主动脉内球囊反搏术联合血栓抽吸术在急诊PCI治疗中的应用

目的观察主动脉内球囊反搏术（IABP）与血栓抽吸术联用在急诊经皮冠状动脉介入治疗（PCI）中的疗效和安全性。方法 ST段抬高型急性心肌梗死（AMI）行急诊冠状动脉造影提示大量血栓征象、并需行血栓抽吸的患者136例,随机分为试验组和对照组两组,试验组PCI术前行IABP后联合导管血栓抽吸;对照组为术前单纯行导管血栓抽吸。观察其疗效与安全性。结果试验组患者的TIMI3级血流、无复流/慢血流率、病死率与对照组比较,差异无统计学意义（P〉0.05）。试验组的血浆中CK-MB其峰值、CTnI峰值、肺动脉楔压较对照组显著降低,试验组患者平均动脉压（MABP）、心脏指数、心输出量、射血分数较对照组显著提高,两组比较差异均有统计学意义（P〈0.01）。结论对合并严重心功能不全的患者行急诊PCI时联用IABP及血栓抽吸术,对于改善心肌缺血、增加冠脉灌注,恢复心功能有明显的作用。

Combined application of intra-aortic balloon counterpulsation and thrombus aspiration in emergent percutaneous coronary intervention

Objective To investigate the efficiency and safety of combined use of intra-aortic balloon pump （IABP） and thrombus aspiration in primary percutaneous coronary intervention （PCI）. Methods A total of 136 patients with acute STsegment elevation myocardial infarction （STEMI） were found to have bulky thrombi by emergent PCI, and then treated with IABP plus thrombus aspiration （observation group） or only thrombus aspiration （control group）. Results There were no significant differences in rates of TIMI 3 flow restoration, no-reflow and slow flow and mortality between both groups （P〈0.05）. Compared with control group, serum peak values of CK-MB and cardiac troponin 1 （CTn1） and pulmonary artery wedge pressure decreased, but mean arterial pressure, cardiac index, cardiac output and ejection fraction increased （P〈0.01） in observation group. Conclusion Combined application of IABP and thrombus aspiration may improve myocardial ischemia, coronary perfusion and heart function in acute myocardial infarction with severe cardiac insufficiency.