冠状动脉无复流现象的病理生理及诊治研究进展  

Coronary No-Reflow Phenomenon: Pathophysiology,Diagnosis and Treatment

作　　者：张文卉[1] 孟照辉[1] 

机构地区：[1]昆明医科大学第一附属医院心内科分子心血管病研究室,昆明650032

出　　处：《医学综述》2015年第2期195-198,共4页Medical Recapitulate

基　　金：国家自然科学基金(30860278;81160025);云南省应用基础研究计划重点项目(2012FB005);云南省中青年学术技术带头人后备人才项目(2011CI057);云南省卫生领军人才培养计划(L-201203)

摘　　要：急性ST段抬高型心肌梗死患者接受直接经皮冠状动脉介入术后,尽管40%--50%的患者梗死相关血管开通,但心肌组织仍然灌注不足,即无复流现象。无复流现象的发病机制复杂,包括远端血栓栓塞、缺血性损伤、再灌注性损伤和微循环个体易损性等。无复流可加重左心室重构、降低左心室功能及短期或长期生存率,早期诊断和治疗可明显改善临床疗效及预后。冠状动脉血管造影、心肌呈色分级、心电图、心肌声学造影、心脏磁共振成像技术等均可检测无复流的发生。此外,在冠状动脉梗死初期或再灌注早期给予患者相应治疗,如远端保护装置、舒血管、抗血小板和溶栓药物等均可减少或改善无复流的发生。该文的目的是全面总结无复流现象发生的机制、评估方法、预防和治疗策略。For acute ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention,up to 40%-50% of patients do not have complete myocardial reperfusion despite successful patency of the infarct-related artery,which is called no-reflow phenomenon. The main pathophysiological mechanisms of no-reflow is complex,including distal atherothrombotic embolization,ischemic injury,reperfusion injury and susceptibility of coronary microcirculation to injury. No-reflow is a poor prediction for left ventricular remodeling and function,and short-term and long-term survival. Therefore,early diagnosis and therapy may obviously improve the clinical efficacy and prognosis. Angiography,myocardial blush grade,electrocardiography,myocardial contrast echocardiography,cardiac magnetic resonance imaging can assess the occurrence of no-reflow. In addition,the early therapies of no-reflow include distal protection device,vasodilator drugs,anti-platelet agents,and thrombolytic agents. Here is to make a review of the mechanisms of no-reflow phenomenon,assessment methods,prevention and treatment strategies.

关 键 词：心肌梗死 再灌注损伤 冠状血管造影术 

分 类 号：R34[医药卫生—基础医学]