17例急性心肌梗死介入治疗无复流现象处理

总结分析1998年2月～2004年5月，共对189例急性心肌梗死(AMI)行冠状动脉介入治疗(PCI)．其中，经溶栓治疗失败行补救性PCI治疗121例，直接PCI治疗68例．治疗中17例发生无复流现象，需急诊治疗．189例急诊介入治疗中，17例(9％)并发无复流现象．121例溶栓失败行补救性PCI治疗中3例(2％)发生无复流现象，68例直接PCI治疗中14例(20％)并发无复流现象．无复流现象的17例病人，心功能分级Killip Ⅰ级11例，Killip Ⅱ级5例，Killip Ⅲ级1例．所有病例均经冠状动脉内给予尿激酶、硝酸甘油、合心爽、东菱克栓酶、腺苷及静脉应用阿托品、多巴胺及肾上腺素升压等治疗后恢复，其中1例无复流发生后出现心脏骤停，经心肺复苏成功，多种药物处理无复流消失．无复流发生后需一种药物治疗恢复4例，两种药物治疗恢复5例，3种及3种以上药物治疗恢复8例．AMI病人PCI治疗中无复流发生率较高，发生机制可能有冠状动脉痉挛、血栓、冠状动脉内微血栓等有关；另一方面与梗死面积大小、严重的心肌损害、心功能不全、梗死时间与再灌注开始时间较长等有关．因此，单一药物治疗效果差，多需综合处理才能恢复．

Treatment of no-reflow phenomenon following percutaneous coronary intervention in 17 patients with acute myocardial infarction

The effect of treatment of no-reflow phenomenon of infarction-related artery(IRA) following percutaneous coronary intervention(PCI) has been assessed in 17 patients with acute myocardial infarction(AMI). Prom February 1998 to May 2004, 17 patients were found with no-reflow phenomenon of IRA following PCI in 189 patients with AMI. Urkinase, nitroglycerin, diltiazem, batroxobin, adenosine, etc, were respectively injected into the IRA in all the patients with no-reflow phenomenon of IRA following PCI and they were treated successfully. 4 patients were treated successfully with one kind of the drugs, 5 patients treated successfully with two kinds of the drugs, three kinds of drugs and more were used in 8 patients. No-reflow phenomenon of IRA following PCI in patients with AMI incidence rate was high. Medical therapy for no-reflow phenomenon of IRA following PCI in patients with AMI is effective, and a combined therapy was better than drugs alone.