急性ST段抬高心肌梗死患者行急诊冠状动脉介入治疗术中无复流影响因素分析

No-reflow during emergency percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction:an analysis of influencing factors

目的探讨急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者行急诊冠状动脉介入术(percutaneous coronary intervention,PCI)中发生无复流的影响因素。方法将2012年6月至2013年1月本院收治的行急诊PCI治疗的急性STEMI患者(n=92),分为正常复流组(n=73)和无复流组(n=19)。通过比较两组的临床症状来分析无复流发生的相关影响因素。结果急性STEMI患者行急诊PCI后无复流发生率为20.7%(19/92),无复流组与正常复流组相比,两组之间入院时的收缩压(SBP)、2型糖尿病患病数、肌钙蛋白T峰值、发病到再灌注时间、球囊扩张次数和靶血管植入支架数量差异均有统计学意义(P<0.05);经多因素logistic回归分析显示入院SBP<100mmHg(1mmHg=0.133kPa)、合并2型糖尿病、球囊扩张次数、肌钙蛋白T峰值、右冠状动脉病变和发病至再灌注时间是急诊PCI术后无复流发生的危险因素。结论急性STEMI患者行急诊PCI后无复流发生与入院SBP<100mmHg、合并2型糖尿病、球囊扩张次数、肌钙蛋白T峰值、右冠状动脉病变及发病至再灌注时间这6种临床因素具有相关性。

Objective To identify the factors of no-reflow during emergency percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods A total of 92 patients with acute STEMI treated with PCI were divided into normal reflow group（73 patients ） and no-reflow group （19 patients） from June 2012 to January 2013.The influencing factors of no-reflow were clarified by comparing clinical symptoms of the two groups. Results The no-reflow rate after undergoing emergency PCI was 20.7% in 92 acute STEMI patients.The systolic blood pressure （SBP）, type 2 diabetes, troponin T peak, period from disease onset to reperfusion, balloon expansion times and stent number of the target blood vessel were significantly different between the two groups （P〈0.05）. Multivariate logistic regression analysis identified that low SBP （SBP〈100 mmHg, 1 mmHg=0.133 kPa）, type 2 diabetes, balloon expansion times, troponin T peak, right coronary artery lesions and period from disease onset to reperfusion were the risk factors for no-reflow during PCI in patients with STEMI. Conclusion No-reflow following emergency PCI in acute STEMI patients is associated with six clinical factors： SBP〈100 mmHg, type 2 diabetes, balloon expansion times, troponin T peak, right coronary artery lesions and period from disease onset to reperfusion.