血栓抽吸对直接经皮冠状动脉介入治疗预后的影响  

Effect of aspiration of coronary thrombus upon prognosis of patients in primary percutaneous coronary intervention

作　　者：艾辉[1] 王春梅[1] 朱小玲[1] 高海[1] 李南[1] 

机构地区：[1]北京市首都医科大学附属北京安贞医院心肺血管疾病抢救中心,100029

出　　处：《中华医学杂志》2010年第11期728-731,共4页National Medical Journal of China

摘　　要：目的观察血栓抽吸在经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者中应用的即刻及住院期间疗效。方法选择2007年12月至2008年11月因AMI住院行直接PCI术并于术中应用了血栓抽吸导管的患者共202例为抽吸组，而直接PCI术中未应用抽吸导管的148例患者作为对照组，比较两组术中术后并发症及住院期间临床事件的发生率。结果两组在年龄、性别、易患因素、病变部位及入院时的左室射血分数、IRA的分布、病变血管支数、手术操作时间等基线资料方面差异均无统计学意义，具有可比性。而抽吸组在就诊距血管再通时间[（79±12）min vs（83±15）min，P=0．007]、PCI术后无复渺慢血流（3．5％vs8．8％，P=0．038）、急性、亚急性支架内血栓（0．5％vs4．7％，P=0．011）、住院期间心衰（11．4％vs19．6％，P=0．035）、再次AMI（1．0％vs6．1％，P=0．010）、病死率（3．5％vs8．8％，P=0．038）、住院时间[（6．9±1．5）dvs（7．3±1．8）d，P=0．028]、心肌酶达峰时间[（12．8±2．2）h vs（13．3±1．9）h，P=0．023]较对照组显著减少，TnI峰值[（44．7±31．2）μg／Lvs（51．9±33．6）μg／L，P=0．041]及CK-MB峰值[（152．0±73．6）U／Lvs（171．0±71．2）U／L，P=0．015]明显低于对照组，直接支架置入率（44．1％vs24．3％，P=0．002）及术后达TIMI3级血流（90．1％vs81．8％，P=0．027）、即刻心电图的ST段回落率（67．8％vs53．4％，P=0．008）则显著高于对照组，两组之间差异有统计学意义。结论直接PCI过程中应用血栓抽吸可减少PCI术中术后并发症，缩短住院期间及改善预后。Objective To evaluate the effect of aspiration of coronary thrombus upon the outcome of in-hospital primary percntaneous coronary intervention （PCI） in acute myocardial infarction （AMI） patients. Methods A total of 202 AMI patients undergoing primary PCI and receiving aspiration thrombectomy catheter during from December 2007 to November 2008 were enrolled into the study group. And 148 receiving only routine PCI but with similar coronary angiography and basic characteristics were enrolled into the control group. The immediate and in-hospital outcomes were compared between two groups. Results There were no significant baseline differences between two groups. Compared with the control group, no-reflow/slow flow （3.5% vs 8. 8%, P = 0. 038 ）, acute and subacute stent thrombosis （0. 5% vs 4. 7%, P = 0. 011 ）, heart failure（ 11.4% vs 19. 6%, P = 0. 035 ）, re-infarction （ 1.0% vs 6. 1%, P=0.010）, in-hospital mortality （3.5% vs 8. 8%, P =0.038）, peak level of serum CK-MB （ 152.0 U/L ± 73.6 U/L vs 171.0 U/L ± 71.2 U/L, P = 0. 015 ） and TnI （44.7 μg/L± 31.2 μg/L vs 51.9 μg/L ± 33.6μg/L, P = 0. 041 ） decreased in the study group. However, stent was directly implanted （44.1% vs 24.3%, P =0.002）, TIMI flow grade 3 was obtained（90. 1% vs 81.8%, P =0.027） and faster ST segment resolution （67.8% vs 53.4%, P =0. 008） improved in the study group. Conclusion Application of thrombus aspiration in patients with acute myocardial infarction is effective to decrease noreflow/slow flow and achieve a better clinical prognosis during hospitalization.

关 键 词：心肌梗塞 血管成形术 经腔 经皮冠状动脉 冠状动脉血栓形成 

分 类 号：R542.22[医药卫生—心血管疾病]