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目的评价经皮冠状动脉介入治疗(PCI)联合血栓抽吸术与单纯PCI对ST段抬高型心肌梗死(STEMI)患者预后的影响。方法选取2012年3月—2014年5月在同济大学附属第十人民医院心内科住院治疗的STEMI患者358例,随机分入血栓抽吸组和对照组,每组179例。血栓抽吸组患者于冠状动脉造影后先行血栓抽吸再行PCI,对照组患者于冠状动脉造影后直接行PCI。收集并比较两组患者术后冠状动脉血流分级[心肌梗死溶栓治疗临床试验(TIMI)分级],PCI术后6、12、18、24h监测的肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白T(cTnT)峰值、PCI术前和术后60min心电图ST段抬高回落百分比(sumSTR)。患者出院后通过电话或门诊随访,记录术后1年有无主要不良心血管事件(MACE)发生。结果两组间术前各级TIMI血流、术中见心肌梗死相关动脉,以及病变血管构成比的差异均无统计学意义(P值均>0.05)。血栓抽吸组术后TIMI 3级、sumSTR>70%的构成比均显著高于对照组(P值均<0.01),sumSTR<30%的构成比,血浆CK-MB和cTnT峰值均显著低于对照组(P值均<0.05、0.01)。术后1年随访中,两组间未用药,以及服用阿司匹林、氯吡格雷、他汀类药物、β肾上腺素受体阻滞剂、钙通道阻滞剂、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、硝酸酯类药物和利尿剂的患者构成比的差异均无统计学意义(P值均>0.05)。两组间术后1年心源性死亡、再发心肌梗死、心源性休克和纽约心脏病学会心功能分级Ⅳ级发生率的差异均无统计学意义(P值均>0.05)。结论血栓抽吸联合PCI可有效减少STEMI患者术后无复流和慢血流的发生,改善心肌再灌注,并有助于缩小心肌梗死面积。
Objective To evaluate the effect of percutaneous coronary intervention (PCI) combined with thrombus aspiration on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). Methods From March 2012 to May 2014, 358 STEMI patients admitted to Department of Cardiology, Tenth People’s Hospital affiliated to Tongji University were randomly divided into thrombus aspiration group and control group, with 179 cases in each group. Patients in the thrombus aspiration group underwent thrombus aspiration after PCI and patients in the control group underwent PCI directly after coronary angiography. Collected and compared the coronary blood flow classification of the two groups after surgery [TIMI classification of myocardial infarction], 6,12,18,24h after PCI monitored creatine kinase isoenzyme CK-MB) and cardiac troponin T (cTnT) peak, STSTR elevation fall percentage (sumSTR) before PCI and 60min after PCI. Patients were followed up by phone or outpatient visit to record the occurrence of major adverse cardiovascular event (MACE) one year after surgery. Results There was no significant difference in TIMI blood flow, intraoperative myocardial infarction related arteries, and angiogenic ratio between the two groups (P> 0.05). Thrombectomy group, the TIMI 3 grade, sumSTR> 70% of the constituent ratio were significantly higher than the control group (P value <0.01), sumSTR <30% of the composition ratio, plasma CK-MB and cTnT peak were significantly lower Control group (P <0.05,0.01). One year after follow-up, no medication was administered between the two groups, and aspirin, clopidogrel, statins, beta adrenergic blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, There was no significant difference in the constituent ratios of superacidium Ⅱ receptor antagonists, nitrates and diuretics (P> 0.05). There was no significant difference in the incidence of cardiac death, recurrent myocardial infarction, cardiogenic shock and grade Ⅳ cardiac function grade in the New York Cardiological Association between the two groups (P> 0.05). Conclusion Thrombus aspiration combined with PCI can effectively reduce the incidence of postoperative no-reflow and slow blood flow in patients with STEMI, improve myocardial reperfusion, and help reduce myocardial infarct size.