冠脉无复流现象治疗的研究进展

心血管疾病是人群中常见的死亡原因之一，随着人口老龄化的加速，心血管疾病中以急性心肌梗死为代表的急性冠脉综合征(ACS)的发病率逐年上升。一旦发生ACS，尽早恢复冠脉的血流就尤为重要，而急诊经皮冠状动脉介入治疗(PCI)仍是目前首选的治疗方案。无复流现象是PCI术后常见的并发症，它是指在冠脉介入治疗过程中，心外膜冠脉狭窄或闭塞已得到正常开通，但由于微循环水平血液仍不能完全恢复，使缺血心肌组织未得到有效再灌注的现象。当冠脉产生无复流现象时，使得再灌注治疗的有益效果减弱，主要不良心脏事件(MACEs)的发生率明显增加，导致患者的不良预后。目前冠脉无复流现象的病理生理学机制尚不完全清楚，可能与冠状动脉微循环障碍有关，分子机制包括炎症通路的激活、缺血与再灌注所致内皮细胞损伤、血栓栓塞症有关的损伤、微血管痉挛、白细胞浸润和细胞水肿等。由于无复流现象与不良的临床结果密切相关，因此，有效的预防和治疗策略非常重要。近来的研究表明，术前预防应用他汀类、抗血小板类、血管扩张剂及某些抗炎药物有助于减少无复流现象的发生、重建冠状动脉血流并改善患者的预后。此外，介入器械的预防使用也具有一定的应用前景。本文就近几年防治冠脉无复流现象治疗的研究进展进行综述。 

Research progress in the treatment of coronary no-reflow phenomenon

Cardiovascular disease is a common cause of death worldwide. With the acceleration of population aging, the incidence of acute coronary syndrome (ACS), represented by acute myocardial infarction, is increasing every year. When ACS occurs, coronary blood flow must be restored as soon as possible, and emergency percutaneous coronary intervention (PCI) remains the preferred treatment option. No-reflow phenomenon is a common complication after PCI, it refers to the normal opening of epicardial coronary stenosis or occlusion during coronary intervention, but the blood myocardial tissue has not been effectively re-perfused because the blood at the microcirculation level cannot be completely recovered. When coronary no-reflow phenomenon occurs, the beneficial effect of reperfusion therapy is weakened, and the incidence of major adverse cardiac events (MACES) is significantly increased, resulting in poor patient prognosis. At present, the pathophysiological mechanism of coronary no-reflow phenomenon is not fully understood, and it may be related to coronary microcirculation disorders. Molecular mechanisms include the activation of inflammatory pathways, endothelial cell damage caused by ischaemia and reperfusion, thromboembolism-related damage, microvascular spasm, leukocyte infiltration and cell oedema. No-reflow phenomenon is closely associated with poor clinical outcomes, thus, effective prevention and treatment strategies are important. Recent studies have shown that the preoperative prophylactic use of statins, antiplatelets, vasodilators and certain anti-inflammatory drugs can reduce the occurrence of no-reflow, restore coronary blood flow and improve patient outcomes. In addition, the preventive use of interventional devices has certain application potential. This article reviews the research progress in the prevention and treatment of coronary no-reflow phenomenon in recent years.