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目的评价血管远端保护装置(PercuSurge)在经皮冠状动脉介入治疗高危急性冠状动脉综合征中预防远端血管栓塞的有效性及安全性。方法接受经皮冠状动脉介入高危急性冠状动脉综合征40例,其中血管远端保护装置组和对照组各20例,血管远端保护装置组与对照组基础临床状况、术前造影差异均无统计学意义。比较两组的基础临床状况、造影结果、介入结果,随访住院期间情况,包括病变血管血流心肌梗死溶栓试验血流分级(thrombolysis in myocardial infarction,TIMI)分级、“罪犯”血管所支配心肌的心肌灌注分级(TIMI myocardial perfusion,TMP)、无复流现象以及主要心血管事件。结果血管远端保护装置组20例均使用抽吸导管,抽出数量不等的血栓。术后TIMI3级血流、TMP3级获得率和无复流在两组间差异均有统计学意义(P<0.01)。与对照组比较,远端保护装置组术后肌钙蛋白Ⅰ(P>0.05)和肌酸激酶同工酶峰值较低(P<0.001),近期左心室射血分数高(P<0.01)。血管远端保护装置组无主要心血管事件,对照组死亡1例。结论血管远端保护装置在高危急性冠状动脉综合征行经皮冠状动脉介入安全可行,可改善术后远端心肌血流灌注,减少无复流现象,改善心功能。
Objective To evaluate the effectiveness and safety of PercuSurge in the prevention of distal embolism in percutaneous coronary intervention in patients with high-risk acute coronary syndrome. Methods Percutaneous coronary intervention in 40 patients with high-risk acute coronary syndromes, including vascular distal protection device group and control group, 20 cases, vascular distal protection device group and control group, the basic clinical conditions, preoperative radiographic differences were not statistically Significance of learning. Baseline clinical status, radiographic results, interventional outcomes, and follow-up during hospitalization were compared between the two groups, including changes in vascular disease, vascular thrombolysis in myocardial infarction (TIMI) classification, and “criminal” blood vessels TIMI myocardial perfusion (TMP), no-reflow phenomenon, and major cardiovascular events. Results 20 cases of vascular distal protection device group were using suction catheter, extract a different number of thrombus. Postoperative TIMI3 grade blood flow, TMP3 grade recovery rate and no-reflow between the two groups were statistically significant (P <0.01). Compared with the control group, the values of Troponin Ⅰ (P> 0.05) and creatine kinase isoenzyme (P <0.001) and the recent left ventricular ejection fraction (LVEF) were higher in the distal protection group than those in the control group (P <0.01). There were no major cardiovascular events in the vascular distal protection device group, and 1 died in the control group. Conclusion The vascular distal protection device is safe and feasible in percutaneous coronary intervention in high-risk acute coronary syndromes, which can improve distal perfusion, reduce no-reflow phenomenon and improve cardiac function.