郭晓金+孙会+王文臣+于冠华

[摘要] 目的 研究行PCI术过程中出现无复流时应用抽吸导管抽吸联合抽吸后抽吸导管内应用药物对无复流现象的疗效观察。 方法 将43例行PCI术过程中出现无复流现象的患者分为两组，均予常规拜阿司匹林、硫酸氢氯吡格雷、他汀类等药物治疗，并行冠脉造影及冠脉支架术，在PCI术中均出现无复流现象，A组在此基础上先进行抽吸导管抽吸病变远端冠状动脉内血液，共抽吸40 mL，抽吸后抽吸导管内注射硝普钠、肾上腺素等药物；B组出现无复流后，直接在指引导管内应用硝普钠、肾上腺素等药物。比较冠脉造影TIMI血流及术后患者超声心动图EF值、术后患者NT proBNP，观察A、B两组治疗方案对无复流现象的疗效。 结果 A组总有效率明显高于B组（χ2=7.305，P=0.007），治疗后A组TIMI血流较B组明显好转（χ2=8.112，P=0.017），A组NT proBNP较B组明显改善（t=4.813，P<0.001），差异有统计学意义。 结论 应用抽吸导管抽吸联合抽吸后抽吸导管内应用药物治疗无复流现象与单纯指引导管内给药治疗无复流现象比较，是一种更有效的治疗方案。

[关键词] PCI术；无复流现象；抽吸导管；冠脉造影

[中图分类号] R542.22 [文献标识码] A [文章编号] 1673-9701（2017）22-0009-04

[Abstract] Objective To study the curative effect of suction by aspiration catheter combined with medication within aspiration catheter on no-reflow during PCI surgery. Methods 43 patients who had no reflow in the course of PCI were divided into two groups. All patients were given conventional bayaspirin， clopidogrel hydrogen sulfate， statins and other drugs. Coronary angiography and coronary stenting were carried out simultaneously. During PCI operation， no reflow phenomenon occurred in all the patients. In group A， on the basis of this， aspiration catheter was used for the suction of distal coronary blood， with a total of 40 mL. After aspiration， sodium nitroprusside， adrenaline and other drugs were injected in the aspiration catheter； in group B， after no reflow， sodium nitroprusside， adrenaline and other drugs were used directly in the guiding catheter. The curative effect of no reflow phenomenon was observed in the therapeutic regimen of group A and group B by coronary angiography TIMI blood flow， postoperative EF value of echocardiography and postoperative NT proBNP. Results The total effective rate in group A was significantly higher than that in group B（χ2=7.305， P=0.007）； after treatment， TIMI blood flow in group A was significantly better than group B（χ2=8.112， P=0.017）， and NT proBNP in group A was significantly improved compared with group B（t=4.813， P<0.001）. The difference was statistically significant. Conclusion Suction of aspiration catheter combined with medication within aspiration catheter after suction in the treatment of no reflow phenomenon is a more effective therapeutic regimen compared with the medication by guiding catheter alone in the treatment of no reflow phenomenon.

[Key words] PCI； No reflow phenomenon； Aspiration catheter； Coronary angiogram

冠状动脉无复流（no reflow）现象是指血管造影无血管机械性阻塞的证据，而冠状动脉循环所支配的节段心肌灌注不足的一种现象。介入心脏病学[1]将其定义为在急性心肌梗死溶栓或介入性治疗使闭塞冠状动脉成功重建后，相应冠状动脉前向血流急剧减少或缺血区心肌组织无血流灌注，并排除心外膜下冠状动脉急性闭塞、严重夹层、血管痉挛或巨大血栓栓塞引起的血管截断现象。随着经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）术的逐渐发展，行PCI术过程中出现无复流现象逐渐受到临床医生的重视，在PCI术中，当出现无复流现象时，明显增加患者的死亡率及致残率，远期死亡风险增加1倍[2]。……