricular end-diastolic diameter（LVEDD）and left ventricular ejection fraction（LVEF）one month after PCI,major adverse cardiovascular events（MACE）rate during hospitalization and one month after PCI.Results Compared with the control group,the value of CTFC in observation group was significantly less,（31.4±5.8）frame numbers vs（22.9±7.3）frame numbers（P 〈0.05）,the proportion of TMPG3was higher after PCI（87.5% vs 62.5%,P 〈0.05）;LVEF and LVEDD in observation group were better than those in control group（58.62±7.13）%vs（45.38±5.28）%;（47.52±3.12）mm vs（57.56±2.68）mm（both P〈 0.05）;MACE rate between two groups was no statistic significance during hospitalization（P〉 0.05）;MACE rate in observation group was significantly lower compared with that in control group one month after PCI（P〈0.05）.Conclusion Thrombus aspiration catheter combined with anisodamine significantly increased myocardial tissue perfusion in elderly patients with AMI after PCI,improved heart function and reduced the incidence of adverse cardiovascular events.