ZEEK血栓抽吸导管对急诊经皮冠状动脉介入治疗的冠状动脉血流保护和手术支出的影响

Impacts of ZEEK thrombus aspiration catheter on coronary blood flow protection and operating expenditure in primary percutaneous coronary intervention

目的探索急诊经皮冠状动脉介入(primary percutaneous coronary intervention,PPCI)治疗时使用血栓抽吸导管对冠状动脉血流保护作用以及对手术医疗支出的影响。方法回顾性分析2013年广东医学院附属福田医院心脏中心行PPCI治疗,术前冠状动脉造影显示罪犯血管心肌梗死溶栓(thrombolysis in myocardial infarction,TIMI)血流2级或以下,或有血栓X线影像的患者71例患者的临床资料。根据是否使用了血栓抽吸导管分为血栓抽吸组(34例)和常规手术组(37例)。对比两组的手术至首次恢复TIMI血流3级的时间;远端栓塞的发生率;术终保持TIMI血流3级的比例;球囊、支架用量;手术总费用。结果血栓抽吸不延长首次恢复TIMI血流3级的时间[(23.4±4.2)min vs.(24.1±7.7)min,P>0.05];显著减少远端栓塞(26.4%vs.54.1%,P<0.001);术终保持TIMI血流3级的比例与对照组比较,差异无统计学意义(94.1%vs.86.4%,P>0.05);显著减少平均预扩张球囊的使用(1.2 vs.0.8,P<0.01);不增加手术总费用。结论 PPCI治疗中在适宜的患者使用血栓抽吸导管可减少远端栓塞的同时不延长首次恢复TIMI血流3级的时间,可减少预扩张球囊的使用,不增加手术医疗支出。

Objectives To investigate the impacts of thrombus aspiration catheter（TAC） on coronary blood flow protection and operating expenditure in primary percutaneous coronary intervention（PPCI）. Methods Retrospective review on 71 cases receiving PPCI in Futian Hospital Affiliated to Guangdong Medical College in 2013 were analyzed.Patients with coronary thrombolysis in myocardial infarction（TIMI） blood flow grade 2 or lower, or with visible angiographic features indicating coronary thrombosis were enrolled into TAC group（34 cases） and traditional PPCI group（37 cases） according to the use of TAC. Time from operation to recovery to TIMI grade 3 blood flow（O-to-3）,incidence of distal embolism（DE）, ratio of patients with final TIMI grade 3 blood flow（FTR）, balloon consumption,stent consumption and operating expenditure（OE） between TAC group and traditional PPCI group were compared.Results TAC did not lengthen O-to-3 [（23.4±4.2） min vs.（24.1±7.7） min, P〉0.05] or increase FTR（94.1% vs.86.4%, P〉0.05）, but significantly reduced DE（26.4% vs. 54.1%,P〉0.001） and average pre-dilatation balloon consumption（1.2 vs. 0.8, P〈0.01）. There was no difference in OE. Conclusions Selective use of TAC in PPCI can reduce distal embolism without lengthening time from O-to-3, while reducing use of pre-dilatation balloon and bringing no additional medical expenditure.