ST段抬高型急性心肌梗死患者急诊经皮冠状动脉介入治疗中无复流现象的处理  

Management of No-reflow in Emergency Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction

作　　者：池菊芳[1] 王勇[2] 刘晓飞[2] 李宪伦[2] 王志军[2] 郑金刚[2] 曾玉杰[2] 

机构地区：[1]绍兴市人民医院,浙江省绍兴市312000 [2]北京中日友好医院

出　　处：《中国全科医学》2008年第6期476-478,共3页Chinese General Practice

摘　　要：目的探讨ST段抬高型急性心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)中无复流现象发生的原因及处理方法。方法回顾性分析43例STEMI患者急诊PCI治疗中无复流现象的发生情况。结果43例患者中,梗死相关血管(IRA)为右冠状动脉者27例(62.8%),前降支13例(30.2%),回旋支3例(7.0%);无复流患者的平均再灌注时间为(5.7±2.8)h。无复流患者给予盐酸地尔硫艹卓、腺苷、溶栓剂等药物治疗和主动脉内反搏泵(IABP)治疗。43例患者中,术中及住院期间共死亡6例,病死率为14.0%。结论无复流现象是STEMI患者PCI治疗中常见的合并症之一,有较高的病死率;药物和IABP的综合治疗对无复流患者有一定的疗效。Objective To explore the cause and management of no - reflow in emergency percutaneous coronary intervention （PCI） for ST elevation myocadial infarction （STEMI）, Methods We analyzed retrospectively 821 cases with STEMI who were given emergency PCI from May 1999 to May 2006. Results No - reflow was found in 43 of the 821 patients with STE- MI （29 male, 14 female; with a range of 48 to 83 years） during PCI, with an incidence of 5, 2% ; 27 cases were found with infarct - related artery （IRA） located in right coronary （RA） （62. 8% ）, 13 cases in left anterior descending artery （LAD） （30. 2% ） and 3 cases in left circumflex artery （LCx） （7.0%） ; The average time from onset to reperfusion was （4. 7±2. 8） hours in patients with no - reflow; All no - reflow patients were given drug treatment （ with intracoronary herbesser, adenosyl and thrombolytics） and intraaortic balloon pumping （IABP）, Intravenous tirofiban （20%） and intracoronary t - PA （ 30% ） were used in the treatment on the basis of patient＇s condition, 6 out of the 43 patients died during the operations and hospital stays, with a death rate of 14, 0%. Conclusion No - reflow is a common complication with a high death rate in PCI for STEMI. The location of IRA and the time from onset to reperfusion are predictors of no - reflow, Combined pharmacological approaches, including IABP, can improve IRA anterograde flow.

关 键 词：心肌梗死 经皮冠状动脉介入治疗 无复流 

分 类 号：R541.4[医药卫生—心血管疾病]