声学微泡联合重组人尿激酶原与单纯应用重组人尿激酶原对急诊经皮冠状动脉介入治疗前降支无复流患者近中远期心功能的影响分析  

A comparative analysis of cardiac function for nearmiddle and long term from STEMI of no reflow with LAD patients treated by contrast microbubbles combined PRO-UK or PRO-UK only

作　　者：司晓云 艾戎 李伟 韦波 石林艳 邓娜 张磊 SI Xiao-yun;AI Rong;LI Wei;WEI Bo;SHI Lin-yan;DENG Na;ZHANG Lei(Department of Cardiology,Affiliated Hospital,Guizhou Medical University,Guiyang 550004,China;Clinical College,Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学附属医院心血管内科,贵州省贵阳市550004 [2]贵州医科大学临床学院

出　　处：《中国心血管病研究》2020年第7期586-590,共5页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金(81960047);贵州省科技计划(黔科合平台人才[2018]5608、黔科合支撑[2019]2800、黔科合基础[2019]1260);贵州省普通高等学校科技拔尖人才支持计划(黔教合KY字[2016]070);贵阳市科技计划(GY2017-34);临床医学PBL教学实践改革项目(2017007)。

摘　　要：目的探讨声学微泡联合重组人尿激酶原与单纯应用重组人尿激酶原对急诊PCI前降支无复流患者近中远期心功能的影响.方法选取贵州医科大学附属医院2017年1月至2018年12月急诊入院行PCI治疗前降支无复流的患者.同意行声学微泡联合重组人尿激酶原治疗的患者45例作为治疗组,同意单纯应用重组人尿激酶原治疗的患者34例作为对照组.记录患者入院时的一般资料,术中治疗组应用声学微泡联合重组人尿激酶原,对照组仅应用重组人尿激酶原.分析两组患者PCI术后30 min的TIMI血流情况,记录两组患者住院期间的心功能指标及不良事件发生情况,记录术后6、12个月随访时的超声心动图指标及不良事件发生情况.结果两组患者的一般资料情况无明显差异.治疗组PCI术后30 min的TIMI血流明显优于对照组(2.11±0.49比1.00±0.34,P<0.01).术后1周内、6个月、12个月时治疗组的左心室射血分数(LVEF)[(42.71±4.67)%比(45.90±4.48)%;(44.62±4.60)%比(49.65±4.50)%;(52.20±5.49)%比(56.03±4.25)%]、左心室收缩末期内径(LVESD)[(39.80±3.47)mm比(33.75±2.87)mm;(39.54±4.66)mm比(32.89±5.10)mm;(38.85±3.97)mm比(29.8±5.23)mm]、左心室舒张末期内径(LVEDD)[(47.60±2.53)mm比(44.15±2.12)mm;(50.38±5.12)mm比(45.16±4.57)mm;(51.38±3.96)mm比(48.26±5.49)mm]均优于对照组(P均<0.05).治疗组术后1周、6个月、12个月时的总不良事件发生率明显低于对照组[10(29.4)比5(11.1);16(50.00)比9(21.95);22(75.86)比10(25.64),P均<0.05].术后6个月时治疗组的病死率低于对照组[3(9.4)比1(2.4),P<0.05];术后12个月时治疗组非致死性心肌梗死发生率低于对照组[6(20.69)比2(5.13),P<0.05].结论与单纯应用重组人尿激酶原相比,声学微泡联合重组人尿激酶原可以明显改善心肌梗死后前降支无复流患者的心功能,降低心肌梗死后近中远期的总体不良事件发生率.ObjectiveTo investigate the effects treated by ultrasound microbubbles combined with recombinant single chainurokinase type plasminogen activator(PRO-UK)or PRO-UK only on cardiac function in near-mid and long term in STEMl patients with LAD no-reflow.Methods Patients who were admitted to the Affiliated Hospital of Guizhou Medical University from January 2017.01 to 2018.12 for emergency PCl treatment with LAD no-reflow were enrolled.45 patients who were treated by ultrasound-microbubbles combined PRO-UK were used as the treatment group and 34 patients who were treated by PRO-UK only were used as the control group.The general information of the patients when they were admitted to the hospital was recorded.The scores of TIMl at 30 min after PCl was analyzed and cardiac function and adverse events were recorded during hospitalization.The results of Cardiac ultrasound and adverse events were recorded at 6 and 12 months of follow-up.Results There was no significant difference in general information between two groups.The TIMl blood flow in the treatment group at 30 min after PCl was significantly better than the control group(2.11±0.49 vs.1.0010.34,p<0.01).The LVEF,LVESD,LVEDD of the treatment group were better than those of the control group within 1 week,6 months and 12 months[(42.71±4.67)%vs.(45.90±4.48)%,(44.62±4.60)%vs.(49.65±4.50)%,(52.20±5.49)%vs.(56.03±4.25)%;(39.80±3.47)mm vs.(33.75±2.87)mm,(39.54+4.66)mm vs.(32.89=5.1O)mm,(38.85±3.97)mm vs.(29.8±5.23)mm;(47.60±2.53)mm vs.(44.15±2.12)mm,(50.38±5.12)mm vs.(45.16±4.57)mm,(51.38±3.96)mm vs.(48.26±5.49)mm all P<0.05].The incidences of total adverse events at 1 week,6 months and 12 months after treatment in the treatment group were significantly lower than that in the control group[10(29.4)vs.5(11.1);16(50.00)vs.9(21.95);22(75.86)vs.10(25.64),all p<0.05].The mortality rate of the treatment group was lower than that of the control group at 6 months after operation[3(9.4)vs.1(2.4),P<0.05];the incidence of non-fatal myocardial infarction in the treatm

关 键 词：声学微泡 重组人尿激酶原 ST段抬高型心肌梗死 不良事件 

分 类 号：R542.22[医药卫生—心血管疾病]