急性心肌梗死患者无复流预测因素的研究  

A study of the predictors of no-reflow after percutaneous coronary intervention for acute myocardial infarction

作　　者：哈生林 李晓东[1] 贾晨红[1] HA Shenglin;LI Xiaodong;JIA Chenhong(Department of Cardiology,Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院心内科,沈阳110004

出　　处：《中国医科大学学报》2020年第11期1021-1025,共5页Journal of China Medical University

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)患者接受急诊经皮冠状动脉介入手术(PCI)发生无复流现象(NRF)的预测因素。方法本研究为回顾性病例对照研究,共纳入137例诊断为急性STEMI并接受急诊PCI治疗的病例。根据球囊扩张或支架植入后的TIMI血流分级,将患者分为无复流组和复流组,收集信息进行统计分析。结果单因素分析结果显示,无复流组患者的年龄、D-二聚体(DD)、支架长度、支架数量均高于复流组患者(P均<0.05)。无复流组患者手术过程中心源性休克的发生率更高。多变量logistic回归分析显示,DD≥184.9μg/L、支架长度≥28 mm分别与NRF存在独立的正相关关系。结论术前DD≥184.9μg/L和支架长度≥28 mm为NRF的独立预测因素。NRF可能提示再灌注损伤更严重,心肌梗死面积更大。Objective To investigate the predictors of no-reflow(NRF)in patients with acute ST-segment elevation myocardial infarction(STEMI)who underwent emergency percutaneous coronary intervention(PCI).Methods This was a case-control study.We included 137 patients diagnosed with acute STEMI;all these patients underwent primary PCI.They were divided into NRF group and reflow group according to the Thrombolysis In Myocardial Infarction Grade Flow classification after balloon expansion or stenting.Patient information was collected and analyzed.Results Univariate analysis showed that the age,D-dimer level,length of stent,and the number of stents in the NRF group were significantly higher than those in the reflow group(all P<0.05).The incidence of intraoperative cardiogenic shock was higher in the NRF group than in the reflow group.Multivariate logistic regression analysis showed that D-dimer levels≥184.9μg/L and stent length≥28 mm were independently and positively correlated with NRF.Conclusion A preoperative D-dimer level≥184.9μg/L and stent length≥28 mm are independent predictors of NRF.In addition,occurrences of NRF may suggest a more severe reperfusion injury and a larger area of infarction within the myocardium.

关 键 词：急性ST段抬高型心肌梗死 无复流现象 预测因素 D-二聚体 支架长度 

分 类 号：R543.3[医药卫生—心血管疾病]