血栓抽吸在急性ST段抬高型心肌梗死患者不同发病时段中应用的临床疗效

Clinical effect of thrombus aspiration performed at different time after onset of acute ST-segment elevation myocardial infarction

目的分析急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中不同时段行血栓抽吸的临床效果。方法选取2015年1月至2018年6月就诊于南昌大学第一附属医院并经冠状动脉造影诊断为高负荷血栓的STEMI患者127例作为研究对象。根据是否行血栓抽吸术,将患者分为血栓抽吸+PCI组(63例,A组)、常规PCI组(64例,B组)。根据发病开始至导丝通过犯罪血管时间≤6 h、>6 h且≤12 h、>12 h且≤24 h,A组又分为A1组(23例)、A2组(27例)、A3组(13例),B组又分为B1组(25例)、B2组(25例)、B3组(14例)。比较各组患者术后心肌梗死溶栓(TIMI)后血流分级、术后1 h ST段回落、术后7d左心室射血分数(LVEF)、术后3个月主要心血管不良事件(MACE)发生。结果A组PCI术后TIMI血流分级达3级比例、术后1 h心电图相关导联ST段完全回落比例和术后7d LVEF均优于B组(P<0.05)。A2组术后TIMI血流分级达3级比例优于B2组(P<0.05),A3组术后TIMI血流分级达3级比例、术后1h ST段完全回落比例和术后7d LVEF均优于B3组(P<0.05)。术后3个月A组与B组、A1组与B1组、A2组与B2组、A3组与B3组间MACE发生率差异均无统计学意义(P>0.05)。结论高血栓负荷STEMI患者PCI术中联合血栓抽吸,有利于减少无复流或慢血流发生,提高术后心肌灌注水平,改善左心室功能,尤其是在心肌缺血12~24 h内,可减少心肌缺血时间延长对心脏的损害。

Objective To analyze the clinical effect of thrombus aspiration performed at different time in percutaneous coronary intervention(PCI) for patients with acute ST-segment elevation myocardial infarction(STEMI). Methods A total of 127 patients with angiography-proved STEMI of high-loaded thrombosis, who were admitted to the First Affiliated Hospital of Nanchang University of China during the period from January2015 to June 2018, were enrolled in this study. According to whether manual thrombus aspiration was performed or not, the patients were divided into group A(n =63, receiving thrombus aspiration +PCI) and group B(n =64, receiving routine PCI). According to the time interval between the disease onset and the passing through the criminal blood vessels of the guide wire, the patients of group A were subdivided into group A1(≤6 h, n=23), group A2(>6 h-≤12 h, n=23) and group A3(>12 h-≤24 h, n=13), and the patients of group B were subdivided into group B1(≤6 h, n=25), group B2(>6 h-≤12 h, n=25) and group B3(>12 h-≤24 h,n=14). The myocardial perfusion grade after thrombolysis in myocardial infarction(TIMI),ST-segment falling at one hour after PCI, left ventricular ejection fraction(LVEF) at 7 days after PCI, and the occurrence of major adverse cardiac events(MACE) within 3 months after PCI were compared between each other among the groups. Results The proportion of TIMI myocardial perfusion grade Ⅲ, the proportion of ST-segment completely falling on ECG-related leads at one hour after PCI, and the LVEF at 7 days after PCI in group A were remarkably better than those in group B(P<0.05). The proportion of TIMI myocardial perfusion grade Ⅲ in group A2 was higher than that in group B2(P <0.05). The proportion of TIMI myocardial perfusion grade Ⅲ, the proportion of ST-segment completely falling at one hour after PCI and the LVEF at 7 days after PCI in group A3 were strikingly better than those in group B3(P<0.05). Three months after PCI, there was no statistically significant difference in the occurrence of MACE between group A and group B, between group A1 and group B1, between group A2 and group B2, as well as between group A3 and group B3(P>0.05). Conclusion In treating patients with high thrombus-loaded STEMI, intraoperative thrombus aspiration during PCI is beneficial to reduce the occurrence of no reflow or slow blood flow, it can improve postoperative myocardial perfusion level and improve left ventricular function, especially when it is performed within 12-24 hours after myocardial ischemia, and reduce the damage to the heart due to long time myocardial ischemia.