冠状动脉内小剂量尿激酶溶栓联合支架植入对急性ST段抬高型心肌梗死患者心肌灌注及短期预后的影响  

Effects of intracoronary low-dose urokinase injection combined with stent implantation in acute STEMI patients on myocardial perfusion and its influence on short-term prognosis

作　　者：赵蓓[1] 刘利峰[1] 刘瑛琪[1] 彭佑华[1] 刘莉[1] 赵京涛[1] 王守力[1] 

机构地区：[1]解放军306医院心内科,北京100101

出　　处：《解放军医学杂志》2015年第8期661-665,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨急诊经皮冠状动脉介入术（PCI）中冠状动脉内小剂量尿激酶溶栓联合支架植入对急性ST段抬高型心肌梗死（STEMI）患者心肌灌注及短期预后的影响。方法选择2011年10月-2013年6月在解放军306医院因急性STEMI接受急诊PCI手术治疗且符合入组标准的患者共183例,随机分为尿激酶组（n=91）和对照组（n=92）。尿激酶组除常规介入治疗外,在支架植入术前经抽吸导管单次或继之在PCI术中反复多次给予5-10万U尿激酶,对照组不给予尿激酶。主要观察指标包括两组患者在PCI术后即刻的TIMI血流分级、校正TIMI帧数,心电图ST段回落,以及PCI术后7、30d左室功能情况。记录30d随访的主要不良心血管事件（MACEs,包括死亡、心绞痛、靶血管再次血运重建、心衰、脑卒中）。结果尿激酶组患者在PCI术后即刻的TIMIⅢ级血流及校正TIMI帧数明显优于对照组（83 vs 71,P=0.034;21.2±10.7 vs 29.6±15.3,P=0.012）,术后90min ST段回落〉70%患者百分比明显高于对照组（93.4%vs 82.6%,P=0.025）。术后7d随访时心脏超声左室射血分数（LVEF）改善不明显（53.5%±9.4%vs 51.6%±8.7%,P=0.158）,30d时心脏超声显示,尿激酶组LVEF明显优于对照组（56.3%±9.8%vs 53.5%±8.1%,P=0.036）。30d时尿激酶组MACEs发生率明显低于对照组（4.4%vs 13.0%,P=0.038）。结论急诊PCI术中于支架植入前单次或反复多次冠脉内给予小剂量尿激酶可有效增加心肌再灌注及左室功能,改善急性心肌梗死患者的短期预后,且安全性较好。Objective To investigate the effects of primary percutaneous coronary intervention （PCI） combined with intracoronary low-dose urokinase therapy on myocardial perfusion and clinical outcome in acute STEMI patients. Methods From Oct. 2011 to Jun. 2013, 183 patients suffering from myocardial infarction with acute ST segment elevation, （STEMI） who had undergone emergent PCI in 306 Hospital of PLA conforming to inclusion criteria were enrolled in the present study. They were randomly assigned to urokinase group （n=91） and control group （n=92）. For urokinase group, besides routine interventional treatment, patients were given single or multiple intracoronary injection of 0.05-0.I million U urokinase immediately before primary PCI, while for control group, patients received routine interventional treatment only. The main indices determined and compared between the two groups included the immediate blood flow grading of thrombolysis in myocardial infarction （TIMI）, corrected TIMI frame count, falling degree of ST segment elevation in ECG after intervention, and left ventricular function on the 7th and 30th day after intervention, and also major adverse cardiac events （MACE） on the 30th day after intervention. Results The TIMI Ⅲ blood flow and corrected TIMI frame count were obviously better in urokinase group than in control group （83 vs 71, P=0.034; 21.2 ±10.7 vs 29.6± 15.3, P=0.012） immediately after PCI, ant the falling degree 〉70% of ST segment elevation at 90rain after intervention was significantly more marked in urokinase group than that in control group （93.4% vs 82.6%, P=0.025）. When compared with urokinase group to control group, although no significant difference was found in left ventricular ejection fraction （LVEF） on the 7th day of follow-up （53.5±9.4 vs 51.6 ± 8.7, P=0.158）, the cardiac ultrasound revealed a better outcome of LVEF （56.3 ± 9.8 vs 53.5± 8.1, P=0.036） and a lower MACEs （including death, angina, target vessel revascularization, heart fail

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 尿激酶型纤溶酶原激活物 血栓溶解疗法 

分 类 号：R542.22[医药卫生—心血管疾病]