抽吸导管在急性心肌梗塞患者急诊经皮冠脉介入治疗中的应用  

Application of thrombus aspiration cather during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

作　　者：江宏飞[1] 王焱[1] 黄卫斌[1] 陈炳煌[1] 陈水龙[1] 郑剑涛[1] 叶涛[1] 肖国胜[1] 

机构地区：[1]厦门大学附属中山医院心脏中心心内科,福建厦门361004

出　　处：《心血管康复医学杂志》2010年第1期68-70,75,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:通过抽吸导管在急性心肌梗塞患者急诊经皮冠脉介入(PCI)治疗中的应用,以评价其可行性及有效性。方法:选择30例急性ST段抬高型心肌梗塞行急诊PCI术的病人,分为两组,各15例,抽吸导管组:予抽吸导管抽吸后,根据血栓负荷情况,决定是即时支架植入,还是择期支架植入术;直接PCI组,予单纯球囊扩张后,植入支架。比较两组术后即刻TIMI血流的分级,并比较两组术前、术后2h肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)定量、高敏C反应蛋白(hs-CRP)、B型脑利钠肽(BNP)、D-二聚体(D-dimer)定量的峰值。结果:抽吸导管组有13例行导管抽吸后行支架植入术,TIMI血流达到TIMI2～3级水平,只有2例出现无复流现象;直接PCI组中有8例病人支架植入后出现无复流现象(P<0.05);两组病人术前CK、CK-MB、cTnT、hs-CRP、D-dimerl比较无统计学差异(P>0.05)。术后,抽吸导管组的下述参数较直接PCI组显著减少,术后2h的峰值比:CK(2152.71±297.84):(3550.93±566.54)IU/I,P<0.05;CK-MB(203.85±23.06):(322.85±46.01)IU/L,P<0.05;cTnT(4.46±0.93):(7.71±1.19)ng/ml,P<0.05;hs-CRP(7.25±1.06):(15.27±3.22)mg/L,P<0.05;BNP(1441.75±321.83):(4589.75±1388.7)pg/ml,P<0.05;D-dimer(134.53±40.15):(245.43±50.15)ng/ml,P<0.05。结论:在急性心肌梗塞急诊PCI术中应用DiverCE抽吸导管行血栓抽吸术,可以减少急性心肌梗塞病人无复流的发生率,提高支架植入术的可靠性及安全性,是有效、安全的。Objective：To evaluate the impact of thrombus aspiration cather during primary percutaneous coronary intervention （PCI） in patients with acute ST-elevation myocardial infarction （MI）.Methods：Thirty consecutive patients with ST-elevation MI for primary PCI were divided two groups. One was treated with the thrombus aspiration cather of Diver CE（thrombus aspiration group）,the other was treated with balloon（direct PCI group）,at the same time.Results：The patients with no-flow was only 2 patients in thrombus aspiration group,but there was 8 patients in direct PCI group. The levels of CK[（2152.71±297.84）vs. （3550.93±566.54） IU/L]、CK-MB[（203.85±23.06） vs.（322.85±46.01） IU/L]、cTnT[（4.46±0.93）vs.（7.71±1.19） ng/ml]、hs-CRP[（7.25±1.06）vs.（15.27±3.22） mg/L]、BNP[（1441.75±321.83） vs. （4589.75±1388.7） pg/ml]、D-dimer[（134.53±40.15） vs. （245.43±50.15）ng/ml]in thrombus aspiration group significantly decreased compared with those of direct PCI group （P〈0.05 all）.Conclusion：The application of thrombus aspiration cather is feasible and safe and can decrease no-flow during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction.

关 键 词：心肌梗塞 心脏导管插入术 血栓栓塞 

分 类 号：R542.22[医药卫生—心血管疾病]