不同血栓抽吸方法治疗ST段抬高心肌梗死的效果比较  

Comparison of combined with different thrombus aspiration catheters or not during percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

作　　者：王芳[1] 颜红兵[2] 周鹏[2] 刘臣[2] 赵博[2] 赵汉军[2] 

机构地区：[1]首都医科大学附属北京安贞医院 心内科28病区,北京100029 [2]中国医学科学院阜外心血管病医院15病区,北京100027

出　　处：《临床荟萃》2014年第4期375-377,共3页Clinical Focus

摘　　要：目的采用不同血栓抽吸方法治疗急性ST段抬高心肌梗死,了解疗效的差异。方法急性ST段抬高心肌梗死患者,行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术;冠状动脉造影示靶血管可见血栓负荷;术中采用抽吸导管抽吸血栓。排除血流动力学不稳定;支架内血栓形成;冠状动脉旁路移植术(coronary artery bypass grafting,CABG)术后;年龄>75岁;既往脑卒中病史;PCI失败或抽吸导管无法通过病变的患者。所有入选患者根据术中应用手动抽吸导管的情况分为3组:只单独Diver抽吸导管抽吸患者304例,只单独Export抽吸导管抽吸患者452例,以及此两种抽吸导管组合抽吸患者203例。记录3组患者基线资料,比较3组间血流分级(TIMI),住院期间及出院后6个月内主要心血管不良事件。结果抽吸导管组合抽吸组患者的年龄更大(56.3±14.5)岁vs(55.7±12.0)岁vs(58.4±17.3)岁(P<0.01),合并高血压的比例更高(61.3%vs 62.1%vs 65.0%,P<0.01),缺血时间相对较长(4.9±5.3)h vs(4.3±8.7)h vs(5.8±7.2)h(P<0.01)。PCI术中3组术前的TIMI0级的患者以两种抽吸导管组合抽吸组居多(51.0%vs 54.8%vs 55.9%,P<0.05),其余各组在术前和术后的TIMI差异均无统计学意义。结论血栓抽吸导管组合抽吸未能进一步降低无复流的发生率。Objective To compare combined with different thrombus aspiration catheters or not during percutaneous coronary Intervention in patients with acute ST-segment elevation myocardial infarction. Methods Retrospective analysis was performed on 155 consecutive PCI-treated acute ST-segment elevation myocardial infarction patients. The main inclusion criteria were patients that met the standard diagnostic criteria for acute ST-segment elevation myocardial infarction. All patients had undergone PCI as part of a regional program that triages patients with acute ST-segment elevation myocardial infarction for early revascularization. Thrombus burden was found in all patients＇ angiography and thrombus aspiration was performed. Exclusion criteria included hemodynamic instability, stent thrombosis, previous coronary artery bypass graft, age〉 75 years, history of stroke, failure to PCI. Based on thrombus aspiration catheters, the patients were classified into three groups： diver group, export group, diver with export group. Post-PCI TIMI flow grade, major adverse cardiovascular events including mortality, target vessel revascularization,target lesion revascularization, reinfarction up to 6 months follow-up were measured. Results 959 patients were enrolled. 304 patients in diver group,452 patients in export group, and 203 patients in diver withexport group. Patients were older in last group （56.3±14.5） years old vs （55.7±12.0） years old vs （58.4±17.3） years old （ P 〈0.01） ,and had a higher incidence of hypertension（61.3% vs 62.1% vs 65.0%, P 〈0. 01）. And the ischemic time was longer （4.9±5.3） h vs （4.3±8.7） h vs （5.8±7.2） h（P d0.01）.The TIMI flow grade was similar between groups except for a higher rate of baseline TIMI flow grade 0 in diver with export group（51.0% vs 54.8% vs 55.90%, p 〈0.05）. Conclusion Combined with different thrombus aspiration catheters or not during PCI can not decrease the incidence of no reflow.

关 键 词：心肌梗死 心电描记术 冠状血管造影术 

分 类 号：R422.22[医药卫生—临床医学]