摘要
目的:比较机械与手动血栓抽吸在急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PPCI)中应用的临床疗效。方法:124例STEMI患者在接受PPCI治疗支架置入前,随机分为机械血栓抽吸组(AngioJet组,66例)和手动血栓抽吸组(Export组,58例)。主要终点是术后30 min时ST段回落(STR)≥50%比例及术后3个月内主要不良心脏事件(MACE)发生率,其他替代终点包括血栓抽吸术后TIMI血流分级、校正TIMI帧数(cTFC)、TIMI心肌灌注染色分级(MBG)、肌酸激酶同工酶(CK-MB)质量峰值时间、肌钙蛋白Ⅰ(cTnI)峰值等,比较组间基线资料以及主要终点、替代终点的差别。结果:术后30 min时STR≥50%比例在AngioJet组显著高于Export组(81.8%vs 65.6%,P=0.038),AngioJet组MACE事件发生率与Export组比较无统计学差异(7.6%vs12.1%,P=0.398)。AngioJet组术后TIMI血流3级比例显著高于Export组(86.4%vs 70.7%,P=0.032),cTFC、MBG、CK-MB质量峰值时间2组间无统计学差异。结论:对于急性心肌梗死血栓负荷重的完全闭塞病变的患者,直接支架置入术前采用AngioJet机械血栓清除相比手动抽吸导管清除血栓能取得更好的心肌灌注效果,但并不能改善术后3个月的临床结果。
Objective：To compare the efficacy of mechanical versus manual thrombus aspiration in primary percutaneous coronary intervention （PPCI） for acute ST-elevated myocardial infarction （STEMI）.Methods：One hundred and twenty-four patients with STEMI were randomly divided into mechanical thrombus aspiration group （AngioJet group,66 cases） and manual thrombus aspiration group （Export group,58 cases） prior to PPCI.The primary endpoints were the percentage of ST-segment resolution （STR） ≥50% and the incidence of major adverse cardiac events （MACE） in 3-month follow-up.Other surrogate endpoints included postoperative TIMI flow grade,corrected TIMI frame count （cTFC）,myocardial blush grade （MBG）,peak time of CK-MB mass and so on,the differences were compared between the two groups.Results：The primary endpoint of the percentage of STR≥50% was higher in AngioJet group than that in Export group （81.8% vs 65.6%,P =0.038）.There was no difference in incidence of MACE in 3-month follow-up between the two groups （7.6% vs 12.1%,P =0.398）.Incidence of postoperative TIMI flow grade 3 was higher in AngioJet group than that in Export group （86.4% vs 70.7%,P =0.032）.There were no differences in cTFC,MBG and peak time of CK-MB mass between two groups.Conclusions：For patients with large thrombotic lesions,AngioJet mechanical thrombus aspiration could achieve better myocardial perfusion compared to manual thrombus aspiration,but the 3-month clinical outcome cannot be improved.
出处
《内科急危重症杂志》
2014年第4期231-234,共4页
Journal of Critical Care In Internal Medicine
