ST段抬高型心肌梗死患者PCI血栓抽吸术后直接与延迟支架置入的疗效比较  

Efficacy comparison between direct stent implantation surgery and delayed stent implantation surgery for patients with ST-segment elevation myocardial infarction after PCT thrombus aspiration surgery

作　　者：韩晓霞[1] 刘秀红[1] 周萍[1] 但国梅 

机构地区：[1]湖北省枣阳市第一人民医院心内科,湖北枣阳441200

出　　处：《海南医学院学报》2016年第7期643-645,648,共4页Journal of Hainan Medical University

基　　金：国家自然基金号(81120)~~

摘　　要：目的:比较直接和延迟支架置入对急性冠状动脉介入(PCI)血栓抽吸术治疗ST段抬高型心肌梗死(STEMI)疗效的影响。方法:74例行PCI血栓抽吸术治疗的STEMI患者被随机分为直接组和延迟组,各为37例。直接组术后直接置入支架,延迟组抗凝和抗血小板治疗14d后再置入支架。比较两组术后6个月的疗效,对心脏功能和结构,支架释放特征影响及不良反应情况等。结果:术后2h延迟组ST段回落幅度显著高于直接组(P<0.05);TIMI帧数显著和无复流/慢血流发生比例显著低于直接组(P<0.05);延迟组置入支架数量和支架长度显著小于直接组(P<0.05);延迟组置入支架释放特征指标支架直径和支架扩张压力显著高于直接组(P<0.05);术后6个月延迟组LVEF改善幅度显著高于直接组(P<0.05),而LVEDd、LVEDV心室重构显著小于直接组(P<0.05);总不良事件发生率为5.4%,显著低于直接组18.9%(P<0.05)。结论:PCI血栓抽吸术延迟支架置入可显著减少慢血流及无复流发生率,显著改善心脏功能和心肌灌注,减少支架使用量,降低不良心血管事件发生,综合疗效优于直接支架置入。Objective： To compare the efficacy of direct stent implantation surgery and delayed stent implantation surgery for patients with ST-segment elevation myocardial infarction （STEMI） after PCT thrombus aspiration surgery. Method： A total of 74 cases with STEMI were selected, who had been given PCT thrombus aspiration surgery treatment, and were randomly divided into Direct group and Delay group （n=37）. Patients in direct group were given direct stent implantation surgery after PCT thrombus aspiration surgery treatment. Patients in delay group were given delayed stent implantation surgery 14 clays after anticoagulation and antiplatelet treatment. The efficacy （heart structure and {unction, stent release characteristics and adverse reactions） of these two methods were compared 6 months after the surgery. Results：Two hours after surgery, ST segment drop amplitude in delay group was significantly higher than that in direct group. （P〈0.05）. TIMI frame numbers were significantly and no reflow/slow blood flow occurrence ratio was not significantly lower than that in direct group （P〈 0.05）. Implantation stent numbers and stent length in delay group were significantly less than that in direct group （P〈0.05）. Stent diameter and stent expansion pressure were significantly higher than that in direct group （P〈0.05）. Six months after surgery, LVEF improvement in delay group was significantly higher than that in direct group （P〈0.05）, while LVEDd, LV- EDV ventricular remodeling was significantly lower than that in direct group （P〈0.05）. The total adverse event occurrence rate in delay group was 5.4%, which was significantly lower than that in Direct group （18.9%） （P〈0.05）. Oonclusion：The delayed stent implantation surgery after PCI thrombus aspiration surgery could obviously reduce the occurrence rate of no reflow/slow blood flow, improve the heart function and myocardial perfusion, reduce the usage amount of stents, the occurrence of adverse cardiovascular events.

关 键 词：ST段抬高型心肌梗死 血栓抽吸术 直接支架置入 延迟支架置入 急性冠状动脉介入 

分 类 号：R541.6[医药卫生—心血管疾病]