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心肌无复流是指在急性心肌梗死(AMI)急诊冠状动脉内干预(PCI)后,部分患者即使解除了心外膜血管阻塞,其所供应心肌组织仍未获得有效血流灌注的现象。其本质是心肌微循环灌注障碍。研究证实无复流可导致梗死的延展、心功能恢复障碍、左室重构等更多的合并症。尽管无复流的确切机制不明,但结果是微循环阻塞、再灌注损伤等导致微循环的破坏。无复流的诊断主要在于冠脉造影提供的心肌缺血的临床证据,近年来心肌对比造影超声心动图(MCE)、核素心肌显像技术、多普勒导丝等广泛应用于无复流的检测及诊断,提高了无复流的检出率。本文对心肌无复流病理生理学、诊断方法、相关因素及治疗方面进行了综述。
Myocardial no-reflow refers to the fact that after AMI emergency PCI, some patients even have their epicardial vascular obstruction unblocked, and the supplied myocardial tissue still does not obtain effective blood perfusion. Its essence is myocardial microcirculation perfusion disorder. Studies have shown that no reflow can lead to infarction extension, cardiac dysfunction, left ventricular remodeling and more complications. Although the exact mechanism of no-reflow is unknown, the result is microcirculation obstruction, reperfusion injury and the like leading to microcirculation destruction. The diagnosis of no-reflow is mainly based on the clinical evidence of myocardial ischemia provided by coronary angiography. In recent years, contrast myocardial contrast echocardiography (MCE), radionuclide myocardial imaging and Doppler guidewires have been widely used in no-reflow Detection and diagnosis, improve the detection rate of no-reflow. This article reviews the pathophysiology, diagnosis, related factors and treatment of myocardial no-reflow.