急性冠脉综合征介入治疗后无复流的临床观察

Clinical Studies of No-reflow in Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention

目的观察急诊经皮冠状动脉介入治疗(PC)I出现无复流现象的急性冠脉综合征(ACS)患者近期预后.方法回顾分析ACS行PCI患者326例,根据PCI术后血流分级(thrombolysis in myocardial infarction,TIMl分级),冠状动脉前向血流,<TIMI2级患者37例为无复流组,随机抽取TIMI3级患者40例为对照组,于术后第7天测定左心室射血分数,于术后6个月随访观察心血管不良事件.结果术后第7天无复流组与对照组比较左心室射血分数明显降低(P<0.05),PCI术后6个月无复流组AMI、充血性心力衰竭明显高于对照组(P<0.05).结论 ACS行急诊PCI过程中冠状动脉无复流患者住院期间心功能明显低于PCI后冠状动脉血流正常患者,心血管事件发生率明显高于PCI后冠状动脉血流正常患者,提示ACS行PCI后冠状动脉无复流患者近期预后差。

Objective Tostudythe prognosis ofpatients with acute coronary syndromes who had no-reflow phenomenon after percutaneous coronary intervention（PCI）.Methods Clinical and angiographic data of 326 ACS patients underwent PCI were retrospectively analyzed.Angiographic no-reflow phenomenon was defined as substantial coronary antergrade flow≤ TIMI 2 class.TIMI 3 class had normal flow.The no-reflowgroup included 37 patients,and 40 patients were selected at random into the normal flow group from 326 patients with coronary antergrade flow TIMI 3 class after primary PCI.Results The left ventricular ejection fraction of patients 7days after operation was lower in the no-reflow group than that in the normal flow group（P〈0.05）.The incidence of AMI,congestive heart failure,unstable angina pectoris,malignant arrhythmia,and the death rate of patients 6 months after PCI was higher in the no-reflow group than that in the normal flow group（P〈0.05）.Conclusions The cardiac function of ACS patients with no-reflowafter PCI is worse,and the incidence of cardiovascular events is higer than those of patients with normal flow after PCI.The patients with severe no-reflow after PCI have poor prognosis.showed the poorest prognosis.