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目的 探讨直接经皮冠状动脉介入 (PCI)治疗急性心肌梗死 (AMI)出现“无血流”(no flow ,NF)的发生率及其临床意义。方法 99例连续行直接PCI的AMI患者根据冠状动脉造影中有无NF现象分为NF组( 18例 ,占 18.2 % )和非NF组 ( 81例 ) ,计算NF的发生率 ,分析两组的一般临床特征、心功能和心血管事件的发生率。结果 与非NF组比较 ,NF组既往有心肌梗死、糖尿病、前壁心肌梗死史和多支血管病变的发生率明显增加 (P <0 .0 5 ) ;NF组左室射血分数 (LVEF)显著降低 ( 0 .38± 0 .11∶0 .6 3± 0 .10 ,P <0 .0 1) ;住院及随访期间 ,NF组非致死性心力衰竭 ( 2 1.4 %∶4 .8% ,P <0 .0 5 )和复合终点事件 ( 4 2 .9%∶18.5 % ,P <0 .0 5 )明显增加 ,总死亡率有增加趋势 ,但差异无显著性 ;而不稳定性心绞痛、非致死性再次心肌梗死、缺血性靶血管重建和总的心脏性死亡的发生率无明显降低。结论 直接PCI治疗AMI过程中 ,NF的发生率为 18.2 % ;出现NF者的心功能降低 ,近、远期预后差
Objective To investigate the incidence of “no flow” (NF) in patients with acute myocardial infarction (AMI) treated by direct percutaneous coronary intervention (PCI) and its clinical significance. Methods Ninety-nine patients undergoing continuous PCI with AMI were divided into NF group (18 cases, 18.2%) and non-NF group (81 cases) according to the presence or absence of NF in coronary angiography. The incidence of NF was calculated. General clinical features, cardiac function and incidence of cardiovascular events. Results Compared with non-NF group, the incidence of previous myocardial infarction, diabetes mellitus, anterior myocardial infarction and multivessel disease were significantly increased in NF group (P <0.05); the left ventricular ejection fraction (LVEF) (0.38 ± 0.11:0.63 ± 0.10, P <0.01). During hospitalization and follow-up, the incidence of non-fatal heart failure (2 1.4% vs 4.8% P <0.05) and the composite end point (42.9%: 18.5%, P <0.05) increased significantly with the increase of total mortality, but the difference was insignificant. However, unstable angina pectoris, There was no significant reduction in the incidence of non-fatal myocardial infarction, ischemic target revascularization and total cardiac death. Conclusion The incidence of NF in direct PCI for AMI is 18.2%. The cardiac function of patients with NF appears to be decreased, and the short-term and long-term prognosis is poor