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目的:探讨直接经皮冠状动脉介入治疗﹙PCI﹚中血栓抽吸导管(ZEEK导管)联合血小板Ⅱb/Ⅲa受体拮抗剂﹙GPⅡb/Ⅲa﹚治疗血栓负荷过重的急性ST段抬高型心肌梗死﹙STEMI﹚的效果。方法:入选STEMI患者136例,随机分为常规PCI组﹙44例﹚、GPⅡb/Ⅲa组﹙45例﹚和GPⅡb/Ⅲa+TA(血栓抽吸)组﹙47例﹚,分析三组PCI术后即刻梗死相关血管﹙IRA﹚的TIMI血流分级、梗死部位心肌灌注水平﹙TMP﹚分级、术后72h内出血、输血比例及术后30d、1年内主要心脏不良事件﹙MACE﹚等。结果:与常规PCI组比较,GPⅡb/Ⅲa组和GPⅡb/Ⅲa+TA组术后即刻IRA的TIMI血流分级[(2.31±0.50)比(2.52±0.48)比(2.69±0.47)]、TMP分级[(2.03±0.65)比(2.31±0.48)比(2.51±0.54)]明显提高,且GPⅡb/Ⅲa+TA组明显高于GPⅡb/Ⅲa组,P均<0.05;GPⅡb/Ⅲa组和GPⅡb/Ⅲa+TA组术后30d、1年MACE发生率均明显低于常规PCI组[30d:(9.6±28.4)%、(7.1±21.7)%比(16.2±37.4)%,1年:(16.3±35.5)%、(12.4±39.3)%比(29.7±46.3)%],P均<0.01。术后72h内出血、输血比例三组间差异无显著性。结论:冠状动脉血栓负荷过重的急性ST段抬高型心肌梗死患者急诊PCI中联合使用血栓抽吸导管和血小板Ⅱb/Ⅲa受体拮抗剂安全、有效,即刻获得的TIMI血流和心肌灌注优于常规PCI组及单用血小板Ⅱb/Ⅲa受体拮抗剂组。
Objective: To investigate the clinical value of thrombolysis catheter (ZEEK catheter) and platelet Ⅱ b / Ⅲa receptor antagonist (GPⅡb / Ⅲa) in the treatment of acute thrombolytic infarction with thrombus overload under direct percutaneous coronary intervention (PCI) (STEMI) effect. Methods: Thirty-six STEMI patients were randomly divided into conventional PCI group (n = 44), GPⅡb / Ⅲa group (n = 45) and GPⅡb / Ⅲa + Immediate myocardial infarction (IRA) classification of TIMI flow, infarction myocardial perfusion (TMP) classification, bleeding within 72h after operation, blood transfusion ratio and 30d after operation, major adverse cardiac events within one year (MACE) and so on. Results: Compared with the conventional PCI group, the TIMI grade of IRA in GPⅡb / Ⅲa group and GPⅡb / Ⅲa + TA group was significantly higher than that in PCI group (2.31 ± 0.50 vs 2.52 ± 0.48 vs 2.69 ± 0.47) [(2.03 ± 0.65) vs (2.31 ± 0.48) vs (2.51 ± 0.54)], and the GPⅡb / Ⅲa + TA group was significantly higher than that of GPⅡb / Ⅲa group (P <0.05); GPⅡb / Ⅲa group and GPⅡb / Ⅲa The incidence of MACE at 30 days and one year after operation in TA + TA group was significantly lower than that in PCI group [30d: (9.6 ± 28.4)%, (7.1 ± 21.7)% vs (16.2 ± 37.4)%, 1 year ), (12.4 ± 39.3)% vs (29.7 ± 46.3)%, P <0.01). There was no significant difference in the proportion of hemorrhage and blood transfusion within 72 hours after operation. CONCLUSIONS: Thrombus aspiration catheters and platelet IIb / IIIa receptor antagonists in patients with acute ST-elevation myocardial infarction who are overloaded with coronary artery thrombosis are safe, effective, and immediately available for TIMI flow and myocardial perfusion In the conventional PCI group and platelet Ⅱ b / Ⅲ a receptor antagonist alone group.