【作者】 潘迪华；

【导师】 李全忠；

【作者基本信息】 桂林医学院 ， 内科学， 2013， 硕士

【摘要】 目的：比较血栓抽吸(thrombus aspiration)加常规急诊经皮冠状动脉冠状动脉介入（percutaneous coronary intervensions，PCI）和单纯常规急诊PCI两种方法对急性ST段抬高心肌梗死(STEMI)患者术后血浆氨基末端脑利钠肽前体(N-terminal pro-brainnatriureticpeptide，NT-proBNP)水平及左室功能及预后的影响，以期进一步探讨血栓抽吸改善STMI患者预后的机理，为冠心病的治疗提供有价值的参考依据。方法：入选2009年8月-2012年10月期间在我院住院诊断为STEMI并行急诊PCI的患者80例，随机分为以下2组：(1)单纯介入治疗组（常规PCI组）：40例，(2)血栓抽吸组+支架置入组（血栓抽吸+常规PCI组）:40例。比较：⑴两组术后即刻心肌梗死溶栓治疗(TIMI)血流分级；(2)两组术后即刻、术后48小时、术后3月、术后6月的NT-proBNP水平；（3）术后肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)及超敏C反应蛋白（hs-CRP）的峰值和达峰时间；（4）术后3天和6月心脏功能情况：使用心脏多谱勒超声心动图测量左室舒张末期容积（LVEDV）、左室收缩末期容积(LVESV)、每搏量(SV)、左室射血分数（LVEF)；（5）术后血管不良事件(major adverse cardiovascular events，MACE)的发生情况。结果：1.入院即刻肘静脉血与罪犯冠状动脉血中NT-proBNP（pg/mL）对比:1804.8士951.3vs1911.8士851.3，无统计学差异，P＞0.05。血栓抽吸组与对照组相比，入院即刻NT-proBNP无统计学差异，术后48小时877.6±651.2vs1316.7±799.6，术后3月123.8±64.2vs188.7±82.4，术后6月113.4±44.1vs177.5±79.2，血栓抽吸组均低于对照组，差异有统计学意义，P＜0.05。2.两组患者出现TIMI0-1级例数：在血栓抽吸组1例(2.5%)，而对照组出现8例(20%)。差异有统计学意义(P＜0.05)。出现TIMI2级例数两组相近10%vs17.5%，差异无统计学意义，P＞0.05。出现TIMI3级例数血栓抽吸组明显多于对照组，87.5%vs52.5%,差异有统计学意义，P<0.05。3.心脏彩超测量心功能：PCI术后3天血栓抽吸组患者左心功能各参数略好于对照组，但差异无统计学意义，P＞0.05。PCI术后6个月时血栓抽吸组左室舒张末期容积（LVEDV）（84.68±12.95vs98.32±18.49）、每搏量（SV）（52.41±8.18vs46.63±7.18）、左室射血分数（LVEF）（61.25±10.05vs47.15±5.05）较对照组明显改善，差异有统计学意义，P＜0.05。4.血栓抽吸组与对照组相比，肌酸激酶同工酶（CK-MB）峰值（187.1±64.3vs221.6±56.1）、肌钙蛋白I（cTnI）峰值（28.2±15.9vs41.2±19.3）、超敏C反应蛋白（hs-CRP）峰值（26.4±20.8vs46.4±22.7）均降低，肌酸激酶同工酶（CK-MB）达峰时间提前（9.8±6.5vs13.1±5.5）差异有统计学意义（P<0.05)。5.术后6个月观察终点比较（MACE）：血栓抽吸组和对照组相比，有减少趋势，但无统计学差异（P>0.05）。结论：1.显示抽吸导管抽合并常规PCI治疗较常规PCI可明显改善TIMI血流分级，减少冠脉“无复流”或“慢血流”。2.抽吸导管抽合并常规PCI治疗较常规PCI可降低NT-proBNP表达。3.抽吸导管抽合并常规PCI治疗较常规PCI可明显改善心肌组织灌注水平，改善左心功能，减少心室重构发生。更多还原

【Abstract】 Objective: To compare the effect between the combination of thrombusaspiration with percutaneous coronary intervensions (PCI) andconventional emergency PCI method on the serum N-terminal pro-brainnatriureticpeptide (NT-proBNP) level and left ventricular function of theSTEMI patients and their prognosis, so as to investigate the mechinism toimprove the prognosis of STEMI patients through thrombus sapiration.Methods:80hospitalized STEMI patients performed PCI in our hospitalfrom August of2009to Octomber of2012were divided randomizedlyinto2groups with40patients in each group according: the conventionalintervention group and the thrombus aspiration group. The NT-proBNPlevels of both groups were compared respectively at the immediatepost-surgery, and48hrs postoperation,3months postoperation and6months postoperation; the cardiac functions of both groups at3daysand6months after surgeries were compared respectively; and LVEDV,LVESV, SV, LVEF, TIMI, postoperative CK-MB, cTnI, hs-CRP peakand peak time, and the occurrence of major adverse cardiovascular events (MACE) were also measured.Results:1. The NT-proBNP（pg/mL）of the immediate admission venousblood and the culprit intravascular blood of patients were1804.8士951.3vs1911.8士851.3, which was of no statistical difference (P>0.05)between the two groups. Compared with the control group, there was nosignificant difference in the the immediate admission NT-proBNP (pg/mL), but the NT-proBNP in the thrombus aspiration group were877.6±651.2vs1316.7±799.6forty-eight hrs postoperations,123.8±64.2vs188.7±82.4three months after surgeries and113.4±44.1vs177.5±79.2six months after operations, which was of statistical difference.2. The number of TIMI grade0-1patients in both groups: there was1case (2.5%) in the thrombus aspiration group, but8cases in the controlgroup, which was of significant difference (P<0.05); TIMI grade-2patients in the thrombus aspiration group and the control group were10%vs17.5%, which was no obvious difference (P>0.05); and TIMI grade-3patients in the thrombus aspiration group and the control group were87.5%vs52.5%, which was of significant difference (P<0.05).3. The results of cardiac functions meaured by UCG showed thatparameters of left ventricular functions in patients in the thrombusaspiration group were slightly better than those in the control group3days after PCI operations, which was of significant difference (P>0.05).But6months after PCI surgeries, parameters of LVEDV, SV and LVEF of the patients in the thrombus aspiration group had beenimproved greatly than those in the control group, which were(84.68±12.95vs98.32±18.49),(52.41±8.18vs46.63±7.18) and(61.25±10.05vs47.15±5.05) respectively. There were significantdifferent (P<0.05).4. Compared the thrombus aspiration group and the control group, theparameters of CK-MB (187.1±64.3vs221.6±56.1), cTnI (28.2±15.9vs41.2±19.3), hs-CRP (26.4±20.8vs46.4±22.7) peak values in both groupsdecreased, and CK-MB peak time (9.8±6.5vs13.1±5.5) in both groupsreached in advance, which were statistically different (P<0.05).5. The observation of the outcome measurement of MACE6months aftersurgeries showed that the thrombus aspiration group had the tendency todecreased, but there was no different between the two groups (P>0.05).Conclusions:1. The combination of thrombus aspiration withconventional PCI treatment can obviously improve TIMI, reduce theno-reflow and slow flow in the coronaries;2. The combination ofthrombus aspiration with conventional PCI treatment may reduce theNT-proBNP expressions;3. The combination of thrombus aspiration withconventional PCI treatment method are better than the conventional PCIin improving the left ventricular functions.更多还原