冠状动脉侧支循环对急性ST段抬高型心肌梗死患者介入治疗术后微循环障碍影响的分析  

Effects of coronary collateral circulation on microcirculation disturbance in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

作　　者：王一彪 李峥 车焕莉 张永勇 陈志强 苗阳 缪黄泰[1] 曾玉杰[1] WANG Yibiao;LI Zheng;CHE Huanli;ZHANG Yongyong;CHEN Zhiqiang;MIAO Yang;MIAO Huangtai;ZENG Yujie(Center for Coronary Artery Disease,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所冠心病中心,100029 [2]北京市昌平区中医医院冠心病科

出　　处：《心肺血管病杂志》2024年第10期1025-1031,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市科技计划(Z221100003522027);北京市属医院科研培育计划(PZ2022004)。

摘　　要：目的:分析冠状动脉侧支循环状态对ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者PCI术后微循环障碍发生情况的影响。方法:根据Rentrop分级将277例STEMI患者分为侧支循环不良组(Rentrop 0-1级)和侧支循环良好组(Rentrop 2-3级),比较两组患者的基本临床资料和PCI术后住院期间预后情况的差异,并探究PCI术后发生慢血流/无复流现象或微血管阻塞(microvascular obstruction,MVO)的影响因素。结果:两组患者在Killip分级、TIMI血流分级以及罪犯血管方面,差异有统计学意义(P<0.05);侧支循环不良组患者在PCI术后发生心绞痛、MVO和慢血流现象的比例高于侧支循环良好组(P<0.05);多因素二元Logistic回归分析显示Rentrop1-3级和PCI术前TIMI血流3级是发生慢血流/无复流现象或MVO的保护因素。结论:冠状动脉侧支循环的形成能够有效预防PCI术后MVO和慢复流/无复流现象的发生,改善STEMI患者的临床预后。Objective:To analyze the influence of coronary collateral circulation status on microcirculation disturbance in ST segment elevation myocardial infarction(STEMI)patients after PCI.Methods:According to Rentrop grades,277 STEMI patients were divided into a group with collateral circulation(Rentrop 2-3)and a group without collateral circulation(Rentrop 0-1).The basic clinical data and prognosis during hospitalization after PCI were compared between the two groups.The influencing factors of slow-flow/no-reflow or microvascular obstruction(MVO)after PCI were investigated.Results:There were significant differences in Killip grade,TIMI blood flow f grade and criminal blood vessels between the two groups(P<0.05);The incidence of angina pectoris,MVO and slow blood flow after PCI in patients with no collateral circulation group was higher than that in patients with collateral circulation group(P<0.05);Multivariate binary Logistic regression analysis showed that Rentrop grade 1-3 and TIMI grade 3 blood flow before PCI were protective factors for slow-flow/no-reflow phenomenon or MVO.Conclusion:The formation of coronary collateral circulation can effectively prevent the occurrence of MVO and slow-flow/no-reflow phenomenon after PCI,and improve the clinical prognosis of STEMI patients.

关 键 词：经皮冠状动脉介入治疗 ST段抬高型心肌梗死 侧支循环 微循环 

分 类 号：R54[医药卫生—心血管疾病]