中国急救医学
中國急救醫學
중국급구의학
CHINESE JOURNAL OF CRITICAL CARE MEDICINE
2001年
4期
211-213
,共3页
高传玉%程兆云%Robert Whitbourn%Andrew MacIsaac%Patracia Fox%Michael Jelinek
高傳玉%程兆雲%Robert Whitbourn%Andrew MacIsaac%Patracia Fox%Michael Jelinek
고전옥%정조운%Robert Whitbourn%Andrew MacIsaac%Patracia Fox%Michael Jelinek
PTCA术%支架术%No-Reflow现象%血小板GP Ⅱb/Ⅲa受体拮抗剂ReoPro
PTCA術%支架術%No-Reflow現象%血小闆GP Ⅱb/Ⅲa受體拮抗劑ReoPro
PTCA술%지가술%No-Reflow현상%혈소판GP Ⅱb/Ⅲa수체길항제ReoPro
目的 评价血小板表面糖蛋白受体(GPⅡb/Ⅲa)拮抗剂ReoPro对硝酸甘油不能缓解的冠状动脉无血流现象(No-Reflow)的疗效以及对住院期间临床预后的影响。方法 回顾性研究了伴或不伴No-Reflow现象病人的临床特点、住院期间主要心血管事件(死亡、心肌梗死、血管再通术)发生率。结果 1093例病人中经皮球囊扩张术(PTCA)352例，支架术741例；共23例病人被描述有No-Reflow现象，其中6例病人对硝酸甘油冠状动脉内注射无反应，在给予ReoPro后TIMI血流明显改善(0.83±0.41vs2.50±0.54，P＜0.002)，与同期不伴有No-Reflow现象相比，住院期间死亡(0vs0.74%，P＞0.75)、靶血管再介入(0vs1.10%，P＞0.75)、搭桥术(0vs0.21%，P＞0.90)发生率无区别，但心肌梗死发生率较高(Q波心肌梗死：16.7%vs0.37%，P＜0.005；无Q波心肌梗死：50%vs1.05%，P＜0.005)。结论 ReoPro能明显改善对硝酸甘油无反应No-Reflow病人的TIMI血流及临床预后，也提示血小板介导的微血管血栓及栓塞是这类病人No-Reflow现象的重要形成因素。
目的 評價血小闆錶麵糖蛋白受體(GPⅡb/Ⅲa)拮抗劑ReoPro對硝痠甘油不能緩解的冠狀動脈無血流現象(No-Reflow)的療效以及對住院期間臨床預後的影響。方法 迴顧性研究瞭伴或不伴No-Reflow現象病人的臨床特點、住院期間主要心血管事件(死亡、心肌梗死、血管再通術)髮生率。結果 1093例病人中經皮毬囊擴張術(PTCA)352例，支架術741例；共23例病人被描述有No-Reflow現象，其中6例病人對硝痠甘油冠狀動脈內註射無反應，在給予ReoPro後TIMI血流明顯改善(0.83±0.41vs2.50±0.54，P＜0.002)，與同期不伴有No-Reflow現象相比，住院期間死亡(0vs0.74%，P＞0.75)、靶血管再介入(0vs1.10%，P＞0.75)、搭橋術(0vs0.21%，P＞0.90)髮生率無區彆，但心肌梗死髮生率較高(Q波心肌梗死：16.7%vs0.37%，P＜0.005；無Q波心肌梗死：50%vs1.05%，P＜0.005)。結論 ReoPro能明顯改善對硝痠甘油無反應No-Reflow病人的TIMI血流及臨床預後，也提示血小闆介導的微血管血栓及栓塞是這類病人No-Reflow現象的重要形成因素。
목적 평개혈소판표면당단백수체(GPⅡb/Ⅲa)길항제ReoPro대초산감유불능완해적관상동맥무혈류현상(No-Reflow)적료효이급대주원기간림상예후적영향。방법 회고성연구료반혹불반No-Reflow현상병인적림상특점、주원기간주요심혈관사건(사망、심기경사、혈관재통술)발생솔。결과 1093례병인중경피구낭확장술(PTCA)352례，지가술741례；공23례병인피묘술유No-Reflow현상，기중6례병인대초산감유관상동맥내주사무반응，재급여ReoPro후TIMI혈류명현개선(0.83±0.41vs2.50±0.54，P＜0.002)，여동기불반유No-Reflow현상상비，주원기간사망(0vs0.74%，P＞0.75)、파혈관재개입(0vs1.10%，P＞0.75)、탑교술(0vs0.21%，P＞0.90)발생솔무구별，단심기경사발생솔교고(Q파심기경사：16.7%vs0.37%，P＜0.005；무Q파심기경사：50%vs1.05%，P＜0.005)。결론 ReoPro능명현개선대초산감유무반응No-Reflow병인적TIMI혈류급림상예후，야제시혈소판개도적미혈관혈전급전새시저류병인No-Reflow현상적중요형성인소。
Objective Evaluating the effect of platelet glycoprotein Ⅱb/Ⅲareceptor inhibitor abciximab(ReoPro)on clinical of patients with no-reflow phenomenon which failed to respond to intracoronary nitroglycerin.Method We respectively studied in-hospital clinical outcome and the incidence of in-hospital cardiac events(death,myocardial infarction,revascularisation)of patients with or without no-reflow phenomenon.Result In 1 093 patients undergoing percutaneous coronary revascularisation(percutaneous transluminal coronary angioplasty-PTCA 352 cases,stenting 741 cases),transient or sustained no-reflow was described by operators in 23 patients.In 17 patients,TIMI flow grade Ⅲ was recovered quickly in catheter lab after intracoronary nitroglycerin was administrated.In the other 6 patients who failed to respond to intracoronary nitroglycerin administration,ReoPro was given intravenously;TIMI flow grade Ⅲ and grade Ⅱ were achieved in 3 patients respectively in the catheter lab(P＜0.002);Q-wave and non Q-wave myocardial infarction(QMI and Non-QMI) occurred in 1 patient and 3 patients respectively;There was no difference on in-hospital death and revascularisation between patients with or without no-reflow phenomenon (P＞0.75),but the incidence of myocardial infarction of the patients with no-reflow phenomenon was significantly higher(QMI:16.7% vs 0.37%,P＜0.005;Non-QMI:50% vs 1.05%,P＜0.005).Conclusion No-reflow phenomenon which failed to respond to intracoronary nitroglycerin generally responded promptly to intravenous ReoPro administration with recovery to TIMI grade Ⅱ or Ⅲflow in the catheter lab;In-hospital death and subsequent revascularisation of patients with no-reflow phenomenon were similar to patients without no-reflow phenomenon.This suggests abciximab (ReoPro) is an effective adjunctive therapy for the no-reflow phenomenon, and that platelet mediated microvascular thrombus and embolization may be the mechanism of nitroglycerin-resistant no-reflow phenomenon during percutaneous revascularisation.
