单纯冠状动脉血栓抽吸术治疗血栓负荷过重的急性心肌梗死疗效分析  

Efficacy analysis of thrombus aspiration in treatment of patients of acute myocardial infarction with high thrombus burden

作　　者：张施明[1] 

机构地区：[1]广西科技大学第一附属医院,广西柳州545002

出　　处：《山东医药》2015年第26期10-13,共4页Shandong Medical Journal

基　　金：广西壮族自治区卫生厅科研立项课题(Z2012606)

摘　　要：目的：探讨单纯应用冠状动脉血栓抽吸术治疗血栓负荷过重的急性ST段抬高型心肌梗死（ STEMI）的疗效。方法回顾性分析在我院行急诊冠状动脉血栓抽吸术的23例急性STEMI患者的病历资料，术前心电图诊断为急性前（间）壁、广泛前壁心肌梗死14例，急性下（后）壁、右室心肌梗死9例。急诊冠状动脉造影（ CAG）示梗死相关血管（ IRA）均为血栓负荷过重。均采用冠状动脉血栓抽吸术处理IRA，至IRA残余狭窄＜80％且血流恢复到TIMI 3级或至少2级以上时结束手术。术后予抗凝药物治疗。分析手术疗效。结果患者均成功行冠状动脉血栓抽吸术，血栓抽吸后即刻造影示IRA残余狭窄均＜80％，TIMI均为2级以上，均未继续行支架置入。发病后10～14 d后复查CAG，IRA远端血流均为TIMI 3级，7例残余狭窄70％～80％，对该7例患者在IRA病变部位置入冠状动脉支架。发病后12～18个月复查CAG，IRA远端血流均为TIMI 3级，置入支架的7例患者中1例出现支架内再狭窄，狭窄程度约50％；未置入支架的患者中1例残余狭窄80％，于IRA病变部位置入冠状动脉支架。术后随访12～18个月，无死亡、再次心肌梗死等发生。结论单纯应用冠状动脉血栓抽吸术急诊治疗血栓负荷过重的急性STEMI患者近期及远期IRA血管再通率高，可使患者避免或延迟置入支架。Objective To investigate the efficacy of thrombus aspiration catheter in treatment of the patients of acute ST-elevation myocardial infarction （ STEMI） with high thrombus burden.Methods The medical records of 23 cases of pa-tients with acute STEMI from the First Affiliated Hospital of Guangxi University of Science and Technology who underwent emergency coronary artery thrombus aspiration were analyzed by retrospective analysis.Preoperative ECG showed that 14 cases were diagnosed as anterior wall acute myocardial infarction （ AMI） , and 9 cases were inferior wall AMI or right ven-tricular AMI.Emergency coronary angiography （ CAG） showed that the infarct-related arteries （ IRA） were all due to high thrombus burden.All IRA were treated by coronary thrombus aspiration.When the IRA residual stenosis was less than 80% and blood flow was restored to TIMI level 3 or above TIMI level 2, we stopped the operation.Postoperative anticoagu-lation therapy was applied, and we analyzed the curative effect.Results All the patients were successfully treated with coronary artery thrombus aspiration.After thrombus aspiration, the residual stenosis of IRA was less than 80% and TIMI was all above level 2.All the patients had no coronary stenting.We reviewed CAG after the onset of 10 to 14 days, the blood flow of the IRA was TIMI level 3.The residual stenosis in 7 cases was 70% to 80%, and we implanted coronary stents for these 7 cases in the IRA lesion sites.We reviewed CAG after the onset of 12 to 18 months, the blood flow of the IRA was TIMI level 3, 1 patient in 7 cases with coronary stent implantation was found the stent restenosis, and the stenosis was about 50%.In those patients without stent implantation, there were 1 case of residual stenosis which was 80%, and the coronary stents were implanted.During the 12 to 18-month follow-up, no death, myocardial infarction and so on oc-curred.Conclusion The short-term and long-term IRA vascular recanalization rate of acute STEMI patients with high thrombus burden who are

关 键 词：血栓抽吸 血栓形成 冠状动脉 支架 血栓负荷过重 急性心肌梗死 

分 类 号：R541.4[医药卫生—心血管疾病]