急性心肌梗死急诊PCI后无复流患者临床和冠脉造影的特征分析  

Evaluation of clinical and angiographic characteristics of no reflow phenomenon after emergency PCI in AMI patients

作　　者：孙婷婷[1] 贺晓楠[3] 张城[2] 陈宇[2] 

机构地区：[1]齐齐哈尔医学院附属第二医院心内科,齐齐哈尔161000 [2]吉林大学中日联谊医院心内科 [3]首都医科大学附属北京安贞医院急诊危重症中心

出　　处：《中国医师杂志》2015年第6期876-878,882,共4页Journal of Chinese Physician

基　　金：北京市博士后科研活动经费资助项目（2012ZZ-40）

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）后无复流的相关临床、冠脉造影特征.方法 将319例AMI行急诊PCI支架术的患者根据手术结果分成无复流组和血流正常组,评估无复流现象的发生率,比较两组患者基本临床资料、造影结果及手术相关资料的差异.结果 13.4％的患者急诊PCI术后出现了无复流.无复流组与正常血流组在合并高血脂、有梗死前心绞痛病史、心功能Killip≥2级、血管病变长度、狭窄及血栓负荷程度、胸痛至球囊扩张时间、球囊的扩张次数等方面差异有统计学意义（P ＜0.05或P＜0.01）.经多因素Logistic回归分析显示有梗死前心绞痛、Killip分级≥2级、高血栓负荷、球囊扩张次数和胸痛至球囊扩张时间是急诊PCI术后无复流发生的独立危险因素.结论 AMI急诊PCI术后无复流现象的出现与有高血脂病史、无梗死前心绞痛史、入院时心功能分级高（Killip≥2级）、血管病变长及狭窄程度重、高血栓负荷、冠脉开通时间长、球囊的扩张次数多等方面相关。Objective To investigate the clinical and angiographic characteristics of no reflow phenomenon after primary percutaneous coronary intervention （PCI） with acute myocardial infarction （AMI）.Methods A total of 319 patients with AMI undergoing primary-PCI was divided into no-reflow and normal reflow groups.The incidence of no-reflow phenomenon,the clinical date,angiography findings,and surgical date were compared between two groups.Results No-reflow phenomenon occurred in forty（13.4%）of the patients after primary PCI.There was dramatic difference in combined hyperlipidemia,angina pectoris history before AMI,heart function ≥2 grades on admission,the length of the vascular lesions,vascular stenosis degree,blood clot load level,coronary artery opening time,and the expansion of the balloon between no-reflow and normal blood flow groups.Multiple logistic regression analysis identified that angina pectoris history before AMI,heart function classification on admission,high thrombus burden,the expansion of the balloon,and coronary artery opening time on angiography as independent predictors of no-reflow phenomenon.Conclusions The occurrence of no-reflow phenomenon after primary PCI was associated with high cholesterol history,no history of pre-infarction angina,heart function classification on admission,long vascular lesions,narrow degree of heavy,blood clots in the high load,coronary artery opened long time,and the expansion of the balloon more frequently.

关 键 词：心肌梗死/治疗/病理生理学 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]