中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2010年
4期
391-394
,共4页
郭方明%李广平%王效浣%陈欣%金玉光
郭方明%李廣平%王效浣%陳訢%金玉光
곽방명%리엄평%왕효완%진흔%금옥광
心肌梗死%介入治疗%血栓抽吸%血栓负荷
心肌梗死%介入治療%血栓抽吸%血栓負荷
심기경사%개입치료%혈전추흡%혈전부하
Myocardial infarction%Pereutaneous coronary intervention%Thrombus aspiration%Thrombus load
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.
目的 探討抽吸導管抽吸血栓是否增加不同血栓負荷的急性心肌梗死患者置入支架後梗死相關動脈血流.方法 所有入選患者據血栓分級是否≥4級分為血栓負荷高、低2組,然後每組據是否應用抽吸導管抽吸血栓治療隨機再分為2組,共4亞組.測定術後相關動脈心肌梗死溶栓(TIMI)血流分級、校正TIMI幀數、心電圖ST段迴落以及術後5～7 d射血分數,觀察住院期間和1箇月主要不良心血管事件.結果 高血栓負荷的靶病變長度和植入支架數量高于低血栓負荷組[分彆為(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)];高血栓負荷最終TIMI血流≥3級(分彆為32、23例,χ~2=5.3299,P<0.05)、心肌顯影≥3級(分彆為30、19例,χ~2=6.9509,P<0.05)、ST段迴落百分比≥50%(分彆為31、18例,χ~2=9.7082,P<0.05)血栓抽吸者多于未行血栓抽吸者.但在低血栓負荷亞組除ST段迴落百分比≥>50%外(χ~2=4.6590,P<0.05),TIMI血流和心肌顯影分級未達到統計學意義水準.高負荷組左室射血分數抽吸血栓組高于未抽吸血栓組[分彆為(58.7±7.8)%、(52.3 ±8.9)%,t=3.23,P<0.05],低負荷組左室射血分數抽吸血栓組高于未抽吸血栓組[分彆為(59.1 ±7.6)%、(55.1 ±9.8)%,t=2.07,P<0.05];住院期間抽吸血栓組總的主要心血管事件髮生率低于未抽吸血栓組(χ~2=4.0332,P=0.0446),且僅高負荷亞組顯示統計學差異趨勢(χ~2=3.5625,P=0.0591).結論 血栓抽吸提高高血栓負荷患者冠脈血流灌註,改善術後患者近期預後.
목적 탐토추흡도관추흡혈전시부증가불동혈전부하적급성심기경사환자치입지가후경사상관동맥혈류.방법 소유입선환자거혈전분급시부≥4급분위혈전부하고、저2조,연후매조거시부응용추흡도관추흡혈전치료수궤재분위2조,공4아조.측정술후상관동맥심기경사용전(TIMI)혈류분급、교정TIMI정수、심전도ST단회락이급술후5～7 d사혈분수,관찰주원기간화1개월주요불양심혈관사건.결과 고혈전부하적파병변장도화식입지가수량고우저혈전부하조[분별위(36.4±15.1)、(31.4±13.7)mm(t=-2.16,P<0.05);45、30례(χ~2=5.9221,P<0.05)];고혈전부하최종TIMI혈류≥3급(분별위32、23례,χ~2=5.3299,P<0.05)、심기현영≥3급(분별위30、19례,χ~2=6.9509,P<0.05)、ST단회락백분비≥50%(분별위31、18례,χ~2=9.7082,P<0.05)혈전추흡자다우미행혈전추흡자.단재저혈전부하아조제ST단회락백분비≥>50%외(χ~2=4.6590,P<0.05),TIMI혈류화심기현영분급미체도통계학의의수준.고부하조좌실사혈분수추흡혈전조고우미추흡혈전조[분별위(58.7±7.8)%、(52.3 ±8.9)%,t=3.23,P<0.05],저부하조좌실사혈분수추흡혈전조고우미추흡혈전조[분별위(59.1 ±7.6)%、(55.1 ±9.8)%,t=2.07,P<0.05];주원기간추흡혈전조총적주요심혈관사건발생솔저우미추흡혈전조(χ~2=4.0332,P=0.0446),차부고부하아조현시통계학차이추세(χ~2=3.5625,P=0.0591).결론 혈전추흡제고고혈전부하환자관맥혈류관주,개선술후환자근기예후.
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 high 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.
