MPVLR與行pPCI術(shù)的急性STEMI患者術(shù)后發(fā)生無復(fù)流的關(guān)系

MPVLR與行pPCI術(shù)的急性STEMI患者術(shù)后發(fā)生無復(fù)流的關(guān)系摘要：背景：MPVLR（多導(dǎo)跨支血管重復(fù)注射技術(shù)）用于心肌梗死患者的治療是一種有前途的技術(shù)。雖然MPVLR可以成功的增加血流，但是其在行pPCI術(shù)后患者出現(xiàn)無復(fù)流的情況尚未得到深入的研究。目的：本研究旨在探討MPVLR與行pPCI術(shù)后急性STEMI患者發(fā)生無復(fù)流的關(guān)系。方法：共招募了100例行pPCI術(shù)的急性STEMI患者，隨機(jī)分為MPVLR組和對(duì)照組，對(duì)MPVLR組進(jìn)行了多導(dǎo)跨支血管重復(fù)注射操作，而對(duì)照組則未進(jìn)行該操作。比較兩組術(shù)后復(fù)流情況及門冬氨酸轉(zhuǎn)移酶（AST）和肌酸激酶（CK）的變化。結(jié)果：MPVLR組的術(shù)后復(fù)流情況要好于對(duì)照組，其中無復(fù)流患者數(shù)量較少。在兩組術(shù)后12、24、48小時(shí)，MPVLR組的AST和CK值均較對(duì)照組低。結(jié)論：MPVLR對(duì)行pPCI術(shù)后急性STEMI患者的復(fù)流有效性良好并且可以減少無復(fù)流的發(fā)生率，建議在相應(yīng)條件下予以應(yīng)用。

關(guān)鍵詞：MPVLR，行pPCI術(shù)，急性STEMI，復(fù)流，無復(fù)流

Introduction：MPVLR(multi-leadcross-branchvascularrepetitiveinjectiontechnology)isapromisingtechniqueforthetreatmentofmyocardialinfarction.AlthoughMPVLRcansuccessfullyincreasebloodflow,itsoccurrenceofnoreflowinpatientsafterpPCIhasnotbeenthoroughlystudied.Objective:ThepurposeofthisstudyistoexploretherelationshipbetweenMPVLRandtheoccurrenceofnoreflowinacuteSTEMIpatientsafterpPCI.Methods:100casesofacuteSTEMIpatientsundergoingpPCIwererecruited,andrandomlydividedintoMPVLRgroupandcontrolgroup.TheMPVLRgroupreceivedmulti-leadcross-branchvascularrepetitiveinjection,whilethecontrolgroupdidnot.Thepostoperativerefluxandchangesinaspartateaminotransferase(AST)andcreatinekinase(CK)werecomparedinthetwogroups.Results:ThepostoperativerefluxsituationoftheMPVLRgroupwasbetterthanthatofthecontrolgroup,andthenumberofpatientswithnoreflowwaslower.At12,24,and48hoursaftersurgery,theASTandCKvaluesintheMPVLRgroupwerelowerthanthoseinthecontrolgroup.Conclusion:MPVLRhasagoodefficacyforpostoperativerefluxinacuteSTEMIpatientsundergoingpPCI,andcanreducetheincidenceofnoreflow,itisrecommendedtobeappliedunderappropriateconditions.

Keywords:MPVLR,pPCIsurgery,acuteSTEMI,reflow,noreflow。AcuteST-segmentelevationmyocardialinfarction(STEMI)isalife-threateningconditionthatrequiresimmediatemedicalattention.Theprimarypercutaneouscoronaryintervention(pPCI)procedureisaneffectivetreatmentforSTEMI.However,duringtheprocedure,thereisariskofpostoperativereflowornoreflow,whichcanincreasethemortalityrateandtheriskoffurthercomplications.

Microvascularprotectionisatechniquethatcanpreventpostoperativereflowandreducetheriskofnoreflow.Themicrovascularprotectiondevice(MPV)hasbeenusedinclinicalpracticetoprotectsmallbloodvesselsduringpPCIsurgery.TheaimofthisstudywastoinvestigatetheefficacyofMPVcombinedwithlocalthrombolysisandrevascularization(MPVLR)forpostoperativereflowinacuteSTEMIpatientsundergoingpPCI.

Thestudyrecruited120patientsdiagnosedwithacuteSTEMIwhowereundergoingpPCIsurgery.ThepatientswererandomlyassignedtoeithertheMPVLRgrouporthecontrolgroup.TheMPVLRgroupreceivedMPVcombinedwithlocalthrombolysisandrevascularization,whilethecontrolgroupreceivedconventionalpPCIsurgerywithoutMPV.Theprimaryoutcomeofthestudywastheincidenceofpostoperativereflowandnoreflow,aswellasthelevelsofaspartateaminotransferase(AST)andcreatinekinase(CK)at12,24,and48hoursaftersurgery.

TheresultsshowedthattheincidenceofpostoperativereflowintheMPVLRgroupwassignificantlylowerthanthatinthecontrolgroup.Additionally,theMPVLRgrouphadalowerincidenceofnoreflowcomparedtothecontrolgroup.Furthermore,theASTandCKvaluesintheMPVLRgroupweresignificantlylowerthanthoseinthecontrolgroupat12,24,and48hoursaftersurgery.

Inconclusion,MPVLRisaneffectivetechniqueforpostoperativereflowinacuteSTEMIpatientsundergoingpPCI.Itcanreducetheincidenceofnoreflowandimprovetheclinicaloutcomesofpatients.However,appropriateconditionsneedtobeappliedbeforeusingthistechnique.Furtherstudiesarenecessarytoconfirmthesefindingsandtoidentifyoptimalpatientselectioncriteria。Additionally,itisimportanttonotethatMPVLRmaynotbesuitableforallSTEMIpatientsundergoingpPCI.Patientswithsignificantbleedingriskorcontraindicationstocontrastdyeshouldbeexcludedfromthistechnique.Furthermore,thedurationoftheproceduremaybeprolongedwiththeuseofMPVLR,whichcouldincreasetheriskofcomplicationssuchasbleedingorinfection.Therefore,carefulconsiderationoftherisksandbenefitsofthistechniqueshouldbetakenbeforeimplementingitinclinicalpractice.

Moreover,althoughthecurrentstudyshowspromisingresultsfortheuseofMPVLRinacuteSTEMIpatientsundergoingpPCI,itisimportanttoconductfurtherstudiestoconfirmthesefindingsandidentifyoptimalpatientselectioncriteria.Futurestudiescouldalsoinvestigatethelong-termoutcomesofMPVLR,suchastheincidenceofrecurrentmyocardialinfarctionormortalityrates.

Insummary,MPVLRisapromisingtechniqueforpostoperativereflowinacuteSTEMIpatientsundergoingpPCI.Ithasthepotentialtoimproveclinicaloutcomesbyreducingtheincidenceofnoreflow.However,appropriatepatientselectionandcarefulconsiderationoftherisksandbenefitsofthistechniquearecrucialinclinicalpractice.Furtherstudiesarenecessarytoconfirmthesefindingsandidentifyoptimalpatientselectioncriteria。InadditiontoMPVLR,thereareotherpotentialstrategiesforreducingreperfusioninjuryandimprovingreflowinSTEMIpatientsundergoingpPCI.Onesuchstrategyistheuseofintra-coronaryvasodilators,suchasnitroprussideoradenosine,whichcanimprovemyocardialperfusionandreducetheoccurrenceofnoreflow.However,theuseoftheseagentsisnotwithoutpotentialcomplications,suchashypotensionorarrhythmias,andtheirefficacyinimprovingclinicaloutcomesremainsunclear.

Anotherapproachistheuseofmechanicalthrombectomydevices,suchasaspirationcathetersorstentretrievers,toremovethrombusfromtheaffectedcoronaryarterypriortostentplacement.Whilethesedeviceshaveshownpromiseinimprovingreflowandreducinginfarctsize,theirusemaybeassociatedwithincreasedproceduraltimeandtheriskofdistalembolization.

Furthermore,adjunctivepharmacotherapymayalsoplayaroleinreducingreperfusioninjuryandimprovingclinicaloutcomes.StudieshaveshownthattheuseofglycoproteinIIb/IIIainhibitors,suchasabciximabortirofiban,mayreducetheincidenceofnoreflowandimprovemyocardialperfusion.Additionally,theuseofanti-inflammatoryagents,suchascolchicineorcanakinumab,mayreducetheinflammatoryresponseassociatedwithreperfusioninjuryandimproveclinicaloutcomes.

Overall,themanagementofSTEMIpatientsundergoingpPCIiscomplexandmultifactorial.WhileMPVLRshowspromiseinreducingtheincidenceofnoreflow,furtherstudiesarenecessarytoestablishitsroleinclinicalpracticeandidentifyoptimalpatientselectioncriteria.Additionally,otherstrategies,suchasintra-coronaryvasodilators,mechanicalthrombectomydevices,andadjunctivepharmacotherapy,mayalsoimprovereflowandreducereperfusioninjury.Ultimately,atailoredapproachtoeachpatient,takingintoaccountindividualdifferencesinanatomy,comorbidities,andproceduralfactors,isnecessarytooptimizeclinicaloutcomes。Futureresearchonreperfusiontherapyshouldalsofocusonimprovinglong-termoutcomesandreducingtheincidenceofadverseevents.Whileprimarypercutaneouscoronaryinterventioniseffectiveforrestoringbloodflowandimprovingshort-termoutcomes,thereisariskofrestenosisandreocclusion,whichcanleadtorecurrentmyocardialinfarctionorothercomplications.

Onepromisingavenueofresearchistheuseofbioresorbablevascularscaffolds(BVS)tosupportthedamagedarteryatthesiteofplaquerupture,whileallowingforrevascularizationandeventualresorptionofthescaffoldmaterial.BVShaveshownpromiseinpreliminarystudies,butlargerrandomizedcontrolledtrialsareneededtoestablishtheirsafetyandefficacyinclinicalpractice.

Anotherareaofactiveresearchistheuseofadjunctivepharmacotherapytoimprovereperfusionandreducetheriskofadverseevents.Severaldrugs,suchasglycoproteinIIb/IIIainhibitors,adenosine,andnicorandil,haveshownpotentialinimprovingreperfusionandreducingreperfusioninjury,butfurtherstudiesareneededtoclarifytheirroleinclinicalpracticeandidentifyoptimaldosingandtimingstrategies.

Inconclusion,reperfusiontherapyisacriticalcomponentofmodernmanagementofacutemyocardialinfarction,andprimarypercutaneouscoronaryinterventionisthepreferredmethodofreperfusioninmos