血栓抽吸导管在急性ST段抬高型心肌梗死患者的疗效研究

目的评价血栓抽吸导管在急性ST段抬高型心肌梗死(STEMI)患者经皮直接冠状动脉介入治疗(PCI)中的疗效。方法回顾性分析天津医科大学宝坻临床学院心内科2008年1月至2011年12月行直接PCI术中成功应用血栓抽吸导管的STEMI患者68例作为研究组,以同期行单纯直接PCI的STEMI患者122例作为对照组。评估PCI术后即刻心肌梗死溶栓试验(TI-MI)血流分级、TIMI心肌组织灌注分级(TMPG)及矫正的TIMI帧数(cTFC)、PCI术中无复流的发生率、直接支架置入率、PCI术后60min完全ST段回落率、肌酸激酶同功酶(CK-MB)和肌钙蛋白T(TNT)峰值、PCI术后7d左心室射血分数(LVEF)。结果研究组与对照组比较:PCI术后即刻TIMI 3级及TMPG 3级血流比例更高(分别为92.6%比77.9%,88.2%比70.5%,P均<0.01);cTFC帧数更少[(44.2±16.8)帧比(57.3±23.6)帧,P<0.01];无复流发生率低(7.4%比22.1%,P<0.01);直接支架置入率高(22.1%比9.0%,P<0.05);PCI术后60min完全ST段回落率高(82.3%比66.4%,P<0.05);CK-MB和TNT峰值低[分别为(171.4±44.6)U/L比(202.4±38.6)U/L,(5.36±1.81)ng/L比(6.48±1.94)ng/L,P均<0.01];PCI术后7dLVEF高[(56.6±7.9)%比(52.6±6.7)%,P<0.01)]。结论应用血栓抽吸导管可以增加急性STE-MI患者直接PCI术中的冠状动脉血流和心肌组织灌注,减少无复流现象的发生,减少心肌坏死,改善心功能,为STEMI患者直接PCI术中一种有效的治疗方法。

Clinical study of thrombus aspiration cathter in patients with acute ST-elevation myocardial infarction during primary percutaneous coronary intervention

Objective To investigate the clinical effect of thrombus aspiration cathter in patients with acute ST-elevation myocardial infarction(STEMI) during percutaneous coronary intervention(PCI).Methods From January 2008 to December 2011,68 patients with acute STEMI who underwent primary PCI were treated with thrombus aspiration cathter as study group,122 patients with acute STEM patients during the same period who underwent primary PCI were treated routinely as control group.Thrombolysis in myocardial infarction(TIMI) flow grade,TIMI myocardial perfusion grade(TMPG),corrected TIMI frame count(cTFC),the rate of occuring no-reflow phenomenon and directly implanting stents,complete ST-segment elevation resolution at 60 minutes after PCI,the peak of creatine kinase-MB(CK-MB) and troponin T(TNT),left ventricle ejection fraction(LVEF) in one week after PCI were all compared between the two groups.Results Compared with the control group,the study group was significantly better TIMI 3 and TMPG 3 flow degree(92.6%vs.77.9%,88.2%vs.70.5%,P<0.01),higher cTFC[(44.2±16.8)vs.(57.3±23.6),P<0.01],lower the rate of no-reflow phenomenon(7.4%vs.22.1%,P<0.01) and higher the rate of directly implanting stents(22.1%vs.9.0%,P<0.05).The complete ST-segment resolution at 90 minutes after PCI was significantly higher in the study group than the control group(82.3%vs.66.4%,P<0.05).The peak of CK-MB and TNT were significantly lower in the study group than the control group[(171.4±44.6)U/L vs.(202.4±38.6)U/L,(5.36±1.81)ng/L vs.(6.48±1.94)ng/L,P<0.01].Compared with control group,the study group enhanced LVEF during one week after PCI [(56.6±7.9)% vs.(52.6± 6.7)%,P<0.01].Conclusion Thrombus aspiration cathter in patients with acute STEMI during primary PCI could improve coronary arterial blood flow and myocardial tissue perfusion,decrease myocardial infarction and no-reflow phenomenon and improve myocardial function.It may be effective treatment way in patients with acute STEMI during primary PCI.