经皮冠状动脉介入治疗急性心肌梗死术中发生慢血流-无复流分析

PCI Cases of Slow Coronary Flow or no Coronary Reflow in Acute Myocardial Infarction

目的探讨在经皮冠状动脉介入(PCI)治疗急性心肌梗死术中发生慢血流-无复流(SCF/NR)的相关影响因素,为防治术中发生慢血流-无复流做指导。方法选择2014年1月—2016年6月因急性心肌梗死在云南省第二人民医院心内科住院行PCI治疗发生慢血流-无复流病例61例,男52例,女9例。收集的内容主要有性别、年龄、体质指数、吸烟、饮酒、高血压病、糖尿病、总胆固醇、三酰甘油、尿酸、肌酐、心肌梗死诊断分型、心功能分级、犯罪血管、瘤样扩张血管、术中及术后血流分级(TIMI)、给药方式及给予药物、冠脉造影结果、发病-球囊时间等。研究术中导致慢血流-无复流的因素有哪些,并应用统计学软件筛选导致慢血流-无复流现象的预测因素。结果使用Logistic回归分析慢血流-无复流的危险因素:年龄、吸烟、体质指数、糖尿病、冠脉血管瘤样扩张、三酰甘油、总胆固醇、发病-球囊时间、给药方式及给予药物与术中发生慢血流-无复流的危险因素关系密切(P<0.05);性别、高血压、饮酒、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、尿酸、肌酐、谷草转氨酶、谷丙转氨酶水平、心肌梗死诊断分型、心功能分级、犯罪血管与术中发生慢血流-无复流形成的危险因素无关系(P>0.05)。结论年龄、吸烟、体质指数、糖尿病、冠脉血管瘤样扩张、三酰甘油、总胆固醇、发病-球囊时间、给药方式及给予药物能够单独地导致术中出现慢血流-无复流组的独立危险因素,提前发现影响患者手术后疗效的相关因素,对于提升预后效果来说很有帮助。

Objective To discuss the related affected factors of the acute myocardial infarction(AMI)which occur in slow coronary flow or no coronary reflow(SCF/NR)in the percutaneous coronary intervention(PCI),so that we make a guide for the prevention and treatment of the SCF/NR in the PCI.Methods 61 cases of PCI for AMI belonged to the SCF/NR group were collected from January 2014 to June 2016,with 52 cases of males and 9 cases of females.The contents collected included gender,age,body mass index,smoking,drinking,hypertension,diabetes,total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,triglyceride,alanine aminotransferase,aspartate transaminase,uric acid,Creatinine,diagnostic classfication of myocardial infarction,cardiac function classfication,crime of blood vessels,coronary artery ectasia,TIMI blood classfiction of intraoperative and postoperative,the drug and delivery way,coronary artery angiography results and diseaseballoon time.At the same time,researchers also analyzed the related factors of SCF/NR in the PCI and used the statistics to select the predictors of SCF/NR via some tools that could analyze statistics skillfully.Results Multi-factors classification logistic regression analysis was used:the relationship between the risk factors of SCF/NR are age,smoking,body mass index,diabetes,coronary artery ectasia,triglyceride,total cholesterol,disease-balloon time,the drug and delivery way was close(P<0.05).The risk factors lead to SCF/NR had no relationship with sex,hypertension,drinking,low density lipoprotei cholesterol,high density lipoprotein cholesterol,alanine aminotransferase,aspartate transaminase,uric acid,creatinine,myocardial infarctiong of diagnostic classfication,cardiac function classfication,criming blood vessels(P>0.05).Conclusion Age,smoking,body mass index,diabetes,coronary artery ectasia,triglyceride,total cholesterol,disease-balloon time、the drug and delivery way are the independent risk factors of SCF/NR in the PCI.Finding the related factors of postoperative treatment effect in advance is helpful to the patients'prognosis.