血栓抽吸联合GPⅡb/Ⅲa治疗血栓负荷过重心肌梗死患者的疗效  

Therapeutic effect of thrombus suck combined with glycoprotein IIbIIIa receptor inhibitors on patients with myocardial infarction and high thrombus burden of coronary

作　　者：林松[1] 叶飞[1] 徐学彬[2] 张爱萍[3] 李银福 郑永宏[5] 马玉玲[1] 朱中生[1] 张俊杰[1] 田乃亮[1] 李枫[2] 孙学文[2] 陈绍良[1] 

机构地区：[1]南京医科大学附属南京第一医院心内科,江苏南京市210006 [2]安徽理工大学附属医院 [3]安徽淮南市第一人民医院 [4]江苏省溧阳市人民医院 [5]江苏省溧阳市中医院

出　　处：《心血管康复医学杂志》2011年第6期558-562,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨直接经皮冠状动脉介入治疗﹙PCI﹚中血栓抽吸导管(ZEEK导管)联合血小板Ⅱb/Ⅲa受体拮抗剂﹙GPⅡb/Ⅲa﹚治疗血栓负荷过重的急性ST段抬高型心肌梗死﹙STEMI﹚的效果。方法:入选STEMI患者136例,随机分为常规PCI组﹙44例﹚、GPⅡb/Ⅲa组﹙45例﹚和GPⅡb/Ⅲa+TA(血栓抽吸)组﹙47例﹚,分析三组PCI术后即刻梗死相关血管﹙IRA﹚的TIMI血流分级、梗死部位心肌灌注水平﹙TMP﹚分级、术后72h内出血、输血比例及术后30d、1年内主要心脏不良事件﹙MACE﹚等。结果:与常规PCI组比较,GPⅡb/Ⅲa组和GPⅡb/Ⅲa+TA组术后即刻IRA的TIMI血流分级[(2.31±0.50)比(2.52±0.48)比(2.69±0.47)]、TMP分级[(2.03±0.65)比(2.31±0.48)比(2.51±0.54)]明显提高,且GPⅡb/Ⅲa+TA组明显高于GPⅡb/Ⅲa组,P均<0.05;GPⅡb/Ⅲa组和GPⅡb/Ⅲa+TA组术后30d、1年MACE发生率均明显低于常规PCI组[30d:(9.6±28.4)%、(7.1±21.7)%比(16.2±37.4)%,1年:(16.3±35.5)%、(12.4±39.3)%比(29.7±46.3)%],P均<0.01。术后72h内出血、输血比例三组间差异无显著性。结论:冠状动脉血栓负荷过重的急性ST段抬高型心肌梗死患者急诊PCI中联合使用血栓抽吸导管和血小板Ⅱb/Ⅲa受体拮抗剂安全、有效,即刻获得的TIMI血流和心肌灌注优于常规PCI组及单用血小板Ⅱb/Ⅲa受体拮抗剂组。Abstract： Objective： To study the therapeutic effect of thrombus suck catheter （ZEEK catheter） combined with gly- coprotein IIb/IIIa receptor inhibitors （GP Ⅱb/Ⅲa） on acute ST segment elevation myocardial infarction （STEMI） during primary percutaneous coronary intervention （PCI） in patients with high thrombus burden of coronary. Methods： A total of 136 STEMI patients were randomly divided into routine PCI group （n= 44）, GP Ⅱb/Ⅲa group （n=45） and G P Ⅱb/Ⅲa ± thrombus aspiration （TA） group （n=47）. Analyses were performed on blood flow grades of thrombolysis in myocardial infarction trial （TIMI） of infract-related arteries （IRA） instant after PCI, thrombolysis in myocardial infarction myocardial perfusion （TMP） classifications of infarct sites, ratios of bleeding and blood transfusion within 72h after PCI and major adverse cardiovascular events （MACE） within 30d and one year after PCI. Results： Compared with routine PCI group, TIMI blood flow grades of IRA E （2.31±0.50） vs. （2.52±0.48） vs. （2.69±0.47）1 and TMP classifications [- （2.03±0.65） vs. （2. 31±0.48） vs. （2.51±0.54）] significantly increased instant after PCI in GPⅡb/Ⅲa group and GPⅡb/Ⅲa TA group, and GPⅡb/Ⅲa TA group was signif- icantly higher than those of GP Ⅱb/Ⅲa group, P（0.05 all; incidence rates of MACE within 30d and one year after PCI in GPⅡb/Ⅲa group and GP Ⅱb/Ⅲa TA group were significantly lower than those of routine PCI group [30d： （9.6±28.4）%, （7,1±21. 7）% vs. （16.2±37.4）%, one year： （16.3±35.5）%, （12.4±39.3）% vs. （29.7±46.3）%1, P〈0.01 all. There were no significant difference in ratios of bleeding and blood transfusion within 72h after PCI among the three groups. Conclusion： Combined application of thrombus suck catheter and GPⅡb/Ⅲa a is safe and effective for treatment of acute STEMI during primary PCI in patients with high thrombus burden in coronary arteries and their instant obta

关 键 词：血栓形成 血小板糖蛋白GPⅡb-Ⅲa复合物 心肌梗塞 

分 类 号：R542.22[医药卫生—心血管疾病]