应用IMR联合SPECT评价血栓抽吸对冠脉微循环的影响  

Using IMR Combined with SPECT to Evaluate the Effect of Thrombus Aspiration on Coronary Microcirculation

作　　者：武艳强[1] 侯爱军[1] 傅向华[2] 汪雁博[2] 傅阳[2] 冯强[1] 牛绍乾 Wu Yanqiang;Hou Aijun;Fu Xianghua;Wang Yanbo;Fu Yang;Feng Qiang;Niu Shaoqian(Handan Central Hospital,Handan 056000;The Second Hospital of Hebei Medical University,Shijiazhuang 050000)

机构地区：[1]邯郸市中心医院,邯郸056000 [2]河北医科大学第二医院,石家庄050000

出　　处：《国际老年医学杂志》2022年第1期43-48,共6页International Journal of Geriatrics

摘　　要：目的应用冠脉微循环阻力指数(IMR)和单光子发射计算机断层显像(SPECT)评价血栓抽吸对冠脉微循环的影响。方法选取103例急性ST段抬高心肌梗死(STEMI)患者,应用随机数表法分为常规组52例及血栓抽吸组51例。常规组采用常规介入方法治疗,血栓抽吸组采用血栓抽吸后行介入治疗。经皮冠状动脉介入治疗术后即刻通过压力-温度导丝测定犯罪血管的IMR,评价术后心肌梗死溶栓试验(TIMI)分级、校正的TIMI血流帧数计数(CTFC)及TIMI心肌灌注分级(TMPG),测量肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cTn)I峰值水平及心电图ST回落(STR)情况,术后7d行SPECT检查评价灌注缺损面积(PDA),心肌梗死24 h后行心脏超声评价心脏功能,随访3个月内主要心脏不良事件及出血事件的发生情况。结果血栓抽吸组在植入支架长度长于常规组,造影剂用量多于常规组,手术时间长于常规组,CK-MB、cTnI、PDA均高于常规组(P<0.05)。血栓抽吸组支架术后CTFC、支架术后IMR值均高于常规组(P<0.05),24 h左室射血分数(LVEF)低于常规组(P<0.05)。两组在心源性死亡、靶血管重建事件、卒中发生及心力衰竭方面未见统计学差异(P>0.05)。结论对于轻度血栓负荷的STEMI患者,血栓抽吸操作时间更长,术中应用造影剂量增多;与常规介入治疗方式相比,STEMI患者直接经皮冠状动脉介入治疗术中,对存在一定血栓负荷的病变进行血栓抽吸,可以造成冠脉微循环损伤,减少有效冠脉微循环灌注,增加心肌梗死面积,但不增加卒中发生率。Objective To evaluate the effect of thrombus aspiration on coronary microcirculation using index of microcirculatory resistance(IMR) and single photon emission computed tomography(SPECT).Methods A total of 103 patients with acute ST-segment elevation myocardial infarction(STEMI) treated in the Second Hospital of Hebei Medical University from October 2017 to June 2018 were selected.The patients were divided into the conventional treatment group(52 cases) and thrombus aspiration group(51 cases) using random number table.The conventional treatment group was treated with percutaneous coronary intervention(PCI),and the thrombus aspiration group was treated with thrombus aspiration followed by PCI.After PCI,IMR of the criminal vessel was determined immediately by the pressure-temperature guide wire.The postoperative thrombolysis in myocardial infarction(TIMI) grade, corrected TIMI frame count(CTFC),and TIMI myocardial perfusion grade(TMPG) were assessed.Creatine kinase isoenzyme(CK-MB) level, cardiac troponin I(cTnI) peak level and ECG ST segment resolution(STR) were measured.Perfusion defect area(PDA) was examined by SPECT 7 days after PCI.The cardiac function was evaluated by echocardiography 24 h after myocardial infarction.The major adverse cardiac events and bleeding events within 3 months of follow-up were documented.Results In the thrombus aspiration group, the length of the implanted stent was longer, the dose of contrast medium was more, and the operation duration was longer than those in the conventional treatment group;the values of CK-MB,cTnI,and PDA were higher than those in the conventional treatment group(P<0.05).In the thrombus aspiration group, CTFC and IMR after stent implantation were higher than those in the conventional treatment group(P<0.05),LVEF was lower than that in the conventional treatment group(P<0.05).There were no significant differences in cardiogenic death, target vessel reconstruction events, stroke, and heart failure between the two groups(P>0.05).Conclusion For STEMI patients with l

关 键 词：急性ST段抬高型心肌梗死 急诊经皮冠状动脉介入治疗 微循环阻力指数 溶栓联合介入治疗 血栓抽吸 心肌梗死面积 

分 类 号：R542.22[医药卫生—心血管疾病]