急性ST段抬高性心肌梗死患者冠状动脉内尿激酶原不同给药方式的疗效观察  

Efficacy of different intracoronary administration methods of prourokinase in patients with acute ST-segment elevation myocardial infarction

作　　者：曹亚丽 姜志安[1] 陈涛[1] 张晓光[1] 赵淑健[1] 殷洪山[1] 王涛[1] Cao Ya -li;Jiang Zhi -an;Chen Tao;Zhang Xiao -guang;Zhao Shu -jian;Yin Hong -shan;Wang Tao(Department of Cardiology,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院,河北石家庄050051

出　　处：《中国急救医学》2018年第12期1081-1085,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的比较急性ST段抬高性心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者在急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中冠状动脉内分次注射与一次性注射重组人尿激酶原两种给药方式对术后心肌灌注及近期预后的影响。方法选择2016-08~2017-10本院连续入选的102例接受急诊PCI的STEMI患者并随机分为两组:A组49例于导丝通过冠状动脉病变后、球囊扩张后、支架置入后分别于冠状动脉内注射重组人尿激酶原4、3、3mL(共20mg),B组53例于导丝通过冠状动脉病变后一次性向冠状动脉内注射重组人尿激酶原10mL(共20mg)。联合术后心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级、TIMI心肌灌注分级(TIMI myocardial perfusion grade,TMPG)、术后90min ST段回落率(ST-segment resolution,STR)及术后第1天和第7天左室射血分数(1eftventricular ejection fraction,LVEF)评估心肌灌注水平,比较术后第7天出血事件及术后3个月主要不良心脏事件(major adverse cardiac events,MACE)的发生。结果两组患者术前TIMI血流分级、TMPG及术后第1天LVEF比较差异无统计学意义(P>0.05)。梗死相关动脉(infarct-relatedartery,IRA)PCI术后,与B组比较,A组TIMI血流分级(P=0.038)、TMPG(P=0.015)改善明显,术后90min ST段回落明显(P=0.032),术后第7天LVEF也有所改善(P=0.001)。两组术后第7天出血事件及术后3个月MACE发生率比较差异无统计学意义(P>0.05)。结论对于行急诊PCI的急性STEMI患者,PCI术中分次给予重组人尿激酶原较一次性给予重组人尿激酶原能更好地改善心肌灌注,且不增加出血及MACE的发生率,最终改善预后。Objective To compare the effects of two prourokinase administration methods on myocardial perfusion and short -term prognosis after pereutaneous coronary intervention (PCI)in patients with acute ST-segment elevation myocardial infarction (STEMI),and the two modes of administration refer to one-time intracoronary prourokinase injection and fractional intracoronary prourokinase injection in PCI.Methods A total of 102STEMI patients undergoing emergency PCI were enrolled and randomly divided into two groups:forty -nine patients in group A received three dose of intracoronary recombinant human prourokinase injection after guide-wire crossing (4mL),balloon dilation (3mL)and stenting (3mL),a total of 20mg,other fifty-three patients in group B received one dose (10mL)of intracoronary recombinant human prourokinase injection only after guide-wirecrossing,also 20mg.Thrombolysis in myocardial infarction (TIMI)flow classification,TIMI myocardial perfusion grading (TMPG),ST -segment resolution (STR)at 90minutes after operation and left ventricular ejection fraction (LVEF)one day and 7days after operation were all used to evaluate myocardial perfusion.Bleeding events within 7days and major adverse cardiac events (MACE)within 3 months after operation were also compared.Results There were no significant differences in TIMI flow classification and TMPG before PCI and the LVEF on the first day after PCI between the two groups (P > 0.05).After PCI in infarct -related artery (IRA),the TIMI flow classification (P =0.038)and TMPG (P =0.015)improved more significantly in group A compared with group B,and the STR in 90 minutes after operation in group A was obviously better than that in group B (P =0.032).7days after operation,the LVEF in group A was also slightly higher than that in group B (P =0.001).There was no statistical differences in the incidence of hemorrhage 7 days after operation and the incidence of MACE within 3months after operation between the two groups (P >0.05).Conclusion For patients with acute STEMI who underwent PC

关 键 词：尿激酶原 急性ST段抬高性心肌梗死(STEMI) 经皮冠状动脉介入(PCI)治疗 无复流 微循环 

分 类 号：R542.22[医药卫生—心血管疾病]