血栓抽吸及冠脉内注射尿激酶原对急性ST段抬高型心肌梗死介入患者术中血流及内皮功能的对比研究  

A Comparative Study of Intracoronary Injection of Prourokinase and Aspiration Technique on Coronary Blood Flow,Endothelial Function in the Treatment of Acute ST-Segment Elevation Myocardial Infarction

作　　者：王国锋[1] 李建微[1] 高堃 王琦[1] WANG Guo-feng;LI Jian-wei;GAO Kun;WANG Qi(Department of Cardiology,the Fourth Affiliated Hospital of China Medical University,Shenyang,Liaoning,110032,China)

机构地区：[1]中国医科大学附属第四医院心内科,辽宁沈阳110032

出　　处：《中国血液流变学杂志》2019年第4期412-415,共4页Chinese Journal of Hemorheology

摘　　要：目的探讨经皮冠状动脉介入治疗(PCI)中冠脉内注射尿激酶原及抽吸技术对急性ST段抬高型心肌梗死(STEMI)患者冠脉血流及内皮功能的影响.方法90例行急诊PCI治疗的STEMI患者作为研究对象,按照治疗方法的不同分为尿激酶原组(n=48)和抽吸组(n=42).尿激酶原组采用冠脉内注射尿激酶原+尼可地尔治疗,抽吸组采用血栓抽吸+冠脉内注射替罗非班治疗.比较两组患者的术后冠脉血流、血清可溶性细胞间黏附分子-1(sICAM-1)、可溶性血管细胞黏附分子-1(sVCAM-1)、血管假性血友病因子(vWF).结果尿激酶原组术后TIMI 3级血流率与抽吸组类似(81.58%vs 78.83%,P=0.931).与术前比较,两组术后血清sICAM-1、sVCAM-1、vWF水平显著升高(均P<0.001);与抽吸组比较,尿激酶原组术后血清sICAM-1[(22.3±3.1)μg/L vs(29.3±4.5)μg/L]、sVCAM-1[(23.0±3.2)μg/L vs(33.0±5.0)μg/L]、vWF[(446.0±80.4)U/L vs(640.5±90.2)U/L]水平显著降低(均P<0.001).结论冠脉内注射尿激酶原与抽吸技术都能高效、安全地帮助患者减轻血栓负荷,恢复心肌供血,对介入术中的冠脉血流影响没有明显差异,但冠脉内注射尿激酶原对于内皮功能更有优势.Objective To explore influence of intracoronary injection of prourokinase and aspiration technique during percutaneous coronary intervention(PCI)on coronary blood flow,endothelial function in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 90 STEMI patients undergoing PCI in the Fourth Afiliated Hospital of China Medical University were selected.According to random number table,48 patients were divided into prourokinase group and 42 patients were divided into aspiration group.Prourokinase group was treated by intracoronary injection of urokinase plus nicorandil,while aspiration group by intracoronary injection of tirofiban.Coronary blood flow,serum levels of soluble intercellular adhesion molecule-1(sICAM-1),soluble vascular cell adhesion molecule-1(sVCAM-1),von Willebrand factor(vWF),were compared between two groups.Results After PCI,TIMI grade 3 rate in two groups was similar(81.58%vs 78.83%,P=0.931).Compared with before PCI,after PCI,there were significant rise in serum levels of sICAM-1,sVCAM-1,vWF in two groups(all P<0.001);compared with aspiration group after PCI,there were significant reductions in serum levels of sICAM-1[(22.3+3.1)μg/L vs(29.3+4.5)μg/L],sVCAM-1[(23.0+3.2)μg/L vs(33.0土5.0)μg/L],vWF[(446.0土80.4)U/L vs(640.5土90.2)U/L]in prourokinase group(all P<0.001).Conclusion Intracoronary injection of prourokinase and aspiration technology can efficiently and safely help patients reduce thrombus load and restore myocardial blood supply.There is no significant difference in coronary blood flow during intervention,but for endothelial function,intracoronary injection of prourokinase is more advantageous.

关 键 词：高负荷血栓 急性ST段抬高型心肌梗死 注射用重组尿激酶原 尼克地尔 抽吸导管 替罗非班 无复流 慢血流 

分 类 号：R542.22[医药卫生—心血管疾病]