冠状动脉内逆向精确溶栓术在急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗中应用的研究  

Application of Precise Intracoronary Retrograde Thrombolysis During Primary PCI in Patients With Acute ST-segment Elevation Myocardial Infarction

作　　者：农京国 田进文[1] 彭亮[1] 黄亚[1] 刘谟焓[1] 孙婷[1] 申文彬[1] 汤喆[1] 刘丽凤[1] 赵宇[1] 刘庆艳[1] 白静[1] 王禹[1] 

机构地区：[1]中国人民解放军总医院心血管内科,北京市100853

出　　处：《中国循环杂志》2016年第12期1160-1164,共5页Chinese Circulation Journal

摘　　要：目的：通过与血栓抽吸术对比,探讨冠状动脉内逆向精确溶栓术在急性ST段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）术中应用的安全性和有效性。方法：连续入选2014-01至2015-12在解放军总医院心脏介入中心确诊急性STEMI并行直接PCI术的患者123例,随机分为冠状动脉内逆向精确溶栓术组（逆向溶栓组,n=60）和血栓抽吸术组（血栓抽吸组,n=63）,其中血栓抽吸组有3例患者因未能完成血栓抽吸术而被剔除出组。主要终点为直接PCI术后无复流的发生率及术后60～90 min内心电图ST段回落≥50%的比例;主要安全终点为住院期间脑卒中和心肌梗死溶栓治疗临床试验（TIMI）出血发生率。结果：（1）逆向溶栓组术后无复流发生率显著低于血栓抽吸组（1.7%vs 15.0%,P=0.008）,术后心电图ST段回落≥50%的比例及超声测得的左心室射血分数显著高于血栓抽吸组[65.0%vs 45.0%,P=0.028;（50.7±8.6）%vs（46.7±8.3）%,P=0.011],差异均具有统计学意义。两组患者住院期间主要不良心血管事件发生率差异无统计学意义（P〉0.05）。（2）两组患者住院期间均未发生脑卒中及TIMI出血事件。结论 ：同血栓抽吸术相比,冠状动脉内逆向精确溶栓术在急性STEMI患者行直接PCI术中应用具有相似的安全性,但可减少无复流的发生并能改善左心室心功能。Objective： In comparison with thrombus aspiration, to study the safety and efficacy of precise intracoronary retrograde thrombolysis during primary percutaneous coronary intervention（PCI） in patients with acute ST-segment elevation myocardial infarction（STEMI）.Methods： A total of 123 consecutive patients with acute STEMI received primary PCI in our hospital from 2014-01 to 2015-12 were enrolled.The patients were randomly divided into 2 groups： RT group, the patients received precise intracoronary retrograde thrombolysis（RT）, n =60 and TA group, the patients received thrombus aspiration（TA）, n =63, among them, 3 patients with failed TA were excluded. Primary end points included occurrence rates of no-flow after PCI and ST-segment resolution（STR）≥50% at（60-90） min after PCI; primary safety end points included occurrence rates of in-hospital stroke and TIMI-hemorrhage events.Results：（1） Compared with TA group, RT group showed decreased no-flow rate after PCI（1.7% vs 15.0%）, P=0.008 and increased rate of STR≥50% after PCI（65.0% vs 45.0%）, P=0.028, improved LVEF by echocardiography（50.7±8.6） % vs（46.7±8.3）%, P=0.011. The in-hospital MACE occurrence rate was similar between 2 groups, P〈0.05.（2） No in-hospitalstroke or TIMI-hemorrhage events occurred in neither group.Conclusion： Intracoronary retrograde precise thrombolysis had the similar safety to thrombus aspiration during primary PCI in patients with acute STEMI, it may reduce no-reflow rate and improve left ventricular function after PCI.

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 血栓溶解疗法 

分 类 号：R541[医药卫生—心血管疾病]