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目的:评价在急性ST段抬高型心肌梗死(STEMI)急诊介入治疗中应用血栓抽吸器的安全性和有效性。方法:选择2005年7月至2006年10月在我中心接受急诊经皮冠状动脉介入治疗的STEMI患者,使用血栓抽吸器者为抽吸器组(n=33),根据冠状动脉造影及临床情况从同期STEMI患者中选取条件相当者作为对照组(n=33),比较两组间的基础资料、术后即刻冠状动脉造影结果以及住院和随访期间情况。结果:两组间基础临床资料相似、抽吸器组支架直接置入率高、远端栓塞发生率低、校正的心肌梗死溶栓治疗临床试验帧数计数(cTFC)值小、心肌灌注分级3级获得率高,住院期间抽吸器组肌酸激酶MB同工酶和肌钙蛋白T峰值浓度较低,术后12小时心电图ST段回落幅度大,均显著优于对照组(P均<0.05～0.01);但两组间无/慢血流、术后心肌梗死溶栓治疗临床试验(TIMI)3级及两组住院期间主要心血管病事件发生情况未显示出统计学差异。结论:在血栓负荷较重的STEMI患者急诊介入治疗时,应用血栓抽吸器安全可行,可显著改善患者术后即刻的远端心肌组织微灌注,减少心肌酶的释放,但远期疗效还需进一步评价。
PURPOSE: To evaluate the safety and efficacy of thrombus aspiration in emergency interventional treatment of acute ST-elevation myocardial infarction (STEMI). Methods: STEMI patients who underwent emergency percutaneous coronary intervention in our center from July 2005 to October 2006 were enrolled as aspirator group (n = 33). According to coronary angiography and clinical The patients in the same period were selected as the control group (n = 33), and the basic data of the two groups were compared. The results of immediate postoperative coronary angiography and hospitalization and follow-up were compared. Results: The basic clinical data were similar between the two groups. The direct placement rate of stents in the aspirator group was high, the incidence of distal embolism was low, the corrected clinical trial of myocardial infarction thrombolysis had a small number of frame counts (cTFC), myocardial perfusion grade 3 Grade, high creatinine kinase MB isoenzyme and troponin T concentration in the aspirator group during hospitalization, and significant drop in the ST segment of electrocardiogram at 12 hours after operation, which were significantly better than those in the control group (all P <0.05 ~ 0.01). However, there was no significant difference between the two groups in the incidence of no / slow blood flow, TIMI level 3 and incidence of major cardiovascular events during hospitalization in both groups. Conclusion: It is safe and feasible to use thrombus aspiration device in emergency interventional therapy in STEMI patients with severe thrombus loading, which can significantly improve the immediate myocardial perfusion and decrease the release of myocardial enzymes in immediate postoperative patients. However, long-term efficacy Further evaluation.