支架置入术后再次血栓抽吸术在急性心肌梗死患者急诊经皮冠状动脉介入治疗中的应用效果评价

摘要

目的 评价支架置入术后再次血栓抽吸术在急性心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)中的应用效果.方法 选取2013年11月—2015年11月凉山彝族自治州第二人民医院收治的急性心肌梗死患者158例,按照随机数字表法分为研究组和对照组,每组79例.两组患者均行急诊PCI,确定梗死相关血管(IRA)后实施血栓抽吸术,然后实施球囊扩张术及支架置入术,研究组患者在支架置入术后再次实施血栓抽吸术.比较两组患者支架置入术后TIMI血流分级、TIMI心肌灌注(TMP)分级及研究组患者支架置入术后和再次血栓抽吸术后TIMI血流分级、TMP分级,比较两组患者术后ST段回落指数,并统计两组患者住院期间及出院后随访15周不良心血管事件发生情况.结果 支架置入术后两组患者TIMI血流分级和TMP分级比较,差异无统计学意义(u值分别为0.292、0.208,P>0.05);研究组患者再次血栓抽吸术后TIMI血流分级和TMP分级优于支架置入术后(u值分别为3.177、3.906,P<0.05);研究组患者再次血栓抽吸术后TIMI血流分级和TMP分级优于对照组支架置入术后(u值分别为7.915、3.751,P<0.05).研究组患者术后2 h、4 h、8 h ST段回落指数均高于对照组(P<0.05).住院期间,研究组患者不良心血管事件发生率为0,低于对照组的8.9%(P<0.05);出院后随访15周,研究组患者不良心血管事件发生率为0,对照组为2.5%,差异无统计学意义(P>0.05).结论 支架置入术后再次血栓抽吸术可有效促进急性心肌梗死患者急诊PCI术后梗死血管再通,改善梗死区域心肌灌注,提高临床疗效,降低近期不良心血管事件发生风险.%Objective To evaluate the application effect of secondary thrombus aspiration after stent implantation in acute myocardial infarction patients treated by emergency PCI. Methods A total of 158 patients with acute myocardial infarction were selected in the Second People's Hospital of Liangshan Yi Autonomous Prefecture from November 2013 to November 2015, and they were divided into control group and study group according to random number table,each of 79 cases. Patients of both groups received emergency PCI after admission,and all of them received thrombus aspiration after definition of infarction related artery,after then were given balloon dilatation and stent implantation,while patients of study group were given extra secondary thrombus aspiration after stent implantation. TIMI flow grades and TMP grades after stent implantation and after secondary thrombus aspiration were compared between the two groups,TIMI flow grades and TMP grades of observation group after stent implantation and after secondary thrombus aspiration were compared,too;ST - segment resolution index after emergency PCI were compared between the two groups,while incidence of adverse cardiovascular events during hospitalization and within 15 weeks after discharge were recorded. Results No statistically significant differences of TIMI flow grades or TMP grades was found between the two groups after stent implantation( u = 0. 292,0. 208;P > 0. 05);TIMI flow grades and TMP grades of study group after secondary thrombus aspiration were statistically significantly better than those after stent implantation( u =3. 177,3. 906;P < 0. 05),so were statistically significantly better than those of control group after stent implantation( u =7. 915,3. 751,P < 0. 05). After 2 hours,4 hours and 8 hours of emergency PCI,ST - segment resolution index of study group was statistically significantly higher than that of control group,respectively(P < 0. 05). During hospitalization,the incidence of adverse cardiovascular events of sturdy group was 0,was statistically significantly lower than that of control group of 8. 9% (P< 0. 05);within 15 weeks after discharge,the incidence of adverse cardiovascular events of sturdy group was 0,that of control group was 2. 5% ,the difference was not statistically significantly different( P > 0. 05). Conclusion Secondary thrombus aspiration after stent implantation can effectively promote the recanalization of infarction related artery of acute myocardial infarction patients treated by emergency PCI,improve the blood perfusion of ischemic myocardium and clinical effect,reduce the short - term risk of adverse cardiovascular events.