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目的探讨对ST段抬高型急性心肌梗死(STEAMI)行急诊经皮冠状动脉介入治疗(PCI)时渐进开通梗死相关血管(IRA)对预防心室颤动(简称室颤)发生的影响。方法 104例STEAMI行急诊PCI的患者分为两组。接受常规介入治疗的52例为对照组,渐进开通IRA的52例为观察组。观察组在开通IRA时,采取逐渐开通前向血流方法。运用心肌梗死溶栓试验(TIMI)分级。TIMI 1级、TIMI 2级每级血流各阶段均保持5 min左右,再使前向血流达到TIMI 3级。如果血栓负荷不重,可用从小到大的球囊扩张。如果血栓负荷重,则血栓抽吸导管抽吸血栓。再根据残存血栓负荷及血流情况选择血栓抽吸导管或球囊导管撤出时机,保证前向血流逐渐开通。观察两组室颤发生的情况。结果观察组室颤发生率较对照组明显减少(0 vs 10%;P<0.01)。ST段回落率观察组明显高于对照组(86%vs 58%,P<0.05)。结论 STEAMI行急诊PCI时渐进开通IRA可减少室颤的发生。
Objective To investigate the effect of progressive opening of infarct-related blood vessels (IRA) on the prevention of ventricular fibrillation (VF) in patients with ST-segment elevation acute myocardial infarction (STEAMI) undergoing emergency percutaneous coronary intervention (PCI). Methods One hundred and forty patients with STEAMI undergoing emergency PCI were divided into two groups. Fifty-two patients receiving conventional interventional therapy as control group, and 52 cases of progressive IRA as observation group. When the IRA was started, the observation group gradually adopted the method of opening the blood flow. Use myocardial infarction thrombolysis test (TIMI) grading. TIMI level 1, TIMI level 2 Each stage of blood flow were maintained for about 5 min, then the forward blood flow to TIMI 3 level. If the thrombus load is not heavy, small to large balloon dilatation. If the thrombus is heavily loaded, the thrombus aspiration catheter aspirates the thrombus. According to the residual thrombus load and blood flow to select the thrombus aspiration catheter or balloon catheter withdrawal timing, to ensure that the anterior blood flow is gradually opened. The occurrence of ventricular fibrillation in both groups was observed. Results The incidence of ventricular fibrillation in observation group was significantly lower than that in control group (0 vs 10%; P <0.01). The rate of ST segment decline in observation group was significantly higher than that in control group (86% vs 58%, P <0.05). Conclusions STEAMI can reduce the incidence of ventricular fibrillation by gradually opening IRA during emergency PCI.