作者：蒋红英，程功，冯盼盼，张骥，贾硕，李兆，王依阳，任园园

单位：

1.710021陕西省西安市，西安医学院 2.710068陕西省西安市，陕西省人民医院心血管内科 3.710068陕西省西安市，陕西省人民医院全科医学科 4.710068陕西省西安市，陕西省人民医院急诊科 通信作者：程功，E-mail：xianchenggong@163.com

单位（英文）：

1.Xi’an Medical University, Xi’an 710021, China 2.Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, China 3.Department of General Medicine, Shaanxi Provincial People’s Hospital, Xi’an 710068, China 4.Department of Emergency, Shaanxi Provincial People’s Hospital, Xi’an 710068, China Corresponding author: CHENG Gong, E-mail: xianchenggong@163.com

关键词：

ST段抬高型心肌梗死; 心肌再灌注; 经皮冠状动脉介入治疗; 微循环; 冠状动脉微循环障碍;

关键词（英文）：

ST-segment elevation myocardial infarction; Myocardial reperfusion; Percutaneous coronary intervention;Microcirculation; Coronary microvascular dysfunction

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.068

基金项目：

心馨-默克心血管科研基金；陕西省中医药管理局委托办事经费任务（2021-ZZ-ZY003）

摘要：

目前,经皮冠状动脉介入治疗(PCI)是ST段抬高型心肌梗死(STEMI)患者的首选再灌注策略,旨在恢复心外膜梗死相关动脉血流,尽早实现微血管再灌注,从而抑制心肌不可逆性损伤。然而,相当比例的患者由于冠状动脉微循环障碍(CMD),初次PCI后并不能实现有效的心肌再灌注。既往心脏保护相关研究主要致力于保护心肌细胞和减小梗死面积,只有少数研究将CMD作为治疗靶点。本文基于CMD的发生机制,总结了其防治策略,包括缺血性损伤(缺血预处理、缺血后处理)、再灌注损伤(腺苷、钙通道阻滞剂、尼可地尔、硝普钠、β-受体阻滞剂、他汀类药物及其他药物)、远端微血管栓塞的防治策略(血栓抽吸术、支架植入术/延迟支架植入术、新型抗血小板药物、溶栓药物及其他),以期能够帮助临床医生积极采取针对性的措施来改善冠状动脉微循环,减少CMD的发生,进而优化STEMI再灌注治疗策略。

英文摘要：

【Abstract】 At present, percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients withST-segment elevation myocardial infarction (STEMI) . It aims to restore the blood flow of epicardial infarction related arteriesand realize microvascular reperfusion as soon as possible, so as to inhibit irreversible myocardial injury. However, a considerableproportion of patients can not achieve effective myocardial reperfusion after primary PCI due to coronary microvasculardysfunction (CMD) . Previous studies on cardiac protection mainly focused on protecting cardiomyocytes and reducing infarct size,and only a few studies took CMD as a therapeutic target. Based on the mechanism of CMD, this paper summarizes its preventionand treatment strategies, including prevention and treatment strategies of ischemic injury (ischemic preconditioning, ischemicpostconditioning) , reperfusion injury (adenosine, calcium channel blocker, nicorandil, sodium nitroprusside, β-receptor blocker,statins and other drugs) , and distal microvascular embolism (thrombus aspiration, stent implantation/delayed stent implantation,new antiplatelet drugs, thrombolytic drugs and others) , in order to help clinicians actively take targeted measures to improvecoronary microcirculation, reduce the occurrence of CMD, and then optimize the treatment strategy of STEMI reperfusion.

参考文献：