冠脉介入术后心肌微循环障碍诊疗新进展
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摘要
目前临床用于治疗冠心病最重要手段是介入治疗(Percutaneous Coronary Intervention,PCI)。冠状动脉微循环的改变对介入治疗术后心肌微循环灌注的恢复有着不可替代的作用。因此,越来越多临床医生和科研人员开始重视冠脉微循环的障碍。但是目前针对介入治疗造成的心肌微循环障碍相关方面的研究相对较少。该文通过对PCI造成心肌微循环障碍的发生机制、临床常用的诊断和评估方式及西医治疗和传统中医治疗等方面进行综合性探讨,能够为相关研究提供一定参考。
Percutaneous coronary intervention(PCI)is the most important treatment of coronary disease in many hospitals these days. The change of coronary artery microcirculation has a non-substitutable effect on the recover of myocardial microcirculation perfusion. As a result,more and more clinicians and researchers pay a lot of attention to coronary artery microcirculation disturbance. But there are only a few researches about coronary artery microcirculation which is caused by PCI. This paper discusses the mechanism,diagnoses,assessment,Western medicine treatment and Chinese traditional medicine treatment of coronary artery microcirculation caused by PCI,and it can also provide some new references for correlational researches.
Percutaneous coronary intervention(PCI)is the most important treatment of coronary disease in many hospitals these days. The change of coronary artery microcirculation has a non-substitutable effect on the recover of myocardial microcirculation perfusion. As a result,more and more clinicians and researchers pay a lot of attention to coronary artery microcirculation disturbance. But there are only a few researches about coronary artery microcirculation which is caused by PCI. This paper discusses the mechanism,diagnoses,assessment,Western medicine treatment and Chinese traditional medicine treatment of coronary artery microcirculation caused by PCI,and it can also provide some new references for correlational researches.
引文
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[21]Mc Laughlin M G,Stone G W,Aymong E,et al.Prognostic utility of comparative methods for assessment of ST-segment resolution after primary angioplasty for acute myocardial infarction:the controlled abciximab and device investigation to lower late angioplasty complications(CADILLAC)trial[J].J Am Coll Cardiol,2004,44(6):1215-1223.
[22]陈德华,郑仕杰,周敬群,等.心脏核磁共振成像对缺血后处理急性ST段抬高型心肌梗死后心室重塑的影响[J].实用临床医药杂志,2014,18(7):54-57.
[23]Kaul,S.Assessment of myocardial collateral blood flow with contrast echocardiography[J].Korean Circ J,2015,45:351-356.
[24]Gurudevan S V,Nelson M D,Rader F,et al.Cocaine-induced vasoconstriction in the human coronary microcirculation:new evidence from myocardial contrast echocardiography[J].Circulation,2013,128(6):598-604.
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[26]史琪,杨媛媛,王梦,等.实时心肌超声造影定量评价心肌梗死后微循环灌注的实验研究[J].新疆医科大学学报,2016,39(2):223-225.
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[32]张晓晖.微循环阻力指数评估冠脉微循环障碍及其与冠心病危险因素聚集的相关性研究[D].南京:东南大学,2015.
[33]Layland J,Nerlekar N,Palmer S,et al.Invasive assessment of the coronary microcirculation in the catheter laboratory[J].Int J Cardiol,2015,199:141-149.
[34]Ng M K,Yong A S,Ho M,et al.The index of microcirculatory resistance predicts myocardial infarction related to percutaneous coronary intervention[J].Circ Cardiovasc Interv,2012,5:515-522.
[35]Samim A,Nugent L,Mehta PK,et al.Treatment of angina and coronary microvascular dysfunction[J].Curr Treat Options Cardiovasc Med,2010,12(4):355364.
[36]张同强.前列腺素E1脂微球载体制剂治疗非ST段抬高心肌梗死的效果[J].中国现代药物应用,2016,10(22):93-94.
[37]李慧,刘华,齐跃.前列地尔对冠心病患者介入治疗效果的影响[J].中国循证心血管医学杂志,2011,3(1):52,59.
[38]李青山,苏广龙.前列地尔对急性脑梗死患者血小板活性的影响[J].中国血液流变学杂志,2014,24(2):229.-230.
[39]刘勉,龚艺,韦锦燕,等.前列腺素E2对大鼠巨噬细胞株NR8383合成血管内皮生长因子促进人脐静脉血管内皮细胞成管、迁移的影响[J].南方医科大学学报,2016,36(7):936-940.
[40]Dong M F,Ma Z S,Ma S J,et al.Effect of prostaglandin E1 on pulmomary arterial hypertension following corrective surgery for congenital heart disease[J].J Cardiovasc Pharmacol Ther,2012,17(3):303-307.
[41]WANG K,ZUO G,ZHENG L,et al.Effects of tirofiban on platelet activation and endothelial function in patients with STelevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Cell Biochem Biophys,2015,71:135-142.
[42]卢健棋,何贵新,潘朝锌.安心颗粒联合替罗非班对急性心肌梗死介入术后心肌微循环的影响[J].广州中医药大学学报,2013,30(6):792-795.
[43]Ghiadoni L,Taddei S.Hypertension and endothelial dysfunction:therapeutic approach[J].Curr Vasc Pharmacol,2012,10:42-60.
[44]赵昌盛,钟群杰,林剑浩.中国膝关节骨关节炎流行病学调查现状[J].广东医学,2016,37(13):2050-2052.
[45]敖秀兰,张婷,程维,等.老年膝关节骨关节炎患者生活质量及影响因素[J].中国老年学杂志,2017,37(6):1522-1524.
[46]Eshtehardi P,Mc Daniel M C,Dhawan S S,et al.Effect of intensive atorvastatin therapy on coronary atherosclerosis progression,composition,arterial remodeling,and microvascular function[J].J Invasive Cardiol,2012,24(10):522.
[47]张冰睿.微血管性心绞痛中医研究进展[J].山东中医药大学学报,2017,41(4):389-392.
[48]李智曼.加味生脉饮治疗冠心病心绞痛的临床疗效分析[J].基层医学论坛,2017,21(5):606-607.
[49]彭燚焱,李福平,钟泉,等.益气活血方对冠心病介入术患者炎性因子及生活质量的影响[J].医学理论与实践,2017,30(18):2695-2696.
[50]张建国,朱正炎,马军力,等.血脂康对介入术后冠心病合并高血脂患者预后的影响[J].世界中医药,2017,12(7):1594-1596,1600.
[51]何贵新,谭炜,卢健祺,等.安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究[J].广西医科大学学报,2014,31(6):938-941.
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[2]Teunissen P F,de Waard G A,Hollander M R,et al.Dopplerderived intracoronary physiology indices predict the occurrence of microvascular injury and microvascular perfusion deficits after angiographically successful primary percutaneous coronary intervention[J].Circ Cardiovasc Interv,2015,8:e001786.
[3]Skinner H.A practical approach to cardiac anaesthesia[J].J Antibiot,2013,46(5):1897-1900.
[4]Ito H.No reflow phenomenon in acute myocardial infarction[J].Nihon Rinsho,2011,69(Suppl 7):142-146.
[5]陈慧斐.经皮冠状动脉介入术对冠状动脉微循环的影响[J].临床心电学杂志,2016,25(4):256-258.
[6]陈慧斐.经皮冠状动脉介入治疗对冠状动脉微循环的影响[J].中国循证心血管医学杂志,2016,8(11):1364-1365.
[7]Kardys I,Oemrawsingh R M,Kay I P,et al.Lipoprotein(a),interleukin-10,C-reactive protein,and 8-year outcome after percutaneous coronary intervention[J].Clin Cardiol,2012,35:482-489.
[8]杨宇,梁梅冰,黄石安,等.经皮腔内冠状动脉介入术对冠状动脉微循环阻力指数及高敏C反应蛋白的影响[J].中国现代医学杂志,2014(23):59-62.
[9]郭李平,常建梅,马燕,等.探讨经皮腔内冠状动脉介入术对冠状动脉微循环阻力指数及高敏C-反应蛋白的影响[J].中西医结合心血管病电子杂志,2015,3(11):144-145.
[10]陈桂英,周立君,李为民,等.冠状动脉无复流现象研究进展[J].中国循环杂志,2007,22(1):11-14.
[11]Lim H E,Choi C U,Na J O,et al.Effects of iatrogenic myocardial injury on coronary microvascular function in patients undergoing radiofrequency catheter ablation of atrial fibrillation[J].Circ Arrhythm Electrophysiol,2013,6(2):318-326.
[12]李小华,周志宏,邢波,等.冠心病经皮PCI治疗患者糖化血清清蛋白水平与冠状动脉病变的相关性研究[J].海南医学,2015(14):2059-2062.
[13]陈青,米树华,周芸,等.冠心病经皮冠状动脉介入治疗患者糖化血清清蛋白水平与冠状动脉病变关系的研究[J].中国全科医学,2014(4):418-421.
[14]Rodino Janeiro B K,Gonzalez Peteiro M,Ucieda Somoza R,et al.Glycated albumin,a precursor of advanced glycation endproducts,up-regulates NADPH oxidase and enhances oxidative stress in human endothelial cells:Molecular correlate of diabetic vasculopathy[J].Diabetes Metab Res Rev,2010,26(7):550-558.
[15]JIN C,LU L,ZHANG R Y,et al.Association of serum glycated albumin,C-reactive protein and ICAM-1 levels with diffuse coronary artery disease in patients with type 2 diabetes mellitus[J].Clin Chim Acta,2009,408(1-2):45-49.
[16]Crea F,Lanza G A,Camici P G.Coronary Microvascular Dysfunction[M].Milan:Springer,2014:181-192.
[17]Herrmann J,Kaski J C.Coronary microvascular dysfunction in the clinical setting:from mystery to reality[J].Eur Heart J,2012,33:2771-2782b.
[18]Galiuto L,Garramone B,Scara A,et al.The extent of microvascular damage during myocardial contrast echocardiography is superior to other known indexes of postinfarct reperfusion in predicting left ventricular remodeling:results of the multicenter AMICI study[J].Jam Coll Cardiol,2008,51:552-559.
[19]DING S,LI Z,GE H,et al.Impact of early ST-segment changes on cardiac magnetic resonance-verified intramyocardial haemorrhage and microvascular obstruction in ST-elevation myocardial infarction patients[J].Medicine(Baltimore),2015,94(35):E1438.
[20]Cuculi F,Herring N,De Caterina A R,et al.Relationship of plasma neuropeptide Y with angiographic,electrocardiographic and coronary physiology indices of reperfusion during ST elevation myocardial infarction[J].Heart,2013,99:1198-1203.
[21]Mc Laughlin M G,Stone G W,Aymong E,et al.Prognostic utility of comparative methods for assessment of ST-segment resolution after primary angioplasty for acute myocardial infarction:the controlled abciximab and device investigation to lower late angioplasty complications(CADILLAC)trial[J].J Am Coll Cardiol,2004,44(6):1215-1223.
[22]陈德华,郑仕杰,周敬群,等.心脏核磁共振成像对缺血后处理急性ST段抬高型心肌梗死后心室重塑的影响[J].实用临床医药杂志,2014,18(7):54-57.
[23]Kaul,S.Assessment of myocardial collateral blood flow with contrast echocardiography[J].Korean Circ J,2015,45:351-356.
[24]Gurudevan S V,Nelson M D,Rader F,et al.Cocaine-induced vasoconstriction in the human coronary microcirculation:new evidence from myocardial contrast echocardiography[J].Circulation,2013,128(6):598-604.
[25]Agati L,Tonti G,Galiuto L,et al.Quantification methods in contrast echocardiography[J].Eur J Echocardiogr,2005,6(suppl2):S14-20.
[26]史琪,杨媛媛,王梦,等.实时心肌超声造影定量评价心肌梗死后微循环灌注的实验研究[J].新疆医科大学学报,2016,39(2):223-225.
[27]Spaan J A,Piek J J,Hoffman JI,et al.Physiological basis of clinically used coronary hemodynamic indices[J].Circulation,2006,113(3):446-455.
[28]Natsumeda M,Nakazawa G,Murakami T,et al.Coronary angiographic characteristics that influence fractional flow reserve[J].Circ J,2015,79:802-807.
[29]Fiarresgaa,Selas M,Oliveira E,et al.Invasive assessment of the coronary microcirculation using the index of microcirculatory resistance:description and validation of an animal model[J].Rev Port Cardiol,2014,33(4):207-212.
[30]Martínez G J,Yong A S,Fearon W F.The index of microcirculatory resistance in the physiologic assessment of the coronary microcirculation[J].Coron Artery Dis,2015,26(Suppl1):e15-26.
[31]Yong AS,Layland J,Fearon WF,et al.Calculation of the index of microcirculatory resistance without coronary wedge pressure measurement in the presence of epicardial stenosis[J].JACC Cardiovasc Interv,2013,6:53-58.
[32]张晓晖.微循环阻力指数评估冠脉微循环障碍及其与冠心病危险因素聚集的相关性研究[D].南京:东南大学,2015.
[33]Layland J,Nerlekar N,Palmer S,et al.Invasive assessment of the coronary microcirculation in the catheter laboratory[J].Int J Cardiol,2015,199:141-149.
[34]Ng M K,Yong A S,Ho M,et al.The index of microcirculatory resistance predicts myocardial infarction related to percutaneous coronary intervention[J].Circ Cardiovasc Interv,2012,5:515-522.
[35]Samim A,Nugent L,Mehta PK,et al.Treatment of angina and coronary microvascular dysfunction[J].Curr Treat Options Cardiovasc Med,2010,12(4):355364.
[36]张同强.前列腺素E1脂微球载体制剂治疗非ST段抬高心肌梗死的效果[J].中国现代药物应用,2016,10(22):93-94.
[37]李慧,刘华,齐跃.前列地尔对冠心病患者介入治疗效果的影响[J].中国循证心血管医学杂志,2011,3(1):52,59.
[38]李青山,苏广龙.前列地尔对急性脑梗死患者血小板活性的影响[J].中国血液流变学杂志,2014,24(2):229.-230.
[39]刘勉,龚艺,韦锦燕,等.前列腺素E2对大鼠巨噬细胞株NR8383合成血管内皮生长因子促进人脐静脉血管内皮细胞成管、迁移的影响[J].南方医科大学学报,2016,36(7):936-940.
[40]Dong M F,Ma Z S,Ma S J,et al.Effect of prostaglandin E1 on pulmomary arterial hypertension following corrective surgery for congenital heart disease[J].J Cardiovasc Pharmacol Ther,2012,17(3):303-307.
[41]WANG K,ZUO G,ZHENG L,et al.Effects of tirofiban on platelet activation and endothelial function in patients with STelevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Cell Biochem Biophys,2015,71:135-142.
[42]卢健棋,何贵新,潘朝锌.安心颗粒联合替罗非班对急性心肌梗死介入术后心肌微循环的影响[J].广州中医药大学学报,2013,30(6):792-795.
[43]Ghiadoni L,Taddei S.Hypertension and endothelial dysfunction:therapeutic approach[J].Curr Vasc Pharmacol,2012,10:42-60.
[44]赵昌盛,钟群杰,林剑浩.中国膝关节骨关节炎流行病学调查现状[J].广东医学,2016,37(13):2050-2052.
[45]敖秀兰,张婷,程维,等.老年膝关节骨关节炎患者生活质量及影响因素[J].中国老年学杂志,2017,37(6):1522-1524.
[46]Eshtehardi P,Mc Daniel M C,Dhawan S S,et al.Effect of intensive atorvastatin therapy on coronary atherosclerosis progression,composition,arterial remodeling,and microvascular function[J].J Invasive Cardiol,2012,24(10):522.
[47]张冰睿.微血管性心绞痛中医研究进展[J].山东中医药大学学报,2017,41(4):389-392.
[48]李智曼.加味生脉饮治疗冠心病心绞痛的临床疗效分析[J].基层医学论坛,2017,21(5):606-607.
[49]彭燚焱,李福平,钟泉,等.益气活血方对冠心病介入术患者炎性因子及生活质量的影响[J].医学理论与实践,2017,30(18):2695-2696.
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