急性冠脉综合症介入术中无复流的观察与处理

Treatment of No-reflow Phenomenon in Percutaneous Transluminal Coronary Intervention for Acute Coronary Syndrome

目的观察分析急性冠脉综合症(ACS)患者经皮冠状动脉介入治疗(PCI)术中出现无复流(no-reflow)现象的原因及处理。方法回顾分析2008年6月-2010年7月接受PCI治疗的ACS患者68例,观察术中无复流现象的发生情况、可能原因、处理结果和出院转归。结果 68例患者中,发生无复流现象6例(8.82%),其中1例于术后24 h死于心源性休克;其余5例出现不同程度胸痛、胸闷,TIMI血流1～2级,经冠状动脉内单独或联合注射硝酸甘油、维拉帕米、替罗非班处理后,TIMI血流恢复到3级,症状缓解,住院期间未发生心血管事件,最终好转出院。结论 PCI术中出现无复流现象可明显增加术中处理难度和风险,预后差、病死率高,提高对无复流现象的认识,及时恰当的处理,可显著改善冠脉血流,改善患者的预后。

Objective To analyze the causes and treatments of no-reflow phenomenon in percutaneous coronary intervention （PCI） for acute coronary syndrome patients. Methods Reviewed 68 patients with acute coronary syndrome who underweny PCI from June 2008 to July 2010 in our hospital. The no-reflow phenomenon and possible reasons, treatment and outcome were observed. Results In all 68 patients, no-reflow phenomenon occurred in 6 cases. One case died of cardiogenic shock 24 hours after the therapy. Five cases were with the symptoms of chest distress and chest pain ;TIMI flow were grade 1 to 2, and were improved from grade 1 to grade 3 after nitroglycerin, verapamil and tirofiban intracoronary injection alone or in combination. The coronary flow was improved and no cardiovascular events occurred before discharged time. Conclusion In PCI, no-reflow phenomenon can increase the risk of operation and mortality. Enhancing the knowledge of no-reflow and coping with it timely in a right way can improve the coronary flow and prognosis of patients.