经桡动脉血栓抽吸在急诊冠脉介入治疗的应用.docVIP

KKME---专业医学搜索引擎/ 经桡动脉血栓抽吸在急诊冠脉介入治疗的应用 　　作者：汝磊生，齐书英，彭育红，杨丽，谷文平，李丽青 作者单位：白求恩国际和平医院心内科，河北 石家庄 050082 　　【摘要】 目的 在经桡动脉急诊冠脉介入治疗(PCI)中用ZEEK血栓抽吸导管来减少和消除急性心肌梗死(AMI)患者冠脉内的血栓，观察其效果、安全性和可行性。方法 选择符合条件的AMI患者共16例行急诊PCI+血栓抽吸(PT)术，同时期的16例行单纯PCI的同类患者设为对照组。以标准方法行急诊PCI和/或PT术，观察两组患者的心肌血流灌注情况、ST段抬高幅度最大的心电图单导联ST段的抬高幅度和心肌酶CKMB的峰值、术后1月、2月及3月经心脏彩色超声多普勒测定的左室射血分数(LVEF)及二尖瓣环舒张早期血流速度与舒张晚期血流速度的比值(E/A)和3个月内的临床预后。结果 血栓抽吸组心肌组织再灌注情况明显改善;心肌酶峰值明显提前，术后1.5 h ST段抬高幅度有下降趋势;术后1个月、2个月和3个月时LVEF和E/A比值有逐渐增大趋势;单纯PCI组有1例患者出现急性血栓形成。结论 血栓抽吸结合经桡动脉直接PCI有较好的近期及远期疗效，操作简便，值得推广。 　　【关键词】 急性心肌梗死,急诊经皮冠状动脉介入治疗,桡动脉,血栓抽吸;心肌灌注 　　Abstract：Objective To observe the effectiveness, safety and feasibility of transradial thrombusaspiration during emergency percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients. Methods Sixteen AMI patients (PT group) underwent both PCI and thrombusaspiration treatment and another 16 AMI patients (control group)underwent PCI only. Parameters as myocardial perfusion, electrocardiogram ST elevation, CKMB, left vetricular ejection fraction(LVEF) and E/A were recorded during 3 months followup. Results Compared with control group, PT group had significantly improved myocardial reperfusion, early arrived CKMB peak, decreased amplitude of elevated ST segment, and improved LVEF and E/A. There was no acute thrombus complication in PT group. Conclusions Thrombusaspiration during emergency PCI has good immediate and longrun effects. 　　Key words：Acute myocardial infarction; Emergency percutaneous coronary intervention; Radial artery; Thrombusaspiration; Myocardial reperfusion 　　循证医学证实大多数急性心肌梗死(acute myocardial infarction，AMI)是由于患者的冠脉动脉(冠脉)内斑块破裂诱发血栓形成所致[1,2]，急诊经皮冠状动脉介入治疗(percutaneous coronary intervention，PCI)行再灌注治疗是目前治疗AMI有效的首选措施，可明显改善左心室功能和降低死亡率[2,3]。而在AMI再灌注治疗中，常发生冠状动脉无复流及末梢栓塞等并发症[3]，严重影响患者的生存率及预后，故消除血栓性物质是治疗AMI的关键。近年来，在对AMI进行介入性再灌注治疗中，为预防冠状动脉无复流及末梢栓塞等并发症的发生，各种新开发的血栓抽吸或切除装置得到广泛关注，并且正在普及应用。我们在经桡动脉急诊PCI中用ZEEK血栓抽吸导管(ZEON Medical公司产品)来减少和消除AMI患者冠脉内的血栓，取得了