發(fā)布時(shí)間：2018-08-19 11:46

【摘要】：目的:在我國(guó),隨著經(jīng)濟(jì)不斷發(fā)展和社會(huì)壓力不斷提高,吸煙、肥胖及體力活動(dòng)減少,人群高血壓、高血脂、高血糖及高同型半胱氨酸血癥等傳統(tǒng)冠心病危險(xiǎn)因素均呈上升趨勢(shì),且發(fā)病日趨年輕化,嚴(yán)重威脅了人類(lèi)健康。尤其以急性ST抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)最為嚴(yán)重。本研究通過(guò)分析靜海區(qū)醫(yī)院CCU科2011年3月至2014年3月收治的STEMI患者的臨床資料,探討STEMI行急診直接PCI術(shù)中對(duì)評(píng)價(jià)為血栓負(fù)荷重的患者應(yīng)用手動(dòng)血栓抽吸裝置治療對(duì)患者心室重構(gòu)及臨床預(yù)后的影響。方法:分析我院2011年3月~2014年3月期間診斷為STEMI行直接急診PCI術(shù)的308例患者,術(shù)中對(duì)評(píng)價(jià)為血栓負(fù)荷重進(jìn)行輔助血栓抽吸治療的152例患者定為血栓抽吸組,對(duì)評(píng)價(jià)為血栓負(fù)荷輕的未應(yīng)用血栓抽吸的156例患者定為對(duì)照組。評(píng)價(jià)患者PCI術(shù)后心肌灌注指標(biāo)包括術(shù)后2hST段回落和心肌灌注TIMI分級(jí),所有患者術(shù)后10天行超聲心動(dòng)圖測(cè)定左室舒張末徑(LVED)及左室射血分?jǐn)?shù)(LVEF),比較兩組患者的指標(biāo)差異及隨訪6個(gè)月心血管不良事件發(fā)生情況。結(jié)果:血栓抽吸可以有效地吸出血栓,從而改善心肌再灌注,兩組ST段回落大于50%的病例比較差異無(wú)統(tǒng)計(jì)學(xué)意義[78.9%(120/152)與71.2%/(111/156),χ2=0.428,p=0.669],但對(duì)ST段回落大于70%的比較血栓抽吸組明顯高于對(duì)照組[73.7%(112/152)與47.4%/(74/156),χ2=4.701,p=0.001]。兩組患者術(shù)后第10天進(jìn)行超聲心動(dòng)圖復(fù)查,顯示出血栓抽吸組LVED低于對(duì)照組[(50.2±4.7)mm與(51.6±4.6)mm,t=2.642,p=0.008],而LVEF值則高于對(duì)照組[(56.9±4.9)%與(49.4±4.2)%,t=14.434,p=0.001],術(shù)后隨訪6個(gè)月再發(fā)心絞痛明顯減少[4.61%(7/152)與10.90%/(17/156),χ2=2.056,p=0.040],再梗死、心力衰竭、心源性猝死等事件并無(wú)顯著性差異[2例(1.31%)與2例(1.28%),p=0.979;5例(3.29%)與8例(5.13%),p=0.423;1例(0.65%)與2例(1.28%),p=0.578]。結(jié)論:STEMI患者在接受急診PCI時(shí),對(duì)評(píng)價(jià)為血栓負(fù)荷重的病變采用血栓抽吸術(shù),不僅能有效改善心肌再灌注,尤其是微循環(huán)再灌注,還可改善左心室收縮功能,改善患者預(yù)后。
[Abstract]:Objective: in China, with the continuous development of economy and social pressure, smoking, obesity and reduced physical activity, people with high blood pressure, hyperlipidemia, Traditional coronary heart disease risk factors such as hyperglycemia and hyperhomocysteinemia are on the rise, and the incidence is getting younger, which is a serious threat to human health. In particular, acute St-elevation myocardial infarction (ST-segment elevation myocardial infarction) is the most serious. This study analyzed the clinical data of STEMI patients treated in CCU Department of Jinghai District Hospital from March 2011 to March 2014. Objective: to investigate the effect of manual thrombotic suction device on ventricular remodeling and clinical prognosis in patients with severe thrombotic load during emergency direct PCI operation with STEMI. Methods: from March 2011 to March 2014, 308 patients who were diagnosed as STEMI undergoing direct emergency PCI operation were analyzed. 152 patients who were evaluated as thrombotic load and treated with auxiliary thrombotic aspiration during operation were selected as thrombotic aspiration group. 156 patients with low thrombus load and no thrombus aspiration were selected as control group. The indexes of myocardial perfusion after PCI were evaluated, including postoperative 2hST segment fall and myocardial perfusion TIMI grade. Left ventricular end-diastolic diameter (LVED) and left ventricular ejection fraction (LVEF),) were measured by echocardiography 10 days after operation. Results: Thrombus aspiration can effectively suck out thrombus and improve myocardial reperfusion. There was no significant difference between the two groups in patients whose St segment retreated more than 50% [78.9% (120 / 152) vs 71.222r / (111156), 蠂 2 + 0.428% p 0.669], but the comparison thrombus aspiration group with St segment retreating more than 70% was significantly higher than the control group [73.7% (112 / 152) vs 47.4AD / (74 / 156), 蠂 ~ 2 4.701p ~ (0.001)]. Echocardiographic reexamination on the 10th day after operation in both groups showed that the LVED in the thrombotic aspiration group was lower than that in the control group [(50.2 鹵4.7) mm and (51.6 鹵4.6) mm respectively], while the LVEF value was higher than that in the control group [(56.9 鹵4.9)% vs (49.4 鹵4.2)% vs (49.4 鹵4.2) t14.434p0.001]. The recurrent angina pectoris in the thrombotic aspiration group decreased significantly [4.61% (7 / 152) and 10.90 / (17156), 蠂 ~ (22.056) P 0.040]. There was no significant difference in sudden cardiac death between 2 cases (1.31%) and 2 cases (1.28%), p0. 979 9 cases (3. 29%) and 8 cases (5. 13%) p0. 423 cases (0. 65%) and 2 cases (1. 28%) p0.578 respectively. Conclusion Thrombus aspiration can not only improve myocardial reperfusion, especially microcirculation reperfusion, but also improve left ventricular systolic function and prognosis of patients with PCI.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R542.22

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