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目的评价经皮冠状动脉介入术(PCI)联合经皮血栓吸除术治疗急性心肌梗死(AMI)的疗效。方法 56例 AMI 患者随机分为 PCI组(n=28)和 PCI 联合血栓吸除术组(n=28)。于 PCI术后24小时、1周行实时心肌声学造影(RT-MCE),记录各组灌注对比积分指数(CSI)、室壁运动积分指数(WMSI)、透壁性对比缺损长度(CDL)和严重室壁运动异常长度(WML)。采用免疫散射比浊法测定血浆超敏 C-反应蛋白(hs-CRP)水平,酶联免疫吸附法测定血浆 N-末端脑利钠肽(NT-ProBNP)和基质金属蛋白酶-9(MMP-9)水平。结果各时间点 PCI 联合血栓吸除术组 CSI、WMSI、CDL 和 WML明显低于 PCI 组(P<0.05)。术后1周 PCI 联合血栓吸除术组血浆 hs-CPR 和 NT-ProBNP 水平低于对照组[(4.56±1.98)mg/L 比(5.96±2.03)mg/L,P<0.05;(544.7±185.3)pmol/L 比(897.6±215.9)pmol/L,P<0.01],血浆 MMP-9无明显升高[(672.7±175.9)μg/L 比(609.6±196.5)μg/L,P>0.05]。结论与 PCI 组相比,PCI 联合经皮血栓吸除术可明显减少术后无再流的发生,改善微循环和心脏功能,是治疗 AMI 的有效方法。
Objective To evaluate the efficacy of percutaneous coronary intervention (PCI) combined with percutaneous thrombectomy in the treatment of acute myocardial infarction (AMI). Methods 56 patients with AMI were randomly divided into PCI group (n = 28) and PCI combined with thrombectomy (n = 28). Real-time myocardial contrast echocardiography (RT-MCE) was performed at 24 hours and 1 week after PCI. The scores of perfusion index (CSI), wall motion integral index (WMSI) Severe ventricular wall motion abnormality length (WML). Serum levels of hs-CRP were measured by immune nephelometry. The levels of plasma N-terminal brain natriuretic peptide (NT-ProBNP) and matrix metalloproteinase-9 )Level. Results CSI, WMSI, CDL and WML in PCI group and thrombectomy group at each time point were significantly lower than those in PCI group (P <0.05). The levels of plasma hs-CPR and NT-ProBNP in PCI group were lower than those in control group (P <0.05) (672.7 ± 175.9) μg / L (609.6 ± 196.5) μg / L, P> 0.05 (P <0.01) ]. Conclusion Compared with PCI group, PCI combined with percutaneous thrombectomy can significantly reduce the incidence of postoperative no-reflow and improve microcirculation and cardiac function, which is an effective method for the treatment of AMI.