冯旭阳,李成祥,高延,郭宣,徐瑞芬,王海昌

• 1:第四军医大学西京医院心脏内科
• 2:第四军医大学口腔医院麻醉科

摘要(Abstract)：

目的评价PercuSurge远端保护装置在急性心肌梗死患者冠状动脉介入治疗(PCI)中的疗效及安全性。方法自2003年12月至2005年12月,共174例接受急诊PCI治疗的急性心肌梗死患者纳入研究,根据是否使用PercuSurge远端保护装置分为远端保护装置(DPD)组78例和对照组96例。比较两组间的基础临床状况、造影情况、介入治疗结果。病变血管术后均行TIMI分级、心肌染色分级。结果DPD组78例中72例抽出肉眼可见的红色、白色碎屑或红色血栓条。两组间的基础临床状况、术前造影情况差异均无统计学意义。DPD组PCI术后TIMI分级≥2级(94.9%比79.2%)和心肌染色分级(2.65±0.68比2.22±0.94)明显高于对照组(均为P<0.05),对照组PCI术后无复流现象发生率(5.1%比16.7%)、远端血管栓塞现象发生率(5.1%比18.8%)和30天不良心血管事件发生率(2.6%比7.3%)均明显高于DPD组(均为P<0.05)。与PCI术前比较,血栓抽吸术后TIMI血流分级(0.43±0.80比2.92±0.28)、心肌染色分级(0.22±0.63比2.27±0.73)和最小管腔直径(0.12±0.23mm比1.97±0.66mm)均明显增加(均为P<0.0001)。结论在急性心肌梗死等冠状动脉内存在大量血栓的情况下应用PercuSurge远端保护装置行PCI是安全有效的。

关键词(KeyWords)： 血管成形术,经腔,经皮冠状动脉;心肌梗死;PercuSurge远端保护装置

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 冯旭阳,李成祥,高延,郭宣,徐瑞芬,王海昌

参考文献(References)：

• [1]Morishima I,Sone T,Okumura K,et al.Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in pa-tients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction.JACC,2000,36:1202-1209.
• [2]Tanaka A,Kawarabayashi T,Nishibori Y,et al.No-reflow phe-nomenon and lesion morphology in patients with acute myocardial infarction.Circulation,2002,105:2148-2152.
• [3]Saber RS,Edwards WD,Bailey KR,et al.Coronary embolization after balloon angioplasty or thrombolytic therapy:an autopsy stud-y of32cases.J Am Coll Cardiol,1993,22:1283-1288.
• [4]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-flowand no-reflow.Chest,2002,122:1322-1332.
• [5]Yamada DM,Topol EJ.Importance of microembolization and in-flammation in atherosclerotic heart disease.Am Heart J,2001,140:S90-102.
• [6]Gibson CM,de Lemos JA,Murphy SA,et al.Combination ther-apy with abciximab reduces angiographically evident thrombus in acute myocardial infarction:a TIMI14substudy.Circulation,2001,103:2550-2554.
• [7]Giri S,Mitchel JF,Hirst JA,et al.Synergy between intracoronary stenting and abciximab in improving angiographic and clinical outcomes of primary angioplasty in acute myocardial infarction.Am J Cardiol,2000,86:269-274.
• [8]Gibson CM,Cannon CP,Murphy SA,et al.Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs.Circulation,2000,101:125-130.
• [9]BaimDS,Wahr D,George B,et al.Saphenous vein graft Angio-plasty Free of Emboli Randomized(SAFER)Trial Investigators.Randomized trial of a distal embolic protection device during per-cutaneous intervention of saphenous vein aorto-coronary bypass grafts.Circulation,2002,105:1285-1290.
• [10]Michaels AD,Gibson CM,Barron HW.Microvascular dysfunction in acute myocardial infarction:focus on the roles of platelet and inflammatory mediators in the no-reflow phenomenon.Am J Car-diol,2000,85:50-60.
• [11]Henriques JP,Zijlstra F,Ottervanger JP,et al.Incidence and clinical significance of distal embolization during primary angio-plasty for acute myocardial infarction.Eur Heart J,2002,23:1112-1117.
• [12]Taghizadeh B,Chiu JA,Papaleo R,et al.AngioJet thrombecto-my and stenting for reperfusion in acute MI complicated with car-diogenic shock.Catheter Cardiovasc Interv,2002,57:79-84.
• [13]Silva JA,Ramee SR,Cohen DJ,et al.Rheolytic thrombectomy during percutaneous revascularization for acute myocardial infarc-tion:experience with the AngioJet catheter.Am Heart J,2001,141:353-359.
• [14]De Luca G,Suryapranata H,Stone GW,et al.Adjunctive me-chanical devices to prevent distal embolization in patients under-going mechanical revascularization for acute myocardial infarc-tion:a meta-analysis of randomized trials.Am Heart J,2007,15:343-353.
• [15]Stone GW,Webb J,Cox DA,et al.Distal microcirculatory pro-tection during percutaneous coronary intervention in acute ST-seg-ment elevation myocardial infarction:a randomized controlled tri-al.JAMA,2005,293:1063-1072.
• [16]Nakamura T,Kubo N,Seki Y,et al.Effects of a distal protection device during primary stenting in patients with acute anterior myo-cardial infarction.Circ J,2004,68:763-768.