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目的观察在常规急诊经皮冠状动脉介入治疗(PCI)的基础上,应用Diver CE抽吸导管能否改善急性心肌梗死(AMI)患者的心肌灌注水平。方法58例AMI患者纳入研究,30例急诊冠状动脉造影提示血栓负荷较大的急性ST段抬高型心肌梗死患者,在急诊PCI时采用Diver CE导管对梗死相关血管内血栓进行抽吸,观察抽吸前后的血栓负荷和血流情况;以同期急诊PCI的28例AMI患者作为对照组。结果30例患者冠状动脉造影均提示大量血栓征象,抽吸后梗死相关血管血栓负荷明显降低;Diver CE+PCI组与单纯PCI组比较,血流心肌梗死试验性溶栓疗法(TIMI)分级及TIMI心肌灌注(TMP)分级均明显改善,肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)峰值明显降低,CK(1 512.7±75.5)U/L vs(1 769.2±83.6)U/L,CK-MB(148.5±32.2)U/L vs(237.5±28.7)U/L(P<0.05),ST段回落幅度大,(67.2±28.1)%vs(42.1±34.2)%(P<0.05),近期左心室射血分数增高(P<0.05);两组住院期间均无主要心血管事件发生。结论与常规PCI比较,在血栓负荷较重的AMI患者中应用Diver CE血栓抽吸导管安全可行,能有效地减少AMI患者梗死相关血管内的血栓负荷,显著改善患者术后即刻的远端心肌血流灌注,但远期疗效尚需进一步评价。
Objective To observe whether myocardial perfusion can be improved by using Diver CE aspiration catheter in patients with acute myocardial infarction (AMI) on the basis of conventional emergency percutaneous coronary intervention (PCI). Methods Fifty-eight patients with acute myocardial infarction (AMI) were enrolled in the study. Thirty patients with acute ST-segment elevation myocardial infarction who underwent coronary angiography in the emergency department underwent thrombus embolization. Diver CE catheter was used to suction the infarct-related intravascular thrombus during emergency PCI. Before and after suction thrombus load and blood flow; the same period emergency PCI 28 cases of AMI patients as a control group. Results Coronary angiography in 30 patients showed a large number of signs of thrombus and the load of infarct-related vascular thrombus after aspiration was significantly decreased. Compared with PCI group, the myocardial infarction-grade thrombolytic therapy (TIMI) and TIMI Myocardial perfusion (TMP) grading were significantly improved, creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) peak was significantly lower, CK (1 512.7 ± 75.5) U / L vs (1 769.2 ± 83.6) U (67.2 ± 28.1)% vs (42.1 ± 34.2)%, P (P <0.05) <0.05), and the left ventricular ejection fraction increased recently (P <0.05). No major cardiovascular events occurred during hospitalization in both groups. Conclusion Compared with conventional PCI, it is safe and feasible to use Diver CE thrombus aspiration catheter in AMI patients with severe thrombus load, which can effectively reduce the infarction-related intravascular thrombus burden in patients with AMI and significantly improve the immediate distal myocardial blood flow Flow perfusion, but the long-term efficacy needs further evaluation.