血栓抽吸联合经皮腔内冠状动脉成形术治疗急性心肌梗死的疗效研究

目的了解在血栓负荷重的STEMI患者中血栓抽吸联合经皮腔内冠状动脉成形术的疗效,比较延迟支架置入与即刻支架置入两种方法对患者住院期间临床疗效的影响。方法分析我院心内科2009年8月—2011年8月因STEMI就诊,接受急诊介入手术治疗的55例患者。根据冠状动脉内介入治疗方法的不同分为:急诊血栓抽吸联合经皮腔内冠状动脉成形术(PTCA)+延迟支架置入术组(A组),PTCA+延迟支架置入术组(B组),急诊直接支架置入术组(C组)。比较3组住院期间发生支架内血栓、死亡、恶性心律失常、急性左心力衰竭、心源性休克的情况。结果3组住院期间心脏事件发生率分别为3%、8%和15%,死亡分别为0、3和3例,术后急性期支架内血栓1例,发生在C组,各组间比较差异无统计学意义(P>0.05);A组和B组发病10～14d行冠状动脉造影发现罪犯血管再次闭塞2例,发生在B组;罪犯血管远端达到TIMI血流Ⅲ级共17例(68%),分别为A组11例(73.3%),B组6例(60%),组间比较差异无统计学意义(P>0.05)。结论在STEMI急诊介入手术中对血栓负荷较重而不宜予支架置入治疗的患者,选择急诊血栓抽吸+经皮腔内冠状动脉成形术恢复罪犯血管血流,并在发病10d左右进行延迟支架置入术安全可靠,效果优于单纯直接支架置入术治疗。

Clinical Observation for Treatment of Acute Myocardil Infarction by Percutaneous Transtuminal Coronary Angioplasty Combining with Catheter Aspiration Coronary Thrombus

Objective To compare the outcomes of primary stenting and delayed stenting and delayed stenting in patients with acute ST elevation myocardial infarction(STEMI)after successful percutanecus transtuminal coronary angiopiasty(PTCA);To observe the efficacy of treatment combining percutaneous transtuminal coronary angioplasty with catheter aspiration coronary thrombus in patients with acute myocardial infarction.Methods We reviewed 55 STEMI patients who had done with primary PCI.Based on treating with the tirofiban,the patients were arranged into 3 groups,including thrombus aspiration combining with PTCA and delayed stenting group(A group)and only PTCA+delayed stenting group(B group);Primary stenting group(C group).We compared the different targets among the 3 groups,including stent thrombosis,death,malignant ventricular arrhythmia,acute leftsided heart failure(ALHF),myocardiogenic shock.Results During the hospitalization,the incidence rates of cardiac events were 3%,8%and 15%,and the fatality number were 0,3 and 3 in A group,B group and C group;One patient had stent thrombosis in C group which didn′t show significant differences(P>0.05);Recurrented stenosis in target artery occurred in 2 patients only in B group.Rate of Ⅲ grades of TIMI flow were 73.3%,60% in A and B group,which didn′t show significant differences(P>0.05).Conclusion The therapy of thrombus aspiration combining with PTCA and delayed stenting is safe and effective for acute myocardial infarction complicated with coronary artery thrombus.