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The No-Reflow phenomenon after direct percutaneous coronary intervention in patients with acute myocardial infarction
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- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF CARDIOLOGY
- Issue:
- z1
- DOI:
- 10.3760/j:issn:0253-3758.2003.z1.004
- Key Word:
- 无再流现象;急性心肌梗死;经皮冠状动脉介入治疗
Abstract： 目的总结分析急性心肌梗死(AMI)冠脉介入治疗(PCI)并发的无再流现象.方法对我院2001年10月至2003年8月间,连续21例AMI直接PCl无再流患者的临床特点、急救处理、冠脉病变特点和可能原因进行分析.结果20例AMI直接PCI患者,21例(9.5%)并发了无再流现象,大多数(19例)出现了冠脉急性闭塞的剧烈表现,需升压药和冠脉内硝酸甘油、钙拮抗剂等紧急处理,少数(2例)无症状,不必治疗.1例因心血管崩溃死亡.进一步分析显示无再流者大多数为100%闭塞(19例)和非血栓性(17例)病变,3例已有侧支循环形成;少数为血栓性病变(4例)、并发远端血栓栓塞3例;大多数(17/19例)发生在球囊预扩成功,血流恢复的基础上植入第一个支架后;少数在植入第二个支架(2例)和球囊扩张已植入的支架后(3例)才出现无再流,硝酸甘油和合心爽有特效;提示无再流主要是冠脉微血管栓塞并发了弥漫痉挛所致.结论AMI直接PCI时,100%闭塞和非血栓病变球囊预扩成功再植入支架时易发生无再流现象,治疗应首选硝酸甘油和钙拮抗剂,血压低时也应使用.
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