Dalal J, Chambers C E
Department of Medicine, Pennsylvania State University, Hershey Medical Center 17033, USA.
J Invasive Cardiol. 1994 Oct;6(8):263-6.
Prompt reperfusion of acutely ischemic myocardium appears to be the rational way of reversing ischemic injury and limiting the extent of eventual necrosis. Recent advances in emergency coronary bypass surgery, percutaneous transluminal coronary angioplasty (PTCA) and thrombolytic therapy have provided methods for effective treatment of acute myocardial infarction. However, several observations indicate this issue is more complex. Although blood flow must be restored to ischemic myocardium if it is to survive, animal experiments suggest potential deleterious effects associated with this reperfusion. These deleterious effects may be associated with unstable ST segments reported early after acute infarct thrombolysis. Though recurrent coronary occlusion cannot be excluded, reperfusion injury in this setting of coronary artery patency must be considered. This case illustrates this proposed reperfusion injury reflected as "tombstone" ST segment elevation in a patient following successful acute infarct PTCA.
急性缺血心肌的及时再灌注似乎是逆转缺血损伤并限制最终坏死范围的合理方法。急诊冠状动脉搭桥手术、经皮腔内冠状动脉成形术（PTCA）和溶栓治疗的最新进展为有效治疗急性心肌梗死提供了方法。然而，一些观察结果表明这个问题更为复杂。虽然缺血心肌若要存活就必须恢复血流，但动物实验表明再灌注存在潜在的有害影响。这些有害影响可能与急性梗死溶栓后早期报告的不稳定ST段有关。尽管不能排除冠状动脉再次闭塞，但在冠状动脉通畅的情况下必须考虑再灌注损伤。本病例说明了这种所谓的再灌注损伤，表现为一名患者在成功进行急性梗死PTCA后出现“墓碑样”ST段抬高。
