急诊心脏介入治疗中无复流现象预防措施的效果观察

A Clinic Study on the Effect of Prevention of No-reflow Phenomenon During Percutaneous Coronary Intervention Therapy

目的观察ST段抬高的急性心肌梗死患者行急诊经皮冠脉介入治疗术(PCI)出现无复流现象的原因及预防措施。方法选择ST段抬高型急性心肌梗死患者143例,无急诊PCI治疗禁忌证,随机分为2组,分别给予常规PCI治疗和血栓抽吸后PCI治疗,监测患者PCI治疗后血浆BNP,PCI术后冠脉造影TIMI血流分级,发病后第7时心脏超声心动图检查,测量左室射血分数(EF),记录病人住院时间,28d病死率。结果二组患者间发病至梗死相关血管开通时间、平均住院时间、PCI治疗术后28d病死率无统计学差异,常规PCI治疗组术后出现无复流现象的发生率高于血栓抽吸组,心脏收缩功能不全的发生率明显高于后者。结论心肌梗死患者PCI术后无复流的发生与冠脉内微血栓形成有关,通过血栓抽吸的方法可以有效的减少无复流的发生。

Objective The study was designed to investigate the cause and prevention of no-reflow phenomenon during primary percutaneous coronary intervention （PCI） therapy in patients with acute myocardial infarction.Methods Total 143 patients were enlisted and randomly divided into 2 groups with different treatments： ordinary PCI and PCI with thrombus aspiration.The plasma levels of BNP were examined and the TIMI grades of coronary perfusion after PCI were recorded.The cardiac structure and the left ventricle ejection fraction （EF） were obtained by ultrasound on the 7th day after onset of AMI.The length of hospital stays and the mortality of 28th day after onset of AMI were recorded.Results There were no significant difference between the two groups in time from onset of AMI to opening of infarction related artery, mean length of hospital stay, and the mortality of 28th day after onset of AMI.The incidence of no-reflow phenomenon after PCI and heart failure in patients accepted ordinary PCI was higher in comparison with that in patients accepted PCI with thrombus aspiration.Conclusion The no-reflow phenomenon after PCI in patients with AMI is related with the microthrombus in coronary artery and can be decreased by use of thrombus aspiration during the PCI procedure.