经皮冠状动脉腔内血栓抽吸术在急性心肌梗死治疗中应用效果的观察

目的：观察经导管血栓抽吸（PT）术用于急性心肌梗死（AMI）的疗效。方法：将AMI患者随机分为单纯经皮冠状动脉腔内成形术组（PCI组）和PT＋PCI组。单纯PCI组常规经皮冠状动脉腔内球囊扩张术（PTCA）后置入冠脉内支架或直接置入冠脉内支架;PT＋PCI组常规PTCA方法选择指引导管,导丝通过病变后,经导丝直接送入Diver抽吸导管至病变部位,反复抽吸至血栓影消失或明显减少,然后直接置入冠脉内支架或常规PTCA方法后置入冠脉内支架。比较两组梗死相关血管（IRA）的血流和心肌灌注差别,比较两组ST回落率、直接支架率,并随访住院期间及出院后心血管事件。结果：PT＋PCI组抽吸导管均通过病变,血栓抽吸后即刻血栓影消失或明显减少,前向血流恢复、梗死部位心肌组织的再灌注及ST回落率、直接支架率均优于单纯PCI组。结论：PT术是处理冠脉内血栓的一种简单有效的方法,初步观察可以改善AMI患者IRA的血流和心肌灌注。

Effect of transcatheter aspiration of coronary thrombus in patients with acute myocardial infarction

Objective:We introduced the effect of transcatheter aspiration of coronary thrombus during emergency PCI in acute myocardial infarction patients.Methods:AMI patients with intra coronary thrombus were selected.The patients were divied into two groups:PCI and PT+PCI.In the PCI groups stents were directly implanted after PTCA.In the PT+PCI groups we used the common coronary wire across the lesion after guiding catheter to the ostium of coronary arteries.Aspiration catheter(DIVER) was directly advanced over the wire to the lesion and aspirated the thrombus.After thrombus disappeared,stent were directly implanted or after PTCA stent were directly implanted.Comparing the differents of the epicardial flow,tissue-level perfusion flow and the rate of descendent level of ST-segment.Results:Thirty five cases of AMI patients received the PCI or PT+PCI treatment.In the PT+PCI group,the coronary re-opened and thrombus disappeared after aspiration.And the epicardial flow,tissue-level perfusion flow and the rate of descendent level of ST-segment were all superior to the PCI group.Conclusion:Transcatheter aspiration of coronary thrombus is a simple and effective method to manage the acute myocardial infarction patients.It maybe improve AMI patient's tissue-level perfusion.