冠心病介入治疗中的无血流现象及处理  

No-reflow phenomenon and treatment during percutaneous coronary intervention

作　　者：高传玉[1] 程兆云[1] Robert Whitbourn Andrew MacIsaac Patracia Fox Michael Jelinek 

机构地区：[1]河南省人民医院,郑州450003 [2]St.Vincent’sHospitalMelbourne,Fitzory3065,Australia

出　　处：《中国急救医学》2001年第4期211-213,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的　评价血小板表面糖蛋白受体 (GPⅡb/Ⅲa)拮抗剂ReoPro对硝酸甘油不能缓解的冠状动脉无血流现象(No -Reflow)的疗效以及对住院期间临床预后的影响。方法　回顾性研究了伴或不伴No -Reflow现象病人的临床特点、住院期间主要心血管事件 (死亡、心肌梗死、血管再通术 )发生率。结果　 10 93例病人中经皮球囊扩张术 (PTCA) 35 2例 ,支架术 741例 ;共 2 3例病人被描述有No -Reflow现象 ,其中 6例病人对硝酸甘油冠状动脉内注射无反应 ,在给予ReoPro后TIMI血流明显改善 (0 83± 0 41vs 2 5 0± 0 5 4,P <0 0 0 2 ) ,与同期不伴有No -Reflow现象相比 ,住院期间死亡 (0vs 0 74% ,P >0 75 )、靶血管再介入 (0vs 1 10 % ,P >0 75 )、搭桥术 (0vs 0 2 1% ,P >0 90 )发生率无区别 ,但心肌梗死发生率较高 (Q波心肌梗死 :16 7%vs0 37% ,P <0 0 0 5 ;无Q波心肌梗死 :5 0 %vs 1 0 5 % ,P <0 0 0 5 )。结论　ReoPro能明显改善对硝酸甘油无反应No -Reflow病人的TIMI血流及临床预后 ,也提示血小板介导的微血管血栓及栓塞是这类病人NoObjective Evaluating the effect of platelet glycoprotein Ⅱb/Ⅲa receptor inhibitor abciximab(ReoPro)on clinical of patients with no-reflow phenomenon which failed to respond to intracoronary nitroglycerin.Method We respectively studied in-hospital clinical outcome and the incidence of in-hospital cardiac events(death,myocardial infarction,revascularisation)of patients with or without no-reflow phenomenon.Result In 1 093 patients undergoing percutaneous coronary revascularisation(percutaneous transluminal coronary angioplasty-PTCA 352 cases,stenting 741 cases),transient or sustained no-reflow was described by operators in 23 patients.In 17 patients,TIMI flow grade Ⅲ was recovered quickly in catheter lab after intracoronary nitroglycerin was administrated.In the other 6 patients who failed to respond to intracoronary nitroglycerin administration,ReoPro was given intravenously;TIMI flow grade Ⅲ and grade Ⅱ were achieved in 3 patients respectively in the catheter lab( P <0 002);Q-wave and non Q-wave myocardial infarction(QMI and Non-QMI) occurred in 1 patient and 3 patients respectively;There was no difference on in-hospital death and revascularisation between patients with or without no-reflow phenomenon ( P >0 75),but the incidence of myocardial infarction of the patients with no-reflow phenomenon was significantly higher(QMI:16 7% vs 0 37%, P <0 005;Non-QMI:50% vs 1 05%, P <0 005).Conclusion No-reflow phenomenon which failed to respond to intracoronary nitroglycerin generally responded promptly to intravenous ReoPro administration with recovery to TIMI grade Ⅱ or Ⅲflow in the catheter lab;In-hospital death and subsequent revascularisation of patients with no-reflow phenomenon were similar to patients without no-reflow phenomenon.This suggests abciximab (ReoPro) is an effective adjunctive therapy for the no-reflow phenomenon, and that platelet mediated microvascular thrombus and embolization may be the mechanism of nitroglycerin-resistant no-reflow phenomenon during percutaneous

关 键 词：PTCA术 支架术 冠心病 No-Reflow现象 血小板 介入治疗 GP0Ⅱb/Ⅲa受体拮抗剂 ReoPro 

分 类 号：R541.4[医药卫生—心血管疾病]