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目的:总结急诊经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）术中无复流合并术后上消化道出血患者的防治过程，并结合文献总结救治经验。病例介绍:患者男性，45岁，因“反复胸痛2周，加重12 h”于2021年8月19日在解放军南部战区总医院心血管内科就诊。患者心电图及心肌肌钙蛋白I均无动态变化，结合患者胸痛特点决定行急诊冠状动脉造影，发现左前降支开口处99%狭窄，PCI术中冠状动脉内反复使用腺苷及替罗非班，有效防治了无复流，手术顺利。术后第二天患者突发黑便及贫血，胃镜提示十二指肠球部溃疡，权衡出血和缺血风险后决定保留双联抗血小板药物治疗，将阿司匹林更换为吲哚布芬，消化道出血得到有效控制。经过7 d治疗，患者好转出院，出院1个月后随访血红蛋白112 g/L，无主要心血管不良事件发生，继续服用质子泵抑制剂药物及双联抗血小板药物等。文献检索及分析:检索PubMed、中国知网和万方数据库。检索的英文关键词包括“PCI” “no-reflow phenomenon” “platelet aggregation inhibitors”及“gastrointestinal bleeding” ，检索的中文关键词包括“经皮冠状动脉介入治疗” “无复流” “血小板聚集抑制剂”及“消化道出血” 。检索年限截至2021年11月30日。共检出符合标准的文献154篇，经进一步筛选标题及摘要获得关于急诊PCI术中无复流的病例报告及系统回顾共20篇。结论:不典型缺血性胸痛的快速识别须结合症状发作特点，同时严格按胸痛中心流程规范诊治；急诊PCI应预防无复流的发生，腺苷和替罗非班均可从不同的方面减少无复流的发生；PCI合并消化道出血应权衡利弊决定双联抗血小板策略，吲哚布芬等出血风险低的抗血小板药物是阿司匹林的替代选择。“,”Objective:We aimed to summarize the experience of the prevention and treatment of a case with no-reflow phenomenon during emergency percutaneous coronary intervention (PCI) and postoperative gastroinestinal bleeding, combined with literature review.Clinical Feature:A 45-year-old man had recurrent chest pain for 2 weeks that aggravated for the past 12 hours. There were no dynamic changes noted on echocardiography and no elevation in cardiac troponin I level. Emergency coronary angiography was performed owing to the chest pain. We noted that the opening of the left anterior descending artery was 99% occluded. Adenosine and tirofiban were repeatedly administered in the coronary artery during the operation, which effectively prevented the no-reflow phenomenon. On the second day following the operation, the patient had sudden black stool and anemia. Gastroscopy results confirmed the presence of a duodenal ulcer. Upon evaluating the risk of bleeding and ischemia, dual antiplatelet treatment was continued but aspirin was replaced with indobufen. Finally, gastrointestinal bleeding was effectively controlled. After 7 days of treatment, the patient\'s condition improved, and he was discharged from the hospital. The follow-up of 1 month later, hemoglobin level was 112 g/L, and no major adverse cardiovascular events occurred. He continued to take proton pump inhibitors, dual antiplatelet drugs, and a few other drugs.Data Review:PubMed, CNKI, and Wanfang databases were searched. The English keywords included “PCI” “no-reflow phenomenon” and “gastroenteric bleeding”. The time frame for the search was limited till November 30, 2021. A total of 154 literatures were found to meet our established standards. After further screening the title and abstract, a total of 20 case reports and systematic reviews on no-reflow during emergency PCI were obtained.Conclusions:The rapid identification of atypical ischemic chest pain should be combined with the characteristics of symptoms at onset, and the diagnosis and treatment should be carried out in strict accordance with the standard process of the hospital. In emergency PCI, prevention of no-reflow is more important. Adenosine and tirofiban can reduce the occurrence of no-reflow from different aspects. The risk of bleeding and ischemia in emergency PCI complicated with gastrointestinal bleeding should be weighed to determine the dual antiplatelet strategy. An antiplatelet drug with a lower bleeding risk such as indobufen can be prescribed as an alternative to aspirin.