冠脉内注射尿激酶原对AMI患者急诊PCI术后心肌微循环的影响  

Influence of intracoronary pro-urokinase injection on myocardial microcirculation after emergency PCI in AMI patients

作　　者：王伟 WANG Wei(Department of Emergency,Guoyao Dongfeng General Hospital,Shiyan,Hubei,442700,China)

机构地区：[1]湖北省十堰市国药东风总医院急诊科,湖北十堰442700

出　　处：《心血管康复医学杂志》2020年第2期186-189,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨冠脉内注射重组人尿激酶原(rhPro-UK)对急性心肌梗死(AMI)患者急诊经皮冠脉介入治疗(PCI)术后心肌微循环的影响。方法:2016年7月~2017年12月我院的90例行PCI治疗的AMI患者被随机均分为PCI对照组(单纯急诊PCI)和联合治疗组(先冠脉内注射rhPro-UK,再行急诊PCI)。比较两组PCI术后即刻TIMI血流分级、校正的TIMI血流帧数(CTFC)、TIMI心肌灌注分级(TMPG),及PCI术前、24h后外周血肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平,并记录两组30d内主要不良心血管事件(MACE)及出血事件发生情况。结果:术后即刻,与PCI对照组比较,联合治疗组TIMI 3级比例(75.56%比91.11%)、TMPG 3级比例(71.11%比93.33%)均显著升高,CTFC[(30.62±4.94)帧比(24.84±5.29)帧]显著降低,P<0.05或<0.01。两组术后24h外周血CK-MB、cTnI水平均显著升高;与PCI对照组比较,联合治疗组术后24h CK-MB[(34.26±5.64)ng/ml比(29.68±4.49)ng/ml]、cTnI[(9.85±2.36)ng/ml比(8.25±2.13)ng/ml]水平显著降低,P均=0.001。联合治疗组30d内MACE发生率显著低于PCI对照组(15.56%比35.56%),P=0.030;两组30d内出血事件发生率无显著差异,P=0.535。结论:冠脉内注射尿激酶原能够显著改善AMI患者急诊PCI术后心肌微循环灌注,减轻心肌损伤,降低30d内MACE发生率,且不显著增加出血风险。Objective:To explore influence of intracoronary injection of recombinant human pro urokinase(rhPro-UK)on myocardial microcirculation after emergency percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods:A total of 90 AMI patients of our hospital from Jul 2016 to Dec 2017 undergoing PCI were randomly and equally divided into PCI control group(alone received emergency PCI)and combined treatment group(received intracoronary rhPro-UK injection first,then emergency PCI).TIMI blood flow grade,corrected TIMI frame count(CTFC)and TIMI myocardial perfusion grade(TMPG)instant after PCI,peripheral blood levels of creatine kinase isoenzyme MB(CK-MB)and cardiac troponin I(cTnI)before and 24h after PCI were compared between two groups,and incidence of major adverse cardiovascular events(MACE)and hemorrhage within 30d were recorded in two groups.Results:Instat after PCI,compared with PCI control group instant,there were significant rise in percentages of TIMI grade 3(75.56%vs.91.11%)and TMPG grade 3(71.11%vs.93.33%),and significant reduction in CTFC[(30.62±4.94)frames vs.(24.84±5.29)frames]in combined treatment group,P<0.05 or<0.01.Compared with PCI control group,there were significant reductions in levels of CK-MB[(34.26±5.64)ng/ml vs.(29.68±4.49)ng/ml]and cTnI[(9.85±2.36)ng/ml vs.(8.25±2.13)ng/ml]in combined treatment group on 24h after PCI,P=0.001 all.Incidence rate of MACE within 30d in combined treatment group was significantly lower than that of PCI control group(15.56%vs.35.56%),P=0.030;there was no significant difference in incidence rate of hemorrhage within 30d between two groups,P=0.535.Conclusion:Intracoronary injection of pro-urokinase can significantly improve myocardial microcirculation perfusion,relieve myocardial injury,reduce incidence rate of MACE within 30d without significantly increasing risk of hemorrhage in AMI patients after emergency PCI.

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 微循环 

分 类 号：R542.22[医药卫生—心血管疾病]