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目的探讨急诊冠状动脉介入治疗(PCI)术中抽吸血栓对急性心肌梗死患者心肌再灌注的影响。方法急性心肌梗死行急诊PCI,冠状动脉造影提示存在血栓且罪犯血管直径≥3 mm的患者134例,随机分为抽栓+PCI组69例和标准PCI组65例。分别记录心外膜血流(TIMI)分级和心肌灌注评分(MBG),观察即刻手术成功率、院内主要心脏不良事件(MACE)(心性死亡、急性心肌梗死或急诊血运重建等)发生率。结果抽栓+PCI组和标准PCI组术后TIMI 3级血流比例分别为92.7%和81.5%。2组比较差异无统计学意义(P>0.05);2组术后MBG 3级比例为75.4%和52.3%,2组比较差异有统计学意义(P<0.05)。2组院内MACE发生率均为0。结论急性心肌梗死患者急诊PCI术中使用机械抽吸血栓方法减少血栓负荷,可以改善心肌微循环灌注水平。
Objective To investigate the effect of thrombus aspiration on myocardial reperfusion in patients with acute myocardial infarction during emergency percutaneous coronary intervention (PCI). Methods Acute myocardial infarction (PCI), coronary angiography (CAG), and thromboembolism were performed in 134 patients with blood vessels ≥ 3 mm in diameter. Sixty-nine patients were randomized to receive bolus + PCI and 65 patients received standard PCI. Cardiac epicardial blood flow (TIMI) grading and myocardial perfusion score (MBG) were recorded. The success rates of immediate surgery, major hospital adverse cardiac events (MACE) (cardiac death, acute myocardial infarction or emergency revascularization) were recorded. Results The ratio of TIMI grade 3 blood flow after thrombolysis + PCI group and standard PCI group was 92.7% and 81.5% respectively. There was no significant difference between the two groups (P> 0.05). The two groups were 75.4% and 52.3% respectively after operation. The difference between the two groups was statistically significant (P <0.05). The incidence of MACE in both groups was 0. Conclusion The use of mechanical aspiration thrombosis in emergency PCI in patients with acute myocardial infarction can reduce the thrombus burden and improve the perfusion of myocardial microcirculation.