摘要
目的探讨选择性血栓抽吸(TA)在高血栓负荷的急性ST段抬高型心肌梗死(STEMI)患者中的应用及疗效。方法选择自2008年12月至2014年6月于沈阳军区总医院心血管内科行直接经皮冠状动脉介入治疗(PCI)的3 016例STEMI患者,其中,239例患者为术者预先计划使用TA(TA组),2 777例患者采用常规球囊预扩张(常规组)。分析两组术中冠状动脉病变特点,血流TIMI分级,PCI相关特点以及出院后1个月、1年临床随访情况。结果 TA组患者既往PCI史显著低于常规组,差异有统计学意义(P<0.05)。罪犯血管病变部位比较,TA组近中段病变比例明显高于常规组,远段病变比例明显低于常规组,组间比较,差异有统计学意义(P<0.05)。抽吸/球囊扩张后,TA组前向TIMI血流≥2级占94.1%(225/239),明显高于常规组的87.8%(2 439/2 777),差异有统计学意义(P<0.05);支架术后,TA组前向TIMI血流≥2级占91.6%(219/239),高于常规组的87.8%(2 438/2 777),但两组比较,差异无统计学意义(P>0.05)。靶血管择期PCI、球囊后扩张及住院期间血小板糖蛋白Ⅱb/Ⅲa抑制药应用情况比较,TA组显著高于常规组,差异有统计学意义(P<0.05)。两组植入支架的总长度比较,差异无统计学意义(P>0.05),但TA组患者植入支架的直径显著大于常规组,差异有统计学意义(P<0.05)。TA组患者30 d及1年MACCE、出血事件发生率,以及30 d支架内血栓发生率较常规组均呈降低趋势,但组间比较,差异均无统计学意义(P>0.05)。结论对血栓负荷重的STEMI患者进行直接PCI时选择性使用TA,能够改善术中及术后梗死相关动脉的血流情况,但不能改善患者近期和长期预后。
Objective To assess the application and effect of elective thrombus aspiration（ TA） in ST segment elevation myocardial infarction（ STEMI） patients with high thrombus burden. Methods A retrospective study was performed on 3 016 cases of STEMI patients who underwent percutaneous coronary intervention（ PCI） from December 2008 to June 2014. Among the patients,239 cases who were treated with TA were divided into the TA group,2 777 cases who were treated with conventional balloon predilation were divided into the conventional group. Comparisons of features of coronary lesions,TIMI（ thrombolysis in myocardial infarction） flow grading,PCI outcomes and 30 days and 1 year outcomes after discharge between the two groups were also performed. Results The history of PCI in the TA group was significantly lower than that in the conventional group（ P〈0. 05）. Criminal vascular lesion sites were compared,the incidence of lesion proportion of proximal and middle segment in the TA group was significantly higher than that in the conventional group,and the incidence of lesion proportion of distal segment in the TA group was significantly lower than that in the conventional group（ P〈0. 05）. After the dilatation of the suction/balloon,the antegrade TIMI blood flow greater than Grade 2 of the TA group was94. 1%（ 225/239）,which was significantly higher than 87. 8%（ 2 49/2 777） of the conventional group（ P〈0. 05）. After the stents,the antegrade TIMI blood flow greater than Grade 2 of the TA group was 91. 6%（ 219/239）,which was higher than 87. 8%（ 2 438/2 777） of the conventional group,there was no statistically significant difference between the two groups（ P〉0. 05）. Target blood vessels after elective PCI,balloon expansion and platelet glycoprotein Ⅱb/Ⅲa depressants application,level of the TA group was significantly higher than that in the conventional group（ P〈0. 05）. Two groups of the total length of the stent had no statistically significant difference（ P〉0. 05）,while the diameter of the stent implanted in the TA group of patients were significantly greater than that in the conventional group（ P〈0. 05）. The incidence of 30 days and 1 year MACCE,bleeding events,and stent thrombosis within 30 days in the TA group showed a trend of reduction compared with the conventional group,while the comparison between the two groups had no statistically significant difference（ P〉0. 05）. Conclusion Elective TA in STEMI patients with high thrombus burden can increase blood flow of infarction related artery during PCI as well as post-balloon dilation,while the 1-year prognosis of STEMI patients cannot be improved via elective TA.
作者
刘亚斌
王贺阳
翟恒博
经子兰
王彩莲
刘海伟
LIU Ya-bin;WANG He-yang;ZHAI Heng-bo;JING Zi-lan;WANG Cai-lian;LIU Hai-wei(Department of Cardiovascular, The General Hospital of Shenyang Military Command, Shenyang 110016, China)
出处
《临床军医杂志》
CAS
2018年第5期566-570,576,共6页
Clinical Journal of Medical Officers
基金
国家重点研发计划项目(2016YFC1301300)
临床重点专科军队建设项目
关键词
心肌梗死
血管成形术
血栓抽吸术
Myocardial infarction
Angioplasty
Thrombus aspiration
