急性ST段抬高型心肌梗死应用血栓抽吸和静脉溶栓开通冠脉的疗效比较

目的 比较急性ST段抬高型心肌梗死（STEMI）患者经导管血栓抽吸和静脉溶栓两种方法对择期PCI即刻及近期疗效的差异.方法 回顾分析2009年1月至2012年1月收治的60例急性STEMI且符合梗死相关动脉（IRA）高血栓负荷患者的临床资料.其中14例通过反复抽吸血栓使IRA血流恢复TIMI 3级,设为抽吸组;22例成功静脉溶栓患者,设为溶栓组.依其IRA的残余狭窄病变（RSL）及非IRA以外的罪犯相关病变（CRL）的冠脉造影,狭窄程度≥70％为冠脉支架置入标准,比较两组IRA的RSL病变与非IRA的CRL病变处理的差异、冠脉TIMI血流分级及心肌灌注呈色（BMG）显像分级的差异、即刻效果、1个月时心功能的差异及MACE差异.结果 IRA及CRL的病变分布及形态、支架置入无复流、支架特征（个数、直径、长度）、支架直接置入率、高压球囊使用率、最后扩张压力等指标,两组比较差异无统计学意义（P＞0.05）,但MBG达到3级者抽吸组明显优于溶栓组（93.0％比63.6％,P＜0.05）.1个月时左室直径、EF值、血浆BNP和hs-CRP,抽吸组均明显优于溶栓组（均P＜0.05）,两组均无MACE事件发生.结论 对高血栓负荷的STEMI患者进行单纯急诊血栓抽吸,择期PCI较静脉溶栓开通后择期PCI效果好,也是安全的.

Efficacy comparison of opening infracted relevant artery by catheter aspiration thrombus or intravenous thrombolysis for patients with acute ST-elevation myocardial infarction

Objective To evaluate the effect instantly and short period of catheter aspiration thrombus and intravenous thrombolysis on elective PCI for patients with acute ST-elevation myocardial infarction （STEMI）.Methods A total of 60 patients from January 2009 to January 2012 diagnosed as acute STEMI with high thrombus burden of the infracted relevant artery （IRA）,of which 14 cases achieved TIMI 3 grade only using catheter thrombus aspiration,and thought as thrombus aspiration group,22 cases reopened successfully IRA by the diug as intravenous thrombolysis group.The standard of implanting stent was remain stenosis lesion （RSL） of IRA and culprit relevant lesion （CRL） of no-IRA with the diameters stenosis ≥70％ by coronary arteriongraphy （CAG）,then compared characteristic differences of RSLs and CRLs,coronary flow TIMI grades and blush myocardium grades （BMG）,the immediate efficacy and heart ultrasound index 1 month after the procedure,MACE rates in followup.Results The distribution and shape of RSLs and CRLs,no-reflow rate after stent implanted,the feature of stent （amount,diameter,length）,stent directly implanted rate,after dilatation balloon used rate and the pressure of stent final dilatated,there were not significant difference in the 2 groups （P＞0.05）.The cases achieved MBG 3 were more in catheter aspiration group （P＜0.05）.The LVEDd and LVEF,plasma hs-CRP and BNP value were better in catheter aspiration group,there were significant difference in the 2 groups （P＜0.05）.There were not MACE in 2 groups during follow-up.Conclusion It is more effective and safe in short period that priority opening IRA by catheter aspiration thrombosis than intravenous thrombolysis for acute STEMI with high thrombus burden.