不同治疗方法在急性ST段抬高型心肌梗死患者急诊冠状动脉介入术中的疗效观察

目的探讨不同治疗方法在急性ST段抬高型心肌梗死（STEMI）行急诊经皮冠状动脉介入治疗（PCI）的疗效。方法观察2012年8月至2013年10月因急性STEMI行急诊PCI，并符合纳入条件的梗死相关血管（IRA）高血栓负荷患者67例，按随机数字表法分为治疗组（静脉应用替罗非班，PCI中行血栓抽吸，联合替罗非班经血栓抽吸导管冠状动脉内注射）35例，对照组（单纯行PCI，仅静脉应用替罗非班）32例。观察两组患者术后罪犯血管心肌染色分级（MBG），术后1．5h心电图最高导联ST段回落百分比（STR）≥50％比率；术后2周及3个月时左心室射血分数（LVEF）和左心室舒张末期内径（LVEDd）的变化；比较两组出血率及主要心脏不良事件（MACE）发生率。结果术后罪犯血管MBG2～3级比例治疗组多于对照组60．0％（21／35）比43．8％（14／32）]，差异有统计学意义（P〈0．05）；术后1．5h心电图最高导联STRl〉50％比率治疗组高于对照组71．4％（25／35）比46．9％（15／32）]，差异有统计学意义（JP〈0．05）；两组患者术后2周LVEDd比较差异无统计学意义（P〉0．05），但LVEF治疗组高于对照组（54．2±5．7）％比（44．7±6．1）％]，差异有统计学意义（P〈0．05）。术后3个月LVEDd治疗组小于对照组（46．5±4．9）mm比（57．1±5.3）mm]，差异有统计学意义（P〈0．05），LVEF治疗组高于对照组（60．5±4．5）％比（43．6±5．7）％]，差异有统计学意义（P〈0．05）。两组患者术后出血情况及MACE发生率比较差异无统计学意义（P〉0．05）。结论STEMI患者急诊PCI中应用血栓抽吸并经血栓抽吸导管冠状动脉内给予替罗非班可增加心肌水平的血流灌注，减少心肌损伤，改善近期预后。

The effect of different treatment methods in patients of acute myocardial infarction with emergency percutaneous coronary intervention

Objective To explore the effect of different treatment methods in patients of acute ST-segment elevation myocardial infarction （STEMI） with emergency percutaneous coronary intervention （PCI）. Methods Sixty-seven patients with high blood clots load in infarction related artery （IRA） and performed emergent PCI because of STEMI from August 2012 to October 2013 were enrolled. They were divided into treatment group （intravenous tirofiban,PCI boc thrombus suction, tirofiban injection via thrombus suction catheter coronary artery injection, 35 cases） and control group （PCI simple, intravenoustirofiban,32 cases）. The myocardial dyeing classification （MBG） with postoperative criminal vascular, ST-segment elevation resolution （STR） ≥ 50 % in electrocardiogram after 1.5 h treatment and the changes of left ventricular ejection fraction （LVEF） and left ventricular end-diastolic diameter （LVEDd） after 2 weeks and 3 months treatment were observed in two groups. The bleeding rate and incidence of major adverse cardiac events （MACE） were compared between two groups. Results The ratio of MBG 2 - 3 grade of postoperative criminal vascular in treatment group was more than that in control group 60.0% （21/35） vs. 43.8%（ 14/32 ） ], and there was significant difference （P 〈 0.05 ）. The ratio of STR ≥ 50% in electrocardiogram after 1.5 h treatment in treatment group was higher than that in control group 71.4% （25/35） vs. 46.9% （ 15/32 ） ], and there was significant difference（P 〈 0.05 ）. There was no significant difference in LVEDd after 2 weeks treatment between two groups （P 〉 0.05）,but LVEF in treatment group was higher than that in control group （54.2± 5.7 ）% vs. （44.7 ± 6.1 ）% ], and there was significant difference （P 〈 0.05 ）. LVEDd after 3 months treatment in treatment group was less than that in control group （46.5±4.9） mm vs. （57.1± 5.3） mm] and LVEF in treatment group was higher than that in control group （60.5 ±4.5