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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
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《岭南心血管病杂志》2021,(2)
对处于时间窗内的急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI),最有效的再灌注方式是直接经皮冠状动脉(冠脉)介入治疗(percutaneous coronary intervention,PCI),是目前STEMI急诊救治的最优选项。然而,部分STEMI患者在急诊PCI治疗中或治疗后出现无复流或慢血流导致梗死相关动脉远端前向血流不佳甚至消失,导致心肌细胞灌注不良或丧失灌注,显著降低患者临床获益,引起不良预后。上述无复流或慢血流现象仍是目前临床和学界不断在探讨的热点问题之一。本文从回顾STEMI患者术后无复流或慢血流的定义和流行病学开始,进一步讨论其对患者预后的影响,进而探讨预防和应对无复流或慢血流现象的药物及介入处理策略,并总结这些策略背后的机制和循证医学证据,希望对心内科介入同道产生裨益。 相似文献
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急性心肌梗死患病率和死亡率高,及时行经皮冠状动脉介入治疗(PCI)是急性ST段抬高型心肌梗死(STEMI)患者最佳的再灌注策略。但PCI术后出现的冠状动脉无复流常影响着患者的治疗效果和预后。本文针对冠状动脉无复流的病理生理机制、诊断、治疗作以综述,以期找到预防与在临床上解决PCI术后冠状动脉无复流的方法。 相似文献
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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
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临床在1985年报道称心肌梗死再灌注救治时有无再流现象发生。之后随着研究的深入,于经皮冠状动脉成形术(PCI)后及急性心肌梗死(AMI)溶栓治疗后此现象均有发现,急性心肌梗死行PCI治疗后,生活质量及预后得到明显改善。但经PCI处理的患者,无再流现象发生率较高,故对患者的预后造成了严重影响。减少无再流现象、改善心肌再灌注是临床治疗的目标。本文对急性心肌梗死后无再流现象的发病机制、危险因素、诊断及防治进展进行综述,旨在完善冠状动脉无再流现象的治疗对策,改善患者的预后。 相似文献
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急性心肌梗死经皮冠状动脉介入治疗术后无复流的防治进展 总被引:2,自引:0,他引:2
急性心肌梗死经皮冠状动脉介入治疗(PCI)术后5%~50%的患者发生无复流现象,即心外膜冠状动脉灌注良好,而心肌灌注不良。无复流是急性心肌梗死PCI术后短期和长期死亡率的独立预测因素,其可能的发病机制包括:远端栓塞;缺血性损伤;再灌注损伤;冠状动脉微循环损伤的易感性。部分患者发生无复流后可自发逆转,这提示即使不能有效预防,亦可进行有效的治疗。一些生化标志物和临床因素可独立预测无复流,一些治疗措施可有效防治无复流,如在支架置入前进行血栓抽吸不仅可预防远端栓塞,而且还可改善心肌灌注和临床结果。然而,不同患者发生无复流的机制可能是不同的,因此应根据患者的不同情况采取个体化防治措施。 相似文献
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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
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Sung Eun Kim MD Ki Hong Choi MD Young Bin Song MD 《Catheterization and cardiovascular interventions》2023,102(3):481-485
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
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Dobrzycki S Nowak K Kozuch M Bachórzewska-Gajewska H Poniatowski B Zuk J 《Kardiologia polska》2006,64(4):437-440
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
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经皮冠状动脉介入治疗术后的无再流现象 总被引:13,自引:0,他引:13
无再流现象 (no reflowphenomenon)是指冠状动脉闭塞 ,血流中断后重新恢复血流 ,却无心肌组织的有效灌注的现象 ,可发生于溶栓治疗及经皮冠状动脉介入治疗 (PCI)术后。本文就PCI术后无再流现象的发生情况、机制、检测、预防和处理等方面的研究进展进行了综述。 相似文献
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Background Percutaneous coronary intervention(PCI) is used as a treatment for acute myocardial infarction(AMI),and one of its major complications is the angiographic no-reflow phenomenon(NR).Although intra-aortic balloon pumping(IABP) is sometimes used in such patients to increase the diastolic coronary blood flow,there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon.Method Twenty-two AMI patient with NR were performed primary PCI between January 2006 a... 相似文献
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No-reflow phenomenon, defined as inadequate myocardial perfusion of the adequately dilated target vessel without evidence of angiographic mechanical obstruction. It is a multifactorial, well-recognised, secondary phenomenon following reperfusion therapy such as thrombolysis or percutaneous coronary interventions (PCI). The pathophysiological mechanisms leading to the no-reflow state are incompletely understood. Embolization of the atheromatous material to the distal vasculature and intense arteriole vasospasm caused by microembolization of platelet-rich thrombi that release vasoactive agents resulting in microvascular obstructions are likely mechanisms. Current prophylaxis and management strategies are derived from limited clinical data. Intracoronary verapamil, adenosine and nitroprusside have been most frequently studied and administered for angiographic no-reflow during PCI for acute myocardial infarction or saphenous vein graft (SVG) lesions and have been shown to improve epicardial flow and microvascular perfusion. The use of distal embolic protection devices in SVG interventions also provide microvascular protection and improve clinical outcomes. However, by far the most important measures are prevention and anticipation during PCI as once no-reflow established, complete reversal of the situation may not be possible. 相似文献
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The diagnosis and treatment of the no-reflow phenomenon in patients with myocardial infarction undergoing percutaneous coronary intervention 下载免费PDF全文
OBJECTIVE
To review the diagnosis and treatment available for myocardial infarction patients having no-reflow in the setting of percutaneous coronary intervention (PCI).DATA SOURCES
Data for the present review were obtained from searches in PubMed (1997 to 2007) using the following key terms: “acute myocardial infarction”, “no-reflow phenomenon”, “myocardial contrast echocardiography”, “coronary angiography” and “cardioprotection devices”.STUDY SELECTION
Mainly original articles and critical reviews written by major research pioneers in interventional cardiology were selected.RESULTS
Despite a fully patent coronary artery post-PCI for myocardial infarction, patients may experience inadequate myocardial perfusion through a given segment of the coronary circulation without angiographic evidence of mechanical vessel obstruction. This phenomenon is defined as no-reflow and is a growing problem in the field of interventional cardiology. Although voluminous clinical trial data are available, the exact mechanisms involved and which treatment should be administered as first-line therapy are currently unknown. The different techniques used to diagnose no-reflow also have their pros and cons; myocardial contrast echocardiography and coronary angiography are the most reliable techniques. In cases when no-reflow was successfully reversed, patient recovery was associated with favourable left ventricular remodelling and increased left ventricular ejection fraction, even in the absence of significant improvement in regional contractile function.CONCLUSION
Based on the trials in the literature, myocardial contrast echocardiography is the gold standard for the diagnosis of no-reflow. If no-reflow occurs following PCI, treatment with intracoronary adenosine or verapamil should be administered, because this form of therapy is inexpensive and safe, improves flow in the target vessel and may reduce infarct size. 相似文献18.
A case of a 72-year-old male with coronary artery disease, history of two myocardial infarctions, ejection fraction of 30% and CABG performed in 1990, is described. In 2001 he underwent PCI of two grafts. The procedure was complicated by ischaemic stroke. In 2003 the patient underwent another PCI of the occluded venous graft which was complicated by no-reflow phenomenon and acute myocardial infarction. A few months later cardiac resynchronization pacing system was implanted. The patient improved, however, one year later died due to progressive heart failure. Diagnosis and treatment of the no reflow phenomenon are discussed. 相似文献
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Depletion of antioxidants is associated with no-reflow phenomenon in acute myocardial infarction 总被引:3,自引:0,他引:3
Matsumoto H Inoue N Takaoka H Hata K Shinke T Yoshikawa R Masai H Watanabe S Ozawa T Yokoyama M 《Clinical cardiology》2004,27(8):466-470
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
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Bartuś S Dudek D Legutko J Turek P Rzeszutko K Dziewierz A Dubiel JS 《Kardiologia polska》2003,58(5):385-389
Residual stenosis, dissection and/or microvascular damage have been proposed as mechanisms of impaired flow after primary angioplasty (PCI) for acute myocardial infarction (MI). In this report we present a patient who underwent PCI for acute anterior MI. Coronary flow reserve (CFR) assessment performed after balloon dilatation suggested possible improvement of coronary flow after stenting. However, we did not observe any improvement in CFR just after stent implantation. We conclude that in patients treated with primary PCI the use of additional pharmacological treatment to prevent microcirculation injury during reperfusion and slow-flow or no-reflow phenomenon should be considered. 相似文献