急性心肌梗死急诊PCI支架术后无复流现象的临床分析

Clinical analysis of no-reflow phenomenon after emergency PCI in AMI patients

目的研究对急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入(PCI)时无复流的发生率及其死亡率,评估其影响因素。方法将169名AMI行急诊PCI支架术的患者,分成无复流组和血流正常组,评估无复流现象的发生率,住院期间死亡率及各项临床指标对无复流的意义。结果两组在平均年龄、性别、合并糖尿病、高血压、高脂血症、吸烟、心梗部位等方面没有显著差异,但在缺乏梗死前心绞痛史、冠脉开通时间,入院时心功能分级(Killip分级)、入院时白细胞计数、肌酸磷酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)及住院期间死亡率等方面具有显著差异。无复流的发生率17.2%。结论无梗死前心绞痛史、冠脉开通时间长、入院时心功能分级低、白细胞计数高、CK-MB与cTnI水平高等是无复流现象发生的独立的危险因素,PCI后出现无复流现象提示预后不良。

Objective To investigate the incidence, mortality and risk factors of no - reflow phenomenon in patients undergoing percutaneous coronary intervention （PCI） for AMI. Methods 169 patients undergoing PCI for AMI were divided into two groups： no - reflow group and normal re - flow group. The incidence of no - reflow phenomenon, in - hospital mortality and risk factors were evaluated. Results There were no significant differences in term of mean age, sex, diabetes, hypertension, hyperlipemia, smoke status and the location of AMI. But there were significant differences in terms of absence of angina pectoris history, the time to recanalization of criminal artery, heart function on admission, WBC count, CK - MB and troponin - Ⅰ level between two groups. Incidence of no - reflow phenomenon was 17.2%. Mortality was significantly higher in no - reflow group than in normal re - flow group （ 13.8 % vs. 3.6% , P 〈 0.05 ）. Conclusion Absence of angina pectoris history before AMI, long time to recanalization of criminal artery, low heart function classification on admission, high WBC count, high level of CK - MB and troponin - Ⅰ are independent risk factors of no - reflow phenomenon. No - reflow after PCI suggests poor prognosis.