血栓抽吸治疗在ST段抬高型心肌梗死患者中的临床疗效分析  

Clinical efficacy analysis of thrombus aspiration in patients with acute ST-segment elevation myocardial infarction

作　　者：谢文杰[1] 陈晞明[1] 陈永权[1] 崔澍春 宋代富 郭国锋 XIE Wen-jie;CHEN Xi-ming;CHEN Yong-quan;CUI Shu-chun;SONG Dai-fu;GUO Guo-feng(Department of Cardiology,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China)

机构地区：[1]广州医科大学第三附属医院心内科

出　　处：《岭南心血管病杂志》2019年第3期257-262,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨ST 段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中应用血栓抽吸的临床疗效。方法回顾性分析2014 年1 月至2016 年12 月因STEMI 于广州医科大学附属第三医院行PCI 治疗的217 例患者的一般临床资料。根据PCI 治疗中有无行血栓抽吸术分为血栓抽吸+PCI 治疗组(A 组,n=76,35%)和单纯PCI 治疗组(B 组,n=141,65%)。收集两组患者的年龄、性别、糖尿病、原发性高血压(高血压)、胆固醇、低密度脂蛋白胆固醇、三酰甘油、有无吸烟及酗酒史等一般资料。记录患者梗死相关动脉(IRA),病变血管数量等手术相关资料,术后心肌再灌注情况及住院期间主要不良心血管事件发生情况。结果血栓抽吸组术后2 h 心电图ST 段回落大于70%的患者比例明显高于单纯PCI 治疗组,差异有统计学意义[81.58%(62/76)vs. 68.09%(96/141),P=0.033]。术后1周血栓抽吸组患者左心室射血分数(left ventricular ejection fraction,LVEF)高于单纯PCI治疗组,差异有统计学意义[59.56%±7.16% vs. 57.26%±8.55%,P=0.013]。住院期间两组患者主要心血管不良事件发生率比较,差异无统计学意义[22.37%(17/76)vs. 23.40%(33/4141),P>0.05]。亚组分析:在年龄<65 岁亚组比较,血栓抽吸组术后1 周LVEF 较单纯PCI 组升高,差异有统计学意义[60.17%±5.89% vs. 58.39%±8.49%,P=0.003];而在年龄≥65岁亚组比较,两组患者术后主要不良心血管事件发生率比较,差异无统计学意义[30.77%(8/26)vs. 41.67%(20/48),P=0.356]。结论急诊PCI 治疗时应用血栓抽吸治疗可改善STEMI 患者术后微循环的再灌注情况,且有助于住院期间心功能的恢复,但对于近期主要不良心血管事件的发生率无明显改善;对于青中年的STEMI患者行PCI治疗时应用血栓抽吸治疗有助于改善患者近期的心脏功能。Objectives To evaluate the clinical efficacy of thrombus aspiration in patients with ST-segment elevation myocardial infarction(STEMI)during percutaneous coronary intervention(PCI). Methods Clinical characteristics of 217 patients with STEMI undergoing PCI in the Third Affiliated Hospital of Guangzhou Medical University from January 2014 to December 2016 were retrospectively analyzed. According to whether undergoing thrombus aspiration treatment during the course of PCI,patients were divided into thrombus aspiration group(n=76,35%)and PCI alone group(n= 141,65%). We collected the general information such as age,sex,diabetes,hypertension,the surgical data such as infarct-related artery(IRA),number of diseased blood vessels,postoperative myocardial reperfusion and hospitalization events,incidence of major adverse cardiovascular events (MACE) during hospitalization. Results The patients percentage of ST-segment resolution(STR)≥70% in 2 hours after thrombectomy was significantly higher in thrombus aspiration group than that in PCI alone group[81.58%(62/76) vs. 68.09%(96/141),P=0.033]. Left ventricular ejection fraction(LVEF)in thrombus aspiration group was higher than that in PCI alone group one week after PCI [59.56%±7.16% vs. 57.26%±8.55%,P=0.013]. There was no significant difference in incidence of MACE between the two groups during hospitalization[22.37%(17/76)vs. 23.40%(33/4141),P>0.05]. In the subgroups of aged <65 years old,LVEF one week after thrombus aspiration was significantly higher in thrombus aspiration group than that in PCI alone group[60.17%±5.89% vs. 58.39%±8.49%,P=0.003]. While in the subgroup of patients aged ≥ 65 years,there was no significant difference in incidence of MACE between the two groups[30.77%(8/26)vs. 41.67%(20/48),P= 0.356]. Conclusions The application of thrombus aspiration therapy in primary PCI can improve the microcirculatory reperfusion after STEMI and contribute to the recovery of heart function during hospitalization,but there is no significant improvement in the incid

关 键 词：心肌梗死 血管成形术 经皮 经腔冠状动脉 血栓抽吸 临床疗效 

分 类 号：R542.22[医药卫生—心血管疾病]