非ST段抬高心肌梗死患者经皮冠状动脉介入术后微血管功能的变化及影响  

Changes and influence of microvascular function in patients with non-ST-segment elevation myocardial infarction after percutaneous coronary intervention

作　　者：刘启云 付倩[2] 董少红 李唐志铭 李江华 LIU Qiyun;FU Qian;DONG Shaohong;LI Tang-zhimin;LI Jianghua(Department of Cardiology,Shenzhen People's Hospital(The Second Clinical Medical College,Jinan University;The First Affiliated Hospital,Southern University of Science and Technology),Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center,Shenzhen 518020,China)

机构地区：[1]深圳市人民医院(暨南大学第二临床医学院,南方科技大学第一附属医院)心内科深圳市心血管微创医学工程技术研究开发中心,518020 [2]深圳市妇幼保健院

出　　处：《心肺血管病杂志》2021年第8期774-778,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：深圳市医疗卫生三名工程项目(SZSM201412012);深圳市医学重点学科建设经费(SZXK003);广东省医学科研基金(A2018530)。

摘　　要：目的:探讨经皮冠状动脉介入治疗(PCI)对非ST段抬高心肌梗死(NSTEMI)患者围术期微血管功能的影响。方法:46例行早期介入治疗的NSTEMI患者,术中行微血管功能评估。监测肌钙蛋白I(cTnI)水平,计算cTnI绝对量的围手术期变化(ΔcTnI)。使用配备多普勒和压力传感器的导丝同时测量基线及充血期间的冠状动脉内压力和流量,计算相关血液动力学指标,对上述数据进行统计学分析。最终入选41例。结果:PCI术后,冠状动脉血流速度和远端冠状动脉压力显著改善。PCI术后的血流储备分数(FFR)和冠状动脉血流储备(CFR)均增加,差异有统计学意义。血运重建术后,微循环阻力指数(IMR)显著增加,术前术后差异有统计学意义(75.49±13.86)vs.(90.99±20.51) mmHg.cm^(-1)·s^(-1)(P<0.001)。25例患者发生围手术期心肌梗死(PPMI)。在未发生PPMI患者组中,围术期IMR无明显改变(80.18±9.35)vs.(82.21±7.38) mmHg.cm^(-1)·s^(-1)(P>0.05)。在发生PPMI的患者中,PCI术后IMR显着增加(72.47±3.11)vs.(96.62±4.83) mmHg.cm^(-1)·s^(-1)(P<0.001)。术前IMR与术前FFR之间无相关性(r=0.233,P>0.05)。IMR围术期变化值与cTnI围术期变化值成正相关(r=0.699,P<0.001)。结论:NSTEMI患者围术期微血管功能与PPMI的发生有关,发生PPMI患者的微血管功能显著恶化。IMR有利于对PCI术后微循环功能的判断。Objective: To explore the effect of percutaneous coronary intervention(PCI) on the perioperative microvascular function of patients with non-ST-segment elevation myocardial infarction(NSTEMI). Methods: 46 patients with NSTEMI who performed early percutaneous coronary intervention were evaluated for microvascular function during the operation. Monitor troponin I(cTnI) levels and calculate the perioperative change(ΔcTnI) of the absolute amount of cTnI. A guidewire equipped with Doppler and pressure sensors was used to simultaneously measure the pressure and flow in the coronary arteries at baseline and during congestion to calculate relevant hemodynamic indicators. Statistical analysis was performed on the above data. Results: 41 cases were selected. After PCI, coronary blood flow velocity and distal coronary pressure were significantly improved. Both FFR and CFR increased after PCI. After removing the epicardial stenosis, the IMR increased significantly, and(75.49±13.86)vs.(90.99±20.51) mmHg·cm^(-1)·s^(-1)(P<0.001). Perioperative myocardial infarction(PPMI) occurred in 25 patients. After removal of epicardial lesions, there was no significant change in perioperative IMR in the non-PPMI group(80.18±9.35)vs.(82.21±7.38) mmHg·cm^(-1)·s^(-1)(P>0.05). In patients with PPMI, IMR increased significantly after PCI(72.47±3.11)vs.(96.62±4.83) mmHg·cm^(-1)·s^(-1)(P<0.001). Whether there was no correlation between preoperative IMR and preoperative FFR(r=0.233, P>0.05). IMR perioperative change was positively correlated with cTnI perioperative change(r=0.699, P<0.001). Conclusions: The perioperative microvascular function of patients with NSTEMI is related to whether PPMI occurs, and the microvascular function of patients with PPMI deteriorates significantly. IMR is helpful to judge the microcirculation function after PCI.

关 键 词：微血管阻力指数 围手术期心肌梗死 非ST段抬高型心肌梗死 

分 类 号：R54[医药卫生—心血管疾病]