尿激酶原联合尼可地尔对STEMI患者急诊PPCI术后心肌灌注和功能的影响  

Effects of prourokinase combined with nicorandil on myocardial perfusion and function in STEMI patients after emergency PPCI

作　　者：徐雷[1] 安少波[1] 杜晓静 都伟[1] 胡喜田 吴志红[1] XU Lei;AN Shaobo;DU Xiaojing(Department of Cardiology, First Hospital of Shijiazhuang City ,Shijiazhuang 050011, CHINA)

机构地区：[1]石家庄市第一医院心内科

出　　处：《江苏医药》2019年第8期780-783,共4页Jiangsu Medical Journal

基　　金：石家庄市科学研究与发展计划自筹课题(161462433)

摘　　要：目的研究尿激酶原联合尼可地尔对ST段抬高型心肌梗死(STEMI)患者急诊直接经皮冠状动脉介入(PPCI)术后心肌灌注和功能的影响。方法 121例STEMI患者随机分为观察组(59例)和对照组(62例)。对照组参照急性STEMI治疗指南进行标准治疗,观察组在对照组治疗的基础上在急诊PPCI术前给予冠状动脉注射尿激酶原与尼可地尔治疗。比较两组治疗后心电图ST段回落率、心肌梗死溶栓(TIMI)血流分级、校正的TIMI血流帧数计数(cTFC)以及血尿酸、前白蛋白(PA)、可溶性CD40配体(sCD40L)、MMP-9水平。随访12个月,比较两组患者生活质量的变化与复发率。结果治疗后,观察组ST段回落率、TIMI血流3级和心肌组织灌注分级3级率均高于对照组,cTFC低于对照组(P<0.05)。治疗后1 d及3 d,两组血尿酸水平均较治疗前降低,且观察组低于对照组(P<0.05),两组血清PA水平均较治疗前降低,且观察组高于对照组(P<0.05),两组sCD40L、MMP-9水平均较治疗前升高,且观察组低于对照组(P<0.05)。治疗后12个月,对照组日常生活及社会行动能力较治疗前改善(P<0.05),观察组日常生活及社会行动能力、抑郁及焦虑状态较治疗前改善(P<0.05),观察组复发率低于对照组(6.78%vs.24.19%)(P<0.05)。结论在常规治疗的基础上,冠状动脉注射尿激酶原与尼可地尔治疗STEMI患者可改善急诊PPCI术后ST段回落率、TIMI血流分级、cTFC以及血尿酸、PA、sCD40L、MMP-9水平,提高患者生活质量,降低复发率。Objective To study the effects of prourokinase combined with nicorandil on myocardial perfusion and function in the patients with ST-elevation myocardial infarction(STEMI) after emergency primary percutaneous coronary intervention(PPCI).Methods A total of 121 STEMI patients was randomly divided into two groups of A(59 cases) and C(62 cases).Group C received standard treatment according to the guidelines for acute STEMI treatment and group A was given additional coronary injection of prourokinase and nicorandil before emergency PPCI.The postoperative ST-segment recovery rate,blood flow grade of myocardial infarction thrombolysis(TIMI),corrected TIMI frame count(cTFC) and serum levels of uric acid,prealbumin(PA),soluble CD40 ligand(sCD40 L) and MMP-9 were compared between two groups after treatment.After 12 months of follow-up,the quality of life and recurrence rate were compared between two groups.Results After treatment,the ST-segment recovery rate,TIMI blood flow grade 3 and TMPG grade 3 in group A were higher than those in group C and the cTFC was lower than that in group C(P<0.05).On the 1st and 3rd day after treatment,serum level of uric acid in the two groups was lower than that before treatment,which in group A was lower than that in group C(P<0.05).Serum level of PA in two groups was lower after treatment than that before,which in group A was higher than that in group C(P<0.05).Serum levels of sCD40 L and MMP-9 after treatment in two groups were higher than those before,which in group A were lower than those in group C(P<0.05).Compared with before,the daily life and social action ability in group C and the daily life and social action ability,depression and anxiety in group A were improved after 12 months of treatment(P<0.05).The recurrence rate in group A was lower than that in group C(6.78% vs.24.19%)(P<0.05).Conclusion On the basis of conventional treatment,coronary artery injection of prourokinase and nicorandil in the treatment of STEMI patients can improve ST-segment recovery rate,TIMI blood flow gra

关 键 词：尿激酶原 尼可地尔 ST段抬高型心肌梗死 经皮冠状动脉介入 心肌灌注 

分 类 号：R542[医药卫生—心血管疾病]