血栓抽吸联合心肌缺血后处理对急性心肌梗死近期预后的影响

Combination of thrombus aspiration and ischemic post-conditioning on short-term prognosis in patients with acute myocardial infarction

目的探讨血栓抽吸联合缺血后处理对急性心肌梗死患者近期预后的影响。方法纳入2012年1月至2014年3月天津市第三中心医院接受直接经皮冠状动脉介入治疗(PCI)的患者234例,随机分为对照组(111例)和血栓抽吸+缺血后处理组(治疗组,123例)。对照组接受常规治疗,治疗组除常规治疗外接受血栓抽吸+缺血后处理治疗,比较两组患者基线情况、PCI相关情况、缺血再灌注指标及临床预后。结果治疗组三酰甘油[1.8(0.4,6.8)m m ol/L比1.3(0.4,3.2)m m ol/L,P=0.034]及即刻ST段回落率(78.0%比59.5%,P<0.001)均高于对照组,差异均有统计学意义;治疗组肌酸激酶[(1643.4±925.9)u/L比(2234.1±1433.3)u/L,P<0.001]、肌酸激酶同工酶[(164.8±90.8)u/L比(229.3±158.9)u/L,P<0.001]峰值及住院期间主要不良心血管事件(major adverse cardiovascular events,MACE)发生率(7.3%比18.9%,P=0.010)均低于对照组,差异均有统计学意义。结论对急性ST段抬高型心肌梗死患者行直接PCI时可考虑同时应用血栓抽吸+缺血后处理的治疗方法,来改善心肌血流灌注、减少住院期间的MACE发生率。

Objective To investigate the effectiveness of combination treatment of thrombus aspiration and ischemic post-condition on patients with acute ST elevated myocardial infarction（SETMI）undergoing primary percutaneous coronary intervention. Methods A total of 234 patients were randomly divided into two groups： one group received routine treatment（control group, n=111）; while another group received the combination treatment of thrombus aspiration and ischemic post-conditioning（treatment group,n=123）. The baseline data, coronary lesion, information of percutaneous coronary intervention, data of reperfusion and in-hospital clinical prognosis of the two groups were evaluated. Results The baseline data of the two groups are comparable except TG level was higher in treatment group. Compared with the control group, the peak value of cardiac enzyme was lower while the rate of immediate ST resolution to baseline was higher with less MACE during hospitalization in the treatment group. Other data were all comparable between the two groups. Conclusions The combination of thrombus aspiration and ischemic post-conditioning during primary PCI in patients with acute myocardial infarction can restore cardiac perfusion and reduce MACE during hospitalization.