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目的:比较血栓抽吸导管及血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂(GPⅡb/Ⅲa受体拮抗剂)在急性ST段抬高型心肌梗死(STEMI)直接冠状动脉介入治疗(PCI)过程中疗效的不同,探讨减少冠状动脉血栓负荷和改善心肌灌注的最佳策略。方法:回顾性分析因STEMI就诊,接受直接PCI的206例患者。根据直接PCI过程中对血栓处理方法的不同分为单纯直接PCI组、血栓抽吸或GPⅡb/Ⅲa受体拮抗剂组、血栓抽吸+GPⅡb/Ⅲa受体拮抗剂组。比较各组在术后慢血流或无复流、ST段50%回落率、TIMI帧数变化、左室射血分数(LVEF)及左室舒张末内径(LVDd)、大出血情况、住院期间死亡率等指标的差异。结果:血栓抽吸+GPⅡb/Ⅲa受体拮抗剂组与单纯直接PCI组相比,慢血流或无复流的发生率、术后TIMI血流帧数和最高导联ST段50%回落率均差异无统计学意义(P>0.05),但术前TIMI血流0~1级患者比例更高(P<0.05);血栓抽吸或GPⅡb/Ⅲa受体拮抗剂组与单纯直接PCI组相比,慢血流或无复流发生率,术后TIMI血流帧数,最高导联ST段50%回落率差异无统计学意义(P>0.05)。术后1周心脏超声示LVEF,LVDd以及住院期间死亡率各组间差异无统计学意义(P>0.05)。术后大出血各组间差异亦无统计学意义(P>0.05)。结论:联合应用血栓抽吸和GPⅡb/Ⅲa受体拮抗剂可有效减轻STEMI患者接受直接PCI中冠状动脉内的血栓负荷,明显改善术前高血栓负荷患者心肌组织微循环的灌注。
AIM: To compare the efficacy of thrombus aspiration catheters and platelet glycoprotein Ⅱb / Ⅲa receptor antagonists (GPⅡb / Ⅲa receptor antagonists) in the treatment of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing direct coronary intervention Of the different, to explore the reduction of coronary artery thrombosis and improve myocardial perfusion the best strategy. METHODS: A retrospective analysis of 206 patients receiving direct PCI due to STEMI was performed. According to the direct PCI process of thrombus treatment methods are divided into simple direct PCI group, thrombus aspiration or GP Ⅱ b / Ⅲ a receptor antagonist group, thrombus aspiration + GP Ⅱ b / Ⅲ a receptor antagonist group. The postoperative slow blood flow or no reflow, the 50% fall-off rate of ST-segment, the change of TIMI frame number, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVDd) Rate and other indicators of the difference. Results: Compared with the direct PCI group, the incidence of slow or no-reflow, the TIMI blood flow frame number and the 50% fall-off rate of the ST lead in the lead-induced thrombocytopenia + GPⅡb / Ⅲa receptor antagonist group (P> 0.05), but there was a higher proportion of patients with TIMI grade 0 ~ 1 before operation (P <0.05). Thrombus aspiration or GPⅡb / Ⅲa receptor antagonist group was significantly higher than that of simple PCI group There was no significant difference in the rate of slow blood flow or no-reflow, post-operative TIMI blood flow frame rate, and 50% fall-off rate of the highest lead ST segment (P> 0.05). There were no significant differences in LVEF, LVDd and in-hospital mortality at 1 week after operation (P> 0.05). There was no significant difference between the groups of postoperative bleeding (P> 0.05). Conclusion: The combination of thrombus aspiration and GPⅡb / Ⅲa receptor antagonist can effectively relieve the coronary artery thrombosis in patients with STEMI and improve the perfusion of myocardial tissue in patients with STEMI.