冠状动脉内联合应用硝普钠及重组人尿激酶原对急诊PCI术中无复流患者心功能及预后的影响  

Research on the Effect of Intracoronary Injection of Sodium Nitroprusside plus Recombinant Human Pro-urokinase on the Cardiac Function and Prognosis in Patients Without Reflow During Emergency PCI

作　　者：王永 高江彦[1] 胡建军[1] 王永军[1] 胡晴[1] 吕培 WANG Yong;GAO Jiangyan;LV Pei(Hebei Provincial Chest Hospital,Hebei Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院心内科,河北石家庄050041

出　　处：《河北医学》2020年第7期1165-1169,共5页Hebei Medicine

基　　金：河北省2019年度医学科学研究重点课题计划,(编号:20191040)。

摘　　要：目的:探讨冠状动脉内联合应用硝普钠+重组人尿激酶原治疗急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)术中无复流的疗效及其对患者术后心功能及预后的影响.方法:选择2017年3月至2019年3月我院心内科收治的STEMI急诊PCI术中出现无复流现象的病人60例,随机数字表法将其分成观察组和对照组,各30例.其中观察组采取冠状动脉内联合应用硝普钠+重组人尿激酶原治疗,对照组则于冠状动脉内单用硝普钠治疗.比较两组治疗前后心肌梗死溶栓(TIMI)血流分级情况,术中及术后24h内出血并发症率,术后第7天和第1个月末心功能参数[左室舒张末内径(LVEDD)、左室射血分数(LVEF)]以及术后1个月内主要心脏不良事件(MACE)的发生情况.结果:治疗后,观察组TIMI血流分级为3级者28例(93.33%),而对照组为20例(66.67%);观察组的TIMI血流分级显著优于对照组(P<0.05).与术后第7天相比,两组术后第1个月末LVEDD均显著降低(P<0.05),LVEF则均显著升高(P<0.05);且在术后第1个月末,观察组LVEDD显著低于对照组同期(P<0.05),而LVEF显著更高(P<0.05).观察组术中及术后24h内的出血率[16.67%(5/30)]较对照组[10.00%(3/30)]差异无统计学意义(P>0.05).术后1个月内,观察组MACE发生率[6.67%(2/30)]低于对照组[20.00%(6/30)],但差异无统计学意义(P>0.05).结论:冠状动脉内联合应用硝普钠+重组人尿激酶原治疗STEMI急诊PCI术中无复流可有效恢复病人冠状动脉血流量及心肌再灌注,提高患者术后心功能,改善预后,且安全可靠.Objective:To explore the clinical efficacy of intracoronary injection of sodium nitroprusside plus recombinant human pro-urokinase in the treatment of acute ST elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI)without reflow and its effect on the cardiac function and prognosis in patients.Methods:The subjects,60 STEMI patients who did not see reflow during emergency PCI in our hospital from March 2017 to March 2019,were divided into observation group(n=30)and control group(n=30)on the basis of random number table.The observation group was treated with intracoronary injection of sodium nitroprusside plus recombinant,and the control group,sodium nitroprusside in the coronary arteries.The two groups were compared in blood flow classification of thrombolysis in myocardial infarction(TIMI)before and after treatment,bleeding complication rate during and within 24h hrs after the operation,cardiac function parameters[left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)]on the 7th day and at the end of the 1st month after the operation as well as the occurrence of major adverse cardiac events(MACE)within 1 month after operation.Results:After treatment,28 patients from the observation group(93.33%)and 20 patients from the control groups(66.67%)were grade 3 in TIMI blood flow classification(93.33%).The observation group saw much better TIMI blood flow classification than the control group did(P<0.05).At the end of the 1st month after the operation,both groups witnessed remarkably lower LVEDD but higher LVEF as compared with those on the 7th day after the operation(P<0.05),and at the end of the 1st month after the operation,the observation group had obviously lower LVEDD but higher LVEF than the control group did over the same period(P<0.05).The bleeding rate of the observation group during and within 24h after the operation was 16.67%(5/30),seeing no big difference from 10.00%(3/30)of the control group(P>0.05).The incidence of MACE of the observat

关 键 词：急诊经皮冠状动脉介入治疗 重组人尿激酶原 硝普钠 急性ST段抬高型心肌梗死 

分 类 号：R541.4[医药卫生—心血管疾病]