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目的评价主动脉内气囊反搏术(IABP)联合血栓抽吸对急诊经皮冠状动脉介入(PCI)治疗的急性大面积ST段抬高型心肌梗死(STEMI)患者临床预后的影响。方法发病12 h内的急性大面积STEMI患者120例随机分为试验组和对照组各60例,均给予规范的药物治疗并急诊冠脉造影,试验组应用IABP联合冠脉内血栓抽吸,对照组单纯血栓抽吸后行PCI术。评价梗死相关血管PCI术后冠脉血流(TIMI)分级,心肌组织灌注(TMP)分级、无复流或慢血流发生率、IABP并发症及术后4 w心功能、主要不良心脏事件的发生情况。结果试验组PCI术后TIMI 3级血流发生率、TMP明显高于对照组;慢血流、无复流发生率明显低于对照组;术后4 w左心室射血分数(LVEF)明显高于对照组,左心室舒张末期内径、主要不良心脏事件的发生率小于对照组(均<0.05)。结论急性大面积STEMI患者急诊PCI前应用IABP联合血栓抽吸能改善梗死相关血管的急性心肌梗死溶栓(TIMI)血流,增加冠脉灌注,改善心功能,减少主要不良心脏事件的发生率,临床应用安全有效。
Objective To evaluate the effect of intra-aortic balloon pump (IABP) combined with thrombus aspiration on the clinical prognosis of patients with acute massive ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods 120 cases of acute massive STEMI within 12 hours after onset were randomly divided into test group and control group of 60 cases, were given standard drug treatment and emergency coronary angiography, the experimental group IABP combined with coronary thrombus aspiration, control Group thrombectomy only after PCI. To assess TIMI classification, myocardial perfusion (TMP) grading, no-reflow or slow blood flow, IABP complications, and postoperative 4-w heart function, major adverse cardiac events What happened? Results The incidence of TIMI grade 3 and TMP in experimental group was significantly higher than that in control group. The incidence of slow flow and no-reflow was significantly lower than that of control group. The left ventricular ejection fraction (LVEF) was significantly higher at 4 weeks after PCI In the control group, the incidence of left ventricular end-diastolic diameter and major adverse cardiac events were less than those in the control group (all <0.05). Conclusion The application of IABP combined with thrombus aspiration in acute large area STEMI can improve the blood flow of acute myocardial infarction thrombolysis (TIMI) in infarct-related vessels, increase coronary perfusion, improve cardiac function and reduce the incidence of major adverse cardiac events. Clinical application of safe and effective.