急性心肌梗死患者经皮冠状动脉介入治疗后无复流现象的临床特点及其对心室功能的影响  

Clinical features of no reflow phenomenon in post-percutaneous coronary intervention patients with acute myocardial infarction and the effect on the left ventricular function

作　　者：苏军红[1] 刘君[2] 傅向华[2] 李世强[2] 谷新顺[2] 薛玲[2] 赵运涛[2] 

机构地区：[1]邯郸市第一医院急诊科,河北邯郸056002 [2]河北医科大学第二医院心内科干部病房河北医科大学心脏介入中心

出　　处：《临床心血管病杂志》2006年第10期612-615,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后无复流患者的临床特征、主要影响因素及其对心功能和预后的影响。方法:根据梗死相关动脉校正的TI MI血流记祯法(CTFC)将同期入院的AMI患者(267例)经PCI治疗后分为有复流组(205例)和无复流组(62例)。测量2组的心肌梗死面积、左心室收缩功能、舒张功能和同步性功能参数。结果:无复流组较有复流组,症状发作至球囊扩张时间显著延迟(17·01±11·33)∶(12·56±9·27)h,P<0·05;心肌酶肌酸激酶(CK)峰值明显增高(4283±3098)∶(2285±1586)I U/LP<0·01;糖尿病比例、侧支循环良好比例明显降低,无梗死前心绞痛的比例、室壁瘤发生率、Killip分级≥2级发生率明显增高,均P<0·05。直接支架术治疗可减少无复流的发生。采用Logistic多元回归分析发现,左前降支近段完全闭塞且无明显侧支循环和无梗死前心绞痛、病理性Q波导联数、心肌酶CK峰值为无复流的独立危险因素。99mTc-MIBI-SPECT心肌灌注断层显像显示无复流组心肌梗死面积显著大于有复流组,P<0·05。无复流患者的收缩功能与舒张功能均明显受损(P<0·05,P<0·01);心室收缩同步功能亦明显下降,术后并发症、死亡率均明显增加(均P<0·05)。结论:无复流现象的发生与左前降支近段闭塞且无明显侧支循环、病理性Q波导联数、CK峰值、无梗死前心绞痛明显相关;PCI后无复流现象增加梗死面积,影响AMI患者的心功能和预后。Objective：This study was to investigate the clinical features and coronary artery character of no-reflow phenomenon post- percutaneous coronary intervention （PCI）in patients with AMI and its influence on heart function and prognosis. Method： The 267 patients （216 male, 51 female, average age [58.27± 11.09] years） were involed in this study. All patients were submitted to coronary angiography （CAG）, percutaneous coronary intervention （PCI） and left ventriculography （LVG） about 2 to 72 hours after onset of AMI and divided into two groups：no reflow group and reflow group according to the result of corrected T1MI frame count（CTFC） post PCI. 99mTc MIBI-SPECT myocardial perfusion image and equilibrium radionuclide angiography （ERNA） were performed in 5 to 8 days after the onset of AMI to evaluate the myocardial infarction area（MIA） and heart function. Result：The time interval of onset to balloon of no reflow group is longer（[17.01±11.33]vs [12.56±9.27], P〈 0.05） ;and CK peak value is higher than that of reflow group. There are lower incidence of diabetes and good collateral circulation, higher incidence of pre-angina pectoris and Killip≥2 grade in patients with no reflow （9.68% vs 23.41%, 24.65% vs 55.61%, 77.41% vs 44. 14%,35.48% vs 16.59%, P 〈0.05, respectively）. The incidence of ventricular aneurysm increased in no reflow group（58.06% vs 23.90%, P 〈0.05）. The treatment of direct stenting could reduce the incidence of no reflow （16.13% vs 37.07%, P 〈0.05）. According to Logistic mutivariable regression analysis, proximal LAD occlusion, the numbers of pathological Q waves leads, CK peak value and lack of angina before AMI are the independent risk factors of no reflow. The area of myocardial infarction in no-reflow group is larger than that in reflow group（[18. 26±2. 73]% vs [14.33±3. 121%, P 〈0.05）. Among no reflow group, systolic and diastolic heart function are both injured（LVEF [46.26 ± 17.23]% vs [59.86 ± 12. 02]% , P 〈0. 01; PER [2.

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 心室功能 预后 

分 类 号：R542.2[医药卫生—心血管疾病]