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目的探讨直接经皮冠状动脉介入治疗(PCI)联合远端保护装置(DPD)或血小板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)。方法冠状动脉造影(CAG)显示冠脉内富含大量血栓者106例,按时间及介入治疗方法分常规PCI组(37例)、DPD组(34例)和GPⅡb/Ⅲa组(35例),回顾性分析三组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)发生情况。结果常规PCI组、DPD组和GPⅡb/Ⅲa组术后即刻IRA的TIMI血流分级分别为(2.41±0.50)、(2.65±0.48)和(2.68±0.47),TMP分级分别为(2.03±0.65)、(2.31±0.48)和(2.37±0.54),术后30d,1年MACE发生率分别为(16.2±37.4)%、(8.6±28.4)%和(7.9±2.7)%,(29.7±46.3)%、(14.3±35.5)%和(18.4±39.3)%。DPD组和GPⅡb/Ⅲa组以上指标均优于常规PCI组(P<0.05)。术后72h内出血、输血情况三组间差异无统计学意义。结论冠脉内血栓负荷过重的STEMI患者急诊PCI中使用DPD或GPⅡb/Ⅲa安全、有效,即刻获得的TIMI血流和心肌灌注优于常规PCI。
Objective To investigate the clinical value of direct percutaneous coronary intervention (PCI) combined with distal protection device (DPD) or platelet Ⅱ b / Ⅲa receptor antagonist (GPⅡb / Ⅲa) in the treatment of thrombotic overload STEMI ). Methods Coronary angiography (CAG) showed that there were 106 cases of coronary thrombosis with large number of thrombi in the coronary artery. The patients in the conventional PCI group (37 cases), the DPD group (34 cases) and the GPⅡb / Ⅲ a group (35 cases) TIMI flow classification, infarction myocardial perfusion (TMP) classification, postoperative bleeding within 72h, the proportion of blood transfusions and the major adverse cardiac events within 1 year after operation were retrospectively analyzed. MACE) happened. Results The TIMI grade of IRA in PCI group, DPD group and GPⅡb / Ⅲa group were (2.41 ± 0.50), (2.65 ± 0.48) and (2.68 ± 0.47) respectively, and the TMP grade was (2.03 ± 0.65) , (2.31 ± 0.48) and (2.37 ± 0.54) respectively. The incidences of MACE at 30 days and 1 year after operation were (16.2 ± 37.4)%, (8.6 ± 28.4) and (7.9 ± 2.7)% and (29.7 ± 46.3) %, (14.3 ± 35.5)% and (18.4 ± 39.3)% respectively. The above indexes of DPD group and GPⅡb / Ⅲa group were better than those of conventional PCI group (P <0.05). There was no significant difference between the three groups in bleeding and blood transfusion within 72 hours after operation. Conclusions STEMI patients with overloaded coronary thrombus are safe and effective in emergency PCI with DPD or GPⅡb / Ⅲa. TIMI flow and myocardial perfusion obtained immediately are superior to conventional PCI.