中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2013年
3期
280-286
,共7页
周华%何晓燕%庄少伟%王娟%来晏%祁炜罡%姚义安%刘学波
週華%何曉燕%莊少偉%王娟%來晏%祁煒罡%姚義安%劉學波
주화%하효연%장소위%왕연%래안%기위강%요의안%류학파
急性心肌梗死%无复流现象%经皮冠脉介入%血栓
急性心肌梗死%無複流現象%經皮冠脈介入%血栓
급성심기경사%무복류현상%경피관맥개입%혈전
Acute myocardial infarction%No-reflow phenomenon%Percutaneous coronary intervention%Thrombus
目的 探讨急性心肌梗死(acute myocardial infarction,AMI)患者急诊经皮冠状动脉介入(percutaneous coronaryintervention,PCI)术后出现无复流现象相关的危险因素.方法 连续选取2008年1月至2010年12月于上海市东方医院心内科住院的AMI患者312例为研究对象.入选标准:发病12 h内,或12 h至24 h内仍有持续缺血性胸痛,成功接受PCI手术治疗且资料完整者.排除标准:冠脉痉挛或罪犯病变直径狭窄程度≤50％、冠脉血流正常行保守治疗,严重左主干或三支血管病变需急诊冠脉搭桥术.根据PCI术后心肌梗死溶栓试验(TIMI)血流分级,患者分为正常血流组和无复流组.比较这两组患者基本临床资料、造影结果及手术相关资料的差异,采用单变量和多变量Logistic回归分析急性心肌梗死患者急诊PCI术后出现无复流现象的影响因素.结果 20.3％的患者急诊PCI术后出现了无复流.单变量分析:年龄、再灌注时间(症状至PCI的时间)、入院时收缩压、心梗Killip分级、急诊PCI术前应用主动脉内气囊反搏(intra-aortic balloon pump,IABP)、PCI术前TIMI血流分级、闭塞病变类型、血栓负荷、靶病变长度、参考血管直径、再灌注方法与无复流现象相关(P＜0.05).多变量Logistic回归模型分析发现,年龄＞65岁(OR=1.470,95％ CI 1.460～1.490,P=0.007)、再灌注时间＞6h(OR=1.270,95％ CI 1.160～1.400,P=0.001)、入院时低收缩压(＜100 mmHg)(1 mmHg=0.133 kPa) (OR=1.910,95％CI 1.018～3.896,P=0.004)、PCI术前应用IABP(OR=1.949,95％ CI 1.168 ～3.253,P=0.011)、PCI术前低(≤1)TIMI血流(OR=1.100,95％ CI 1.080 ～1.250,P＜0.01)、高血栓负荷(OR=1.600,95％ CI 1.470～2.760,P=0.030)、长靶病变(OR=1.948,95％ CI 1.908～1.990,P=0.019)是急诊PCI术后发生无复流现象的独立危险因素.结论 可根据急性心肌梗死患者临床、造影及手术时的发现来预测急诊PCI术后是否发生无复流现象.
目的 探討急性心肌梗死(acute myocardial infarction,AMI)患者急診經皮冠狀動脈介入(percutaneous coronaryintervention,PCI)術後齣現無複流現象相關的危險因素.方法 連續選取2008年1月至2010年12月于上海市東方醫院心內科住院的AMI患者312例為研究對象.入選標準:髮病12 h內,或12 h至24 h內仍有持續缺血性胸痛,成功接受PCI手術治療且資料完整者.排除標準:冠脈痙攣或罪犯病變直徑狹窄程度≤50％、冠脈血流正常行保守治療,嚴重左主榦或三支血管病變需急診冠脈搭橋術.根據PCI術後心肌梗死溶栓試驗(TIMI)血流分級,患者分為正常血流組和無複流組.比較這兩組患者基本臨床資料、造影結果及手術相關資料的差異,採用單變量和多變量Logistic迴歸分析急性心肌梗死患者急診PCI術後齣現無複流現象的影響因素.結果 20.3％的患者急診PCI術後齣現瞭無複流.單變量分析:年齡、再灌註時間(癥狀至PCI的時間)、入院時收縮壓、心梗Killip分級、急診PCI術前應用主動脈內氣囊反搏(intra-aortic balloon pump,IABP)、PCI術前TIMI血流分級、閉塞病變類型、血栓負荷、靶病變長度、參攷血管直徑、再灌註方法與無複流現象相關(P＜0.05).多變量Logistic迴歸模型分析髮現,年齡＞65歲(OR=1.470,95％ CI 1.460～1.490,P=0.007)、再灌註時間＞6h(OR=1.270,95％ CI 1.160～1.400,P=0.001)、入院時低收縮壓(＜100 mmHg)(1 mmHg=0.133 kPa) (OR=1.910,95％CI 1.018～3.896,P=0.004)、PCI術前應用IABP(OR=1.949,95％ CI 1.168 ～3.253,P=0.011)、PCI術前低(≤1)TIMI血流(OR=1.100,95％ CI 1.080 ～1.250,P＜0.01)、高血栓負荷(OR=1.600,95％ CI 1.470～2.760,P=0.030)、長靶病變(OR=1.948,95％ CI 1.908～1.990,P=0.019)是急診PCI術後髮生無複流現象的獨立危險因素.結論 可根據急性心肌梗死患者臨床、造影及手術時的髮現來預測急診PCI術後是否髮生無複流現象.
목적 탐토급성심기경사(acute myocardial infarction,AMI)환자급진경피관상동맥개입(percutaneous coronaryintervention,PCI)술후출현무복류현상상관적위험인소.방법 련속선취2008년1월지2010년12월우상해시동방의원심내과주원적AMI환자312례위연구대상.입선표준:발병12 h내,혹12 h지24 h내잉유지속결혈성흉통,성공접수PCI수술치료차자료완정자.배제표준:관맥경련혹죄범병변직경협착정도≤50％、관맥혈류정상행보수치료,엄중좌주간혹삼지혈관병변수급진관맥탑교술.근거PCI술후심기경사용전시험(TIMI)혈류분급,환자분위정상혈류조화무복류조.비교저량조환자기본림상자료、조영결과급수술상관자료적차이,채용단변량화다변량Logistic회귀분석급성심기경사환자급진PCI술후출현무복류현상적영향인소.결과 20.3％적환자급진PCI술후출현료무복류.단변량분석:년령、재관주시간(증상지PCI적시간)、입원시수축압、심경Killip분급、급진PCI술전응용주동맥내기낭반박(intra-aortic balloon pump,IABP)、PCI술전TIMI혈류분급、폐새병변류형、혈전부하、파병변장도、삼고혈관직경、재관주방법여무복류현상상관(P＜0.05).다변량Logistic회귀모형분석발현,년령＞65세(OR=1.470,95％ CI 1.460～1.490,P=0.007)、재관주시간＞6h(OR=1.270,95％ CI 1.160～1.400,P=0.001)、입원시저수축압(＜100 mmHg)(1 mmHg=0.133 kPa) (OR=1.910,95％CI 1.018～3.896,P=0.004)、PCI술전응용IABP(OR=1.949,95％ CI 1.168 ～3.253,P=0.011)、PCI술전저(≤1)TIMI혈류(OR=1.100,95％ CI 1.080 ～1.250,P＜0.01)、고혈전부하(OR=1.600,95％ CI 1.470～2.760,P=0.030)、장파병변(OR=1.948,95％ CI 1.908～1.990,P=0.019)시급진PCI술후발생무복류현상적독립위험인소.결론 가근거급성심기경사환자림상、조영급수술시적발현래예측급진PCI술후시부발생무복류현상.
Objective To find out possible risk factors for no-reflow (NR) phenomenon in patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI).Methods A total of 312 consecutive patients with acute myocardial infarction were enrolled from January 2008 to December 2010 at the Cardiology Departmemt of East Hospital,Tongji University School of Medicine in this study.Inclusion criteria were:(1) patients underwent successful primary PCI within 12 h of symptom onset;or (2) patients with ischemic chest pain continuing for more than 12 h underwent successful primary PCI within 24 h of symptom onset.Exculsion criteria were:(1) coronary atery spasm; (2) diameter stenosis of the culprit lesion was ≤50％ and coronary blood flow was normal; (3) patients with severe left main coronary or multivessel disease,who had to require emergency surgical revascularization.According to thrombolysis in myocardial infarction (TIMI) flow grade,the patients were divided into reflow group and NR group.The clinical date,angiography findings and surgical date were compared between two groups.Univariate and multivariate logistic regression were used to determine the predictors for NR phenomenon.Results Sixtyone (20.3％) of the patients developed NR phenomenon after primary PCI.Univariate analysis showed that patients' age,time from onset to reperfusion,systolic blood pressure (SBP) on admission,Killip class of myocardial infarction,intra-aortic balloon pump (IABP) use before primary PCI,TIMI flow grade before primary PCI,type of occlusion,thrombus burden on baseline angiography,target lesion length,reference luminal diameter and method of repusion were correlated with NR phenomenon (P＜ 0.05 for all).Multiple logistic regression analysis identified that age ＞ 65 years (OR =1.470,95％ CI 1.460-1.490,P =0.007),long time from onset to reperfusion ＞6 hours (OR =1.270,95％ CI 1.160-1.400,P =0.001),low SBP on admission ＜100mmHg (1 mmHg=0.133 kPa) (OR=1.910,95％ CI 1.018-3.896,P =0.004),IABP use before PCI (OR =1.949,95％ CI 1.168-3.253,P =0.011),low (≤1) TIMI flow grade before primary PCI (OR =1.100,95％ CI 1.080-1.250,P ＜ 0.01),high thrombus burden (OR =1.600,95％ CI 1.470-2.760,P =0.030) and long target lesion (OR =1.948,95％ CI 1.908-1.990,P =0.019) on angiography as independent predictors of NR phenomenon.ConclusionsThe occurrence of NR phenomenon after primary PCI for acute myocardial infarction can be predicted using simple clinical,angiographic and procedural features.
