应用扩张后球囊推送法治疗急性心肌梗死无复流即刻效果的研究  

Therapy for No-Reflow after Emergency PCI with Immediate Effect by Expanding Balloon Push Method

作　　者：王政[1] 田学峰[1] 朱贵家[1] 

机构地区：[1]黑龙江省医院心内科,黑龙江哈尔滨161006

出　　处：《中西医结合心血管病电子杂志》2014年第14期57-59,61,共4页Cardiovascular Disease Electronic Journal of Integrated Traditional Chinese and Western Medicine

基　　金：黑龙江省医院新技术项目

摘　　要：目的：经皮冠状动脉介入治疗（Percutaneous coronary intervention，PCI）是急性心肌梗死（acute myocardial infarction，AMI）血管重建的首选方法。然而由于血栓负荷较重引起的无复流现象，使患者的PCI收益大为降低，心肌不能得到有效再灌注，直接影响AMI患者的预后。为减少无复流发生率，目前国内外治疗无血流以药物冲洗、血栓抽吸为主，都不能完全改善慢血流状态，其成功率40-60%。本研究对AMI血栓负荷较重完全闭塞的患者，在上述方法无效的基础上，应用扩张起来的球囊缓慢通过血栓闭塞段，通过推送的方法将血栓推开，从而改善无复流。方法 AMI行PCI术中，对血栓进行血栓抽吸、药物冲洗后引起的无复流现象（TIMI＜Ⅱ级），应用扩张起来的球囊缓慢通过血栓闭塞段，通过推送血栓的方法将血栓推开，观察处理后的即刻效果。结果本研究共入选10例患者，均给予扩张起来的球囊缓慢通过血栓闭塞段，将血栓推开。其中处理后即刻TIMI＜Ⅱ级例数为1例（A组），TIMI≥Ⅱ级为9例（B组）（P＜0.05）。推送过程中未出现血管撕裂、血管夹层及血管漏渗等不良事件。结论无复流血管应用扩张球囊推送方法是安全的，并且使无复流发生率明显降低。Objective Percutaneous coronary intervention （PCI） acute myocardial infarction （AMI） is the preferred method of revascularization. However due to no-reflow phenomenon caused by the heavy load, thus greatly reduced PCI in patients with income, myocardial cannot get effective reperfusion, directly affects the prognosis of AMI patients. In order to reduce the incidence of no-reflow, flush with no blood flow to drug treatment at home and abroad, thrombus suction is given priority to, but can＇t improve slow blood flow state completely, and the success rate is 40-60%. This study of acute myocardial infarction patients with thrombus load heavy occlusion, on the basis of the above method is invalid, the application of balloon expansion up slowly by a thrombosis occlusion, pushes away the thrombus, by using the method of push thrombosis so as to reach the purpose of improving no reflow. Methods No-reflow phenomenon （TIMI〈level 2） after thrombus aspiration and intravascular delivery in PCI, the application of balloon expansion up slowly by a thrombosis occlusion, pushes away the thrombus, by using the method of push thrombosis observed after treatment with immediate effect. Results 10 patients were performed in this study, the balloon expansion up slowly by a thrombosis occlusion, pushes away the thrombus. Grade of processed instantly TIMI〈2 cases as 1 cases （group A）, TIMI grade 2 or more for 9 cases （group B） （P〈0.05）. Push torn does not appear in the process of blood vessel, blood vessels, interlayer and adverse events such as vascular leakage seepage. Conclusion Expanding balloon push method is safe for no-reflow, and signiifcantly reduce the incidence of no-reflow.

关 键 词：急性心肌梗死 冠状动脉介入治疗 血栓 无复流 球囊 

分 类 号：R542.22[医药卫生—心血管疾病]