超声联合微泡对急性ST段抬高心肌梗死PCI后冠脉微栓塞的治疗作用

Percutaneous coronary intervention (PCI) is the preferred treatment for myocardial infarction with ST-segment elevation and is effective in opening the infarct-related artery. However, coronary microembolization caused by thrombus fragment during PCI contribute to increased infarct size and poor outcome. Nowdays, treatments for coronary microembolization are suboptimal. Ultrasound and microbubble are expected to manage this complication for their excellent capacity in dissolving thrombus. However, most of the researches about the thrombolysis effect of ultrasound and microbubble are focus on thrombus in large artery rather microvascular. In our pilot studies, we have confirmed that ultrasound and microbubble are effective in inducing thrombolysis in vitro and in rats with abdominal aorta thrombosis and have established the mini-pig model simulated coronary microembolization after PCI. We have began to investigate the feasibility of microvesscular thrombolysis with ultrasound and microbubble with intravital microscope in the model with mesentery microvascular embolization . In the second step, the therapeutic effect of ultrasound and microbubble on coronary microembolization by dissolving microembolus will be investigated on the mini-pig model simulated coronary microembolization after PCI .

经皮冠状动脉介入（PCI）能有效开通急性ST段抬高型心肌梗死患者的心外大血管，但脱落的微栓子会造成冠脉微栓塞，严重影响患者预后。目前对于冠脉微栓塞的治疗效果欠佳。超声联合微泡能溶解血栓，有望改善冠脉微栓塞。然而，现有研究集中于溶解大血管内的血栓，能否溶解微血管血栓仍有待证实。我们的前期研究亦证实超声联合微泡能有效溶解体外及体内腹主动脉血栓，并成功建立冠脉微栓塞小型猪模型。本项目现已开始在肠系膜微血管栓塞模型上，体视显微镜下证实超声联合微泡溶解微血管栓塞的可行性；拟通过贴近临床实际的冠脉微栓塞小型猪模型，采用心肌酶学、放射性微球定量心肌血流、磁共振及组织病理等方法，证实超声联合微泡改善PCI后冠脉微栓塞的有效性，以期建立一种无创、有效治疗冠脉微栓塞，改善心肌灌注的新方法。

经皮冠状动脉介入（PCI）能有效开通急性ST段抬高型心肌梗死患者的心外大血管，但脱落的微栓子会造成冠脉微栓塞，严重影响患者预后。目前对于冠脉微栓塞的治疗效果欠佳。超声联合微泡能溶解血栓，有望改善冠脉微栓塞。然而，现有研究集中于溶解大血管内的血栓，能否溶解微血管血栓仍有待证实。我们的前期研究亦证实超声联合微泡能有效溶解体外及体内腹主动脉血栓，并成功建立冠脉微栓塞小型猪模型。本项目通过在肠系膜微血管栓塞模型上，验证了超声联合微泡溶解微血管栓塞的可行性，同时在脑微循环栓塞模型（白色和红色微血栓模型）上，发现应用超声联合微泡，能减少脑组织梗死面积并改善脑梗塞后的神经功能，减少相关的后遗症。随后，我们在犬微循环栓塞模型（白色和红色微血栓模型）上证实超声联合微泡能提高两种微血栓梗塞模型的治疗效果，减轻心肌损伤、改善心肌灌注、改善心功能，从而进一步证实了超声联合微泡在PCI术后治疗冠脉微栓塞的可行性。本项目的研究成果提示超声联合微泡治疗有望成为改善STEMI再灌注患者冠脉无复流的一种有效、安全的辅助方法。