血栓抽吸联合替罗非班对急性ST段抬高心肌梗死患者心肌再灌注的影响

目的 探讨急性ST段抬高心肌梗死急诊经皮冠状动脉介入治疗（PCI）中联合应用ZEEK血栓抽吸导管和替罗非班对心肌组织灌注及临床预后的影响.方法 84例经冠脉造影证实为血栓负荷病变的急性ST段抬高心肌梗死患者随机分为血栓抽吸＋替罗非班42例（A组）和标准PCI 42例（B组）,比较两组患者手术后即刻梗死相关动脉（IRA）的心肌梗死溶栓（TIMI）血流、心肌灌注分级（MBG）、心电图ST段回落百分比、左心室射血分数（LVEF）及住院期间主要心脏不良事件（MACE）和出血性并发症发生率.结果 A组术后即刻TIMI血流、MBG、ST段抬高回落百分比及LVEF均明显优于B组（P〈0.05）,两组住院期间的MACE发生率及出血并发症比较差异无统计学意义（P〉0.05）.结论 在急性心肌梗死急诊PCI中联合使用ZEEK导管血栓抽吸和替罗非班安全可行,可有效清除冠状动脉内血栓,改善心肌组织灌注和术后心脏功能,并且不增加主要心脏不良事件的发生率.

The efficiency and safety of the Zeek aspiration thrombectomy catheter and tirofiban in primary percutaneous coronary intervention of acute myocardial infarction

Objective To assess the effect of the Zeek aspiration thrombectomy catheter and tirofiban in the myocardial reperfusion and clinical prognosis in patients with acute ST-segment elevation myocardial infarction （AMI） who were undergone primary percutaneous coronary intervention （PCI）. Methods 84 patients of AMI with thrombotic burden lesion confirmed by coronary angiography were randomly divided into the aspiration catheter and tirefiban group （n=42） and standard percutaneous coronary intervention （PCI） group （n=42）. Compared the TIMI flow grade, myocardial blush grade （MBG）, ST segment resolution, left ventricular ejection fraction （LVEF） post PCI, hemorrhage and major adverse cardiac events（MACE） rate during hospitalization between two groups. Results Compared with control group, TIMI flow grade, MBG and high LVEF improved in study group, while the difference of MACE and haemorrhage rate during hospitalization were no significant. Conclusion In AMI patients treated with primary PCI, Combination of thrombus aspiration and tirofiban was safe and effective, which could lower thrombosis burden, improve distal myocardium pdrfusion and cardiac function after procedure, does not increase the incidence of MACEs.