急诊PCI联合冠脉内血栓抽吸治疗中青年急性心肌梗死的疗效观察  

Application of thrombus aspiration in percutaneous coronary intervention of young and middle-aged patients with acute myocardial infarction

作　　者：徐忠武 吴鹏[2] 李平[2] 黄流强 Xu Zhong-wu;Wu Peng;Li Ping;Huang Liu-qiang(Wuming Hospital of Guangxi Medical University,Manning 530100,China;The First People’s Hospital of Yulin,Yulin 537000,China)

机构地区：[1]广西医科大学附属武鸣医院,南宁530100 [2]玉林市第一人民医院,玉林537000

出　　处：《湖南师范大学学报（医学版）》2021年第2期76-79,共4页Journal of Hunan Normal University(Medical Sciences)

基　　金：玉林市科学研究与技术开发计划项目(20171602)。

摘　　要：目的:探讨冠脉内血栓抽吸在中青年急性心肌梗死经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中应用的近中期疗效和安全性。方法:连续选择于2017年1月~2020年1月住院的急性ST段抬高型心肌梗死且行急诊PCI患者123例,随机分为A组(血栓抽吸+直接支架植入)41例、B组(血栓抽吸+球囊扩张+支架植入)41例、C组(常规介入组:球囊扩张+支架植入)41例。比较TIMI3级、TMPG3级、胸痛缓解、ST抬高回落、肌酸激酶MB同工酶峰值前移14小时等发生率及住院期间心力衰竭、恶性心律失常、心源性休克发生率,并于住院24小时及术后6月行心脏超声检查,测定左室射血分数(LVEF)和左室舒张末期内径(LVD)。结果:1.PCI术后A组、B组的TIMI3级、TMPG3级、胸痛缓解、ST段回落≥50%、CK-MB峰值前移14小时及心源性休克、恶性心律失常、急性左心衰等发生率和总死亡率均明显低于C组,差异均有统计学意义,但A组与B组比较差异均无明显统计学意义;2.PCI术6月后A、B组左室舒张末期内径均明显低于C组,左室射血分数均明显高于C组,差异均有统计学意义;但A组与B组比较差异无明显统计学意义。结论:在中青年急性心肌梗死介入治疗中应用冠脉内抽吸可减少"慢血流"或"无复流"、心力衰竭、恶性心律失常、心源性休克等发生率,改善左心功能和近中期预后,值得在临床中进一步应用。Objective To investigate the short-term and medium-term efficacy and safety of thrombus aspiration in percutaneous coronary intervention of young and middle-aged patients with acute myocardial infarction.Methods 123 patients with acute ST segment elevation myocardial infarction who underwent emergency PCI from January 2017 to January 2020 were randomly divided into group A(thrombus aspiration+direct stent implantation),group B(thrombus aspiration+balloon dilatation+stent implantation),and group C(conventional intervention group:balloon dilatation+stent implantation).The incidence of TIMI grade 3,TMPG grade 3,chest pain relief,ST elevation fall 50%,CK-MB peak shift 14 hour and the incidence of heart failure,malignant arrhythmia and cardiogenic shock during hospitalization were compared.Echocardiography was performed and left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVD)were measured 24 hours after hospitalization and 6 months after operation.Results 1.The incidence of TIMI grade 3,TMPG grade 3,chest pain relief,ST elevation fall 50%,CK-MB peak shift 14 hour and the incidence of heart failure,malignant arrhythmia and cardiogenic shock in group A and group B were significantly lower than those in group C,but there was no significant difference between group A and group B;2.The LVD and the EF of group A and B were significantly lower and higher than those of group C six months after PCI;but there were no significant difference between the two groups.Conclusion Thrombus aspiration in percutaneous coronary intervention can reduce the incidence of"slow flow"or"no reflow",heart failure,malignant arrhythmia,cardiogenic shock,and improve left ventricular function and short-term and medium-term prognosis,which is worthy of further clinical application.

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 心源性休克 

分 类 号：R542.22[医药卫生—心血管疾病]