低频高能超声消融血栓的疗效分析

Effects of ultrasound energy on thrombi in virto and in acute myocardial infarction

目的:评价低频高能超声对体外全血细胞血栓及急性心肌梗死(AMI)患者冠脉内血栓的消融效果及其安全性。方法:应用ACOLYSIS SYSTEMTM超声溶栓仪对20块全血细胞血栓及13例AMI患者冠脉内血栓行超声消融,观察超声对体外血栓的消融效果及AMI患者梗死相关血管(IRA)的TIMI血流、血栓影像改变,检测体外血栓消融后碎块大小及AMI患者消融手术前后CK-MB、心电图ST段及临床症状的改变。结果:释放超声能量(40kHz,18W/cm2)15秒内(11.5±2.25秒)20块血栓肉眼观察完全溶解,溶解速度为0.138±0.018g/s,碎片直径为6.84±2.94μm,90％的碎片直径小于红细胞直径。13倒AMI患者均有一支有大量血栓的IRA,超声消融术终重复造影IRA内未再见有血栓影像.IRA均达TIMI3级,开通率为100%(13/13),残余狭窄为(45.97±11.65%)%;消融成功后10分钟内13例患者胸痛消失、抬高的ST段均明显下降(100%),CK-MB峰值时间明显提前。住院期间无死亡,心源性休克、复发严重心肌缺血、再梗死等严重并发症。结论:超声能有效地消融体内及体外新鲜血栓,开放IRA,恢复TIMI3级血流,可能是治疗AMI,快速重建冠脉血运的又一新方法。

Objective: To evaluate the feasibility of high intensity, low frequency ultrasound thrombolysis in vitro and in patients with acute myocardial infarction (AMI). Methods: Ultrasounds of 40 kHz and 18 W/cm2 was used to dissolve the blood clots in vitro and introduced via catheterization to treat 13 AMI patients. Results: Microscopic examination revealed that the diameter of 90% of blood pieces produced in dissolving was smaller than that of red blood cells and prepared blood clots in vitro were completely dissolved in 15 seconds (dissolving speed =0. 138±0. 018 g/s). At least one infarction related arteries (IRA) with massive thrombosis was found in all the 13 patients. The repeated angiography at the end of ultrasound thrombolysis showed no image of thrombi again in IRA. Ultrasound induced successful reperfusion in all the 13 patients and the rate of residual stenosis was (45. 97±11.65)%. In 10 minutes after the treatment, disappearance of chest pain, significantly decrease (100%) of elevated ST segment (P <0. 05) and obvious migrating forward of CK-MB peak value were found in all patients. There was no occurrence of sudden death, cardiogenic shock, recurrent severe myocardial ischemia and re-infarction etc. during ultrasound thrombolysis and hospitalization. Conclusion: High intensity, low frequency ultrasound thrombolysis can be used as a new approach for treating AMI, opening IRA as early as possible and restoring TIMI blood flow grade Ⅲ .