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目的探讨急性ST段抬高性心肌梗死(STEMI)直接冠状动脉介入治疗时无复流的临床疗效。方法 66个月期间对132例STEMI实施直接PCI,13例(9.8%)梗死相关动脉(IRA)出现无复流。冠状动脉内处理包括注射各种药物、生理盐水或动脉血冲洗和主动脉气囊反搏术。结果 13例无复流患者中,6例发生在右冠状动脉,其中5例IRA粗大。10例合并有高血压(其中9例还合并2型糖尿病),9例合并高血脂症。经过处理,9例IRA为3级TIMI前向血流,以后临床经过良好。3例TIMI2级血流,1例术后临床经过良好,1例在术后24h死亡。1例TIMI0-1级血流,术中死亡。结论直接PCI的无复流发生率为9.8%,死亡率达15.4%。无复流主要见于IRA为粗大右冠状动脉合并高血压病以及高血脂症的患者。无复流的处理应当是综合性的,但并非总是有效。
Objective To investigate the clinical effect of no-reflow in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing direct coronary intervention. METHODS: Thirty-six STEMI patients underwent PCI during 66 months, and 13 patients (9.8%) with infarction-related artery (IRA) developed no-reflow. Coronary treatment includes injection of various medications, saline or arterial blood washing and aortic balloon counterpulsation. Results Of the 13 patients with no-reflow, 6 were found in the right coronary artery, and 5 were found to have gross IRA. 10 patients with hypertension (including 9 also type 2 diabetes mellitus), 9 patients with hyperlipidemia. After treatment, 9 cases of IRA for grade 3 TIMI forward blood flow, after clinical well. 3 cases of TIMI2 grade blood flow, 1 case of postoperative clinical well, 1 case died after 24h. 1 case of TIMI0-1 grade blood flow, intraoperative death. Conclusions The incidence of no-reflow in direct PCI is 9.8% and the mortality rate is 15.4%. No-reflow is mainly seen in patients with an IRA that has a gross right coronary artery with hypertension and hyperlipidemia. No-reflow should be comprehensive but not always effective.