摘要
目的:评价ST段抬高心肌梗死(STEMI)行急诊PCI术中联合应用抽吸导管的有效性。方法:回顾性评价首诊符合STEMI并经绿色通道行急诊经皮冠状动脉介入治疗(PCI),并经冠状动脉造影(CAG)明确梗死相关冠状动脉(IRA)完全闭塞的96例患者的临床资料。根据是否联合应用抽吸导管,将96例患者分为抽吸导管组(n=48)和非抽吸导管组(n=48)。结果:两组患者除性别外(10.4%比29.2%,P=0.021),一般临床特征无统计学差异。两组IRA除右冠状动脉病变分别为64.6%、39.6%,P=0.014,其余差异无统计学意义。两组PCI即时TIMI血流分别为2.8±0.6、3.0±0.2,P<0.001;两组术后90 min ST回落>70%分别为72.9%、52.1%,P=0.035;植入支架类型及个数两组间无差异;未见术中出血并发症。术后1个月及1年随访,两组的左室舒张末容积(LVEDV)及左室射血分数(LVEF)无统计学差异;平均1年随访期间,两组主要不良心血管事件(MACE)无统计学差异,但抽吸导管组有降低趋势(log rankχ2=0.266,P=0.013)。平均1年随访期间发生MACE组(n=43)和非MACE组(n=53)"无复流"分别为9.3%、0,P=0.023;术中IABP支持分别为21.4%、1.9%,P=0.002;发病—球囊扩张时间分别为(3.6±2.0、2.1±1.0)h,P=0.002;Killip分级分别为1.8±1.1、1.2±0.7,P<0.001;PCI即时TIMI分别为2.9±0.3、2.6±0.7,P<0.001。结论:急诊PCI中联合应用抽吸导管能改善心肌灌注,术后发生MACE可能与"无复流"、术中IABP支持、发病—球囊扩张时间、Killip分级、PCI即时TIMI等因素有关。
Objective： To evaluate the effectiveness of ST-segment elevation myocardial infarction （STEMI） undergoing primary PCI combined with thrombus aspiration. Methods： In this single-center retrospective evaluation, 96 patients with the firstly diagnosed STEMI, with coronary angiography（CAG） showing infarct-related coronary artery （IRA） occlusion and undergoing primary percutaneous coronary intervention （PCI） were divided into two groups ： thrombus aspiration group （ n = 48 ）, non- thrombus aspiration group （ n = 48 ）. Results： In addition to sex（ 10. 4% vs 29. 2%, P = 0. 021 ）, general clinical features of two groups of patients had no statisticaldifference. In addition to the right coronary artery disease with the infarct-related coronary artery（II^A） occlusion being 64.6% vs 39.6% （P =0. 014） , the rest had no difference between two groups; PCI instant TIMI flow grade （2.8 ± O. 6 vs 3.0 ± 0.2, P 〈 O. 001 ） and the complete ST segment resolution rate （72.9% vs 52.1% , P = 0. 035 ） between two groups were significantly different; type and number of stents implanted had no difference between the two groups; no bleeding complications occurred in two groups. After 1 month and 1 year follow-up, left ventricular end-diastolic volume （LVEDV） and left ventricular ejection fraction （LVEF） had no significant difference between two groups; during average 1-year follow-up period, two major adverse cardiac events（MACE） had no significant difference, but there was a tendency to decrease in MACE rate at 1-year follow-up, which favored thrombus aspiration catheter group（log rank X^2 = O. 266, P = O. 013 ）. Average 1- year follow- up between MACE group（ n =43 ） and non- MACE group （ n = 53 ） showed significant differences： no- reflow（ 9.3% vs 0%, P =0.023）, IABP support（21.4% vs 1.9%, P =0.002）, disease-balloon time[ （3.6 ±2.0） h vs （2.1± 1.0） h, P = 0.002 ], Killip classification （ 1.8± 1.1 vs 1.2 ± 0.7, P 〈 0.001 ）, PCI instant TIMI flow grade 3 （ 2.9± O. 3 vs 2.6±0.7, P 〈0.001 ）. Conclusion： Primary PCI in combined with thrombus aspiration catheter can improve myocardial perfusion, MACE occurred after primary PCI may be related to no-flow, IABP support, the incidenceballoon time, Killip classification, PCI instant TIMI.
出处
《现代医学》
2012年第1期25-29,共5页
Modern Medical Journal
