急性心肌梗死患者冠状动脉内抽吸物成分与再灌注水平的关系

目的通过对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术中的抽吸物成分进行病理分析,研究不同抽吸物成分与心肌水平再灌注的关系。方法连续入选STEMI并行急诊PCI的患者150例,其中男性96例,女性54例。术者根据术中情况进行血栓抽吸。抽吸物用福尔马林固定后24 h内送病理科,行光学显微镜检查。根据病理检查结果将患者分为3组:血栓组、斑块组、混合组。分析3组患者的临床情况。结果 150例患者中,因病变迂曲钙化抽吸导管不能通过病变处致抽吸失败的4例,抽吸后未见固态物质未送病理检查的15例。资料完整者131例,其中男性87例,女性44例。抽吸成功率87.33%。3组患者TMP分级0²级的发生率:血栓组:43.86%(25/57),斑块组:14.81%(4/27),混合组:17.02%(8/47),多因素非条件Logistic分析结果显示,抽吸物病理结果为斑块成分是与急诊PCI术后心肌灌注水平关系密切的因素(OR:3.412,P=0.011)。结论 STEMI患者通过抽吸清除斑块成分对改善心肌灌注具有重要作用。

Relationship between myocardial reperfusion and intracoronary aspiration ingredients in patients with acute myocardial infarction undergone primary percutaneous coronary intervention

Objective To study the relationship between myocardial reperfusion and intracoronary aspiration ingredients in patients with acute ST- segment elevation myocardial infarction（ STEMI） undergone primary percutaneous coronary intervention（ PCI）. Methods Aspiration catheter was used in 150 consecutive patients（ 96 males and 54 females） with STEMI undergoing primary PCI. Filtered,aspirated materials were fixed in formalin for 24 hours. Histological sections were prepared and stained with hematoxylin and eosin for examination. According to the pathological findings,patients were divided into 3groups： thrombus group,plaque group and mixed group. Clinical data and myocardial reperfusion were analyzed and compared among the three groups. Results Aspiration catheter was successfully reached the lesion in 97. 3%（ 146 /150） of the patients,and no materials obtained in 15 cases. Effective thrombus aspiration was done in 87. 33%（ 131 of 150） of the patients. The rates of coronary flow less than TMP class3 in criminal vessel were 43. 86%（ 25 /57）,14. 81%（ 4 /27） and 17. 02%（ 8 /47） in thrombus group,plaque group and mixed group,respectively. Multivariate and non-conditional Logistic analysis showed that plaque components were closely related with the level of myocardial reperfusion after primary PCI（ OR：3. 412,P = 0. 011）. Conclusions Intracoronary aspiration plays an important role in improving myocardial reperfusion in patients with STEMI undergone primary PCI.