【摘要】 目的:比较血栓抽吸术后急诊支架与延迟支架置入对ST段抬高型心肌梗死(STEMI臆者的治疗效果。方法:入选2012-l1至2014-01期间因STEMI行充分血栓抽吸并经血栓抽吸导管冠状动脉(冠脉)内注射替罗非班、硝普钠和硝酸甘油后梗死相关动脉恢复心肌梗死溶栓治疗(TIMI)血流3级的患者共计82例,由SAS软件产生的随机数字法分为急诊支架组(n=41例)和延迟支架组(n=41例)。急诊支架组患者立即置入支架,而延迟支架组患者则不立即置入支架,而是继续抗血小板和抗凝治疗10~14天后再行支架置入。对两组主要指标和次要指标进行比较,主要指标包括心电图ST段回落幅度、慢血流/无复流发生率及心肌染色3级的百分比,次要指标包括支架置入参数、对心室重塑的影响及主要不良心血管事件。结果:延迟支架组在经皮冠状动脉介入治疗(PCI)术后的心电图ST段回落幅度、TIMI血流3级和心肌染色3级百分比以及校正TIMI帧数分别为(68.2±9.2)%、97.5%、69.0%和(19.5±5.2)帧,与急诊支架组比较差异有统计学意义(P<0.05)。延迟支架组与急诊支架组在PCI术中发生无复流/慢血流的比例分别为2.5%和31.0%,两组比较差异有统计学意义(P<0.01)。延迟支架组和急诊支架组支架数量分别为(1.21±0.32)枚和(1.76±0.76)枚,平均支架长度分别为(283±11.7)mm和(33.7±12.9)mm,平均支架直径分别为(3.17±0.76)nm和(2.82±0.87)mm,差异有统计学意义(P<0.01);延迟支架组的扩张压力(18.5±6.2)atm]也明显高于急诊支架组[(13.6±7.1)atm],而延迟支架组75%的患者采取了高压后扩张,高于急诊支架组(23.8%),差异有统计学意义(P<0.01)。随访6个月时发现,延迟支架组和急诊支架组在左心室射血分数、左心室收缩短分数与1周时有下降趋势,但差异无统计学意义(P>0.05)。而左心室舒张末期容积(LVEDV)及左心室舒张末期内径(LVETD)与1周时比较有明显的增加(P<0.05);而这种变化在急诊支架组更为明显(P<0.05)。随访6个月时结果显示,与急诊支架组比较延迟支架组主要不良事件发生率明显下降(P<0.05)。结论:STEMI患者PCI中血栓抽吸术后延迟支架置入可以减少支架术后慢血流/无复流现象的发生,改善支架贴壁和心肌灌注,减少不良心血管事件发生。更多还原

【Abstract】 Objective:To compare the efficacy between emergent and delayed stent implantation in patients with ST-elevation myocardial infarction(STEMI) after thrombus extraction.Methods:A total of 82 STEMI patients who received thrombus extraction and intracoronary injection of tirofiban,sodium nitroprusside,nitroglycerin via thrombus extraction catheter and with recovered TIMI 3 flow from 2012-11 to 2014-01 were retrospectively studied.The patients were randomized into 2 groups by SAS software:Emergent group,the patients received stent implantation immediately upon diagnosis and Delayed group,the patients were treated by anti-platelet and anticoagulant medication for 10-14 days,and then received stent implantation.n=41 in each group.The primary and secondary indicators were compared between 2 groups which including ST-segment resolution(STR),the occurrence rate of no-refiow/slow-reflow,myocardial blush grade(MBG) 3,parameters of stent,ventricular remodeling condition,the incidence of major adverse cardiac events(MACE).Results:① Delayed group had the post PCI STR at(68.2 ± 9.2)% ,TIMI 3 grade at 97.5% ,MBG 3 at 69.0% and corrected TIMI frame count(CTFC) at(19.5 ± 5.2),compared with Emergent group,P<0.05.The occurrence rate of noreflow/slow-reflow in Delayed group and Emergent group were 2.5% and 31.0% ,P<0.01.② The parameters of stents in Delayed group and Emergent group were as the number at(1.21 ± 0.32) vs.(1.76 ± 0.76),the mean length at(28.3± 11.7) mm vs.(33.7 ± 12.9) mm,the mean diameter at(3.17 ± 0.76) mm vs.(2.82 ± 0.87) mm,all P<0.01.Delayed group had the higher dilating pressure than that in Emergent group,(18.5 ± 6.2) atm vs(13.6 ± 7.1) atm,P<0.01,and more patients in Delayed group receive high-pressure non-compliant balloon dilation 75% vs 23.8% ,P<0.01.③ With6 months of follow-up study,there were slightly declining trend for LVEF and LVSF in both groups than that at 1week condition,P>0.05,while LVEDV and LVEDD increased than 1 week,P<0.05,the changes were more obvious in Emergent group,P<0.05.Delayed group had less MACE occurrence,P<0.05.Conclusion:Delayed stent implantation in STEMI patients after thrombus extraction had reduced incidence of post PCI no-reflow/slow-reflow phenomenon,improved myocardial reperfusion and less MACE occurrence.更多还原