急性ST段抬高型心肌梗死急诊经抽吸导管治疗后择期支架置入术的临床研究

Clinical study of acute ST-segment elevation myocardial infarction treated by emergency thrombus aspiration and elective stent implantation

目的 观察急性ST段抬高心肌梗死（STEMI）患者经血栓抽吸治疗冠脉恢复“再灌注”后终止手术并择期PCI治疗的近期临床疗效.方法 2009年1月至2012年1月急性STEMI行急诊冠脉介入治疗60例,分为导管抽吸组（28例）和强化介入组（32例）.导管抽吸组是单纯通过反复抽吸血栓而使梗死相关血管（IRA）血流已达TIMI3级,择期PCI术处理所有狭窄血管;强化介入组是导管抽吸血栓和直接行IRA的支架置入,择期处理非靶病变.比较两组两次手术过程及1个月后心功能等相关指标.结果 导管抽吸组二次手术前的血清BNP、hs-CRP明显降低（P＜0.05）;4例IRA免于支架置入术（P,＜0.01）;残余狭窄病变选择支架的直径小、长度短,高压球囊扩张及扩张压力小,心肌呈色3级水平高（P＜0.05,或P＜0.01）.两组效果无显著性差别.两次手术累计时间、X线曝光时间、对比剂用量及患者经济支出方面,导管抽吸组均明显低于强化介入组（P＜0.05）;1个月时复查心脏彩超,左室直径、EF值导管抽吸组明显优于强化介入组（P＜0.05）.结论 STEMI患者急诊PCI时,先导管抽吸血栓充分恢复冠脉血流,强化抗凝保护下择期PCI术,即刻及近期疗效可靠.

Objective To explore the clinical efficacy in near future priority catheter thrombus aspiration to open infarcted relevant artery（IRA） and select other opportunity stents implanted in ST elevation myocardial in- faretion（STEMI） patients. Methods Sixty patients with acute STEMI from department of cardiology in the first af- filiated hospital of Henan university of TCM between January 2009 to January 2012 were with high thrombus bur- den in IRA. 18 cases of them were taken for thrombus aspiration group （TAG）, their IRA was able to be achieved TIMI 3 grade coronary flow only using catheter thrombus aspiration. The other 42 cases were taken for intensify in- tervention group （ I1 G）, which were immediately implanted stents after using catheter thrombus aspiration. Re- suits Serum BNP, hs-CRP were decreased significantly in thrombus catheter aspiration group （TAG）. 4 of 18 cases were free of stents implanted in TAG, but all cases were implanted stents in IRA during emergency PCI in Ⅱ G, there was very significant difference between 2 groups （P〈0.O1）. The length and diameter of which was im- planted stents, the pressure of after dilatation balloon inflated, and the MBG 3 of being gained all were significant difference between RSLs in TAG and CRLs in Ⅱ G （P〈0.05 or P〈0.01 ）. Because of twice intervention opportuni- ty, accumulative procedure time, X-ray exposure time, contrast agent dosage and relevant economic expenses all were better in TAG than fIG （P〈0.05）. LVEDd and LVEF after the procedure were more normal in TAG than Ⅱ G after 1 month （P〈0.05）. Conclusion It is an effective in near future that priority aspiration thrombus can open IRA and recover coronary flow during emergency PCI in acute STEMI, and implanting stents at other one opportu- nity accompanying intensify anti-thrombus treatment.