血管内超声在ST段抬高型心肌梗死患者急诊介入诊疗中的应用研究

目的探讨血管内超声（IVUS）在ST段抬高型心肌梗死（STEMI）患者急诊介入诊疗中的应用价值。方法对入选的100例STEMI患者行冠脉造影（CAG），根据CAG结果对梗死相关血管行血栓抽吸术或经皮冠状动脉腔内成形术（PTCA）。试验组52例应用IVUS评价梗死相关血管最小管腔面积、斑块性质及是否夹层，决定是否置入支架，以及是否达到支架置入术后IVUS满意标准，如没有，则进一步干预，直到满意。对照组48例根据CAG结果决定是否置入支架，以及支架置入术后是否达到CAG的满意标准，如果没有，则进一步干预，直到满意。结果支架置入术后即刻梗死相关血管远端TIMI血流，术后1个月、3个月、6个月主要心血管不良事件，临床心功能（NYHA分级）及EF值两组比较差异无统计学意义（P〉0．05）。试验组未出现与IVUS相关的严重并发症，支架置入率低，与对照组相比差异有统计学意义（P〈0．05）。结论在STEMI患者急诊介入诊疗中应用IVUS是安全的、可行的，支架置入率低。

The application research of IVUS in emergency PCI to STEMI patients

Objective Explore application of intravascular ultrasound （IVUS） in patients with ST-segment elevation myocardial infarction （STEMI） undergoing primary PCI. Methods In 100 cases of patients with STEMI were undergoing coronary angiography （CAG）. According to the resuhs of the CAG, the related blood vessels have be operated by thrombosis suction technique or percutaneous coronary arterial lumen angioplasty（PTCA ）. Treatment group 52 cases of application IVUS evaluated infarction related vascular minimum pipe cavity area plaque properties, decided whether plant stents, and evaluated whether the stents were satisfied, and then further intervention until satisfaction. Control group 48 cases according to the CAG results decided whether plant stents, and evaluated whether the stents were satisfaction standard, and if not, further intervention was underwent until satisfaction. Results Observe immediate infarction of the related blood vessels distal TIMI flow after intracoronary stenting. The major cardiovascular adverse events, clinical cardiac function （NYHA classification） and EF value were evaluated after 1, 3 and 6 months, and there were no obvious difference between the two groups （P〉0.05）. The test group did not appear serious complications associated with IVUS. Test group stenting rate was low, there was statistical significance （P〈0.05）. Conclusion IVUS in emergency interventional diagnosis and treatment of patients with STEMI is safe and feasible, stents rate is low.