【摘要】 急性ST段抬高型心肌梗死(STEMI)的发生和发展伴随着血栓形成并致冠脉血管闭塞,STEMI发病主要机制是冠脉血管壁上存在着不稳定性粥样硬化斑块(易损斑块),易损斑块破裂触发了凝血瀑布,导致血栓的形成和进展.高血栓负荷STEMI是经皮冠状动脉介入(PCI)治疗中的挑战性问题,PCI在开通冠脉血管的过程中,血栓因受到挤压而导致脱落,脱落的血栓可导致远端血管栓塞,发生慢血流或无复流现象,从而危及患者生命,使PCI失败.冠脉内血栓抽吸可有效清除血栓,减少慢血流和无复流事件的发生,并提高心肌组织的灌注水平,有利于保护心功能和改善预后.延迟支架术对于高血栓负荷和伴有血流动力学不稳定的患者有益,血管内低温治疗及使用抗栓溶栓药物可作PCI的辅助治疗,对于血栓负荷较少的患者行直接支架术治疗是合理的.更多还原

【Abstract】 The onset and progression of acute ST-elevation myocardial infarction (STEMI) are associated with thrombosis and occlusion of coronary arteries. The main pathogenesis of STEMI is the presence of unstable atherosclerotic plaques (vulnerable plaques) in the coronary arteries,which rupture and trigger a coagulation cascade,leading to the thrombosis and progression of thrombus. The treatment of STEMI patients with high thrombotic load is a challenging problem in PCI. When PCI opens a coronary artery,a clot can become compressed and fall off.Detached thrombus can lead to distal vascular embolism,slow flow or no reflow,which can endanger patients’ lives and cause PCI failure. Intracoronary thrombus aspiration is an effective therapeutic measure to remove thrombus,which can reduce the occurrence of slow blood flow and no reflow events,and improve the perfusion level of myocardial tissue,which is beneficial to protect cardiac function and improve prognosis.Deferred stenting is beneficial to patients with high thrombotic load and hemodynamic instability. The intracoronary therapeutic hypothermia and antithrombotic and thrombolytic agents can be used as adjuvant therapy with PCI.For patients with low thrombus load,primary stenting is reasonable.更多还原