CAJ | 학술논문

目的观察在急性ST段抬高的心肌梗死(STEMI)急诊介入术中应用血栓抽吸导管进行血栓抽吸的临床疗效.方法 2008年6月至2010年6月行急诊经皮冠状动脉介入术的患者96例,完全随机分为研究组(50例)和对照组(46例).2组均采取直接支架置入或球囊预扩张后置入支架.研究组此之前沿导丝送人ZEEK血栓抽吸装置至病变部位负压抽吸.观察2组的手术情况、术后效果.结果研究组发病距血管再通时间、直接支架置入率和术后达心肌梗死溶栓试验(TIMI)3级血流情况[分别为(5.1±2.3)h、44.0%(22/50)、92.0%(46/50)]明显好于对照组[分别为(6.2±3.5)h、30.4%(14/46)、82.6%(38/46)],无复流或慢血流发生率明显低于对照组[4.0%(2/50)比13.0%(6/46)],差异均有统计学意义(均P<0.05).研究组cTnT峰值及CK-MB峰值明显低于对照组[研究组与对照组分别为(5.1±2.6)pe/L、(142.0±68.3)U/L及(8.5±2.9)μg/L、(176.0±71.2)U/L],心电图ST段回落率、左心室射血分数明显大于对照组[研究组与对照组分别为64.0%(32/50)、(56.0±13.5)%及45.7(21/46)、(45.6±10.2)%],住院期间心力衰竭发生率、再次急性心肌梗死发生率及心源性死亡率较明显低于对照组[研究组与对照组分别为14.0%(7/50)、0、2.0%(1/50)及23.9%(11/46)、4.3%(2/46)、8.7%(4/46)],差异均有统计学意义(均P<0.05).结论 STEMI急诊介入术中血栓抽吸治疗安全可靠,增加心肌的血流灌注,减少坏死心肌数量,改善STEMI患者的近期预后.
목적 관찰재급성ST단태고적심기경사(STEMI)급진개입술중응용혈전추흡도관진행혈전추흡적림상료효.방법 2008년6월지2010년6월행급진경피관상동맥개입술적환자96례,완전수궤분위연구조(50례)화대조조(46례).2조균채취직접지가치입혹구낭예확장후치입지가.연구조차지전연도사송인ZEEK혈전추흡장치지병변부위부압추흡.관찰2조적수술정황、술후효과.결과 연구조발병거혈관재통시간、직접지가치입솔화술후체심기경사용전시험(TIMI)3급혈류정황[분별위(5.1±2.3)h、44.0%(22/50)、92.0%(46/50)]명현호우대조조[분별위(6.2±3.5)h、30.4%(14/46)、82.6%(38/46)],무복류혹만혈류발생솔명현저우대조조[4.0%(2/50)비13.0%(6/46)],차이균유통계학의의(균P<0.05).연구조cTnT봉치급CK-MB봉치명현저우대조조[연구조여대조조분별위(5.1±2.6)pe/L、(142.0±68.3)U/L급(8.5±2.9)μg/L、(176.0±71.2)U/L],심전도ST단회락솔、좌심실사혈분수명현대우대조조[연구조여대조조분별위64.0%(32/50)、(56.0±13.5)%급45.7(21/46)、(45.6±10.2)%],주원기간심력쇠갈발생솔、재차급성심기경사발생솔급심원성사망솔교명현저우대조조[연구조여대조조분별위14.0%(7/50)、0、2.0%(1/50)급23.9%(11/46)、4.3%(2/46)、8.7%(4/46)],차이균유통계학의의(균P<0.05).결론 STEMI급진개입술중혈전추흡치료안전가고,증가심기적혈류관주,감소배사심기수량,개선STEMI환자적근기예후.
Objective To evaluate the effect of thrombus-aspiration during emergency percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI). Methods The STEMI patients underwent emergent PCI from June 2008 to June 2010. Fifty patients received aspiration thrombecto-my were enrolled in study group and 46 patients who only received routine PCI were enrolled in control group. The clinical data, information after operation and the follow-up data were compared between the two groups. Results There were no significant differences between two groups on baseline. In the study group, stents were directly implanted and TIMI flow grade 3 was obtained with a significant difference of no-reflow/slow flow ( P = 0. 029 ). There were lower peak serum CK-MB(P =0.031) , TnT(P = 0.023)and faster ST segment resolution(P = 0.005) in the study group. The heart failure(P = 0.025) , re-infarction(P = 0.041)and mortality(P =0.043)in the hospital were decreased in the study group. Conclusion Thrombus-aspiration is safe and has good immediate effects during emergency PCI with STEMI, which can improve myocardium perfusion and reduce myocardial necrosis.