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目的:探讨经皮冠状动脉内血栓抽吸术在血栓负荷重的急性ST段抬高型心肌梗死老年患者直接介入治疗(PCI)中的应用。方法:选择2009-01-2010-12期间在我院接受直接PCI的急性ST段抬高型心肌梗死老年患者117例,其中直接介入术加血栓抽吸治疗者为血栓抽吸组,共44例;仅行常规直接PCI者73例为对照组。研究初级终点为术后TIMI 3级血流率,次级终点为随访6个月的左心室射血分数(LVEF)、主要心血管病事件(MACE)发生率及纽约心功能分级。结果:血栓抽吸组术后TIMI 3级高于对照组,达到95.5%,术后肌酸激酶同工酶及TnI达峰时间稍提前于对照组,但与对照组比较均差异无统计学意义;随访6个月结果显示,累计MACE发生率在血栓抽吸组和对照组分别为4.6%和9.5%,差异无统计学意义,LVEF在住院1周时血栓抽吸组及对照组分别为[(51.4±9.2)%︰(48.0±11.8)%,P>0.05],随访6个月时分别为[(54.5±6.8)%︰(49.9±10.5)%,P<0.05];6个月时血栓抽吸组纽约心功能分级优于对照组,但差异无统计学意义。结论:血栓抽吸可以改善血栓负荷重的老年患者急诊PCI术后TIMI血流,并可明显改善6个月时LVEF,可能对预后产生积极作用。
Objective: To investigate the application of percutaneous coronary thrombolysis in the direct interventional therapy (PCI) of elderly patients with acute ST-segment elevation myocardial infarction with thrombus burden. Methods: A total of 117 elderly patients with acute ST-elevation myocardial infarction undergoing direct PCI in our hospital from January 2009 to December 2010 were enrolled. Thrombus aspiration group was treated by direct interventional therapy plus thrombus aspiration, 44 patients ; Only conventional direct PCI in 73 cases as the control group. The primary end point was postoperative TIMI grade 3 blood flow. The secondary end point was left ventricular ejection fraction (LVEF), the prevalence of major cardiovascular events (MACE), and NYHA functional classifications at follow-up of 6 months. Results: After thrombectomy, TIMI level 3 was significantly higher than that of control group (95.5%). The peak time of creatine kinase isoenzyme and TnI peaked earlier than control group, but there was no significant difference compared with control group ; 6 months follow-up showed that the cumulative incidence of MACE in the thrombus aspiration group and the control group were 4.6% and 9.5%, the difference was not statistically significant, LVEF in the hospital 1 week when the thrombus aspiration group and the control group were [ (51.4 ± 9.2)%, (48.0 ± 11.8)%, respectively; P> 0.05], and were significantly higher than those in the control group at 6 months (54.5 ± 6.8%, 49.9 ± 10.5% Thrombectomy group New York heart function classification better than the control group, but the difference was not statistically significant. Conclusion: Thrombus aspiration can improve TIMI blood flow after PCI in elderly patients with thrombus overload, and can significantly improve LVEF at 6 months, which may have a positive effect on prognosis.