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目的评价冠状动脉内血栓吸引治疗急性心肌梗死(AMI)的疗效和安全性。方法选取88例因AMI行急诊经皮冠状动脉介入治疗(PCI)时发现冠状动脉内有血栓的患者,随机分为血栓吸引组43例和对照组45例。血栓吸引组采用抽吸导管对冠状动脉内血栓进行吸引,对照组采用常规PCI治疗。观察术后两组TIMI血流分级、ST段回落情况、30d和1年时左心室射血分数(LVEF)以及主要心脏不良事件(MACE)。结果与常规PCI相比,血栓吸引能显著改善心肌灌注(术后即刻TIMI血流3级:36例比30例,P<0.05),使ST段明显回落[术后2h ST段回落≥50%者:65.2%(28/43)比35.6%(16/45),P<0.01];血栓吸引组30d和1年时LVEF有升高趋势、MACE发生率有下降趋势,但差异均无统计学意义。结论与常规PCI相比,血栓吸引安全有效,能明显改善即刻心肌灌注,增加ST段回落,有改善1年临床预后的倾向。
Objective To evaluate the efficacy and safety of intra-coronary thrombosis in the treatment of acute myocardial infarction (AMI). Methods A total of 88 patients with thrombus in the coronary artery who underwent emergency PCI during PCI were enrolled in this study. They were randomly divided into thrombus aspiration group (n = 43) and control group (n = 45). Thrombus aspiration group using suction catheter to attract intra-coronary thrombus, the control group using conventional PCI. TIMI grade, ST-segment depression, left ventricular ejection fraction (LVEF) at 30 and 1 year, and major adverse cardiac events (MACE) were observed. Results Compared with conventional PCI, thrombus aspiration could significantly improve myocardial perfusion (TIMI grade 3 immediately after operation: 36 cases more than 30 cases, P <0.05) : 65.2% (28/43) vs 35.6% (16/45), P <0.01]. The LVEF of thrombus aspiration group increased at 30 days and 1 year, and the incidence of MACE showed a downward trend, but the difference was not statistically significant significance. Conclusions Compared with conventional PCI, thrombus attraction is safe and effective. It can significantly improve immediate myocardial perfusion and increase ST-segment depression with a tendency to improve clinical outcomes for 1 year.