血栓抽吸术联合PCI在ST段抬高心肌梗死高血栓负荷患者中的临床疗效

The clinical effect of thrombus aspiration combined with PCI in ST segment elevation myocardial infarction patients with high thrombus burden

目的探讨ST段抬高心肌梗死高血栓负荷患者(STEMI)应用血栓抽吸联合PCI术的临床疗效。方法选取我院2016年1月~2018年6月住院并行PCI术的高血栓负荷STEMI患者150例为研究对象,根据PCI术前是否行血栓抽吸分为对照组(n=72)和观察组(n=78),对照组行PCI治疗,观察组行血栓抽吸联合PCI治疗。记录患者的一般资料、梗死相关动脉(IRA)、病变血管数量、术前血流TIMI和血栓负荷分级。收集术后患者肌酸激酶同工酶(CK-MB)的峰值、2h心电图ST段回落百分比(sum-STR%)、心肌灌注分级、5~7d左室射血分数(LVEF)、左室舒张末内径(LVDD)及住院期间主要心血管不良事件(MACE)的发生率。结果两组患者一般资料、梗死相关动脉、病变血管数量、术前血流TIMI及血栓负荷分级比较,差异无统计学差异(P>0.05)。术后,两组肌酸激酶同一酶的峰值比较,差异无统计学意义(P>0.05)。观察组的sum-STR≥70%比例、心肌灌注呈色(TMP)≥3级的比例及左室射血分数均高于对照组,住院期间总MACE发生率低于对照组(均P<0.05)。结论高血栓负荷的STEMI患者采用血栓抽吸联合PCI治疗,有助于患者心功能恢复和改善近期预后。

Objective To retrospectively analyze the clinical effect of thrombus aspiration combined with PCI for STEMI patients with high thrombus burden.Methods 150 STEMI patients with high thrombus burden in hospital were enrolled.According to whether undergoing thrombus aspiration treatment during the course of PCI,patients were divided into PCI alone(Control group,n=72)and thrombus aspiration combined with PCI group(observation group,n=78).We recorded for general information,infarct-related artery,number of diseased vessels,thrombosis in myocardial infarction(TIMI)flow grade before PCI and thrombosis load grade.The peak value of CK-MB,sum-STR 2 hours post-PCI,TIMI myocardial perfusion grade(TMP),LVEF and LVDD 5~7 days after PCI and the incidence of major cardiovascular adverse events during hospitalization were collected.All data was analyzed by SPSS 18.0 software.Results There were no significant differences between patients of observation group and control group in characteristics at baseline,infarct-related artery,the number of diseased vessels,the peak value of CK-MB,thrombosis in myocardial infarction(TIMI)flow grade and thrombosis load grade before PCI.The sum-STR≥70%(81.58%vs 68.09%),postoperative TMP grade 3(78.95%vs 49.65%)and LVEF(59.56±7.16 vs 57.26±8.55)in observation group were higher than that in control group(P<0.05).The percentage of major adverse cardiovascular events in observation group was lower than that in control group(P<0.05).Conclusion Thrombus aspiration combined with PCI for STEMI patients with high thrombus burden can relieve cardiac function and improve recent-term prognosis.