冠状动脉内血栓抽吸治疗急性心肌梗死患者的有效性及安全性分析

目的评价急诊经皮冠状动脉介入（percutaneous coronary intervention，PCI）治疗使用血栓抽吸导管的有效性及安全性，同时对抽吸物成分进行病理分析探讨血栓抽吸临床获益的机制。方法选择梗死相关血管前向血流心肌梗死溶栓试验血流0～Ⅰ级的急性ST段抬高性心肌梗死患者62例，按电脑数字随机法分为血栓抽吸组加PCI治疗组30例和标准PCI治疗组32例。比较两组术后心肌梗死溶栓试验血流分级、心电图ST段回落指数、住院期间血清心肌钙蛋白Ⅰ浓度的变化及左心室射血分数值。通过测定血清心肌钙蛋白Ⅰ浓度峰值及左心室射血分数值，术后3个月主心血管事件（MACE）包括心源性死亡、急性心肌梗死或急诊血运重建等，对抽吸物有斑块组与无斑块组进行对比分析。结果两组基线情况和冠状动脉造影特征比较，差异无统计学意义（P〉0．05）。血栓抽吸组心电图ST段完全回落比例明显高于非抽吸组，差异有统计学意义（65．67％±11．34％ vs. 43．63％±10．76％，P〈0．05）。抽吸组即刻心肌梗死溶栓试验血流Ⅲ级患者比例高于非抽吸组，差异有统计学意义86．6％（26／30）vs．78．1％（25／32），P〈0．05]。两组的血清心肌钙蛋白浓度术前及术后14h浓度比较。差异无统计学意义（P〉0．05）。治疗3个月内两组均未发生主要心血管事件。抽吸物有斑块组术后14h血清心肌钙蛋白浓度及左心室射血分数高于无斑块组，差异有统计学意义（21．32±0．78）μLg／L vs（21．32±0．78）μg／L，P〈0．05；57．00％±9．00％vs. 59．00％±1．00％，P〈0．05]。结论急性ST段抬高性心肌梗死患者PCI治疗使用血栓抽吸可以有效清除血栓和部分斑块物质，可改善心肌再灌注和心功能。

Effectiveness and safety of thrombus aspination in patients with acute myocardial infarction during primary percutaneous coronary intervention

Objectives To investigate the effectiveness and safety of thrombus aspination before direct percutaneous coronary intervention （PCI）. Aspirates were analysed pathologically and the clinical impacts were investigated. Methods Sixty-two ST-segment elevation myocardial infarction patients with infarction related artery thrombolysis in myocardial infarction trial（TIMI） blood flow 0-Ⅰ grade were enrolled in this group. Thirty cases treated with aspiration plused PCI and 32 ceses treated standard PCI were divided randomly. TIMI grading, ST-fall index after surgery, cardiac treponin （cTnI） changes and left ventricular enjection fraction （LVEF） during hospitalization were compared. Clinical impacts were discussed througth measurement of cTnI peak value, LVEF, major adverse cardiac events （MACE） three months after surgery including cardiac death, acute myocardial infraction or acute blood stream reconstruction etc. The aspirate with plaque and aspirate without plaque were compared. Results Both groups had no significant difference in the basic situation and the characteristics of coronary artery angiography（P〉0.05）. The number of patients with over 50% electrocardiogram ST-fall were significantly higher in the aspiration group than in the non- aspiration group, and the difference had statistical significance （65.67%±11.34% vs. 43.63%±10.76%, P〈0.05）. The over 50% ST-fall in the instant aspiration group with grade TIMI Ⅲ was 86.6%（26/30）,the over 50% ST-fall in the non-aspiration group was 78.1% （25/32）, the results had statistic significance （P〈0.05）. Both groups had no cardiac events in the period of three months therapy. The cTnI and LVEF in the aspiration group were higher than those in the non-aspiration group, and the differencese had statistic significance （21.32±⒈0.78 ）μg/L vs. （21.32 ±0.78 ） μg/L, P〈0.05;57.00%±9.00% vs. 59.00%±1.00%,P〈0.051. Conclusions The thrombus aspiration before PCI in patients with ST-segment elevation myocardial infarction can eliminate the thrombi and partial plaques and improve the myocardial reperfusion and cardiac function.