CAJ | 학술논문

目的观察DIVER血栓抽吸导管在急性心肌梗死(AMI)经皮冠状动脉介入治疗中应用的有效性及安全性,评价其对心肌组织灌注、心脏功能及9个月后支架内再狭窄的影响.方法 86例接受急诊经皮冠状动脉介入治疗(PCU术的ST段抬高型AMI患者,造影证实病变血管完全闭塞.将患者随机分为两组,使用DIVER血栓抽吸导管的43例患者为抽吸组,未使用抽吸导管而行PCI的43例患者为非抽吸组,比较两组2h内ST段回落率、罪犯血管TIMI血流、住院期间主要心脏不良事件、术前及术后血B型钠尿肽原(Pro-BNP)水平、术后超声心动图检查测定心脏功能以及术后9个月冠状动脉造影的结果.结果两组2h内ST段回落率[(95.35％(41/43)与79.07％(34/43),x2=11.862,P =0.0006]；抽吸组术后心肌梗死溶栓治疗临床试验(TIMI)3级血流发生率明显高于非抽吸组[93.02％(40/43)与81.40％(35/43),x2=6.06,P =0.0335]；抽吸组TIMI 2级血流(慢血流)、TIMI 0～1级血流(无复流)发生率明显低于非抽吸组[分别为6.98％(3/43)与13.95％(6/43),f=3.12,P=0.0495,及0与6.98％(3/43),x2=5.29,P=0.0352]；抽吸组术后1d超声心动图测定的左心室射血分数、左心室舒张末期内径无明显高于非抽吸组[(0.420±0.054)％与(0.408±0.052)％,t=1.0496,P=0.766；(56.5±4.5)mm与(57.6±4.4)nm,t =1.0419,P=0.7832)；抽吸组术后1个月及9个月左心室射血分数明显高于非抽吸组[(0.452±0.050)％与(0.432±0.049)％,t=3.3957,P=0.0482；(0.469±0.053)％与(0.413±0.052)％,ι=4.9457,P=0.0336]；术后1个月及9个月左心室舒张末期内径明显小于非抽吸组[(49.6±5.1) mm与(53.4±4.6)mm,t =3.4548,P =0.0473,(46.5 ±4.4)mm与(50.2±4.8)mm,t=3.7260,P =0.0421].随访9个月,两组心血管事件(心绞痛、心肌梗死、心力衰竭、心因性死亡)发生率分别为0和0,差异无统计学意义(P＞0.05).术后9个月冠状动脉造影结果显示抽吸组支架内再狭窄发生率低于非抽吸组(2.33％与6.98％,x2=4.4351,P=0.0463).结论 AMI患者行急诊PCI术中应用DIVER血栓抽吸导管抽吸安全有效,可改善心肌组织灌注及术后心脏功能,减少支架内再狭窄发生. 目的觀察DIVER血栓抽吸導管在急性心肌梗死(AMI)經皮冠狀動脈介入治療中應用的有效性及安全性,評價其對心肌組織灌註、心髒功能及9箇月後支架內再狹窄的影響.方法 86例接受急診經皮冠狀動脈介入治療(PCU術的ST段抬高型AMI患者,造影證實病變血管完全閉塞.將患者隨機分為兩組,使用DIVER血栓抽吸導管的43例患者為抽吸組,未使用抽吸導管而行PCI的43例患者為非抽吸組,比較兩組2h內ST段迴落率、罪犯血管TIMI血流、住院期間主要心髒不良事件、術前及術後血B型鈉尿肽原(Pro-BNP)水平、術後超聲心動圖檢查測定心髒功能以及術後9箇月冠狀動脈造影的結果.結果兩組2h內ST段迴落率[(95.35％(41/43)與79.07％(34/43),x2=11.862,P =0.0006]；抽吸組術後心肌梗死溶栓治療臨床試驗(TIMI)3級血流髮生率明顯高于非抽吸組[93.02％(40/43)與81.40％(35/43),x2=6.06,P =0.0335]；抽吸組TIMI 2級血流(慢血流)、TIMI 0～1級血流(無複流)髮生率明顯低于非抽吸組[分彆為6.98％(3/43)與13.95％(6/43),f=3.12,P=0.0495,及0與6.98％(3/43),x2=5.29,P=0.0352]；抽吸組術後1d超聲心動圖測定的左心室射血分數、左心室舒張末期內徑無明顯高于非抽吸組[(0.420±0.054)％與(0.408±0.052)％,t=1.0496,P=0.766；(56.5±4.5)mm與(57.6±4.4)nm,t =1.0419,P=0.7832)；抽吸組術後1箇月及9箇月左心室射血分數明顯高于非抽吸組[(0.452±0.050)％與(0.432±0.049)％,t=3.3957,P=0.0482；(0.469±0.053)％與(0.413±0.052)％,ι=4.9457,P=0.0336]；術後1箇月及9箇月左心室舒張末期內徑明顯小于非抽吸組[(49.6±5.1) mm與(53.4±4.6)mm,t =3.4548,P =0.0473,(46.5 ±4.4)mm與(50.2±4.8)mm,t=3.7260,P =0.0421].隨訪9箇月,兩組心血管事件(心絞痛、心肌梗死、心力衰竭、心因性死亡)髮生率分彆為0和0,差異無統計學意義(P＞0.05).術後9箇月冠狀動脈造影結果顯示抽吸組支架內再狹窄髮生率低于非抽吸組(2.33％與6.98％,x2=4.4351,P=0.0463).結論 AMI患者行急診PCI術中應用DIVER血栓抽吸導管抽吸安全有效,可改善心肌組織灌註及術後心髒功能,減少支架內再狹窄髮生.
목적 관찰DIVER혈전추흡도관재급성심기경사(AMI)경피관상동맥개입치료중응용적유효성급안전성,평개기대심기조직관주、심장공능급9개월후지가내재협착적영향.방법 86례접수급진경피관상동맥개입치료(PCU술적ST단태고형AMI환자,조영증실병변혈관완전폐새.장환자수궤분위량조,사용DIVER혈전추흡도관적43례환자위추흡조,미사용추흡도관이행PCI적43례환자위비추흡조,비교량조2h내ST단회락솔、죄범혈관TIMI혈류、주원기간주요심장불량사건、술전급술후혈B형납뇨태원(Pro-BNP)수평、술후초성심동도검사측정심장공능이급술후9개월관상동맥조영적결과.결과 량조2h내ST단회락솔[(95.35％(41/43)여79.07％(34/43),x2=11.862,P =0.0006]；추흡조술후심기경사용전치료림상시험(TIMI)3급혈류발생솔명현고우비추흡조[93.02％(40/43)여81.40％(35/43),x2=6.06,P =0.0335]；추흡조TIMI 2급혈류(만혈류)、TIMI 0～1급혈류(무복류)발생솔명현저우비추흡조[분별위6.98％(3/43)여13.95％(6/43),f=3.12,P=0.0495,급0여6.98％(3/43),x2=5.29,P=0.0352]；추흡조술후1d초성심동도측정적좌심실사혈분수、좌심실서장말기내경무명현고우비추흡조[(0.420±0.054)％여(0.408±0.052)％,t=1.0496,P=0.766；(56.5±4.5)mm여(57.6±4.4)nm,t =1.0419,P=0.7832)；추흡조술후1개월급9개월좌심실사혈분수명현고우비추흡조[(0.452±0.050)％여(0.432±0.049)％,t=3.3957,P=0.0482；(0.469±0.053)％여(0.413±0.052)％,ι=4.9457,P=0.0336]；술후1개월급9개월좌심실서장말기내경명현소우비추흡조[(49.6±5.1) mm여(53.4±4.6)mm,t =3.4548,P =0.0473,(46.5 ±4.4)mm여(50.2±4.8)mm,t=3.7260,P =0.0421].수방9개월,량조심혈관사건(심교통、심기경사、심력쇠갈、심인성사망)발생솔분별위0화0,차이무통계학의의(P＞0.05).술후9개월관상동맥조영결과현시추흡조지가내재협착발생솔저우비추흡조(2.33％여6.98％,x2=4.4351,P=0.0463).결론 AMI환자행급진PCI술중응용DIVER혈전추흡도관추흡안전유효,가개선심기조직관주급술후심장공능,감소지가내재협착발생.
Objective To observe the safety and efficiency of DIVER thrombus aspiration catheter application during percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI)and to evaluate its impacts on the myocardial reperfusion,cardiac function and in-stent restenosis after 9months.Methods A total of 86 cases of ST-segment elevation patients of AMI treated with PCI and confirmed complete occlusion lesion by angiography from November 2008 to December 2010 were randomly divided into two groups:aspiration group(n =43)with DIVER thrombus aspiration cathetcrs were used,and non-aspiration group (n =43).ST-segment recovery within two hours,TIMI grade,the in-hospital adverse major cardiac events,the levels of Pro-BNP,coronary function determined by ultrasound heartbeat graph and the results of coronary angiography after PCI for 9 months were compared between two groups.Results There was significant difference on ST-segment recovery within two hours between these two groups[95.35％(41/43)vs 79.02％(34/43),x2 =11.862,P =0.0006].The incidence of TIMI 3 grade flow was significantly higher,the incidence of TIMI 2(slow flow)and TIMI 0-1(no-reflow)grade flow were much lower in aspiration group than those in non-aspiration group immediately after PCI[TIMI 3:93.02％(40/43) vs 81.40％(35/43),x2 =6.06,P =0.0335 ; TIMI 2:6.98％(3/43) vs 13.95 ％(6/43),x2 =3.12,P =0.0495 ; TIMI 0-1:0 vs 6.98 ％(3/43),x2 =5.29,P =0.0352].There was no difference on LVEF[(0.420±0.054) ％ vs(0.408±0.052)％,t =1.0496,P =0.766and LVEDD(56.5±4.5)mm vs(57.6±4.4)mm,t =1.0419,P =0.7832]between these two groups one day after PCL LVEF was significandy higher in aspiration group than that in non-aspiration group one and nine months after PCI[(0.452±0.050) ％ vs(0.432±0.049) ％,t =3.3957,P =0.0482 ;(0.469±0.053) ％ vs (0.413±0.052)％,t =4.9457,P =0.0336].LVEDD was significantly smaller in aspiration group than that in non-aspiration group one and nine months after PCI[(49.6±5.1) mm vs(53.4±4.6) mm,t =3.4548,P =0.0473 ;(46.5±4.4) mm vs(50.2±4.8) mm,t =3.7260,P =0.0421].There were no cardiovascular events (angina,myocardial infarction,heart failure,cardiac death)in both groups during 9 months follow-up.The coronary angiography results showed that the occurrence rate of in-stent restenosis in aspiration group was significantly lower than that in non-aspiration group(2.33％ vs 6.98％,x2 =4.4351,P =0.0463).Conclusion The application of DIVER thrombus aspiration catheters during PCI in all patients with AMI was safe and effective,it can improve the myocardial tissue perfusion and the post-operative cardiac function and can lower the occurrence rate of in-stent restenosis.