急诊PCI术后心肌缺血再灌注损伤的临床表现及分析

目的对急性心肌梗死急诊经皮冠状动脉介入术（PCI）再灌注后，分析MIRI特殊临床表现。方法回顾分析我院经急诊PCI开通梗死相关血管，恢复血流冉灌注的51例AMI患者的临床资料。MIRI判断标准为：AMI直接PCI开通梗死相关血管后2h内，急性发生的严重心动过缓和低血压，或严重室性心律失常，或IRA前向血流≤TIMI2级且除外因造影可见的血栓、栓塞、夹层或痉挛等所致急性闭塞，或再灌注后心源性休克和持久的左心功能不全。分析MIRI的临床表现。结果51例患者中，有30例发生MIRI，MIRI发生率为58.8％，再灌注后45例胸痛迅速缓解，15例患者出现缓慢心律失常；频发室早12例，室速5例，室颤6例，2例无复流，3例慢复流，21例出现一过性低血压；4例术后出现持续低血压超过1周。4例出现ST段回落后又抬高，1例ST段无明显下降。结论冠脉血管再通后的MIRI发生率58．8％。再灌注时间越短越易发生MIRI，再灌注后绝大部分患者胸痛迅速缓解，且有心律失常发生，一过性低血压也比较常见。ST段回落后反常性抬高可能是心肌再灌注的指标，也可能室壁瘤形成。

Analysis on Clinical Manifestation of Myocardial Ischemical Reperfusion Injury after Emergency Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction

Objective To analyse clinical manifestation of myocardial ischemia reperfusion injury during primary percutaneous coronary intervention for acute myocardial infarction. Methods Clinical and angiographic data of 51 AMI patients in whom the infarct-related arteries were successfully revascularized by emergency primary PCI were analyzed retrospectively. MIRI was defined if the following conditions existed after PCI in two hours： severe bradycardia or hypotension, or severe ventricular arrhythmias requiring electrical cardioversion or drugs, or IRA antegrade flow ≤TIMI 2 grade flow without angiographic evidence of thrombus,emboli,dissection or spasm,or cardiogenic shock,heart failure for a long times. Analyse clinical manifestation of MIRI. Results The rate of MIRI is 58.8%. After repufusion,chest pain was reliefed in 45 patients, bradycardia took place in 15 patients,frequency of ventricular premature beats in 12 patients,ventricular tachycardia in 5 patients, ventricular fibrillating in 6 patients,Transient hypotension in 21 patients, hypotension persistent more than 7 days in 4 patients, ST segment elevation anomaly in 4 patients and ST segment undescend in 1 patient was also observed. Conclusion The rate of MIRI is 58.8% after IRA revascularization. The shorter time intervals from AMI onset to IRA revascularization, the easyer MIRI will be. Chest pain released in most of patients,after reperfusion companied with the presenting of arrhythmias. Transient hypotension and ST segment elevation anomaly could also been seen. ST segment elevation anomaly maybe the index of MIRI or no-reflow or mean vntricular aneurysm.