右冠状动脉闭塞致急性下壁心肌梗死行急诊经皮冠状动脉介入治疗中无复流的相关因素

Related factors of no-reflow during primary percutaneous coronary intervention for right coronary artery occlusion attributed to acute inferior wall myocardial infarction

目的探讨右冠状动脉闭塞致急性下壁心肌梗死行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中出现无复流的相关影响因素。方法选择常熟市第二人民医院自2010年1月至2014年8月收治的右冠状动脉闭塞致急性下壁心肌梗死行PCI治疗的患者共120例。根据PCI治疗后靶病变血管心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级分为两组:TIMI≤2级为无复流组,TIMI血流3级为复流正常组。分别记录两组患者手术相关资料,包括发病至冠状动脉造影(coronary angiography,CAG)时间、PCI治疗时间、血管长度、血管成角、后扩张次数、支架数量、血栓负荷等参数,进行统计学分析。结果无复流组与正常血流组患者进行手术资料对比发现,发病至CAG时间、PCI治疗时间、血管长度、血管成角、后扩张次数、支架数量、血栓负荷均可影响患者无复流的发生率,两组上述指标比较,差异均有统计学意义(P<0.05)。相反,术中使用抽吸导管和替罗非班可明显减少无复流的发生,两组比较,差异有统计学意义(P<0.05)。相关因素进行多变量Logistic回归分析发现,干预前TIMI血流分级、血管长度、支架数量、使用抽吸导管、血栓负荷均可影响患者无复流的发生率,具有明显的统计学差异(P<0.05)。结论影响无复流的因素较多,使用血栓抽吸及替罗非班可减少血栓负荷,减少微血管损害,有助于减少无复流的发生。

Objectives To explore the related factors of no-reflow during primary percutaneous coronary intervention（PCI） for right coronary artery occlusion attributed to acute inferior wall myocardial infarction. Methods From January2010 to August 2014,120 patients who diagnosed with right coronary artery occlusion caused by acute inferior wall myocardial infarction receiving PCI in No.2 People＇s Hospital of Changshu were collected. According to the thrombolysis in myocardial infarction（TIMI） blood flow grade of target lesions after PCI, these patients were divided into no-reflow group（TIMI grade≤2） and normal group（TIMI grade 3）. Operation-related information, including duration of onset to coronary angiography（CAG）, PCI duration, vessel length, vessel angle, times of expansion, thrombus load and other parameters recorded and analyzed. Results Duration of onset to CAG, PCI duration, vessel length, vessel angle,times of expansion, quantity of stents and thrombus load augmented the incidence of no-reflow phenomenon（P〈0.05）.On the contrary, tirofiban and aspiration catheter in operation reduced the occurrence of no-reflow significantly（P〈0.05）. Multivariate Logistic regression analysis indicated that TIMI flow grade before intervention, vessel length,quantity of stents, use of suction catheter and thrombus load could affect the incidence of no-reflow（P〈0.05）.Conclusions There are many factors influencing the no-reflow phenomenon. Use of thrombus aspiration and tirofiban can reduce thrombus load and microvascular damage, thus contributes to reduce the incidence of no-reflow.