替罗非斑联合Diver血栓抽吸导管介入治疗对急性心肌梗死患者心肌再灌注的作用  

Effect of interventional therapy on myocardial reperfusion in patients with acute myocardial infarction by the combination of non spot and Diver thrombus aspiration catheter

作　　者：黄永培 林良才[1] 罗招川 

机构地区：[1]什邡市人民医院心内科,四川什邡618400

出　　处：《西部医学》2017年第7期974-977,981,共5页Medical Journal of West China

基　　金：四川省卫生厅科研课题(1104583)

摘　　要：目的探讨替罗非斑联合Diver血栓抽吸导管在冠脉介入治疗中对急性ST段抬高型心肌梗死患者心肌再灌注的作用。方法选取行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的急性ST段抬高型心肌梗死患者84例,所有患者均经冠脉造影确诊合并冠脉血栓,按照完全随机数字表法分为观察组和对照组各42例。对照组患者在PCI术中给予Diver血栓抽吸导管介入治疗,观察组患者在PCI术中应用DiverCE血栓抽吸导管抽吸联合替罗非班进行治疗。两组再根据情况选择合适支架置入或经球囊预扩张后置入支架,观察并记录两组患者90min内ST回落、校正TIMI帧数计数(CTFC)、手术前后冠脉血流情况、不良心血管事件以及术后出血相关并发症。结果两组患者90min内ST回落、CTFC差异明显(p<0.05),但观察组患者90min内ST回落明显高于对照组(p<0.05),而CTFC明显小于对照组(p<0.05)。经秩和检验,两组患者术前TIMI血流分级差异不明显(u=0.59,p>0.05)。两组患者术后TIMI血流分级差异明显(u=6.75,p<0.05)。两组患者心脏猝死、非致命性心肌梗死发生率比较无明显差异(p>0.05)。对照组患者反复缺血性心绞痛发生率为19.0%,观察组患者反复缺血性心绞痛发生率为2.4%,明显低于对照组(X2=5.44,p<0.05)。观察组患者再灌注心律失常发生率明显低于对照组(p<0.05)。两组患者牙龈出血、穿刺点血肿、尿潜血、大便潜血、总出血发生率差异无统计学意义(p>0.05)。结论替罗非斑联合Diver血栓抽吸导管介入治疗能有效改善急性心肌梗死患者血流灌注,但并不增加患者出血风险,值得临床推广应用。Objective To explore and analyze the effect of the combination of non spot and Diver thrombus aspira- tion catheter on myocardial reperfusion in patients with acute ST segment elevation myocardial infarction. Methods 84 patients with acute ST elevation myocardial infarction need percutaneous coronary artery interventional therapy （percuta- neous coronary, intervention, PCI） from January 2012 to January 2016 were included in the present study. The patients were diagnosed as coronary artery thrombosis and randomly divided into observation group and control group, 42 cases in each group. Patients in the control group were treated with Diver thrombus aspiration catheter in PCI operation, and the observation group was treated with DiverCE thrombus aspiration catheter aspiration combined with PCI in the observation group. The two groups according to the situation, select the appropriate stent or balloon dilation after stent implantation, the two groups were observed and recorded in the 90min ST fall, corrected TIMI frame count （CTFC）, bleeding related complications before and after surgery, coronary blood flow, and postoperative adverse cardiovascular events. Results The ST moving down in 90 rain and CTFC of observation group and control group was significantly different （p〈0.05）. The ST moving down in 90 rain of observation group was higher than that of control group （p〈O. 05）. CTFC of observa- tion group was lower than that of control group （p〈0.05）. The difference of TIMI blood flow classification of observa- tion group and control group was not obvious （u=0.59, p〉0.05）. Differences of TIMI blood flow were significantly different （u=6.75, p〈0.05） in two groups after operation. There was no significant difference in the incidence of sud- den cardiac death and non fatal myocardial infarction between the two groups （p〉〈0.05）. The control group of patients with recurrent isehemic angina incidence rate was19.0%, the observation group was 2.4%, significantly lower than the con

关 键 词：替罗非斑 Diver血栓抽吸导管 急性心肌梗死 心肌再灌注 

分 类 号：R542.22[医药卫生—心血管疾病]