急性ST段抬高型心肌梗死经皮冠状动脉介入治疗术中采用球囊缓慢撤压方法预防无复流和慢血流现象的作用研究

Effi cacy of slowly defl ating balloon for prevention of no refl ow and slow fl ow phenomenon during percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

目的评估急性ST段抬高型心肌梗死(STEMI)患者接受经皮冠状动脉介入治疗(PCI)术中采用球囊缓慢撤压方法对无复流(NR)和慢血流(SF)现象的预防作用。方法选取2017年1月至2020年12月就诊于解放军联勤保障部队第九六七医院(原解放军第二一零医院)心内科,符合STEMI诊断标准并接受PCI的患者242例。根据PCI术中球囊撤压方法不同将患者分为球囊缓慢撤压组(试验组,115例)和常规方法撤压组(对照组,127例),收集两组患者的基本临床资料以及PCI的相关资料,比较两组患者PCI术中NR和SF的发生率及术后即刻抬高ST段回落≥50%的比例。结果(1)两组患者基本临床资料比较,差异均无统计学意义(均P>0.05);(2)两组患者PCI相关资料比较,差异均无统计学意义(均P>0.05);(3)两组患者NR和SF发生率比较:球囊预扩张后,两组恢复心肌梗死溶栓治疗试验(TIMI)血流分级Ⅲ级且心肌呈色分级(MBG)≥Ⅱ级的发生率分别为90.4%和85.8%,差异无统计学意义(P=0.270);支架释放后,试验组NR和SF的发生率明显低于对照组(3.5%比11.0%,P=0.025),差异有统计学意义;支架内球囊后扩张后,试验组NR和SF的发生率明显低于对照组(1.7%比7.9%,P=0.028),差异有统计学意义;(4)两组术后即刻心电图比较:试验组术后即刻心电图抬高ST段回落≥50%的比例明显高于对照组(97.4%比89.8%,P=0.017),差异有统计学意义。结论STEMI患者行PCI术中采用球囊缓慢撤压方法与常规方法撤压比较,能够明显降低NR和SF的发生率,缩短ST段回落时间。

Objective To evaluate the efficacy of slowly deflating balloon for prevention of no reflow(NR)and slow flow(SF)phenomenon during percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 242 patients who met the STEMI diagnostic standard and underwent PCI from January 2017 to December 2020 in the Department of Cardiovascular Diseases of the 967 Hospital of the Joint Service Support Force of the Chinese Peopple’s Liberation Army were consecutively selected.They were divided into two groups based on the deflation speed of the balloon in PCI:slowly deflating balloon group(115 cases)and the conventional deflating balloon group(127 cases).Baseline clinical data and PCI-related information in two groups of patients were collected.The incidence of NR and SF phenomenon during PCI was compared between the two groups.Results(1)There were no statistical significant difference of the baseline clinical data between the two groups(all P>0.05);(2)There were no significant differences of PCIrelated information between the two groups(all P>0.05);(3)Comparison of the incidence of NR and SF in two groups of patients:According to thrombolysis in myocardial infarction(TIMI)blood flow classifi cation and myocardial blush grade(MBG)assessment,the rate of the TIMIⅢand MBG≥Ⅱwas restored 90.4%and 85.8%between the two groups,with no signifi cant diff erence(P=0.270);After the stent was released,the rate of NR and SF in the slowly balloon defl ating group was signifi cantly lower than that in the conventional balloon defl ating group,and the diff erence was statistically signifi cant(3.5%vs.11.0%,P=0.025);The rate of NR and SF in the slowly balloon defl ating group after post-expansion of stent balloon was signifi cantly lower than that in the conventional balloon defl ating group,and the diff erence was statistically signifi cant(1.7%vs.7.9%,P=0.028);(4)Comparison of postoperative electrocardiogram(ECG)between two groups of patients:The percentage of ST-segment resolution(STR)≥50%in immediately postoperative ECG of the slowly balloon deflating group was significantly higher than that of the conventional balloon deflating group,and the difference was statistically significant(97.4%vs.89.8%,P=0.017).Conclusions Compared with conventional deflating balloon,slowly deflating balloon during PCI in patients with acute ST-segment elevation myocardial infarction can significantly reduce the occurrence of NR and SF phenomenon and shorten the STR.