冠状动脉内联合应用重组人尿激酶原和替罗非班对行急诊PCI的STEMI患者心肌血流灌注的影响  

Effects of intracoronary low-dose recombinant human prourokinase and tirofiban on myocardial perfusion in STEMI patients with primary PCI

作　　者：林东升 傅广 何仲春 马丽霞 罗辉 王照飞 LIN Dongsheng;FU Guang;HE Zhongchun;MA Lixia;LUO Hui;WANG Zhaofei(Department of Cardiology,The First Hospital of Changsha,Changsha,410005,China)

机构地区：[1]长沙市第一医院心血管内科一病区,长沙410005

出　　处：《临床心血管病杂志》2021年第3期215-219,共5页Journal of Clinical Cardiology

基　　金：长沙市第一医院2019年度院级科研基金项目(No:长一医发[2019]73号)。

摘　　要：目的:探讨在ST段抬高型心肌梗死(STEMI)患者急诊行经皮冠状动脉介入治疗(PCI)过程中,冠状动脉(冠脉)内应用小剂量重组人尿激酶原联合小剂量替罗非班对心肌血流灌注以及预后的影响。方法:将76例STEMI患者随机分为联合用药组(36例)和替罗非班组(40例),联合用药组梗死相关动脉(IRA)内应用小剂量重组人尿激酶原(10~20 mg)联合小剂量替罗非班(0.1 mL/kg,5μg/kg),替罗非班组IRA内应用替罗非班(0.2 mL/kg,10μg/kg),然后两组患者分别行常规PCI治疗。比较两组患者术后心肌血流灌注、心肌梗死范围、临床预后以及1年随访结果等指标。结果:两组患者一般临床资料无统计学差异。联合用药组术后校正的TIMI帧数(cTFC)及肌酸激酶同工酶(CK-MB)峰值均明显低于替罗非班组(P<0.05),ST段回落大于50%的比例明显高于替罗非班组(P<0.05);两组患者住院期间出血事件发生率无统计学差异。1年随访,联合用药组患者N末端脑钠肽前体(NT-proBNP)水平明显低于替罗非班组(P<0.05),左室射血分数(LVEF)与左室舒张末期内径(LVEDD)缩小幅度明显高于替罗非班组(均P<0.05);两组患者主要不良心脑血管事件(MACCE)发生率相当。结论:冠脉内联合应用小剂量重组人尿激酶原和小剂量替罗非班可进一步改善STEMI患者心肌灌注水平,改善临床预后,且不增加住院期间出血风险。Objective:To observe the effects of intracoronary low-dose recombinant human prourokinase(rhPro-UK)and tirofiban on myocardial perfusion and prognosis in ST-elevation myocardial infarction(STEMI)patients with primary PCI.Methods:A total of 76 patients with STEMI were randomly divided into the combination group(n=36)and the tirofiban group(n=40).Patients in the combination group were treated with low-dose rhPro-UK(10-20 mg)and low-dose tirofiban(0.1 mL/kg,5μg/kg)in the infarct-related artery(IRA).In contrast,patients in the tirofiban group were treated with low-dose tirofiban(0.2 mL/kg,10μg/kg).Then all patients underwent primary PCI.Indicators of postoperative myocardial perfusion,myocardial infarction area,clinical prognosis,and 1-year follow-up were compared between the two groups.Results:There was no statistical difference in general clinical data between the two groups.Compared with the tirofiban group,the combination group had reduced corrected TIMI frame count(cTFC)and the peak of creatine kinase isoenzyme(CK-MB),but increased the number of ST-segment regression(STR)≥50%(all P<0.05);There was no difference in the incidence of in-hospital bleeding events between the two groups.All patients were followed up for one year,compared with the tirofiban group,NT-proBNP level was lower,while left ventricular ejection fraction(LVEF)and the reduction of left ventricular end diastolic diameter(LVEDD)were higher in the combination group(all P<0.05);The incidence of major adverse cardiovascular and cerebrovascular events(MACCE)was comparable between the two groups.Conclusion:The combination of intracoronary low-dose rhPro-UK and tirofiban used in STEMI patients could further improve myocardial perfusion and clinical prognosis without increasing the risk of bleeding during hospitalization.

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 无复流/慢血流 重组人尿激酶原 替罗非班 

分 类 号：R541.4[医药卫生—心血管疾病]