急性冠状动脉综合征经皮冠状动脉介入治疗中无复流现象的处理

The treatment of No-Reflow phenomena in ACS emergency PCI operations

目的 分析急性冠状动脉综合征 (ACS)患者急诊经皮冠状动脉介入治疗 (PCI)术中无复流 (No Reflow)现象的原因、处理。方法 对 2 0 0 1- 0 6～ 2 0 0 3- 10经治的 72例ACS急诊PCI术中No -Reflow现象的冠状动脉的特点、可能原因、紧急处理及 1～ 2 8个月的结果进行分析。结果 1例术后 4h死于反复室颤 ,1例术后 76h死于心力衰竭 ,5例术中出现急性冠脉闭塞表现 ,经过冠状动脉内注射合心爽、硝酸甘油、IABP后好转 ,3例存活至今 ,1例术后 2 8个月死于脑干出血。结论 ACS患者急诊PCI术中出现No Reflow现象时 ,过程凶险 ,预后差 ,病死率高 ,治疗应首选联合应用冠状动脉内注射合心爽 (地尔硫 艹卓)、硝酸甘油或主动脉内球囊反搏 (IABP)。

Objective To analyze the cause of ACS (acute coronary syndrome) patients in emergency PCI (percutaneous coronary interventions) operations and treatment.Methods To study the characteristics of coronary artery,possible reason,emergency treatment and results of 1～28 months in 72 cases of ACS emergency PCI operations of No-Reflow phenomena which was between June 2001 and Oct 2003.Results One case died of repeated ventricular fibrillation 4 hours after the procedure one case died of heart failure 76 hours after the procedure and five cases showed acute coronary artery occlusion.By coronary injecting HERBESSER,nitroglycerin and IABP,the patients got better.Three of five are living now,one of them died of hemorrhage of brain stem 28 months after the procedure.Conclusion When ACS patients in emergency PCI operations show No-Reflow phenomena,the process is dangerous,the prognosis is bad,and the death rate is high,so we should first use HERBESSER together with nitroglycerin or IABP (intra-aortic balloon pump).