中文摘要：

急性ST段抬高型心肌梗死患者接受直接经皮冠状动脉介入术后,尽管40%--50%的患者梗死相关血管开通,但心肌组织仍然灌注不足,即无复流现象。无复流现象的发病机制复杂,包括远端血栓栓塞、缺血性损伤、再灌注性损伤和微循环个体易损性等。无复流可加重左心室重构、降低左心室功能及短期或长期生存率,早期诊断和治疗可明显改善临床疗效及预后。冠状动脉血管造影、心肌呈色分级、心电图、心肌声学造影、心脏磁共振成像技术等均可检测无复流的发生。此外,在冠状动脉梗死初期或再灌注早期给予患者相应治疗,如远端保护装置、舒血管、抗血小板和溶栓药物等均可减少或改善无复流的发生。该文的目的是全面总结无复流现象发生的机制、评估方法、预防和治疗策略。

英文摘要：

For acute ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention,up to 40%-50% of patients do not have complete myocardial reperfusion despite successful patency of the infarct-related artery,which is called no-reflow phenomenon. The main pathophysiological mechanisms of no-reflow is complex,including distal atherothrombotic embolization,ischemic injury,reperfusion injury and susceptibility of coronary microcirculation to injury. No-reflow is a poor prediction for left ventricular remodeling and function,and short-term and long-term survival. Therefore,early diagnosis and therapy may obviously improve the clinical efficacy and prognosis. Angiography,myocardial blush grade,electrocardiography,myocardial contrast echocardiography,cardiac magnetic resonance imaging can assess the occurrence of no-reflow. In addition,the early therapies of no-reflow include distal protection device,vasodilator drugs,anti-platelet agents,and thrombolytic agents. Here is to make a review of the mechanisms of no-reflow phenomenon,assessment methods,prevention and treatment strategies.