血管远端保护装置大坪医院心血管内科王旭开.ppt

CK-MB升高程度越明显，病人预后越差，死亡率越高目前认为CK-MB升高远期死亡率增加的原因可能为微梗死引起恶性心律失常远端栓塞导致微循环异常－血栓阻塞/猝死0102微血栓的来源?ThesystemisCEmarkedforcentralandperipheralvascularapplications外源性：介入过程中机械损伤①自发性：斑块破裂急性冠脉综合征患者大隐静脉旁路移植血管（SVG）介入颈动脉球囊成形和支架植入术肾动脉支架植入术其他介入，尤其是斑块旋磨和旋切时临床容易发生微栓塞的患者：ACS病理生理ThesystemisCEmarkedforcentralandperipheralvascularapplicationsResealedFissureOcclusiveThrombusActiveFissureMuralThrombusTopolEJ.CurrentandEmergingAnti-ThromboticTherapiesforAcuteCoronarySyndromes.JInvCardiol1998;10:2D-7D.易发生远端微血栓的操作ThesystemisCEmarkedforcentralandperipheralvascularapplicationsSpontaneousEventThrombolysisPTCAStenting越少越多心肌救治链ThesystemisCEmarkedforcentralandperipheralvascularapplications病人到达胸痛的识别药物治疗冠脉再通远端血栓微血管保护心肌代谢支持(“ReperfusionInjury”)PresentedbyW.O’NeilatInterventionalCardiologyFellow’sCourse,SanJose,2001TIMI有局限性、主观性ThesystemisCEmarkedforcentralandperipheralvascularapplications无少量慢充盈正常TIMI血流帧数技术法

CorrectedTIMIFrameCount定义:在梗死相关动脉造影剂首先到达冠状动脉远端所需要的电影帧数。CTFC?15to?27Mean=21.0framesTIMI血流帧数技术法(CTFC)ThesystemisCEmarkedforcentralandperipheralvascularapplications0102识别开始计分的第一帧画面:LAD:达到心脏远端分叉

LCX:最远分叉,包含病变血管的主要分叉

RCA:后侧降支的第一分叉主干血管的部分充盈血管边缘现象染色在不断深入运动中所采用的远端路标:ThesystemisCEmarkedforcentralandperipheralvascularapplicationsNormalFlowintheAbsenceofMI:21.0±3.1Frames05101521FirstFrameDefinitionLastFrameDefinitionFrame0:DyeTouchesOneorNoBordersFrame21:DyeFirstEntersLandmarkFrame1:DyeTouchesBothBordersMovesForwardRCA1stbranchoffposterolateralLCXLastbranchoffmostdistalOMLAD“Whale’stail”or“pitchfork”ormostdistalbranchLADatapexDistalLandmarkCorrectedTIMIFrameCount01这种方法也不能完全反映出心肌组织水平的实际灌注情况，而心肌组织的灌注主要取决于微血管水平－小冠脉和毛细血管02MYOCARDIUMBLUSH心肌染色ThesystemisCEmarkedforcentralandperipheralvascularapplications作为测定心肌