急诊冠状动脉介入术中抽吸血栓对急性心肌梗死患者心肌再灌注的影响  

The impact of thrombus aspiration on myocardial reperfusion during PCI in acute myocardial infarction

作　　者：王苏[1] 李志忠[1] 朱小玲[1] 马临安[1] 刘巍[1] 刘形[1] 陶英[1] 李勇[1] 李十红[1] 周玉杰[1] 马长生[1] 吕树铮[1] 

机构地区：[1]首都医科大学附属北京安贞医院十五病房,北京100029

出　　处：《中国综合临床》2007年第12期1073-1075,共3页Clinical Medicine of China

基　　金：北京市优秀人才培养专项基金(2004200300623)

摘　　要：目的探讨急诊冠状动脉介入治疗(PCI)术中抽吸血栓对急性心肌梗死患者心肌再灌注的影响。方法急性心肌梗死行急诊PCI,冠状动脉造影提示存在血栓且罪犯血管直径≥3 mm的患者134例,随机分为抽栓+PCI组69例和标准PCI组65例。分别记录心外膜血流(TIMI)分级和心肌灌注评分(MBG),观察即刻手术成功率、院内主要心脏不良事件(MACE)(心性死亡、急性心肌梗死或急诊血运重建等)发生率。结果抽栓+PCI组和标准PCI组术后TIMI 3级血流比例分别为92.7%和81.5%。2组比较差异无统计学意义(P>0.05);2组术后MBG 3级比例为75.4%和52.3%,2组比较差异有统计学意义(P<0.05)。2组院内MACE发生率均为0。结论急性心肌梗死患者急诊PCI术中使用机械抽吸血栓方法减少血栓负荷,可以改善心肌微循环灌注水平。Objective To assess the impact of thrombus aspiration on myocardial reperfusion in acute myocardial infarction （ AMI） patients undergoing PCI. Methods Acute myocardial infarction patients with angiographic evidence of coronary thrombus and reference vessel diameter ≥3 mm were subjected to either PCI with thrombus aspiration group （ n = 69 ） or standard PCI group （ n = 65 ）. Epicardial Final TIMI flow and myocardial blush grade were analyzed, Immediate procedure success, major adverse cardiac event （ cardiac death, acute myocardial infarction or ischemia driven revascularization ） in-hospital were observed. Results Final TIMI 3 flow was achieved in 92.7% of patients in thrombus aspiration group and in 81.5% in the control group （ P 〉 0.05 ）. Myocardial blush grade 3 degree was achieved in 75.4% in thrombus aspiration group and 52.3% in control group （ P 〈 0.05 ）. The incidence of MACE in-hospital was 0. Conclusion Thrombus removal with aspiration device is associated with improved myocardial reperfusion in AMI patients undergoing PCI.

关 键 词：急性心肌梗死 介入治疗 血栓抽吸 

分 类 号：R542.22[医药卫生—心血管疾病]