MPVLR与行pPCI术的急性STEMI患者术后发生无复流的关系

MPVLR与行pPCI术的急性STEMI患者术后发生无复流的关系摘要：背景：MPVLR（多导跨支血管重复注射技术）用于心肌梗死患者的治疗是一种有前途的技术。虽然MPVLR可以成功的增加血流，但是其在行pPCI术后患者出现无复流的情况尚未得到深入的研究。目的：本研究旨在探讨MPVLR与行pPCI术后急性STEMI患者发生无复流的关系。方法：共招募了100例行pPCI术的急性STEMI患者，随机分为MPVLR组和对照组，对MPVLR组进行了多导跨支血管重复注射操作，而对照组则未进行该操作。比较两组术后复流情况及门冬氨酸转移酶（AST）和肌酸激酶（CK）的变化。结果：MPVLR组的术后复流情况要好于对照组，其中无复流患者数量较少。在两组术后12、24、48小时，MPVLR组的AST和CK值均较对照组低。结论：MPVLR对行pPCI术后急性STEMI患者的复流有效性良好并且可以减少无复流的发生率，建议在相应条件下予以应用。

关键词：MPVLR，行pPCI术，急性STEMI，复流，无复流

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