将抽吸导管用于左主干闭塞急性心肌梗死的临床观察  

Clinical observation of aspiration catheter in acute myocardial infarction with left main coronary artery occlusion

作　　者：张利彬[1] 甘舜进[1] 郭金成[1] 张海滨[1] 张学坤[1] 张立新[1] 高国旺[1] 

机构地区：[1]首都医科大学附属北京潞河医院心内科,北京101149

出　　处：《中国介入心脏病学杂志》2015年第7期390-393,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的分析抽吸导管在左主干闭塞急性心肌梗死(AMI)患者中的临床效果。方法纳入2008年1月至2013年12月在首都医科大学附属北京潞河医院因左主干闭塞引起的AMI患者68例,根据治疗方案分为研究组(38例)和对照组(30例)。对照组先常规置入主动脉球囊反搏(IABP)后再置入支架,研究组先进行血栓抽吸治疗,再根据造影结果选择置入支架或球囊预扩张后再置入支架。观察两组患者造影资料以及临床结果等。结果研究组患者发病距血管再通时间[(4.8±2.1)h比(6.3±3.2)h,P=0.039]、无复流发生率(2.6%比20.0%,P=0.033)、平均肌钙蛋白T(Tn T)峰值[(5.2±2.1)μg/L比(8.6±2.7)μg/L,P=0.000]、肌酸激酶同工酶(CK-MB)峰值[(143.8±65.2)μg/L比(180.6±68.3)μg/L,P=0.047]显著低于对照组;而置入支架数量[(3.3±1.8)枚比(1.8±0.5)枚,P=0.013]、TIMI血流分级Ⅲ级发生率[92.1%比63.3%,P=0.026]、ST段回落率(65.8%比36.7%,P=0.035)显著高于对照组,差异均有统计学意义;两组患者左心室舒张末内径(LVEDd)比较,差异无统计学意义(P>0.05),但研究组患者再次AMI发生率[0比13.3%,P=0.038]以及病死率显著低于对照组;而平均左心室射血分数(LVEF)[(58.6±11.3)%比(43.2±10.8)%,P=0.000]显著高于对照组。结论将抽吸导管用于左主干闭塞AMI患者的治疗操作方便且不良反应少、疗效好,能够有效降低患者死亡率,值得临床推广应用。Objective To analyze the clinical effect of aspiration catheter in acute myocardial infarction with left main coronary artery occlusion. Methods 68 cases of AMI caused by left main occlusion admitted between 2008 January to 2013 December in our hospital were divided into the study group （ n = 30 cases） and the control group （ n = 30 cases） for study according to the treatment provided. The control group underwent emergency percutaneous coronary intervention （PCI） with IABP protection, and the study group underwent aspiration catheter thrombus aspiration followed by stent implantation. The imaging data were compared between the two groups. Results The study group had shorter symptoms onset revaseularization time [ （4.8 ±2.1） h vs. （6.3±3.2） h, P=0.039], lower no-reflow rate （2.6% vs. 20. 0%, P= 0. 033 ） lower peak TnT level [ （5.2 ± 2. 1 ）μg/L vs. （ 8.6 ± 2.7 ） μg/L, P = 0. 000 ] and lower peak CK-MB level [ （ 143.8 ± 65.2） μg/L vs. （ 180. 6 ± 68. 3） txg/L, P = 0. 047 ] as compared to the control group. The study group had more stents implanted [ （ 3.3 ± 1.8 ） stents vs. （ 1.8 ± 0. 5 ） stents, P = 0.013] , higher rates of TIMI 3 flow （92. 1% vs. 63.3% , P =0.226） and ST resolution （65.0% vs. 36. 7% , P = 0. 035）. There was no difference in LVEDd between the 2 groups. The re-occurance of AMI （0 vs. 13.3%, P = 0. 038） and mortality rates were lower in the study group. Conclusions Aspiration catheter has the advantages of convenient operation with less side effects and good curative effect in the treatment of AMI patients with left main occlusion.

关 键 词：抽吸导管 急性心肌梗死 左主干闭塞 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]