中国循环杂志
中國循環雜誌
중국순배잡지
CHINESE CIRCULATION JOURNAL
2015年
4期
317-321
,共5页
吴志勇%盛国太%祝志云%常智堂%余茂生%唐昱%李华泰
吳誌勇%盛國太%祝誌雲%常智堂%餘茂生%唐昱%李華泰
오지용%성국태%축지운%상지당%여무생%당욱%리화태
心肌梗死%直接经皮冠状动脉介入%延迟支架置入%急诊支架置入%疗效观察
心肌梗死%直接經皮冠狀動脈介入%延遲支架置入%急診支架置入%療效觀察
심기경사%직접경피관상동맥개입%연지지가치입%급진지가치입%료효관찰
Myocardial infarction%Percutaneous coronary intervention%Delayed stent implantation%Emergent stent implantation%Clinical effect
目的：比较血栓抽吸术后急诊支架与延迟支架置入对ST段抬高型心肌梗死（STEMI）患者的治疗效果。<br> 方法：入选2012-11至2014-01期间因STEMI行充分血栓抽吸并经血栓抽吸导管冠状动脉（冠脉）内注射替罗非班、硝普钠和硝酸甘油后梗死相关动脉恢复心肌梗死溶栓治疗（TIMI）血流3级的患者共计82例，由SAS软件产生的随机数字法分为急诊支架组（n=41例）和延迟支架组（n=41例）。急诊支架组患者立即置入支架，而延迟支架组患者则不立即置入支架，而是继续抗血小板和抗凝治疗10~14天后再行支架置入。对两组主要指标和次要指标进行比较，主要指标包括心电图ST段回落幅度、慢血流/无复流发生率及心肌染色3级的百分比，次要指标包括支架置入参数、对心室重塑的影响及主要不良心血管事件。<br> 结果：延迟支架组在经皮冠状动脉介入治疗（PCI）术后的心电图ST段回落幅度、TIMI血流3级和心肌染色3级百分比以及校正TIMI帧数分别为（68.2±9.2）%、97.5%、69.0%和（19.5±5.2）帧，与急诊支架组比较差异有统计学意义（P<0.05）。延迟支架组与急诊支架组在PCI术中发生无复流/慢血流的比例分别为2.5%和31.0%，两组比较差异有统计学意义（P<0.01）。延迟支架组和急诊支架组支架数量分别为（1.21±0.32）枚和（1.76±0.76）枚，平均支架长度分别为（28.3±11.7）mm和（33.7±12.9）mm，平均支架直径分别为（3.17±0.76）mm和（2.82±0.87）mm，差异有统计学意义（P<0.01）；延迟支架组的扩张压力[（18.5±6.2）atm]也明显高于急诊支架组[（13.6±7.1）atm]，而延迟支架组75%的患者采取了高压后扩张，高于急诊支架组（23.8%），差异有统计学意义（P<0.01）。随访6个月时发现，延迟支架组和急诊支架组在左心室射血分数、左心室收缩短分数与1周时有下降趋势，但差异无统计学意义（P>0.05）。而左心室舒张末期容积（LVEDV）及左心室舒张末期内径（LVEDD）与1周时比较有明显的增加（P<0.05）；而这种变化在急诊支架组更为明显（P<0.05）。随访6个月时结果显示，与急诊支架组比较，延迟支架组主要不良事件发生率明显下降（P<0.05）。<br> 结论：STEMI患者PCI中血栓抽吸术后延迟支架置入可以减少支架术后慢血流/无复流现象的发生，改善支架贴壁和心肌灌注，减少不良心血管事件发生。
目的：比較血栓抽吸術後急診支架與延遲支架置入對ST段抬高型心肌梗死（STEMI）患者的治療效果。<br> 方法：入選2012-11至2014-01期間因STEMI行充分血栓抽吸併經血栓抽吸導管冠狀動脈（冠脈）內註射替囉非班、硝普鈉和硝痠甘油後梗死相關動脈恢複心肌梗死溶栓治療（TIMI）血流3級的患者共計82例，由SAS軟件產生的隨機數字法分為急診支架組（n=41例）和延遲支架組（n=41例）。急診支架組患者立即置入支架，而延遲支架組患者則不立即置入支架，而是繼續抗血小闆和抗凝治療10~14天後再行支架置入。對兩組主要指標和次要指標進行比較，主要指標包括心電圖ST段迴落幅度、慢血流/無複流髮生率及心肌染色3級的百分比，次要指標包括支架置入參數、對心室重塑的影響及主要不良心血管事件。<br> 結果：延遲支架組在經皮冠狀動脈介入治療（PCI）術後的心電圖ST段迴落幅度、TIMI血流3級和心肌染色3級百分比以及校正TIMI幀數分彆為（68.2±9.2）%、97.5%、69.0%和（19.5±5.2）幀，與急診支架組比較差異有統計學意義（P<0.05）。延遲支架組與急診支架組在PCI術中髮生無複流/慢血流的比例分彆為2.5%和31.0%，兩組比較差異有統計學意義（P<0.01）。延遲支架組和急診支架組支架數量分彆為（1.21±0.32）枚和（1.76±0.76）枚，平均支架長度分彆為（28.3±11.7）mm和（33.7±12.9）mm，平均支架直徑分彆為（3.17±0.76）mm和（2.82±0.87）mm，差異有統計學意義（P<0.01）；延遲支架組的擴張壓力[（18.5±6.2）atm]也明顯高于急診支架組[（13.6±7.1）atm]，而延遲支架組75%的患者採取瞭高壓後擴張，高于急診支架組（23.8%），差異有統計學意義（P<0.01）。隨訪6箇月時髮現，延遲支架組和急診支架組在左心室射血分數、左心室收縮短分數與1週時有下降趨勢，但差異無統計學意義（P>0.05）。而左心室舒張末期容積（LVEDV）及左心室舒張末期內徑（LVEDD）與1週時比較有明顯的增加（P<0.05）；而這種變化在急診支架組更為明顯（P<0.05）。隨訪6箇月時結果顯示，與急診支架組比較，延遲支架組主要不良事件髮生率明顯下降（P<0.05）。<br> 結論：STEMI患者PCI中血栓抽吸術後延遲支架置入可以減少支架術後慢血流/無複流現象的髮生，改善支架貼壁和心肌灌註，減少不良心血管事件髮生。
목적：비교혈전추흡술후급진지가여연지지가치입대ST단태고형심기경사（STEMI）환자적치료효과。<br> 방법：입선2012-11지2014-01기간인STEMI행충분혈전추흡병경혈전추흡도관관상동맥（관맥）내주사체라비반、초보납화초산감유후경사상관동맥회복심기경사용전치료（TIMI）혈류3급적환자공계82례，유SAS연건산생적수궤수자법분위급진지가조（n=41례）화연지지가조（n=41례）。급진지가조환자립즉치입지가，이연지지가조환자칙불립즉치입지가，이시계속항혈소판화항응치료10~14천후재행지가치입。대량조주요지표화차요지표진행비교，주요지표포괄심전도ST단회락폭도、만혈류/무복류발생솔급심기염색3급적백분비，차요지표포괄지가치입삼수、대심실중소적영향급주요불양심혈관사건。<br> 결과：연지지가조재경피관상동맥개입치료（PCI）술후적심전도ST단회락폭도、TIMI혈류3급화심기염색3급백분비이급교정TIMI정수분별위（68.2±9.2）%、97.5%、69.0%화（19.5±5.2）정，여급진지가조비교차이유통계학의의（P<0.05）。연지지가조여급진지가조재PCI술중발생무복류/만혈류적비례분별위2.5%화31.0%，량조비교차이유통계학의의（P<0.01）。연지지가조화급진지가조지가수량분별위（1.21±0.32）매화（1.76±0.76）매，평균지가장도분별위（28.3±11.7）mm화（33.7±12.9）mm，평균지가직경분별위（3.17±0.76）mm화（2.82±0.87）mm，차이유통계학의의（P<0.01）；연지지가조적확장압력[（18.5±6.2）atm]야명현고우급진지가조[（13.6±7.1）atm]，이연지지가조75%적환자채취료고압후확장，고우급진지가조（23.8%），차이유통계학의의（P<0.01）。수방6개월시발현，연지지가조화급진지가조재좌심실사혈분수、좌심실수축단분수여1주시유하강추세，단차이무통계학의의（P>0.05）。이좌심실서장말기용적（LVEDV）급좌심실서장말기내경（LVEDD）여1주시비교유명현적증가（P<0.05）；이저충변화재급진지가조경위명현（P<0.05）。수방6개월시결과현시，여급진지가조비교，연지지가조주요불량사건발생솔명현하강（P<0.05）。<br> 결론：STEMI환자PCI중혈전추흡술후연지지가치입가이감소지가술후만혈류/무복류현상적발생，개선지가첩벽화심기관주，감소불양심혈관사건발생。
Objective: To compare the efifcacy between emergent and delayed stent implantation in patients with ST-elevation myocardial infarction (STEMI) after thrombus extraction. <br> Methods: A total of 82 STEMI patients who received thrombus extraction and intracoronary injection of tiroifban, sodium nitroprusside, nitroglycerin via thrombus extraction catheter and with recovered TIMI 3 lfow from 2012-11 to 2014-01 were retrospectively studied. The patients were randomized into 2 groups by SAS software: Emergent group, the patients received stent implantation immediately upon diagnosis and Delayed group, the patients were treated by anti-platelet and anticoagulant medication for 10-14 days, and then received stent implantation. n=41 in each group. The primary and secondary indicators were compared between 2 groups which including ST-segment resolution (STR), the occurrence rate of no-relfow/slow-relfow, myocardial blush grade (MBG) 3, parameters of stent, ventricular remodeling condition, the incidence of major adverse cardiac events (MACE). <br> Results: ①Delayed group had the post PCI STR at (68.2 ± 9.2)%, TIMI 3 grade at 97.5%, MBG 3 at 69.0%and corrected TIMI frame count (CTFC) at (19.5 ± 5.2), compared with Emergent group, P<0.05. The occurrence rate of no-relfow/slow-relfow in Delayed group and Emergent group were 2.5% and 31.0%, P<0.01. ②The parameters of stents in Delayed group and Emergent group were as the number at (1.21 ± 0.32) vs. (1.76 ± 0.76), the mean length at (28.3 ± 11.7) mm vs. (33.7 ± 12.9) mm, the mean diameter at (3.17 ± 0.76) mm vs. (2.82 ± 0.87) mm, all P<0.01. Delayed group had the higher dilating pressure than that in Emergent group, (18.5 ± 6.2) atm vs (13.6 ± 7.1) atm, P<0.01, and more patients in Delayed group receive high-pressure non-compliant balloon dilation 75% vs 23.8%, P<0.01. ③With 6 months of follow-up study, there were slightly declining trend for LVEF and LVSF in both groups than that at 1 week condition, P>0.05, while LVEDV and LVEDD increased than 1 week, P<0.05, the changes were more obvious in Emergent group, P<0.05. Delayed group had less MACE occurrence, P<0.05. <br> Conclusion: Delayed stent implantation in STEMI patients after thrombus extraction had reduced incidence of post PCI no-relfow/slow-relfow phenomenon, improved myocardial reperfusion and less MACE occurrence.
