高血栓负荷的急性ST段抬高型心肌梗死患者急诊冠脉介入治疗39例临床分析  

Analysis of 39 cases of acute ST-segment elevation myocardial infarction(ASTEMI) with high thrombus burden treated by emergency percutaneous coronary intervention

作　　者：裘存新[1] 章锡林[1] 汪靖[1] 胡剑平[1] 孙建琦[1] 张长兵 方钊华[1] 张晓玲 

机构地区：[1]黄山市人民医院心内科,安徽黄山245000

出　　处：《安徽医药》2017年第11期2038-2041,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨高血栓负荷的急性ST段抬高型心肌梗死(ASTEMI)患者行急诊经皮冠脉介入治疗(PCI)的疗效及安全性。方法回顾性分析行急诊PCI的ASTEMI患者共189例,其中39例经冠状动脉造影(CAG)显示血栓负荷较重者行血栓抽吸联合国产替罗非班及球囊扩张、支架置入等PCI治疗,观察术中梗死相关血管(IRA)、血栓抽吸物以及患者胸痛缓解率,伴发心律失常情况,术后IRA的心肌梗死溶栓试验(TIMI)血流分级、ST段回落百分比(STSR),心功能评价、出血并发症及术后30d的主要心脏不良事件(MACE)等。结果 39例行血栓抽吸联合替罗非班治疗的急诊PCI患者中,IRA发生于左前降支20例,右冠状动脉18例,左回旋支1例;肉眼观察血栓抽出物为红色血栓30例,白色血栓4例,3例少许脂质颗粒,2例未见血栓和脂质颗粒。术中出现再灌注心律失常38例。术后胸痛缓解34例。心电图示术后2 h STSR>50%者35例。术中出现慢血流、无复流共5例。术后心脏彩超示30例左室射血分数(LVEF)>50%,6例LVEF<50%;术后消化道轻度出血2例,消化道大出血1例。术后19 h颅内出血1例。术后30 d内死亡3例。结论 ASTEMI患者急诊PCI,血栓负荷较重的患者总体风险大,病死率高,应用血栓抽吸针对血栓负荷重者联合替罗非班治疗,前向血流恢复快,无复流、慢血流发生率低,总体疗效和安全性良好。Objective To observe the efficacy and safety of thrombus aspiration combined with tirofiban therapy in patients with acute ST-elevation myocardial infarction（ASTEMI） with high thrombus burden. Methods A total of 189 patients with ASTEMI who underwent emergent PCI from Jan 2010 to Dec 2014 were retrospectively analyzed. 39 patients had been confirmed with high thrombus burden by coronary angiography（CAG）,who received PCI treatment,such as thrombus-aspiration combined with injection of tirofiban in coronary, balloon expansion,stent implantation. After PCI,the outcomes,infarct-related artery（IRA）,thrombus suction content,rate of chest pain remission,accompanied with reperfusion arrhythmia,the incidence of no-reflow or slow flow,post-procedure thrombolysis of IRA after myocardial infarction（TIMI） flow grade,50% ST-segment elevation resolution（STR）,bleeding complications,and postoperative cardiac function evaluation（Left ventricular ejection fraction,LVEF） and major adverse cardiac events（MACE） within 30 days were observed. Results 39 PCI patients underwent thrombus-aspiration combined with injection of tirofiban in coronary,IRA on left anterior descend-ing（LAD） artery was 20 cases,18 cases on right coronary artery（RCA）,1 case on left circumflex（LCX） artery. 30 cases were red thrombus,4 cases were white thrombus,3 cases included a few lipid particles,2 cases were no thrombus and no lipid granule. 38 cases accompanied with reperfusion arrhythmia during operation. 34 cases with chest pain remission after operation. STSR 〉 50% was 35 cases after operation 2 h. 5 cases were founded no-reflow or slow flow during operation. After operation,LVEF 〉 50% was 30 cases,LVEF 〈50% was 6 cases. The incidence of slight hemorrhage was 2 cases and massive hemorrhage was 2 cases,which happened on the diges-tive tract and cerebral hemorrhage respectively. 3 cases died within 30 days. Conclusions Application of thrombus aspiration combined with the injection of tirofiban in coronary artery in

关 键 词：血栓抽吸 替罗非班 急性心肌梗死 经皮冠状动脉介入治疗 高血栓负荷 

分 类 号：R542.22[医药卫生—心血管疾病]