经皮冠状动脉介入术中血栓抽吸治疗急性ST段抬高型心肌梗死的疗效观察

Effect of thrombus aspiration on acute ST-segment elevation myocardial infarction during percutaneous coronary intervention

目的探讨经皮冠状动脉介入术(PCI)中血栓抽吸治疗急性ST段抬高型心肌梗死(STEMI)的临床疗效。方法选择珠海市中西医结合医院心血管内科于2017年1月至2018年9月期间收治的91例STEMI患者为研究对象,根据随机数表法分为观察组(n=46)和对照组(n=45),对照组患者行常规PCI及支架置入治疗,观察组患者在PCI术中应用血栓抽吸技术,比较两组患者支架置入术后梗死相关血管TIMI血流分级情况,术后2 h的心电图ST段回落情况及术后7 d心脏彩超检查左室射血分数(LVEF),以及住院期间再发心肌梗死情况。结果观察组患者术后即刻TIMI血流Ⅲ级的比例和2 h ST段回落≥50%的比例分别为93.48%和91.30%,均明显高于对照组的82.22%和75.56%,术后即刻无复流的发生率为2.17%,明显低于对照组的15.56%,差异均有统计学意义(P<0.05);观察组患者术后LVEF为(63.25±7.24)%,明显高于对照组的(57.18±6.37)%,差异有统计学意义(P<0.05);观察组与对照组患者住院期间再发心梗发生率分别为2.17%和4.44%,差异无统计学意义(P>0.05)。结论急性ST段抬高型心肌梗死经皮冠状动脉介入术中血栓抽吸可以有效减少冠脉内血栓负荷,降低无复流现象的发生,提高PCI治疗成功率,改善患者的心功能。

Objective To investigate the clinical effect of thrombus aspiration in percutaneous coronary intervention(PCI) for acute ST-segment elevation myocardial infarction(STEMI). Methods A total of 91 STEMI patients,who treated in Internal Medicine-Cardiovascular Department of Zhuhai Integrated Chinese and Western Medicine Hospital from January 2017 to September 2018, were selected as the research subjects. According to the random number table method, they were divided into the observation group(n=46) and the control group(n=45). The patients in the control group were treated with routine PCI and stent implantation, and those in the observation group were treated with thrombus aspiration technique during PCI. The grading of TIMI blood flow in infarction-related vessels after stent implantation, ECG ST-segment depression >50% at 2 hours after stent implantation, left ventricular ejection fraction(LVEF) detected by color Doppler echocardiography at 7 days, and recurrent myocardial infarction during hospitalization were compared between the two groups. Results The proportion of TIMI blood flow grade Ⅲ and ST-segment depression(>50%) in the observation group were 93.48% and 91.30%, respectively, which were significantly higher than corresponding 82.22% and 75.56% in the control group;the no-reflow rate after operation was 2.17%, which was significantly lower than 15.56% in the control group(P<0.05). The LVEF in the observation group was(63.25±7.24)%, which was significantly higher than(57.18±6.37)% of the control group(P<0.05). There was no significant difference in the recurrent MI rate between the observation group and the control group during hospitalization(2.17% vs 4.44%, P>0.05). Conclusion Thrombus aspiration during PCI for STEMI can effectively reduce the thrombus load in coronary artery, reduce the occurrence of no-reflow, improve the success rate of PCI treatment and the cardiac function of patients.