抽吸导管在急性ST段抬高型心肌梗死直接经皮冠脉介入治疗中的疗效观察

目的评价抽吸导管在急性ST段抬高型心肌梗死（STEMI）直接经皮冠脉介入治疗（PCI）中的疗效。方法随机入选行急诊PCI的急性STEMI患者80例，其中使用抽吸导管后行支架置人术32例（抽吸导管组），未使用抽吸导管而行球囊扩张及支架置人术48例（直接PCI组）。观察两组术后即刻TIMI血流分级、无复流现象、术后即刻胸痛缓解率、术后1hST段回落≥50％（STR≥50％）发生率和心梗后24h及2周左室舒张末径（LVDD）、左室射血分数（LVEF）。结果抽吸导管组即刻TIMI血流2-3级高于直接PCI组（94％比75％，P〈0．05），抽吸导管组无复流现象低于直接PCI组；抽吸导管组术后1hSTR≥50％、胸痛缓解率均高于急诊PCI组（94％比71％、88％比71％，均P〈0．05）；抽吸导管组心梗后24hLVDD低于直接PCI组（54．2±4．1）mm比（56．2±4．2）mm，P〈0．05]，心梗后24hLVEF高于直接PCI组（57．6＋5．24）％比（55．0±4．6）％，P〈0．05]，梗后2周LVDD及LVEF两组间差异无统计学意义。结论急诊PCI时联合使用抽吸导管可减少无复流发生，改善心肌再灌注及心肌梗死早期心功能。

The efficacy of thrombus aspiration catheter applied primary percutaneous coronary intervention in patients with acute ST elevation myocardial infarction

Objective To estimate the efficacy of thrombus aspiration catheter applied in primary percutaneous coronary intervention （PCI） in patients with ST elevation myocardial infarction （STEMI）. Methods 80 patients with STEMI underwent PCI were divided into two groups： 32 patients who were treated with thrombus aspiration catheter before PCI （thrombus aspiration group） and 48 patients who underwent intervention without thrembus aspiration device （PCI group）. TIMI flow grade, no-flow, angina resolution, ST segment resolution （STR） ≥50%, the left ventricular end diastolic diameter and the left ventricular ejection fraction （LVEF） of 24 hours after MI （24 h LVDD, 24 h LVEF）, LVDD and LVEF of 2 weeks after MI （2 weeks LVDD, 2 weeks LVEF） were observed. Results The indexes were improved in the thrombus aspiration group compared with PCI group： TIMI 2-3 grade （94% vs 75%）, STR≥50%（94% vs 71%）, angina resolution （88% vs 71%）, 24 h LVDD （54.2±4.1）mm vs （56.2±4.2）mm, 24 h LVEF （57.6±5.24）% vs （55.0±4.6）%（all P〈0.05）]. No significant difference existed between the two groups in the level of 2 weeks LVDD and 2 weeks LVEF. Conclusion The application of thrembus aspiration catheter during primary PCI ean decrease no-flow and improve myocardial perfusion and early heart function in patients with STEMI.