【摘要】 目的 探讨急性ST段抬高心肌梗死(STEMI)患者直接经皮冠状动脉内介入治疗(1PCI)术中应用血栓抽吸导管进行血栓抽吸对窦性心律震荡(HRT)的影响及临床意义。方法 选择2012年1月至2014年1月在广州市第一人民医院心内科住院诊断为STEMI的患者224例,入选病例均接受直接PCI治疗并随机(随机数字表法)分为对照组116例和血栓抽吸组108例。患者于PCI术后48 h进行24 h动态心电图检查,计算窦性心律震荡指标震荡初始(To)和震荡斜率(Ts),分析两组患者To、Ts的差异。术后对患者随访6个月,记录随访期间心脏不良事件(MACE)的发生情况。采用多因素Logistic回归分析血栓抽吸及HRT指标To、Ts对患者PCI术后6个月内MACE发生的预测意义。结果 与对照组相比,血栓抽吸组患者HRT指标To、Ts值均优于对照组[(-1.26±0.78)%比(-0.86±0.56)%,P<0.05;(2.76±1.01)%比(2.38±0.89)%,P<0.05];术后6个月内MACE的发生率明显低于对照组,差异有统计学意义(5.56%比14.66%,P<0.05)。多因素Logistic回归分析显示,Ts<2.5 ms/RR是STEMI患者直接PCI术后近期预后的独立预测因子,而直接PCI术中应用血栓抽吸则对降低MACE事件的发生有保护作用(P<0.05)。结论 STEMI患者直接PCI术中应用血栓抽吸能改善患者的HRT,降低MACE的发生率,改善临床预后。更多还原

【Abstract】 Objective To investigate the effects of thrombus aspiration administration on heart rate turbulence(HRT) in patients with ST-segment elevation myocardial infarction(STEMI) underwent primary percutaneous coronary intervention(PCI) therapies.Methods 224 STEMI patients who hospitalized in Cardiac Care Unit(CCU)of our department from January 2012 to January 2014 were enrolled and randomly divided into experimental group(n=108) in which thrombus aspiration was applied during PCI and control group(n=116).The enrolled cases accepted 24 hour holter monitoring electrocardiogram examinations 48 hours after PCI.The indexes of HRT including Turbulence onset(To) and Turbulence slope(Ts) and Major adverse cardiac events(MACE) that took place within6 months after PCI in both groups were measured and recorded.Results Compared with control group,the HRT indexes of To and Ts in experimental group were superior and the incidence rate of MACE was lower(P<0.05).Multiple factors logistic regression analysis indicated that Ts<2.5 ms/RR was one independent predicative factor for the MACE of STEMI patients while thrombus aspiration administration was a protective factor.Conclusion Thrombus aspiration administration during primary PCI can improve HRT of STEMI patients,reduce incidence rates of MACE and improve the clinical prognosis.更多还原