经皮冠状动脉介入术联合经皮血栓吸除术治疗急性心肌梗死的临床评价

目的 评价经皮冠状动脉介入术(PCI)联合经皮血栓吸除术治疗急性心肌梗死(AMI)的疗效.方法 56例AMI患者随机分为PCI组(n=28)和PCI联合血栓吸除术组(n=28).于PCI术后24小时、1周行实时心肌声学造影(RT-MCE),记录各组灌注对比积分指数(CSI)、室壁运动积分指数(WMSI)、透壁性对比缺损长度(CDL)和严重室壁运动异常长度(WML).采用免疫散射比浊法测定血浆超敏C-反应蛋白(hs-CRP)水平,酶联免疫吸附法测定血浆N-末端脑利钠肽(NT-ProBNP)和基质金属蛋白酶-9(MMP-9)水平.结果 各时间点PCI联合血栓吸除术组CSI、WMSI、CDL和WML明显低于PCI组(P＜0.05).术后1周PCI联合血栓吸除术组血浆hs-CPR和NT-ProBNP水平低于对照组(4.56±1.98)mg/L比(5.96±2.03)mg/L,P＜0.05;(544.7±185.3)pmol/L比(897.6±215.9)pmol/L,P＜0.01],血浆MMP-9无明显升高(672.7±175.9)μg/L比(609.6±196.5)μg/L,P＞0.05].结论 与PCI组相比,PCI联合经皮血栓吸除术可明显减少术后无再流的发生,改善微循环和心脏功能,是治疗AMI的有效方法.

The efficacy of percutaneous coronary intervention combined percutaneous thrombectomy on coronary thrombotic lesions in patients with acute myocardial infarction

OBJECTIVE: To evaluate the efficacy of percutaneous coronary intervention (PCI) combined percutaneous thrombectomy on coronary thrombotic lesions in patients with acute myocardial infarction (AMI). METHODS: PCI were performed in 56 patients with AMI and positive coronary thrombus shown by angiography and these patients were randomly divided into PCI therapy group (n = 28) and PCI combined percutaneous thrombectomy group (n = 28). Real-time myocardial contrast echocardiography (RT-MCE) was performed at 24h and 1 week after PCI. Contrast score index (CSI), regional wall motion score index (WMSI), endocardial length of contrast defect (CDL), and wall motion abnormality (WML) were calculated. The plasma level of hs-CRP was measured by immunonephelometry. The plasma concentration of N-terminal proB-type natriuretic peptide (NT-proBNP) and matrix metalloproteinase-9 (MMP-9) were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS: CSI, WMSI, CDL and WML at 24 hours and 1 week post procedure as well as the levels of hs-CPR and NT-proBNP at 1 week post procedure (4.56 +/- 1.98) mg/L vs. (5.96 +/- 2.03) mg/L, P < 0.05; (544.7 +/- 185.3) pmol/L vs. (897.6 +/- 215.9) pmol/L, P < 0.01] were significantly lower in PCI combined percutaneous thrombectomy group than those in PCI group in various time points. There were no differences in the plasma level of MMP-9 between the two groups (672.7 +/- 175.9) microg/L vs. (609.6 +/- 196.5) microg/L, P > 0.05] at 1 week after PCI. CONCLUSIONS: PCI combined percutaneous thrombectomy can significantly reduce no-reflow phenomenon, improve microcirculation and myocardial dysfunction. Thus PCI combined percutaneous thrombectomy is a feasible therapy in patients with AMI.