尿激酶原联合尼可地尔术前冠状动脉灌注对ST段抬高型心肌梗死患者经皮冠状动脉介入术后心功能和炎性反应及预后的影响  

Effects of prourokinase combined with nicorandil coronary perfusion on cardiac function,inflammatory response and MACE after PCI in STEMI patients

作　　者：韩孝宇[1] 代玉涵 朱爱红[1] 姜晓冬 安建立[2] 张扬[1] 王文广[1] 杨红梅[1] 撖越 HAN Xiao-yu;DAI Yu-han;ZHU Ai-hong;JIANG Xiao-dong;AN Jian-li;ZHANG Yang;WANG Wen-guang;YANG Hong-mei;HAN Yue(Department of cardiology,First Hospital of Qinhuangdao,Qinhuangdao 066000.China)

机构地区：[1]秦皇岛市第一医院心内科,河北省秦皇岛市066000 [2]秦皇岛市第一医院介入治疗科

出　　处：《中国心血管病研究》2021年第5期408-413,共6页Chinese Journal of Cardiovascular Research

基　　金：秦皇岛市重点研发计划科技支撑项目(201703A083);秦皇岛市科技计划自筹支撑项目(201902A168)

摘　　要：目的探讨尿激酶原联合尼可地尔对ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)术后心功能、炎性反应和不良心血管事件(MACE)发生的影响。方法入选2018年11月~2019年11月在我院心内科收治的126例行PCI的STEMI患者为研究对象,按照随机数表法分为观察组和对照组,各63例,对照组给予尿激酶原(10mg),观察组在对照组基础上给予尼可地尔(12mg)治疗。比较两组患者术后心功能指标、炎症反应和MACE发生情况。结果两组术后6个月心功能和炎性反应较本组术后1和3个月均有所改善(P<0.05)。观察组术后1和3个月左心室舒张末期内径(LVEDD)、左心室收缩末期容积指数(LVESVI)较对照组均有所下降(P<0.05),术后6个月LEVDD[(43.29±3.18)mm比(47.43±3.58)mm]和LVESVI[(32.86±6.43)ml/㎡比(38.17±6.93)ml/㎡]显著低于对照组(P<0.05);术后1和3个月左心室射血分数(LVEF)和峰值射血率(PER)较对照组有所提高(P<0.05),术后6个月LEVF[(59.48±4.19)%比(56.89±4.49)%]和PER[(1.91±0.19)EDV/s比(1.82±0.24)EDV/s]显著高于对照组(P<0.05)。两组术后炎性反应C反应蛋白(CRP)(12h、7d)和白细胞介素-6(IL-6)(12h)时点出现升高,术后其他时点均有所下降(P<0.05)。观察组术后6个月髓过氧物酶(MPO)[(171.62±21.11)mg/L比(198.25±20.11)mg/L]、CRP[(3.08±0.86)mg/L比(4.23±0.51)mg/L]、IL-6[(2.51±0.44)mg/L比(3.08±0.95)mg/L]和BNP[(139.94±17.36)ng/L比(168.95±19.64)ng/L]均显著低于对照组(P<0.05);观察组靶血管血运重建、心绞痛、心力衰竭和再发心肌梗死比例均低于对照组,但差异无统计学意义(P>0.05);MACE总发生率为(11.11%比28.57%)显著低于对照组(P<0.05)。结论尿激酶原联合尼可地尔应用于接受PCI术的STEMI患者,可有效改善其心功能,抑制炎症反应,减少MACE的发生。Objective To explore the effect of prourokinase combined with nicorandil on cardiac function,inflammatory response and major adwerse cardiovascular events(MACE)in patients with ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods A total of 126 patients with STEMI undergoing PCI who were admitted to the Department of Cardiology in our hospital from November 2018 to November 2019 were selected as the research object.They were divided into observation group and control group according to random number table method.The control group was given a single prourokinase perfusion(10 mg)and the observation group was given nicorandil(12 mg)on the basis of the control group.The postoperative cardiac function ultrasound indexes,inflammatory response and the occurrence of MACE were compared between the two groups.Results The cardiac function and inflammatory response at 6 months after surgery in both groups were improved compared with those at 1 and 3 months after the surgery(P<0.05);LEVDD and LVESVI in the observation group decreased 1 and 3 months after the operation compared with the control group(P<0.05)and 6 months after the operation,LEVDD[(43.29±3.18)mm vs.(47.43±3.58)mm]and LVESVI[(32.86±6.43)ml/㎡ vs(38.17±6.93)ml/㎡]were significantly lower than that of the control group(P<0.05);the observation group had an increase in LEVF and PER at 1 and 3 months after the operation compared with the control group(P<0.05),6 months LEVF[(59.48±4.19)%vs.(56.89±4.49)%]and PER[(1.91±0.19)EDV/s vs.(1.82±0.24)EDV/s]were significantly higher than the control group,(P<0.05).The postoperative inflammatory response CRP(12 h and 7 d)and IL-6(12 h)in both groups increased in the point,and decreased in the other points after the operation(P<0.05);MPO[(171.62±21.11)mg/L vs.(198.25±20.11)mg/L],CRP[(3.08±0.86)mg/Lvs.(4.23±0.51)mg/L],[IL-6(2.51±0.44)mg/L vs.(3.08±0.95)mg/L and BNP(139.94±17.36)pg/ml vs.(168.95±19.64)pg/ml]of the observation group 6 months after the opera

关 键 词：尿激酶原 尼可地尔 ST段抬高型心肌梗死 经皮冠状动脉介入 急诊 心功能 心血管事件 炎性反应 

分 类 号：R541.4[医药卫生—心血管疾病]