血栓抽吸及血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂在急性ST段抬高型心肌梗死直接冠状动脉介入治疗中的应用  

To explore clinical use of thrombus aspiration and platelet glycoprotein Ⅱb/Ⅲa receptor antagonists during primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients

作　　者：刘健[1] 马玉良[1] 王伟民[1] 赵红[1] 卢明瑜[1] 

机构地区：[1]北京大学人民医院心内科,北京100044

出　　处：《临床心血管病杂志》2011年第2期119-122,共4页Journal of Clinical Cardiology

摘　　要：目的：比较血栓抽吸导管及血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂（GPⅡb/Ⅲa受体拮抗剂）在急性ST段抬高型心肌梗死（STEMI）直接冠状动脉介入治疗（PCI）过程中疗效的不同,探讨减少冠状动脉血栓负荷和改善心肌灌注的最佳策略。方法：回顾性分析因STEMI就诊,接受直接PCI的206例患者。根据直接PCI过程中对血栓处理方法的不同分为单纯直接PCI组、血栓抽吸或GPⅡb/Ⅲa受体拮抗剂组、血栓抽吸＋GPⅡb/Ⅲa受体拮抗剂组。比较各组在术后慢血流或无复流、ST段50%回落率、TIMI帧数变化、左室射血分数（LVEF）及左室舒张末内径（LVDd）、大出血情况、住院期间死亡率等指标的差异。结果：血栓抽吸＋GPⅡb/Ⅲa受体拮抗剂组与单纯直接PCI组相比,慢血流或无复流的发生率、术后TIMI血流帧数和最高导联ST段50%回落率均差异无统计学意义（P〉0.05）,但术前TIMI血流0~1级患者比例更高（P〈0.05）;血栓抽吸或GPⅡb/Ⅲa受体拮抗剂组与单纯直接PCI组相比,慢血流或无复流发生率,术后TIMI血流帧数,最高导联ST段50%回落率差异无统计学意义（P〉0.05）。术后1周心脏超声示LVEF,LVDd以及住院期间死亡率各组间差异无统计学意义（P〉0.05）。术后大出血各组间差异亦无统计学意义（P〉0.05）。结论：联合应用血栓抽吸和GPⅡb/Ⅲa受体拮抗剂可有效减轻STEMI患者接受直接PCI中冠状动脉内的血栓负荷,明显改善术前高血栓负荷患者心肌组织微循环的灌注。Objective：To Compare the difference between only primary percutaneous coronary intervention and thrombus-aspiration and/or platelet glycoprotein Ⅱb/Ⅲa receptor antagonists（GPⅡb/Ⅲa） in the patients with ST-segment elevation myocardial infarction（STEMI） during the primary percutaneous coronary intervention（PCI）,we try to explore the best strategies to reduce thrombus burden and improve myocardial reperfusion.Method：We reviewed 206 STEMI patients who had done with primary PCI.The patients were arranged into 3 groups,including only primary percutaneous coronary intervention group,thrombus-aspiration or GPⅡb/Ⅲa receptor antagonists group and thrombus-aspiration plus GPⅡb/Ⅲa receptor antagonists group.We compare the different targets among the three groups,including rate of no-reflow or slow-reflow,post-procedure Thrombolysis In Myocardial Infarction（TIMI） frame counts,50% ST-segment elevation resolution（STR）,the figures of Left ventricular ejection fraction（LVEF） and Left ventricular diastole diameter（LVDd） by UCG,the rate of major haemorrhage,mortality in hospital.Result：Comparing with the only primary PCI group,thrombus-aspiration plus GP Ⅱb/Ⅲa receptor antagonists group have no statistics significant difference in risk of no-reflow or slow-reflow,TIMI frame counts,50% STR（P0.05）,but have more TIMI 0-1 blood rate flow pre-procedure（P0.05）.The figures of LVEF and LVDD by UCG and mortality in hospital were no difference among three groups（P0.05）.The rate of major haemorrhage was no difference among three groups（P0.05）.Conclusion：The combine of thrombus-aspiration and Ⅱb/Ⅲa antagonists can reduce thrombus burden,prevent the rate of no-reflow andimprove myocardial microvascular reperfusion in patients with STEMI during direct PCI.

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 血栓抽吸 血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂 

分 类 号：R542.2[医药卫生—心血管疾病]