急诊PCI后无复流AMI患者近期预后临床观察  

Clinical studies of no-reflow phenomenon in 144 acute myocardial infarction patients with emergency percutaneous coronary intervention

作　　者：刘丕栋[1] 邢智敏[2] 孙新勇[1] 王岚峰[1] 李竹琴[1] 杨树森[1] 周立君[1] 李为民[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院心内科,黑龙江哈尔滨150001 [2]哈尔滨医科大学分校附属医院

出　　处：《中国急救医学》2005年第6期411-413,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的观察急诊经皮冠状动脉介入治疗(PCI)出现无复流现象的AMI患者近期预后。方法回顾分析AMI行PCI患者547例,根据PCI术后血流分级(thrombolysisinmyocardialinfarction,TIMI分级),冠状动脉前向血流≤TIMI2级患者74例为无复流组,随机抽取TIMI3级患者70例为对照组,分别于术后第3天和第7天测定左心室射血分数,于术后3个月随访观察心血管不良事件。结果入院后第3天和第7天无复流组与对照组比较左心室射血分数明显降低(P<0.05),PCI术后3个月无复流组AMI、充血性心力衰竭、不稳定型心绞痛发病率及死亡率明显高于对照组(P<0.05)。恶性心律失常和心脏外科手术发生率两组间无显著性差异(P>0.1)。结论AMI行急诊PCI过程中冠状动脉无复流患者住院期间心功能明显低于PCI后冠状动脉血流正常患者,心血管事件发生率明显高于PCI后冠状动脉血流正常患者。提示AMI行PCI后冠状动脉无复流患者近期预后差。Objective To study the clinical significance of no-reflow phenomenon in acute myocardial infarction (AMI) patients who underwent emergency percutaneous coronary intervention (PCI).Methods Clinical and angiographic data of five hundred and forty-seven AMI patients underwent emergency PCI in our hospital were retrospectively analyzed.Angiographic no-reflow phenomenon was defined as substantial coronary antergrade flow ≤2 class, without the influence of mechanical obstruction of embolism,thrombus, dissection and spasm on normal flow after PCI. TIMI 3 class had normal flow. The no-reflow group included 74 patients, and 70 patients selected at random from 473 patients with coronary antergrade flow TIMI 3 class after primary PCI were the normal flow group.Results The incidence of left ventricular dysfunction group was much higher in no-reflow group than that in the normal flow group during hospitalization, and patients with no-reflow had significantly higher major cardiac events (MACE) rates during three months after these patients were discharged home.Conclusions The severity of no-reflow phenomenon after an emergency PCI correlated well with the severity of myocardial damage. The patients with severe no-reflow showed the poorest prognosis.

关 键 词：急性心肌梗死 无复流 经皮冠状动脉介入治疗 心血管不良事件 

分 类 号：R542.22[医药卫生—心血管疾病]