摘要
目的 探讨抽吸导管抽吸血栓是否增加不同血栓负荷的急性心肌梗死患者置入支架后梗死相关动脉血流.方法 所有入选患者据血栓分级是否≥4级分为血栓负荷高、低2组,然后每组据是否应用抽吸导管抽吸血栓治疗随机再分为2组,共4亚组.测定术后相关动脉心肌梗死溶栓（TIMI）血流分级、校正TIMI帧数、心电图ST段回落以及术后5～7 d射血分数,观察住院期间和1个月主要不良心血管事件.结果 高血栓负荷的靶病变长度和植入支架数量高于低血栓负荷组[分别为（36.4±15.1）、（31.4±13.7）mm（t=-2.16,P〈0.05）;45、30例（χ^2=5.9221,P〈0.05）];高血栓负荷最终TIMI血流≥3级（分别为32、23例,χ^2=5.3299,P〈0.05）、心肌显影≥3级（分别为30、19例,χ^2=6.9509,P〈0.05）、ST段回落百分比≥50%（分别为31、18例,χ^2=9.7082,P〈0.05）血栓抽吸者多于未行血栓抽吸者.但在低血栓负荷亚组除ST段回落百分比≥〉50%外（χ^2=4.6590,P〈0.05）,TIMI血流和心肌显影分级未达到统计学意义水准.高负荷组左室射血分数抽吸血栓组高于未抽吸血栓组[分别为（58.7±7.8）%、（52.3 ±8.9）%,t=3.23,P〈0.05],低负荷组左室射血分数抽吸血栓组高于未抽吸血栓组[分别为（59.1 ±7.6）%、（55.1 ±9.8）%,t=2.07,P〈0.05];住院期间抽吸血栓组总的主要心血管事件发生率低于未抽吸血栓组（χ^2=4.0332,P=0.0446）,且仅高负荷亚组显示统计学差异趋势（χ^2=3.5625,P=0.0591）.结论 血栓抽吸提高高血栓负荷患者冠脉血流灌注,改善术后患者近期预后.
Objective To examine whether Diver DE aspiration increasing hish TIMI thrombus grade artery flow in acute ST-elevation myocardial infarction （ASTEMI） undergoing primary PCI.Methods All patients were grouped by the thrombus grades into two groups：high thrombus load group and low thrombus load group,and the patients in the above two groups were further randomly assigned,according whether need aspiration,to aspiration group and no aspiration group.TIMI,adjusted TIMI numbers of frames,resolution of maximal ST-segment elevation,and LVEF were calculated in 5-7 days after operation;Major adverse cardiovascular events（MACE） were tracked during hospitalization and in one month following-up.Results The length of target lesions is longer,the numbers ofbracket is more,in the high thrombosis load group （（36.4±15.1）mm,45） than the low load group （（31.4±13.7）mm,30） （t=-2.16,χ^2=5.9921,P〈0.05）.TIMI blood flow above grade 3（χ^2=5.3299,P〈0.05）,myocardialvisualization greater than grade 3（χ^2=6.9509,P〈0.05）,and ST segment resolution greater than 50%（χ^2=9.7082,P〈0.05） is different between aspiration group and non-aspiration group in these with 0high thrombosis loads.But apart from the ST resolution（χ^2=4.6590,P〈0.05）,the other indexes were not significantly different in the low thrombosis load group.LVEF is higher in aspiration group than in non-aspiration group,in the high thrombosis load group（（58.7±7.8）% vs.（52.3±8.9）%）（t=3.23,P〈0.05） and in low thrombosis load group（（59.1±7.6）% vs.（55.1 ±9.8）%）（t=2.07,P〈0.05）.It was found that a significant decrease of MACE rate in total aspiration group compared with no aspiration group（χ^2=4.0332,P=0.0446）,and there was only a lower trend in high thrombus level between two groups（χ^2=3.5625,P=0.0591）.Conclusiom Diver CE aspiration,increasing infarction related artery flow,would improve the prognosis of ASTEMI following primary percutaneous coronary intervention.
出处
《中国综合临床》
2010年第4期391-394,共4页
Clinical Medicine of China
关键词
心肌梗死
介入治疗
血栓抽吸
血栓负荷
Myocardial infarction
Pereutaneous coronary intervention
Thrombus aspiration
Thrombus load
