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目的:研究ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)术中选择性使用血栓抽吸导管的即刻效果及近期预后。方法:入选因ST段抬高型心肌梗死于我院就诊并行急诊PCI治疗的患者,随机分为常规性血栓抽吸组(50例)和选择性血栓抽吸组(50例)。观察两组PCI术中血栓抽吸的阳性率和抽出血栓的完整性、血流TIMI分级、血栓脱落情况及术后2hST段回落情况。随访术后1个月内主要不良心血管事件。结果:选择性血栓抽吸组26例使用血栓抽吸导管,血栓抽吸阳性率明显高于常规性血栓抽吸组(84.62%︰56.00%,P<0.05)。两组抽到血栓的完整性、血栓脱落和术后即刻TIMI分级未见差异。术后2h常规性血栓抽吸组ST段回落≥50%为41例,选择性血栓抽吸组ST段回落≥50%为39例,两组比较无显著差异。术后1个月随访,两组患者的主要不良心血管事件发生率无显著性差异。结论:ST段抬高型心肌梗死患者急诊PCI术中选择性使用血栓抽吸策略根据低压预扩后判断血栓负荷,提高了判断血栓负荷的准确性和抽吸出血栓的阳性率。
Objective: To study the immediate effect and short-term prognosis of selective thrombus aspiration catheter in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). Methods: Patients with ST-segment elevation myocardial infarction treated with PCI in our hospital were randomly divided into routine thrombus aspiration group (n = 50) and selective thrombus aspiration group (n = 50). The positive rate of thrombus aspiration and the integrity of thrombus withdrawal, grade of blood flow TIMI, thrombus shedding and postoperative 2 h ST segment depression were observed in both groups. Follow-up within 1 month after major adverse cardiovascular events. Results: Thrombus aspiration catheter was used in 26 cases of selective thrombus aspiration group. The positive rate of thrombus aspiration was significantly higher than that of conventional thrombus aspiration group (84.62%: 56.00%, P <0.05). There was no difference between the two groups in the completeness of the thrombus, thrombus shedding, and immediately after the TIMI classification. In the conventional thrombus aspiration group, the ST-segment drop was ≥50% at 2 hours after operation, and in the selective thrombus aspiration group, the ST-segment drop was ≥50% at 39 cases. There was no significant difference between the two groups. One month after the operation, there was no significant difference in the incidence of major adverse cardiovascular events between the two groups. Conclusions: The selective thrombus aspiration strategy in patients with ST-segment elevation myocardial infarction undergoing emergency PCI can be used to determine the thrombus burden based on the pre-expansion of low pressure and improve the accuracy of thrombus loading and the positive rate of thrombus aspiration.