心肌缺血再灌注无复流诊断方法的研究进展

Research advances in diagnostic methods for myocardial ischemia-reperfusion without reflow

近年来,心血管事件的发生率及死亡率呈现上升趋势。急性冠脉综合征(acute coronary syndrome,ACS)作为心血管系统的急危重症之一,起病凶险且病死率高。经皮冠状动脉介入治疗是目前治疗ACS的有效方法,可及时开通闭塞血管,实现心肌再灌注,显著降低病死率。然而血运重建后冠状动脉无复流的发生是导致ACS患者病死率升高的重要原因。对无复流进行早期诊断是紧急再灌注治疗的关键。冠状动脉造影是导管室中诊断无复流最直接的方法,也是现阶段临床上常用的诊断措施之一。冠状动脉内生理评估基于冠状动脉血流动力学原理,通过测量冠脉血流速度和冠脉压力来评估心脏的供血功能。此外,许多非侵入性心脏影像学检查技术的兴起,也为无复流的诊断提供了广阔的应用前景。本文通过系统总结和分析TIMI血流分级、校正TIMI帧数、冠状动脉血流储备、微循环阻力指数、心电图、心血管磁共振成像等诊断方法的最新进展和当前面临的挑战,以期为无复流的早期诊断和全面评估提供参考。

In recent years,the incidence and mortality of cardiovascular events are increasing.Acute coronary syndrome(ACS),as one of the acute and critical illnesses of cardiovascular system,has an aggressive onset and a high mortality rate.Percutaneous coronary intervention is an effective treatment for patients with ACS,which can open the occluded vessels in time,realize myocardial reperfusion,and significantly reduce the mortality rate.However,the occurrence of coronary artery no-reflow after hemodialysis is an important cause of increased mortality in ACS.Early diagnosis of no-reflow is critical for urgent reperfusion therapy.Coronary angiography is the most direct method to diagnose no-reflow in the catheterization laboratory and is one of the commonly used diagnostic measures in clinical practice at this stage.Intracoronary physiologic assessment is based on the principles of coronary hemodynamics,which assesses the blood supply function of the heart by measuring coronary blood flow velocity and coronary pressure.In addition,the rise of many non-invasive cardiac imaging techniques has provided a broad application prospect for the diagnosis of no-reflow.In this article,we systematically summarize and analyze the recent advances and current challenges of diagnostic methods such as TIMI flow grading,corrected TIMI frame rate,coronary flow reserve,microcirculatory resistance index,electrocardiography,and cardiovascular magnetic resonance imaging,with the aim of providing a reference for early diagnosis and comprehensive assessment of anelectasis.