心肌梗死再灌注后无复流现象的研究进展

心肌无复流是指在急性心肌梗死(AMI)急诊冠状动脉内干预(PCI)后,部分患者即使解除了心外膜血管阻塞,其所供应心肌组织仍未获得有效血流灌注的现象。其本质是心肌微循环灌注障碍。研究证实无复流可导致梗死的延展、心功能恢复障碍、左室重构等更多的合并症。尽管无复流的确切机制不明,但结果是微循环阻塞、再灌注损伤等导致微循环的破坏。无复流的诊断主要在于冠脉造影提供的心肌缺血的临床证据,近年来心肌对比造影超声心动图(MCE)、核素心肌显像技术、多普勒导丝等广泛应用于无复流的检测及诊断,提高了无复流的检出率。本文对心肌无复流病理生理学、诊断方法、相关因素及治疗方面进行了综述。

No-Reflow Phenomenon Following Reperfusion in Acute Myocardial Infarction

The no reflow phenomenon is characterized by inadequate myocardial perfusion without angiographic manifestations of mechanical vascular occlusion.which occurs on patients with first acute myocardial infarction underwent successful emergency percutaneous coronary intervention(PCI).The essence of no-reflow is the failue of microcirculation perfusion.Studies have demonstrated that patients with no reflow will have larger myocardial infarctions,disturbance of heart functional recovery,left ventricular remodeling and many other complications compared with those with reflow.Although the clear mechanism resulting in no-reflow phenomenon is not known,the outcome of this phenomenon is the microcirculatory destroy caused by microcirculatory occulation and its reperfusion injury.Diagnosis is usually based on clinical evidence of myocardial ischemia combined with coronary angiography.The detection rate of no-reflow has been elevated with the development of diagnostic techniques to assess coronary microcirculation,including myocardial contrast echo(MCE),Single-photon emission computed tomography (SPECT),and Doppler wire.This article will review the pathophysiology,diagnostic method,correlation factor and therapeutic approach about this clinical problem.