血栓抽吸联合微导管靶向应用重组人尿激酶原对ST抬高型急性心肌梗死患者心肌血流灌注的影响  

Effect of thrombus aspiration combined with microcatheter targeted application of recombinant human prourokinase on myocardial blood perfusion in patients with ST elevated acute myocardial infarction

作　　者：马飞虹 乔增勇[2] MA Feihong;QIAO Zengyong(Anhui University of Science and Tcchnology,Huaina,Anhui,232000,China;Department of Cardiology,The South Branch of the Sixth People's Hospital,Shanghai Jiaotong University)

机构地区：[1]安徽理工大学,安徽淮南232000 [2]上海交通大学附属第六人民医院南院心内科

出　　处：《临床心血管病杂志》2020年第12期1088-1092,共5页Journal of Clinical Cardiology

基　　金：上海市科学技术委员会重大课题资助(No:20170703)。

摘　　要：目的:探讨在血栓抽吸基础上冠状动脉(冠脉)内选择性应用溶栓药物重组人尿激酶原是否可改善行急诊PCI术的ST段抬高型心肌梗死(STEMI)患者的心肌血流灌注及预后。方法:采用回顾性分析的方法,选取心内科行急诊PCI术的STEMI患者,按照术中血栓抽吸后、支架植入前经微导管靶向注射重组人尿激酶原或替罗非班分为重组人尿激酶原组(55例)与替罗非班组(55例),术后即刻评估患者TIMI分级、校正的TIMI帧数计数(cTFC)、ST段回落率(SUM-STR),并随访记录患者一般资料及血清肌钙蛋白-I(cTnI)、B型利钠肽(BNP)、左室射血分数(LVEF)、主要不良心血管事件(MACE)及出血情况等。结果:与替罗非班组比较,重组人尿激酶原组药物干预后TIMI水平与LVEF值明显升高,慢血流与MACE发生率明显降低,cTFC、cTnI、BNP峰值明显降低,SUM-STR>70%比例明显升高(均P<0.05);重组人尿激酶原组出血事件发生率有降低趋势,但两组差异并无统计学意义。结论:血栓抽吸联合微导管靶向应用重组人尿激酶原可显著改善STEMI患者的心肌血流灌注和预后,且出血事件有降低趋势,安全系数更高,更新了传统"易化PCI"方案,值得在临床大力推广。Objective:To investigate whether the selective application of thrombolytic drug recombinant human urokinase based on thrombus aspiration can improve myocardial blood perfusion and prognosis in patients with ST-segment elevation myocardial infarction(STEMI)undergoing emergency PCI.Method:Retrospective analysis was performd in STEMI patients who underwent emergency PCI in the Department of Cardiology.According to recombinant human urokinase or timofiban was injected by microcatheter targeting after intraoperative thrombectomy and before stent implantation,all patients were divided into two groups:recombinant human prourokinase group(n=55)and tirofiban group(n=55).TIMI grading,corrected TIMI frame count(cTFC)and ST segment resolution rate(SUM-STR)were evaluated immediately after operation,the general data,serum cardial troponic-I(cTnI),brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),major adverse cardiovascular events(MACE)and bleeding events were followed up.Result:Compared with the tirofiban group,TIMI grade and LVEF in the recombinant human prourokinase group were significantly increased,the incidence of coronary slow flow and MACE were significantly decreased,the peak values of cTFC,cTnI and BNP were significantly reduced,and the proportion of SUM-STR>70%was significantly increased(all P<0.05);while the incidence of bleeding events in the recombinant human prourokinase group was decreased,but there was no significant difference between the two group.Conclusion:Thrombus aspiration combined with microcatheter targeted application of recombinant human urokinase can significantly improve myocardial blood perfusion and prognosis in patients with STEMI,it has fewer bleeding events and higher safety,update the traditional"simple PCI"solution,which is worthy promotion in the clinic.

关 键 词：急性心肌梗死 慢血流 血栓抽吸 重组人尿激酶原 心肌血流灌注 

分 类 号：R542.2[医药卫生—心血管疾病]