急性ST段抬高心肌梗死直接经皮冠状动脉介入术冠状动脉无复流现象对预后的影响  

Clinical significance of no-reflow phenomenon after primary percutaneous coronary intervention in ST segment elevation acute myocardial infarction

作　　者：王国涛[1] 马丽华[2] 张文琪[2] 贺晓楠[2] 李淑梅[2] 

机构地区：[1]大庆市第四医院心内科 [2]吉林大学第二医院心脏中心

出　　处：《中国心血管病研究》2006年第1期31-33,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的研究急诊经皮冠状动脉介入(PCI)治疗冠状动脉(冠脉)中无复流现象的临床意义。方法自2000年1月至2004年1月,回顾性分析我院336例急性ST段抬高心肌梗死(STEMI)直接PCI患者的临床和影像资料。急诊PCI支架置入即刻,在无影响血流的血栓、栓塞、夹层、痉挛情况下,冠脉造影前向血流≤TIMI2级为无复流,TIMI3级为正常血流。冠脉无复流患者42例,利用Excel随机函数表,由其余294例急诊PCI冠脉前向血流恢复正常的患者中随机抽取45例,为正常血流组。随访6个月,观察有无心脏性猝死和非致命性心脏事件。结果无复流组发生充血性心衰、恶性心律失常、再发心绞痛、心脏性猝死高于冠脉血流正常组,无复流组6个月后左室射血分数显著低于冠脉血流正常组。结论无复流患者的心肌损害严重,梗死或濒临坏死的心肌范围广泛,强烈提示AMI预后不良。Objective To explore the clinical significance of no-reflow phenomenon after primary percutaneous coronary intervention （PCI） in ST segment elevation acute myocardial infarction. Methods Cilnical and angiographic data of 336 patients who had primary PCI for ST-segment elevation acute myocardial infarction between January 2000 and January 2004 were retrospectively analyzed. No-reflow was defined as substantial coronary antergrade flow ≤TIMI 2 class without mechanical obstruction of embolism, thrombus , dissection and spasm influence normal flow after PCI. Normal flow was defined as TIMI 3 class, No-flow group contained 42 patients and, and normal flow group contained 45 patients randomized using random count table of Excel from 294 patients with coronary antergrade flow TIMI 3 class after primary PCI. Results Congestive heart failure, cardiac arrhythmia, reoccurred angina pectoris, sudden cardiac death was higher in no-reflow group than the normal flow group （P〈0.05） .LVEF in no-reflow group was significantly lower than the normal flow group after 6 months （P〈0.05）, Conclusion The no-reflow phenomenon identifies patients who have suffered from serious myocardial damage, larger area of necrotic and jeopardized myocardiu, and poor prognosis.

关 键 词：心肌梗塞 血管成形术 预后 ST段 经皮冠状动脉介入术 

分 类 号：R542.22[医药卫生—心血管疾病]