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目的观察分析急性冠脉综合症(ACS)患者经皮冠状动脉介入治疗(PCI)术中出现无复流(no-reflow)现象的原因及处理。方法回顾分析2008年6月-2010年7月接受PCI治疗的ACS患者68例,观察术中无复流现象的发生情况、可能原因、处理结果和出院转归。结果 68例患者中,发生无复流现象6例(8.82%),其中1例于术后24 h死于心源性休克;其余5例出现不同程度胸痛、胸闷,TIMI血流1～2级,经冠状动脉内单独或联合注射硝酸甘油、维拉帕米、替罗非班处理后,TIMI血流恢复到3级,症状缓解,住院期间未发生心血管事件,最终好转出院。结论 PCI术中出现无复流现象可明显增加术中处理难度和风险,预后差、病死率高,提高对无复流现象的认识,及时恰当的处理,可显著改善冠脉血流,改善患者的预后。
Objective To investigate the causes and management of no-reflow during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods A retrospective analysis of 68 patients with ACS admitted to PCI between June 2008 and July 2010 was performed. The incidence of recurrent no-recurrence, the possible causes, the treatment outcome and the outcome of discharge were observed. Results Sixty-eight patients (8.82%) had no-reflow phenomenon. One patient died of cardiogenic shock 24 h after operation. The remaining five patients experienced chest pain, chest tightness, grade 1 to 2 TIMI , After intracoronary administration of nitroglycerin alone or in combination, verapamil, and tirofiban, TIMI blood flow returned to grade 3, symptoms were relieved, and cardiovascular events did not occur during hospitalization and eventually were discharged. Conclusion No-reflow during PCI can significantly increase the difficulty and risk of intra-operative treatment, poor prognosis and high mortality, and raise awareness of no-reflow phenomenon. Correct and timely treatment can significantly improve coronary blood flow and improve patients The prognosis.