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目的:探讨急性心肌梗死(AMI)直接冠状动脉介入治疗(PCI)术后发生心肌水平无再流的危险因素。方法:58例因首次AMI接受直接PCI治疗的患者,在术后48h接受心肌声学造影(MCE)检查,评价心肌水平血流灌注。比较发生心肌无再流和有再流的患者在临床和冠状动脉造影资料上的差异,采用Logistic多因素分析方法确定心肌水平无再流的危险因素。结果:17例(29.3%)判断为心肌水平无再流。与心肌水平有再流的患者比较,发生心肌水平无再流者前壁心肌梗死的比例显著较高,入院时血糖水平显著较高,肌酸激酶(CK)峰值显著较高,单支血管病变的比例较高,球囊扩张后罪犯血管血流达到TIMI3级的比例较低,有梗死前心绞痛的比例较低,长期使用他汀类药物的比例也较低。多因素分析示缺乏梗死前心绞痛、入院时血糖水平高、CK峰值高是发生心肌水平无再流的独立危险因素。结论:缺乏梗死前心绞痛、入院时血糖高、CK峰值高的AMI患者是直接PCI术后发生心肌水平无再流的高危人群。
Objective: To investigate the risk factors of myocardial no-reflow in patients with acute myocardial infarction (AMI) undergoing direct coronary intervention (PCI). Methods: Fifty-eight patients undergoing primary PCI for primary AMI underwent myocardial contrast echocardiography (MCE) at 48 hours after surgery to assess myocardial perfusion. The differences in clinical and coronary angiographic data between patients with and without myocardial reperfusion were compared. Logistic multivariate analysis was used to determine the risk factors for no-reflow myocardial levels. Results: Seventeen (29.3%) patients were judged as no evidence of reflow at myocardial level. There was a significantly higher rate of myocardial infarction in those with no-reflow at myocardial levels compared with patients with re-flow at myocardial level, significantly higher blood glucose levels at admission, and a significantly higher peak of creatine kinase (CK) Of the proportion of high, after the balloon dilatation of criminals blood flow to TIMI3 grade lower proportion of pre-infarction angina pectoris lower proportion of long-term use of statins is also low. Multivariate analysis showed that the lack of pre-infarction angina, high blood glucose levels at admission, and high CK peak were independent risk factors for myocardial no-reflow. CONCLUSIONS: The lack of pre-infarction angina, high blood glucose at admission, and high peak AMI is a high-risk population of patients with no-reflow myocardial levels after PCI.