目的：分析急性ST段抬高型心肌梗死（STEMI）患者行急诊经皮冠状动脉介入治疗（PCI）后出现无复流的相关危险因素。方法选择2012年5月~12月于皖南医学院第一附属弋矶山医院心内科就诊STEMI且行急诊PCI的患者166例，其中男性139例，女性27例，年龄36~91（63.10±11.96）岁。按照血管机械开通后的造影情况分为正常灌注组（142例）和无复流组（24例）。采集患者缺血时间、合并基础疾病等一般临床资料，入院即刻和入院后采静脉血，检测中性粒细胞百分比、血小板计数（PLT）、低密度脂蛋白胆固醇（LDL-C）水平等，测定病变血管直径和靶病变长度。结果无复流组缺血时间和中性粒细胞百分比均高于正常灌注组，差异有统计学意义（P均＜0.01）。结果显示，缺血时间＞6 h （OR=1.578，95%CI：1.245~2.000）和中性粒细胞百分比＞80.0%（OR=3.405，95%CI：1.027~11.293）均为急诊PCI术后无复流的危险因素。结论急性ST段抬高型心肌梗死行急诊PCI的患者，缺血时间明显延长，中性粒细胞百分比明显升高，发生无复流的概率会更高。%Objective To analyze the relevant risk factors of no-reflow during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods STEMI patients undergone primary PCI were chosen (n=166, male 139, female 27, aged from 36 to 91 and average age=63.10±11.96) from the Department of Cardiovascular Diseases of the First Affiliated Yijishan Hospital of Wannan Medical College from May 2012 to Dec. 2015. All patients were divided into normal perfusion group (n=142) and no-reflow group (n=24) according to the outcomes of angiography after vascular mechanical patency. The general clinical materials including ischemia time and complicating basic diseases were collected. The samples of vein blood were collected at the time of hospitalization and after hospital admission for detecting neutrophil percentage, platelet count (PLT) and low-density lipoprotein-cholesterol (LDL-C), and diseased vascular diameter and target lesion length were measured.Results The ischemia time and neutrophil percentage were all higher in no-reflow group than those in normal perfusion group (allP<0.01). The results of regression analysis showed that ischemia time>6 h (OR=1.578, 95%CI: 1.245~2.000) and neutrophil percentage>80.0% (OR=3.405, 95%CI:1.027~11.293) were risk factors of no-reflow after primary PCI.Conclusion In the patients with acute STEMI undergone primary PCI, ischemia time is longer and neutrophil percentage increases significantly and probability of no-reflow will be higher.
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