急性非ST段抬高型心肌梗死急诊经皮冠状动脉介入术中行血栓抽吸术对心肌灌注及心脏功能的影响

摘要

目的 探讨急性非ST段抬高型心肌梗死(NSTEMI)急诊经皮冠状动脉介入术(PCI)术中行血栓抽吸术对心肌组织灌注及心脏功能的影响.方法 纳入2013年1月至2014年7月于北京安贞医院行急诊PCI的首发急性NSTEMI患者,将患者分为血栓抽吸组和非血栓抽吸组.血栓抽吸组在行PCI时先使用抽吸导管进行血栓抽吸,后置入支架;非血栓抽吸组仅行支架置入.术后即刻采用心肌梗死溶栓治疗(TIMI)血流分级和校正的TIMI帧数(CTFC)评估术后心肌组织灌注水平,术后1周采用超声心动图检测心脏功能,观察患者住院期间主要心脏不良事件发生情况.结果 共纳入NSTEMI患者82例,血栓抽吸组和非血栓抽吸组各41例.血栓抽吸组术后TIMI 3级比例明显高于非血栓抽吸组,TIMI 2级和TIMI 0 ～1级比例明显低于非血栓抽吸组,差异均有统计学意义[92.7％(38/41)比58.5％ (24/41),4.9％(2/41)比26.8％(11/41),2.4％(1/41)比14.6％ (6/41),均P＜0.05];血栓抽吸组CTFC明显少于非血栓抽吸组,差异有统计学意义[(28±5)帧比(39±5)帧,P＜0.01].术后Ⅰ周血栓抽吸组左心室射血分数明显高于非血栓抽吸组[(57±10)％比(48±8)％],而左心室舒张末期内径明显小于非血栓抽吸组[(50±5)mm比(54 ±5)mm],差异均有统计学意义(均P＜0.01).术后住院期间2组患者均未发生主要心脏不良事件.结论 NSTEMI患者急诊PCI中行血栓抽吸术可有效清除冠状动脉内微血栓,改善心肌组织灌注和心脏功能,而不增加主要心脏不良事件的发生率.%Objective To explore the effect of thrombus aspiration during emergent percutaneous coronary intervention (PCI) on myocardial perfusion and cardiac function in patients with non-ST-elevation myocardial infarction (NSTEMI).Methods NSTEMI patients undergoing emergent PCI from January 2013 to July 2014 were enrolled and randomly divided into thrombus aspiration group which was given thrombus aspiration before stent implantation during PCI,and non-thrombus aspiration group which was given stent implantation only during PCI.The thrombolysis in myocardial infarction (TIMI) blood flow classification and corrected TIMI frame count (CTFC) immediately after operation were used to assess myocardial perfusion and echocardiography 1 week after operation was used to measure the cardiac function.The major adverse cardiac events in hospital were observed.Results A total of 82 patients were enrolled,and there were 41 cases in thrombus aspiration group and 41 cases in non-thrombus aspiration group.In thrombus aspiration group the ratio of TIMI grade 3 was higher,the ratio of TIMI grade 2 and 0-1 were lower compare with that in non-thrombus aspiration group [92.7％ (38/41) vs 58.5％ (24/41),4.9％ (2/41)vs26.8％ (11/41),2.4％ (1/41)vs 14.6％ (6/41),allP＜0.05];the CTFC of thrombus aspiration group was less than that of non-thrombus aspiration group with a significant difference [(28 ±5) frames vs (39 ± 5) frames,P ＜ 0.01].One week after PCI,the left ventricular ejection fraction was obviously higher and the left ventricular end-diastolic diameter was obviously smaller in thrombus aspiration group,compared with those in non-thronbus aspiration group [(57 ±10)％ vs (48 ±8)％,(50 ±5) mm vs (54 ±5) mm,both P ＜0.01].No major adverse cardiac events in hospital occurred in both groups.Conclusions Thrombus aspiration can effectively clear the microthrombus,improve the myocardial perfusion and cardiac function during PCI in NSTEMI patients,without increasing the incidence of major adverse cardiac events.