急性ST段抬高心肌梗死急诊介入治疗术中血栓抽吸的临床应用分析

发布时间：2018-08-19 11:46

【摘要】：目的:在我国,随着经济不断发展和社会压力不断提高,吸烟、肥胖及体力活动减少,人群高血压、高血脂、高血糖及高同型半胱氨酸血症等传统冠心病危险因素均呈上升趋势,且发病日趋年轻化,严重威胁了人类健康。尤其以急性ST抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)最为严重。本研究通过分析静海区医院CCU科2011年3月至2014年3月收治的STEMI患者的临床资料,探讨STEMI行急诊直接PCI术中对评价为血栓负荷重的患者应用手动血栓抽吸装置治疗对患者心室重构及临床预后的影响。方法:分析我院2011年3月~2014年3月期间诊断为STEMI行直接急诊PCI术的308例患者,术中对评价为血栓负荷重进行辅助血栓抽吸治疗的152例患者定为血栓抽吸组,对评价为血栓负荷轻的未应用血栓抽吸的156例患者定为对照组。评价患者PCI术后心肌灌注指标包括术后2hST段回落和心肌灌注TIMI分级,所有患者术后10天行超声心动图测定左室舒张末径(LVED)及左室射血分数(LVEF),比较两组患者的指标差异及随访6个月心血管不良事件发生情况。结果:血栓抽吸可以有效地吸出血栓,从而改善心肌再灌注,两组ST段回落大于50%的病例比较差异无统计学意义[78.9%(120/152)与71.2%/(111/156),χ2=0.428,p=0.669],但对ST段回落大于70%的比较血栓抽吸组明显高于对照组[73.7%(112/152)与47.4%/(74/156),χ2=4.701,p=0.001]。两组患者术后第10天进行超声心动图复查,显示出血栓抽吸组LVED低于对照组[(50.2±4.7)mm与(51.6±4.6)mm,t=2.642,p=0.008],而LVEF值则高于对照组[(56.9±4.9)%与(49.4±4.2)%,t=14.434,p=0.001],术后随访6个月再发心绞痛明显减少[4.61%(7/152)与10.90%/(17/156),χ2=2.056,p=0.040],再梗死、心力衰竭、心源性猝死等事件并无显著性差异[2例(1.31%)与2例(1.28%),p=0.979;5例(3.29%)与8例(5.13%),p=0.423;1例(0.65%)与2例(1.28%),p=0.578]。结论:STEMI患者在接受急诊PCI时,对评价为血栓负荷重的病变采用血栓抽吸术,不仅能有效改善心肌再灌注,尤其是微循环再灌注,还可改善左心室收缩功能,改善患者预后。
[Abstract]:Objective: in China, with the continuous development of economy and social pressure, smoking, obesity and reduced physical activity, people with high blood pressure, hyperlipidemia, Traditional coronary heart disease risk factors such as hyperglycemia and hyperhomocysteinemia are on the rise, and the incidence is getting younger, which is a serious threat to human health. In particular, acute St-elevation myocardial infarction (ST-segment elevation myocardial infarction) is the most serious. This study analyzed the clinical data of STEMI patients treated in CCU Department of Jinghai District Hospital from March 2011 to March 2014. Objective: to investigate the effect of manual thrombotic suction device on ventricular remodeling and clinical prognosis in patients with severe thrombotic load during emergency direct PCI operation with STEMI. Methods: from March 2011 to March 2014, 308 patients who were diagnosed as STEMI undergoing direct emergency PCI operation were analyzed. 152 patients who were evaluated as thrombotic load and treated with auxiliary thrombotic aspiration during operation were selected as thrombotic aspiration group. 156 patients with low thrombus load and no thrombus aspiration were selected as control group. The indexes of myocardial perfusion after PCI were evaluated, including postoperative 2hST segment fall and myocardial perfusion TIMI grade. Left ventricular end-diastolic diameter (LVED) and left ventricular ejection fraction (LVEF),) were measured by echocardiography 10 days after operation. Results: Thrombus aspiration can effectively suck out thrombus and improve myocardial reperfusion. There was no significant difference between the two groups in patients whose St segment retreated more than 50% [78.9% (120 / 152) vs 71.222r / (111156), 蠂 2 + 0.428% p 0.669], but the comparison thrombus aspiration group with St segment retreating more than 70% was significantly higher than the control group [73.7% (112 / 152) vs 47.4AD / (74 / 156), 蠂 ~ 2 4.701p ~ (0.001)]. Echocardiographic reexamination on the 10th day after operation in both groups showed that the LVED in the thrombotic aspiration group was lower than that in the control group [(50.2 卤4.7) mm and (51.6 卤4.6) mm respectively], while the LVEF value was higher than that in the control group [(56.9 卤4.9)% vs (49.4 卤4.2)% vs (49.4 卤4.2) t14.434p0.001]. The recurrent angina pectoris in the thrombotic aspiration group decreased significantly [4.61% (7 / 152) and 10.90 / (17156), 蠂 ~ (22.056) P 0.040]. There was no significant difference in sudden cardiac death between 2 cases (1.31%) and 2 cases (1.28%), p0. 979 9 cases (3. 29%) and 8 cases (5. 13%) p0. 423 cases (0. 65%) and 2 cases (1. 28%) p0.578 respectively. Conclusion Thrombus aspiration can not only improve myocardial reperfusion, especially microcirculation reperfusion, but also improve left ventricular systolic function and prognosis of patients with PCI.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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