急性ST段抬高型心肌梗死患者急诊介入治疗术中血栓抽吸的临床应用

Clinical application evaluation of thrombus aspiration on emergency percutaneous coronary intervention of patients with ST-segment elevation type of myocardial infarction

目的：探讨急性ST段抬高型心肌梗死直接行急诊PCI术中应用血栓抽吸装置对患者心室重构及临床预后的影响。方法回顾性分析2011年3月至2014年3月期间诊断为急性ST段抬高型心肌梗死行直接急诊PCI 308例患者的临床资料，术中进行血栓抽吸的152例患者定为血栓抽吸组，156例未应用血栓抽吸者定为对照组。评价患者PCI术后心肌灌注指标包括术后2 h的ST段回落和心肌灌注TIMI分级，所有患者术后10 d行超声心动图测定左心室舒张末期内径（ LVED）及左心室射血分数（ LVEF），比较两组患者的指标差异及随访6个月心血管不良事件发生情况。结果两组 ST段回落＞50％的病例比较差异无统计学意义[78．9％（120／152）与71．2％（111／156），χ2＝0．428，P＝0．669]，但对ST段回落＞70％的比较血栓抽吸组明显高于对照组[73．7％（112／152）与47．4％（74／156），χ2＝4．701， P＝0．001]。两组患者术后第10天进行超声心动图复查，显示出血栓抽吸组LVED低于对照组（50．2±4．7） mm与（51．6±4．6） mm，t＝2．642，P＝0．008），而 LVEF值则高于对照组（56．9±4．9）％与（49．4±4．2）％，t＝14．434，P＝0．001）。术后随访6个月再发心绞痛明显减少[4．61％（7／152）与10．90％（17／156），χ2＝2．056，P＝0．040]。结论急性ST段抬高型心肌梗死患者在接受急诊PCI时，采用血栓抽吸术，不仅能有效改善心肌再灌注，尤其是微循环再灌注，还可改善左心室收缩功能，改善患者预后。

Objective To investigate the influence of thrombus aspiration on ventricular remodeling of patients with ST？segment elevation type of myocardial infarction （ STEMI ） who underwent emergency percutaneous coronary intervention （ PCI） and its predicative value for patients′ prognosis. Methods Three hundred and eight patients who were diagnosed with STEMI line emergency PCI and hospitalized in the Cardiology Department of Jinghai Clinical College of Medical University of Tianjin from March 2011 to March 2014 were retrospective analyzed, including 152 patients received thrombus aspiration during primary PCI as thrombus aspiration group,and the remaining 156 patients without thrombus aspiration as control group. Indexes of myocardial perfusion levels such as ST？segment resolution 2 hours after PCI and TIMI myocardial perfusion grade were measured in all patients. All patients accepted echocardiography examinations to detect left ventricular end diastolic diameter（LVED） and left ventricular ejection fraction（LVEF） 10 days after PCI. The indexes differences of the two groups,secondary end points major cardiac adverse events（MACE） at 6 months were compared. Results There was no statistical difference between the ratio of two groups for ST segment fell more than 50%（ 78. 9%（ 120/152） vs. 71. 2%（ 111/156） ,χ2=0. 428,P=0. 669） . But for ST segment fell more than 70%,the ratio of the thrombus aspiration group was significantly higher than that in the control group （ 73. 7%（ 112/152 ） vs. 47. 4% （ 74/156 ） , χ2 = 4. 701, P = 0. 001 ） . Two groups of patients were treated by echocardiography 10 days after PCI,showed the LVED in the thrombus aspiration group was lower than that in the control group（（50. 2±4. 7） mm vs. （51. 6±4. 6） mm,t=2. 642,P=0. 008）,while the LVEF value was higher than that in the control group（（56. 9±4. 9）% vs. （49. 4±4. 2）%,t=14. 434,P=0. 001）. Recurrent angina pectoris decreased significantly in the thrombus aspiration group at 6 months （ 4. 61% （ 7/152 ） vs. 10. 90%（17/156）,χ2=2. 056,P=0. 040）. Conclusion STEMI patients adopt thrombus aspiration that undergoing emergency PCI,not only can improve myocardial reperfusion,especially microcirculation reperfusion, but also can improve the left ventricular systolic function and the prognosis of patients.