血栓抽吸导管对急性心肌梗死病人介入术中无复流及术后心肌组织灌注的影响

Effect of Application of Thrombus Aspiration Catheter on No Reflow and Postoperative Myocardial Perfusion in Patients with Acute Myocardial Infarction Undergoing Emergency PCI

目的观察常规应用血栓抽吸导管干预对急性ST段抬高型心肌梗死(STEMI)病人无复流及介入术后心肌组织灌注的影响。方法选择首次因STEMI行急诊经皮冠状动脉介入治疗(PCI)病人126例,据血栓积分分为≥2分组和<2分组,≥2分组均予以血栓抽吸,<2分组再随机分为血栓抽吸组(抽吸组)及标准PCI组(标准组)。分析比较各组病人临床基线情况,冠状动脉造影结果,心肌灌注及心电图ST段回落。结果血栓积分≥2分组症状开始至再灌注时间较抽吸烟、标准组长(P<0.05),术中应用GPⅡb/Ⅲa者比例较血栓积分<2分血栓抽吸组高(P<0.05)。与血栓积分<2分标准PCI组相比较,<2分血栓抽吸组无复流发生率更低(P<0.05),校正TIMI计帧数(CTFC)较少(P>0.05);ST段回落明显(P<0.05),心肌灌注水平更理想(P<0.05)。结论常规应用血栓抽吸导管可减少STEMI病人PCI后无复流的发生,改善心肌组织灌注,即使对于血栓负荷不重的STEMI,血栓抽吸仍可有利于心肌组织灌注的恢复。

Objective To observe the effect of conventional application of thrombus aspiration catheter on no reflow and postoperativemyocardial perfusion in patients with ST elevation myocardial infarction （ STEMI） undergoing emergency percutaneous coronary di-vided into intervention （ PCI） .Methods One hundred and twenty six patients with STEMI underwent emergency PCI for the firsttime were 2 groups according to thrombus integral： Group A （ thrombus integral more than 2） , group B （ thrombus integral less than2） . Then group B was randomized into thrombus aspiration group （ group B1）and standard PCI group （ group B2） .Clinical baseline,coronary angiographic results,myocardial perfusion and electrocardiogram （ ECG）were observed.Results The time of symptomsbegan to reperfusion in group A was longer than that in group B （ P 〈0.05） .The ratio of intraoperative use of GP Iib/IIIa in group Awas higher than that in group B （ P 〈0.05） .Compared with group B2, the incidence of no reflow was lower,myocardial infarction trial（ TIMI）frame counting （ CTFC）was less,TIMI myocardial perfusion grading （ TMPG）and dropped ST segment were better ingroup B1 （ P 〈0.05） . Conclusion Routine application of thrombus aspiration catheter can reduce the occurrence of no reflow afterPCI in patients with STEMI,improve myocardial perfusion. Even for STEMI without heavy thrombus load,thrombus aspiration canstill be beneficial to the recovery of myocardial perfusion.