急性ST段抬高型心肌梗死急诊介入术中血栓抽吸疗效观察  

Effects of thrombus aspiration during emergency percutaneous coronary intervention in acute ST segment elevation myocardial infarction patients

作　　者：黄伟光[1] 罗景云[1] 赵强[1] 徐元杰[1] 崔进[1] 吴同果[1] 

机构地区：[1]广州市红十字会医院心内科,510220

出　　处：《中国医药》2011年第6期641-643,共3页China Medicine

基　　金：广东省科学事业费计划项目（2009B080801056）

摘　　要：目的 观察在急性ST段抬高的心肌梗死（STEMI）急诊介入术中应用血栓抽吸导管进行血栓抽吸的临床疗效。方法2008年6月至2010年6月行急诊经皮冠状动脉介入术的患者96例，完全随机分为研究组（50例）和对照组（46例）。2组均采取直接支架置入或球囊预扩张后置入支架。研究组此之前沿导丝送人ZEEK血栓抽吸装置至病变部位负压抽吸。观察2组的手术情况、术后效果。结果研究组发病距血管再通时间、直接支架置入率和术后达心肌梗死溶栓试验（TIMI）3级血流情况[分别为（5．1±2．3）h、44．0％（22／50）、92．0％（46／50）]明显好于对照组[分别为（6．2±3．5）h、30．4％（14／46）、82．6％（38／46）]，无复流或慢血流发生率明显低于对照组[4．0％（2／50）比13．0％（6／46）]，差异均有统计学意义（均P〈0．05）。研究组eInT峰值及CK-MB峰值明显低于对照组[研究组与对照组分别为（5．1±2．6）pg／L、（142．0±68．3）U／L及（8．5±2．9）μg／L、（176．0±71．2）U／L]，心电图ST段回落率、左Jb室射血分数明显大于对照组[研究组与对照组分别为64．0％（32／50）、（56．0±13．5）％及45．7（21／46）、（45．6±10．2）％]，住院期间心力衰竭发生率、再次急性心肌梗死发生率及心源性死亡率较明显低于对照组[研究组与对照组分别为14．0％（7／50）、0、2．0％（1／50）及23．9％（11／46）、4．3％（2／46）、8．7％（4／46）]，差异均有统计学意义（均P〈0．05）。结论STEMI急诊介入术中血栓抽吸治疗安全可靠，增加心肌的血流灌注，减少坏死心肌数量，改善STEMI患者的近期预后。Objective To evaluate the effect of thrombus-aspiration during emergency percutaneous coronary intervention（PCI） in patients with acute ST segment elevation myocardial infarction （STEMI）. Methods The STEMI patients underwent emergent PCI from June 2008 to June 2010. Fifty patients received aspiration thrombectomy were enrolled in study group and 46 patients who only received routine PCI were enrolled in control group. The clinical data, information after operation and the follow-up data were compared between the two groups. Results There were no significant differences between two groups on baseline. In the study group, stents were directly implanted and TIMI flow grade 3 was obtained with a significant difference of no-reflow/slow flow （ P = 0. 029 ）. There were lower peak serum CK-MB（ P = 0.031 ）, TnT（ P = 0.023 ） and faster ST segment resolution（ P = 0.005 ） in the study group. The heart failure（ P = 0.025 ）, re-infarction（ P = 0.041 ） and mortality（ P = 0.043 ） in the hospital were decreased in the study group. Conclusion Thrombus-aspiration is safe and has good immediate effects during emergency PCI with STEMI, which can improve myocardium perfusion and reduce myocardial necrosis.

关 键 词：急性心肌梗死 经皮冠状动脉介入 血栓抽吸 

分 类 号：R542.2[医药卫生—心血管疾病]