CAJ | 학술논문

目的：评估血栓抽吸联合替罗非班对急性ST段抬高型心肌梗死（ STEMI）患者早期经皮冠状动脉介入（ PCI）术后心肌再灌注及预后的影响。方法连续选取2008年1月—2013年1月于苏州大学附属第二医院就诊的急性STEMI患者456例，采用随机数字表法分为：单纯PCI组（对照组）140例；血栓抽吸组168例；血栓抽吸+替罗非班组148例。比较各组PCI术后心肌梗死溶栓试验（ TIMI）心肌再灌注（ TMP）分级、校正的TIMI帧数（ CTFC）、术后1个月和术后12个月主要不良心脏事件（ MACE）发生情况。采用多因素Logistic回归分析急性STEMI患者术后1个月和术后12个月发生MACE的影响因素。结果3组患者梗死血管和病变血管支数比较，差异均无统计学意义（ P>0.05）；3组患者PCI术后TMP分级及药物洗脱支架使用率比较，差异均有统计学意义（P<0.05）。对照组CTFC为（31.5±5.8），血栓抽吸组为（21.8±7.2），血栓抽吸+替罗非班组为（20.9±6.3），3组比较差异有统计学意义（ F=5.176，P=0.006）；其中血栓抽吸组、血栓抽吸+替罗非班组CTFC低于对照组（ q=3.225、3.734，P<0.001）。多因素Logistic回归分析结果显示，糖尿病、血肌酐水平、左心室射血分数与急性STEMI患者术后1个月发生MACE有回归关系（P<0.05）；年龄、血肌酐水平、左心室射血分数、治疗方法与急性STEMI患者术后12个月发生MACE有回归关系（P<0.05）。结论血栓抽吸联合替罗非班能明显改善急性STEMI患者早期PCI术后心肌再灌注水平，降低急性STEMI患者PCI术后12个月MACE发生率。
목적：평고혈전추흡연합체라비반대급성ST단태고형심기경사（ STEMI）환자조기경피관상동맥개입（ PCI）술후심기재관주급예후적영향。방법련속선취2008년1월—2013년1월우소주대학부속제이의원취진적급성STEMI환자456례，채용수궤수자표법분위：단순PCI조（대조조）140례；혈전추흡조168례；혈전추흡+체라비반조148례。비교각조PCI술후심기경사용전시험（ TIMI）심기재관주（ TMP）분급、교정적TIMI정수（ CTFC）、술후1개월화술후12개월주요불양심장사건（ MACE）발생정황。채용다인소Logistic회귀분석급성STEMI환자술후1개월화술후12개월발생MACE적영향인소。결과3조환자경사혈관화병변혈관지수비교，차이균무통계학의의（ P>0.05）；3조환자PCI술후TMP분급급약물세탈지가사용솔비교，차이균유통계학의의（P<0.05）。대조조CTFC위（31.5±5.8），혈전추흡조위（21.8±7.2），혈전추흡+체라비반조위（20.9±6.3），3조비교차이유통계학의의（ F=5.176，P=0.006）；기중혈전추흡조、혈전추흡+체라비반조CTFC저우대조조（ q=3.225、3.734，P<0.001）。다인소Logistic회귀분석결과현시，당뇨병、혈기항수평、좌심실사혈분수여급성STEMI환자술후1개월발생MACE유회귀관계（P<0.05）；년령、혈기항수평、좌심실사혈분수、치료방법여급성STEMI환자술후12개월발생MACE유회귀관계（P<0.05）。결론혈전추흡연합체라비반능명현개선급성STEMI환자조기PCI술후심기재관주수평，강저급성STEMI환자PCI술후12개월MACE발생솔。
Objective To evaluate the influence of thrombus aspiration combined with tirofiban therapy on myocardial reperfusion and clinical prognosis after primary percutaneous coronary intervention( PCI ) on patients with acute ST elevation myocardial infarction(STEMI). Methods Enrolled 456 patients with acute STEMI who received treatment consecutively in the Second Affiliated Hospital of Soochow University from January 2008 to January 2013. Using random number table,the subjects were randomly divided into control group with only PCI( n =140 ), thrombus aspiration group( n =168 ), and thrombus aspiration+ tirofiban group(n=148). Comparison was made among the three groups in TIMI myocardial reperfusion(TMP) grading after PCI,adjusted CTFC and the incidence rates of MACE at 1 month and 12 months after operation. Multivariate Logistic regression analysis was conducted to find out the influencing factors for the incidence rates of MACE at 1 month and 12 months after operation. Results The three groups were not significantly different in the numbers of infarction vessel and lesion vessel( P>0. 05);the three groups were significantly different in TMP grading and the number of drug eluting stent(P<0. 05). The CTFCs of control group,thrombus aspiration group and thrombus aspiration + tirofiban group were(31. 5 ± 5. 8), (21. 8 ± 7. 2)and ( 20. 9 ± 6. 3 ) respectively, with significant differences among the three groups( F = 5. 176, P = 0. 006 );thrombus aspiration group and thrombus aspiration+ tirofiban group were lower than control group in CTFC(q=3. 225,3. 734;P<0. 001 ). Multivariate Logistic regression analysis showed that diabetes mellitus, serum creatinine level, left ventricular ejection fraction had regression relation with the MACE incidence of acute STEMI patients at 1 month after operation(P<0. 05);age,serum creatinine level, left ventricular ejection fraction and therapeutic method had regression relation with the MACE incidence of acute STEMI patients at 12 months after operation ( P <0. 05 ) . Conclusion The combined use of thrombus aspiration and tirofiban can effectively improve the myocardial reperfusion level of acute STEMI patients after early PCI and significantly decrease the incidence rates of MACE at 12 months after operation.