摘要
[目的]探讨急性ST段抬高型心肌梗死（STEM I）血栓病变的直接经皮冠状动脉介入治疗（primary pecutaneouscoronary intervention,PPCI）中,先行血栓抽吸与常规PCI两种治疗策略对患者预后的影响。[方法]2007年2月~2009年8月连续入院、诊断为急性STEM I并接受直接PCI的患者共164例,随机分为先抽吸组（D组）与常规PCI组（P组）两组。比较两组治疗前后血栓积分、TIM I计帧分级、无复流现象的改善以及术后1周的射血分数,术后随访1年时无严重心脏不良事件（MACE）的累计生存率。[结果]抽吸前后D组较P组血栓负荷明显降低（P=0.011）。D组无复流现象的发生明显低于P组（9.6%对26.4%,P=0.008）,TIM I计帧血流（帧）明显改善[（23.15±7.57）对（27.03±7.81）,P=0.002]。支架植入后D组获得更大的管腔直径（mm）[（3.24±0.36）对（3.11±0.30）,P=0.01]与更短的支架长度（mm）[（24.26±11.45）对（29.19±13.69）,P=0.002]。术后1周射血分数（%）D组高于P组[（51.73±7.55）对（47.75±8.18）,P=0.002]。术后随访1年,D组再发心绞痛者明显低于P组,但两组再发心梗及死亡率差异无显著性意义。D组无MACE存活率明显高于P组（90.4%对75.8%,P=0.016）。[结论]急性ST抬高型心肌梗死血栓病变的直接PCI中,首先进行血栓抽吸与常规PCI相比,不仅能有效降低血栓负荷,增加心肌的有效灌注,而且改善患者预后,在血栓负荷较重的患者中应作为首选治疗措施。
[Objective] To compare the efficacy and prognosis of treatment between thrombus aspiration and conventional procedures during primary percutaneous coronary intervention（PPCI） in ST elevation myocardial infarction（STEMI） patients with coronary thrombus.[Methods] From February 2007 to August 2009,total 164 consecutive patients during PPCI were randomized to take initial treatment with thrombus aspiration first（D group） and conventional PCI（P group）.[Results] None of them had device-related complications.Compared to P group,D group achieved better results in TIMI thrombus grade（P=0.011）,TIMI Frame Count（P=0.002） without reflow phenomenon（9.6 % vs 26.4%,P=0.008）,and more lumen diameter[（3.24±0.365） mm vs（3.11±0.30） mm,P=0.01],less stent length[（24.26 ±11.45）mm vs（29.19 ±13.69）mm,P=0.002].Ejection fraction（EF%） of D group was improved[（51.73±7.55） vs（47.75±8.18）,P=0.002] in 1 week.Cumulative Survival with MACE free in D group was significant higher than that in P group（90.4% vs 75.8%,P=0.016） in 1 year follow-up.[Conclusions] Compared with conventional PCI,initial treatment thrombus aspiration first in patients with STEMI and coronary thrombus is safe and effective and improves prognosis in the patients.
出处
《大连医科大学学报》
CAS
2011年第3期235-239,共5页
Journal of Dalian Medical University
关键词
血栓抽吸
急性心肌梗死
预后
thrombus aspiration
ST elevation myocardial infarction
prognosis
