汤成春,马根山,冯毅,陈忠,戴启明,童家毅,沈成兴,李拥军

• 1:东南大学附属中大医院心内科

摘要(Abstract)：

目的探讨和评价急性心肌梗死(AMI)急诊冠状动脉介入治疗(PCI)中联合应用Div-erCE血栓抽吸术的疗效及安全性。方法选择符合急诊PCI的AMI并经冠状动脉造影明确梗死相关冠状动脉(IRA)内高负荷血栓性病变的56例患者,随机分为两组,Diver CE组(n=28)用DiverCE血栓抽吸导管抽吸血栓后再行PCI治疗,对照组(n=28)直接行PCI治疗。结果Diver CE血栓抽吸术后的PCI术后ST段回落(STR)(>70%)明显优于对照组(71.4%比39.3%,P<0.05);术后冠状动脉TIMI血流(2.8±0.4比2.0±0.6,P<0.05)、血栓积分(TS)(0.1±0.2比1.5±1.0,P<0.05)、左室舒张末期容积(left ventricular end-diastolic volume,LVEDV)(50±12mL比60±14mL,P<0.05)、左室射血分数(LVEF)(0.58±0.18比0.46±0.14,P<0.05)较对照组明显改善,慢血流/无复流发生率低(3.6%比14.3%,P<0.05);30d时主要不良心脏事件(MACE)包括死亡、心肌梗死和靶血管再成形术和缺血性卒中的发生率两组未见明显差异(0比3.6%,P>0.05)。未见与Diver CE血栓抽吸相关的血管并发症。结论Diver CE血栓抽吸术能促进AMI急诊PCI术后STR,改善TIMI血流、TS和左心室功能;该方法操作简单,安全性高;对AMI患者,若其冠状动脉内以血栓性病变为主,应考虑应用Diver CE血栓抽吸术。

关键词(KeyWords)： 心肌梗死;冠状动脉血栓形成;血管成形术,经腔,经皮冠状动脉

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 汤成春,马根山,冯毅,陈忠,戴启明,童家毅,沈成兴,李拥军

参考文献(References)：

• [1]Burzottaf,Trani C,Romagnoli E,et al.A pilot study with a new,rapid-exchange,thrombus-aspirating device in patients with thrombus-containing lesions:the Diver C.E.study.Catheter Cardiovasc Interv,2006,67:887-893.
• [2]Sakuma T,Leong-poi H,Fisher NG,et al.Further insights into the no-reflowphenomenon after primary angioplasty in acute myo-cardial infarction:the role of microthromboemboli.J Am Soc Echocardiogr,2003,16:15-21.
• [3]Yip HK,Chen MC,Chang HW,et al.Angiographic morpholog-ic features of infarct-related arteries and timely reperfusion in a-cute myocardial infarction:predictors of slow-flow and no-reflow phenomenon.Chest,2002,122:1322-1332.
• [4]Napodano M,Paspuetto G,Saca S,et al.Intracoronary throm-bectomy improves myocardial reperfusion in patients undergoing direct angioplasty for acute myocardial infarction.J Am Coll Car-diol,2003,42:1395-1402.
• [5]Dudek D,Mielecki W,Legutko J,et al.Percutaneous throm-bectomy with the RESCUE system in acute myocardial infarction.Kardiol Pol,2004,61:523-533.
• [6]Margheri M,Falai M,Vittori G,et al.Safety and efficacy of the AngioJet in patients with acute myocardial infarction:results from the Florence Appraisal Study of Rheolytic Thrombectomy(FAST).J Invasive Cardiol,2006,18:481-486.
• [7]Svilaas T,Vlaar PJ,van der Horst IC,et al.Thrombus Aspira-tion during Primary Percutaneous Coronary Intervention.NEngl J Med,2008,358:557-567.
• [8]Yan HB,Wang J,Li N,et al.Diver CE versus Guardwire Plus for thrombectomy in patients with inferior myocardial infarction:a trial of aspiration of thrombus during primary angioplasty for infe-rior myocardial infarction.Chin Med J(Engl),2007,120:557-561.