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 探讨sT段抬高型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202例，无急诊PCI治疗禁忌证，随机分为3组，分别给予常规PCI治疗、血栓抽吸和冠脉内注入血小板膜糖蛋白Ⅱb，Ⅲa受体拮抗剂后PCI等不同的治疗，监测患者PCI治疗后血浆脑钠肽前体（pro—BNP）和PCI术后冠脉造影TIMI血流分级，记录患者住院时间和28d死亡率。结果三组患者间发病至梗死相关血管开通时间、总平均住院时间、PCI治疗术后28d死亡率差异无统计学意义。常规PCI治疗组无复流现象的发生率高于血栓抽吸组和冠脉内注入血小板膜糖蛋白Ⅱb／Ⅲa受体拮抗剂组，并且血浆pro—BNP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，通过血栓抽吸和冠脉内注入血小板膜糖蛋白Ⅱb／Ⅲa受体拮抗剂的方法可以有效减少无复流的发生。

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 myocar- dial infarction. Methods Total 202 patients were enlisted and randomly divided into 3 groups with different treatments： ordinary PCI, PCI with thrombus aspiration, and PCI with platelet membrane glycoprotein Ⅱ b/Ⅲa receptor antagonist injection into coronary artery. All patients had no contraindications of primary PCI. The plasma levels of BNP were examined after PCI. The TIMI grades of coronary perfusion were recorded. 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 three 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 and PCI with platelet membrane glycoprotein Ⅱ b/ Ⅲ a receptor antagonist injection into coronary artery. 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 or injection of platelet membrane glyeoprotein Ⅱ b/Ⅲ a receptor antagonist into coronary artery.