AngioJet流体溶血栓吸引术对急性心肌梗死血栓性病变的疗效  

AngioJet rheolytic thrombectomy in coronary thrombotic lesion for patients with acute myocardial infarction

作　　者：刘海波[1] 高润霖[1] Richard A Clugston Jamie M Rankin Geoffrey Mews Geoffrey DCope 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院,北京100037 [2]Department of Cardiology,Royal Perth Hospital

出　　处：《中华心血管病杂志》2002年第12期732-734,共3页Chinese Journal of Cardiology

摘　　要：目的　AngioJet流体溶血栓吸引术是通过流体击碎并吸引冠状动脉内血栓而将其移出体外的一种新的冠状动脉介入治疗技术。本研究以TIMI心肌灌注级别作为疗效指标评价该技术对急性心肌梗死血栓性病变的疗效。方法　选择澳大利亚皇家珀斯医院 2 0 0 0年 1月至 2 0 0 1年 1月所有冠状动脉造影明确显示血栓性病变的急性心肌梗死患者共 2 8例作为研究对象。其中 1 3例患者于支架置入术前进行了AngioJet流体溶血栓吸引术 (AngioJet组 ) ,而另 1 5例患者只行直接支架置入术(支架组 )。重点比较两组患者之间治疗前后心表面冠状动脉TIMI血流及TIMI心肌灌注级别 (后者与预后有强烈的相关性 )的变化。结果　支架组术后心表面冠状动脉TIMI血流及TIMI心肌灌注级别均明显优于AngioJet组 (分别为 2 60± 0 0 9vs 2 2 3± 0 1 6 ,P =0 0 4 2及 2 50± 0 1 1vs 1 92± 0 2 3 ,P=0 0 2 4 )。AngioJet组冠状动脉穿孔的例数显著多于支架组 (分别为 3例及 0例 ,P =0 0 4 9)。结论对于急性心肌梗死血栓性病变 ,支架置入术治疗可获得良好疗效 ;支架置入前采用AngioJet流体溶血栓吸引术并不增加疗效 。Objective AngioJet rheolytic thrombectomy (ART) is intended for removing thrombus in the treatment of coronary artery disease with thrombotic lesion This study was to evaluate the safety and efficacy of ART in the treatment of patients with both acute myocardial infarction (AMI) and thrombotic lesions Methods Twenty eight patients with AMI and angiographically evident coronary thrombus were included in this study between January 2000 and January 2001 in Royal Perth Hospital (Australia) The patients were divided into 2 groups according to different treatment strategy: (1) ART prior to stent placement (AngioJet group, n =13); (2) Primary coronary stenting (stent group, n =15) Epicardial TIMI flow, myocardial (tissue level) flow (which has strong prognostic significance for AMI), and procedural adverse events were compared between two groups by t test Results Both postprocedural epicardial TIMI flow and postprocedural myocardial flow in stent group were significantly better than those in AngioJet group (2 60±0 09 vs 2 23±0 16, P =0 042 and 2 50±0 11 vs 1 92±0 23, P =0 024, respectively) The incidence of coronary perforation in AngioJet group was significantly higher than that in stent group (3 cases and 0 case, respectively, P =0 049) Conclusions In the treatment of patients with AMI and thrombotic lesions, primary coronary stenting is safe and effective AngioJet rheolytic thrombectomy prior to stent placement is not superior to primary stenting and may have some potential adverse effects

关 键 词：AngioJet流体溶血栓吸引术 急性心肌梗死 疗效 冠状动脉血栓形成 AMI 

分 类 号：R542.22[医药卫生—心血管疾病]