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1.
经皮冠状动脉介入术(PCI)是目前心肌血运重建的主要手段,其可迅速开通梗死相关动脉,恢复心肌血运,保护心功能,但无复流现象严重影响PCI临床疗效及患者预后。无复流现象是PCI常见并发症之一,是指在冠状动脉无明显持续性机械性病变情况下发生向前血流明显减慢或完全无血流的现象。本文综述了PCI后冠状动脉无复流现象的研究进展,以期为临床有效防治无复流现象提供参考。  相似文献   

2.
目的 观察比索洛尔对急性心肌梗死患者早期急诊经皮冠状动脉介入治疗( PCI)术后无复流,经系列治疗血流再通后的心功能和血浆脑钠尿肽的影响.方法 入选我院2009-01-2011-03间符合急性心肌梗死早期急诊PCI的426例患者,其中38例患者置入支架后出现血流无复流现象,无复流患者中33例给予相应治疗血流再灌注达心肌...  相似文献   

3.
随着冠心病急诊介入治疗的逐渐增多,冠状动脉无再流、慢血流的发生率也随之增加,急性心肌梗死急诊经皮冠状动脉介入(PCI)无再流、慢血流现象的出现使患者死亡、再梗死及心力衰竭的发生率大幅上升。我院从2005年11月开始在冠状动脉内注射替罗非班治疗急性ST段抬高心肌梗死急诊介入中慢血流和无再流现象,探讨急诊PCI术中出现无再流、慢血流时应用替罗非班的疗效及其安全性。现在报道如下。  相似文献   

4.
冠状动脉介入治疗术后靶血管血流减慢TIMI 2级称之为"慢血流现象".靶血管血流为TIMI0~1级称之为无复流现象(no-reflow).目前报道影响介入术后冠状动脉血流减慢可能因素有术后的残余狭窄、微血管痉挛、再灌注损伤、远端微血栓形成等.TIMI桢数法评价冠状动脉血流的简单、方便、重复性好的方法,经皮冠状动脉介入术后(PCI)冠状动脉血流快慢是评价预后的指标,也是预测再狭窄的指标之一.冠状动脉血流状态不仅与介入治疗后心肌组织灌注相关,同时患者的临床因素也是影响冠状动脉血流的因素之一.  相似文献   

5.
经皮冠状动脉介入治疗(PCI)已广泛用于急性心肌梗死(AMI)患者以尽可能早的开通梗死相关动脉并达充分再流。再灌注治疗后的冠脉血流是AMI患者临床疗效的一个主要的决定因素。研究报道PCI过程中血小板或栓子的释放可能会导致冠脉造影时的无再流现象。该研究的目的是评价行PCI治疗的AMI患者手术过程中斑块体积的减小对术后冠脉血流的影响。  相似文献   

6.
付伟 《中国老年学杂志》2012,32(8):1565-1567
目的探讨冠状动脉内直接注射替罗非班治疗急性心肌梗死(AMI)老年患者介入治疗中无复流现象的临床疗效。方法 2009年8月至2011年4月采用冠状动脉内直接注射替罗非班治疗AMI患者PCI术中出现的无复流现象,并与采用维拉帕米治疗的对照组进行比较,观察TIMI血流分级、TMPG血流分级及cTFC结果。结果观察组患者在注射药物后首次和PCI手术结束前末次冠状动脉造影TIMI 3级血流获得率均明显高于对照组,差异具有统计学意义(χ2=6.22、6.48,均P<0.05)。两组患者未用药前cTFC比较无明显差异(t=0.27,P>0.05),而在冠状动脉内注射药物后首次及PCI后末次,两组患者的cTFC均明显减少,而且观察组cTFC均低于对照组,差异具有统计学意义(t=7.12、7.57,均P<0.05)。观察组患者在注射药物后首次和PCI手术结束前末次冠状动脉造影TMPG 3级血流获得率均明显高于对照组,差异具有统计学意义(χ2=5.39、5.84,均P<0.05)。结论冠状动脉内注射血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班可以增加AMI患者PCI术中发生无复流现象后冠状动脉血流和心肌组织灌注,改善术后梗死相关动脉无复流现象,为AMI患者PCI术中出现无复流现象后的一种简单有效的治疗方法。  相似文献   

7.
目的:评价血小板Ⅱb/Ⅲa受体拮抗剂替罗非班经冠状动脉注射对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)治疗后无再流的疗效。方法:STEMI急诊经皮经腔冠状动脉成形术/支架置入术梗死相关动脉再通后存在无再流现象50例。2005-01-2007-10,20例冠状动脉内注射硫氮唑酮(0.5~2.0mg),2007-11-2010-03,30例冠状动脉内注射替罗非班(0.5~1.0mg);注射完后10min行冠状动脉造影,评定冠状动脉血流TIMI分级。结果:硫氮唑酮组应用后20~40min内TIMI血流3级10例,TIMI血流0~2级10例;替罗非班组应用后20~40min内TIMI血流3级24例,TIMI血流0~2级6例。达TIMI3级患者替罗非班组多于硫氮唑酮组(P<0.05)。结论:经冠状动脉给予替罗非班(0.5~1.0mg)后能有效改善急诊PCI术中无再流现象。  相似文献   

8.
急性心肌梗死患者行经皮冠状动脉介入术(PCI)时,无再流现象的发生严重影响了再通治疗的成功率。因此,改善心肌再灌注,减少无再流现象的发生率成为当今PCI治疗的新热点。本文主要对PCI后无再流现象的预防和治疗进展及存在问题进行综述。  相似文献   

9.
<正>随着冠心病发病率的升高及再灌注技术的进步,越来越多的急性心肌梗死患者接受冠状动脉介入等再灌注治疗。但是,再灌注损伤(例如慢血流/无复流)的存在严重削弱了其疗效。因此,如何保护再灌注后受损心肌、提高疗效成为近年来临床面临的棘手问题。国外曾报道,冠脉注射尼可地尔可显著改善经皮冠状动脉内介入治疗(PCI)术中无复流现象[1],但我国尚未见类似报道。在此,将我院应用尼可地尔改善亚急性期前壁心肌梗死患者PCI术中无复流现象的病  相似文献   

10.
内皮细胞损伤对于经皮冠状动脉介入术后血流的意义   总被引:2,自引:1,他引:1  
目的:研究经溶栓或经皮冠脉介入术(PCI)治疗后冠脉恢复正常血流患者和冠脉无复流患者内皮细胞的损伤情况,并探讨其临床意义。方法:选择90例PCI患者,根据术后血流分级(TIMI分级)分为两组,冠状动脉血流≤TIMI2级40例,为无复流组,TIMI3级50例,为对照组。检测两组患者冠脉血中内源性一氧化氮(NO)、内皮素(ET)、血小板表面活化标志蛋白(CD63)水平,以此判断内皮细胞受损情况。结果:PCI术后无复流组较对照组冠脉中NO明显减少[(41.52±6.1):(61.94±10.7)μmol/L],而ET[(117.42±11.1):(59.08±9.8)mg/L]、CD63[(7.43±8.2)%:(2.05±2.8)%]显著增加(P均0.05)。提示在PCI后患者出现无复流现象者较血流恢复正常者冠状动脉内皮损伤更严重。结论:内皮细胞损伤是冠状动脉PCI术后无复流的重要原因。  相似文献   

11.
The no-reflow phenomenon is an impairment of microcirculation after successful percutaneous coronary interventions (PCI). The no-reflow phenomenon is usually observed during acute myocardial infarction. This case-report describes no-reflow phenomenon in a patient undergoing elective PCI in the right coronary artery, occluded due to restenosis in implanted stent. After deflation of balloon during angioplasty in restenosed stent, no-reflow phenomenon occurred, followed by asystolia. The patient was successfully resuscitated. During resuscitation procedures, abciximab was administered what improved myocardial perfusion. This case demonstrates that no-reflow phenomenon can be a serious problem during elective PCI, leading even to a cardiac arrest. It shows also the necessity for administration of drugs improving tissue perfusion when no-reflow phenomenon occurs.  相似文献   

12.
急性心肌梗死直接介入治疗后无复流的血管因素   总被引:1,自引:0,他引:1  
目的:探讨急性ST段抬高型心肌梗死(STEAMI)患者直接经皮冠状动脉内介入治疗(percutaneous coronary intervention,PCI)后与无复流有关的血管因素。方法:回顾性分析410例STEAMI患者直接PCI后的临床和造影资料,无复流患者51例,由其余359例直接PCI后TIMI3级血流者中随机抽取60例作为正常血流组。结果:无复流的发生率为12.44%。:两组在几乎完全闭塞、血栓、钙化、长病变等造影发现的罪犯血管形态学改变存在显著性差异。结论:STEAMI患者如果在造影时发现罪犯血管存在几乎完全闭塞、血栓、钙化、长病变等形态学改变,则直接PCI后无复流的发生率明显著增加。  相似文献   

13.
BACKGROUND: No-reflow phenomenon is observed in approximately one-third of patients after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), and is associated with poor functional and clinical outcomes. On the other hand, the formation of free radicals in vasculature exerts deleterious effects on coronary microcirculation. HYPOTHESIS: We hypothesized that redox state in coronary circulation may play a crucial role in no-reflow phenomenon in AMI. METHODS: Consecutive 26 patients with first AMI who underwent primary PCI < 24 h after onset were enrolled. Before PCI, blood samples were obtained from coronary sinus to measure plasma or serum antioxidative vitamins (vitamin C, vitamin E, and beta-carotene) and antioxidative enzymes (extracellular glutathione peroxidase [GPX], superoxide dismutase, and catalase). After PCI, the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (CTFC) was measured in the target vessel. Patients with TIMI < or = 2 flow despite an optimal PCI result were designated as no-reflow group (Group NR, n = 6) and the others as reflow group (Group R, n = 20). RESULTS: Levels of vitamin C, vitamin E, and GPX before PCI were significantly lower in Group NR than in Group R. The CTFC correlated inversely with levels of vitamin C, vitamin E, and GPX (p < 0.05). CONCLUSIONS: Depletion of antioxidants is associated with no-reflow phenomenon in AMI. These findings strongly suggest that the redox state in coronary circulation plays an important role in the pathogenesis of no-reflow phenomenon.  相似文献   

14.
经皮冠状动脉介入治疗(PCI)已经是治疗冠心病的重要手段,但无复流现象却严重影响PCI近期和远期预后。目前治疗无复流的方法很多,但效果尚不理想。本文就PCI中无复流的治疗进展作一综述。  相似文献   

15.
经皮冠状动脉介入治疗(PCI)是急性ST段抬高性心肌梗死患者的首选治疗策略。虽然PCI后冠脉血流恢复,但仍经常观察到无复流现象,并且与较差的临床预后有关。导致该现象的病因机制复杂且相互关联,对这些机制的进一步认识有助于制定个性化的预防和治疗策略。可以使用冠脉造影、心肌对比超声及心脏磁共振等技术诊断无复流。许多药物可能改善实验室和临床无复流,但一些药物尚未明确地改善临床结果。  相似文献   

16.
Acute coronary syndrome is one of the leading causes of death worldwide. Percutaneous coronary intervention (PCI), along with various devices, have been technically developed to dramatically improve mortality risk in patients with acute myocardial infarction. However, no-reflow phenomenon still remains a problematic complication during a PCI, even in the era of drug eluting stents. There are various hypotheses and mechanisms for no-reflow phenomenon, but none have been confirmed. Treatment for no-reflow phenomenon also depends on various underlying conditions, but have not yet shown effective improvement. We presented a case of no-reflow phenomenon caused by an unusual cause.  相似文献   

17.
目的 探讨ST段抬高型急性心肌梗死患者行急诊经皮冠脉介入治疗术(PCI)出现无复流现象的原因及预防措施.方法 选择ST段抬高型急性心肌梗死患者202例,无急诊PCI治疗禁忌证,随机分为3组,分别给予常规PCI治疗、血栓抽吸和冠脉内注入血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂后PCI等不同的治疗,监测患者PCI治疗后血浆脑钠肽前体(pro-BNP)和PCI术后冠脉造影TIMI血流分级,记录患者住院时间和28 d死亡率.结果 三组患者间发病至梗死相关血管开通时间、总平均住院时间、PCI治疗术后28d死亡率差异无统计学意义.常规PCI治疗组无复流现象的发生率高于血栓抽吸组和冠脉内注入血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂组,并且血浆pro-BNP明显高于后者.结论 心肌梗死患者PCI术后无复流的发生与冠脉内微血栓形成有关,通过血栓抽吸和冠脉内注入血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂的方法可以有效减少无复流的发生.  相似文献   

18.
The no-reflow phenomenon is frequently associated with adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). We describe two cases in which the no-reflow phenomenon developed during PCI and was successfully resolved by direct intracoronary aspiration using the Export aspiration catheter.  相似文献   

19.
background To investigate the effect of intra-aortic balloon pumping (IABP) on no-reflow phenomenon in primary percutaneous coronary intervention (PCI) for ST-Elevation Myocardial Infarction (STEMI). Methods Clinical data of 22 acute myocardial infarction patients after PCI with angiographic no-reflow phenomenon were retrospectively analyzed between January 2006 and December 2009.12 patients underwent IABP, other 10 patients as control group. We observed difference of cardiac structure, brain natriuretic pe...  相似文献   

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