经皮冠状动脉介入术中对无复流现象预防的临床研究

目的 探讨经皮冠状动脉介入治疗术中发生无复流现象的高发因素和强化抗血小板治疗对无复流现象的预防效果。方法 对618例冠心病患者行经皮冠状动脉介入治疗，根据介入术中发生无复流现象情况判别无复流现象高发的危险因素，并观察强化抗血小板治疗对急性冠状动脉综合征患者无复流现象的预防作用和不良反应。结果 患者年龄、性别，是否伴发高血压、糖尿病，血脂异常，目前吸烟，术前PT、APTI＇不影响无复流现象发生，但是，急性冠状动脉综合征、右冠状动脉病变、病变血管直径〉4mm、血管病变呈弥漫性病变、冠状动脉瘤样扩张伴狭窄、罪犯血管处有血栓征象患者无复流现象明显增加。术前应用替罗非班强化抗血小板治疗可以有效预防介入术中无复流现象的发生而不增加不良反应。结论 冠心病患者介入治疗前通过评价临床和冠状动脉造影情况可以发现预测无复流现象发生的危险因素，术前应用替罗非班强化抗血小板治疗可以有效预防无复流现象的发生。

Clinical study of the prevention of no-reflow phenomenon during percutaneous coronary intervention

Objective To discuss the risk factors of no-reflow phenomenon during percutaneous coronary intervention(PCI)and the curative effect of intensive of intensive antiplatelet treatment with tirofiban.Method 618 coronary heart disease(CAD)patients accepted PCI.According to the patients with or without no-reflow phenomenon,to determine the risk factors of no-reflow phenomenon by clinical and coronary angiographic morphologic feature,and to observe the effect of intensive antiplatelet treatment on acute coronary syndrome patients with no-reflow phenomenon and adverse reaction.Results No-reflow phenomenon was more in the patients with acute coronary syndrome,coronary lumen >4 mm,right coronary lesion,diffuse lesion,coronary ectasia with stenosis,thrombotic sign found in culprit vessel.Intensive antiplatelet treatment with tirofiban before PCI could reduce no-reflow phenomenon effectively.Conclusion The risk factors of no-reflow phenomenon can be forecast by clinical and coronary angiographic morphologic features,and intensive antiplatelet treatment with tirofiban can prevent no-reflow phenomenon from happening.