ST段抬高型急性心肌梗死患者经皮冠状动脉介入术中注射重组人尿激酶原对其出血程度、血浆纤溶因子及血管再通的影响  

Effect of injection of recombinant human prourokinase during percutaneous coronary intervention on bleeding degree,plasma fibrinolytic factor and vascular recanalization in patients with ST segment elevation acute myocardial infarction

作　　者：邸亚丽 张红梅 王斌 李志国 高翔 李霞 纪征 孙淑娴 杨立明 张宇 Di Yali;Zhang Hongmei;Wang Bin;Li Zhiguo;Gao Xiang;Li Xia;Ji Zheng;Sun Shuxian;Yang Liming;Zhang Yu(Department of Cardiology,Tangshan Gongren Hospital,Hebei Province,Tangshan 063000,China;Department of Party committee,Tangshan Gongren Hospital,Hebei Province,Tangshan 063000,China)

机构地区：[1]河北省唐山市工人医院心内科,063000 [2]河北省唐山市工人医院党委工作部,063000

出　　处：《中国综合临床》2021年第3期256-263,共8页Clinical Medicine of China

基　　金：河北省医学科学研究课题计划(20201512)。

摘　　要：目的探讨ST段抬高型急性心肌梗死(ST-segment elevation myocardial infarction,STEMI)经皮冠状动脉介入(percutaneous coronary intervention,PCI)术中采用冠状动脉注射重组人尿激酶原(recombinant human prourokinase for injection,rhPro-UK)对患者出血程度、血浆纤溶因子及血管再通的影响。方法2018年11月至2019年11月选取唐山市工人医院治疗的124例STEMI患者作为观察对象,采用前瞻性队列研究方法。按照计算机随机数字法将患者分为观察组63例,对照组61例。均采取血栓抽吸,对照组给予冠状动脉内注射25μg/kg的替罗非班,观察组给予冠状动脉内注射20 mg的rhPro-UK,之后两组均行急诊PCI治疗。记录两组STEMI患者的出血程度、心肌微循环指标、血浆纤溶因子变化、血管再通情况、心电图ST段回落情况及左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)、左心室射血分数(left ventricular ejection fraction,LVEF)、心脏指数(cardiac index,CI)的变化。结果观察组的磷酸肌酸同工酶(creatine kinase isoenzymes MB,CK-MB)峰值(184.64±21.47)U/L及CK-MB峰值时间(14.32±2.02)h显著低于对照组[(258.94±31.64)U/L)、(16.58±2.09)h],差异有统计学意义(t=15.345、t=6.123,P均<0.001);观察组治疗后人组织纤溶酶原激活物(human tissue plasminogen activator,t-PA)(0.85±0.28)kU/L显著高于对照组(0.74±0.24)kU/L,人纤溶酶原激活物抑制剂(human plasminogen activator inhibitor,PAI-1)(0.16±0.05)kU/L较对照组(0.32±0.08)kU/L显著下降(t=2.345,P=0.021;t=13.401,P<0.001);ST段完全回落观察组77.78%(49/63)明显高于对照组54.10%(33/61)(Z=7.758;P=0.005),ST段无回落观察组4.76%(3/63)明显低于对照组19.67%(12/61)(Z=6.480;P=0.011)。观察组治疗后7 d的LVEDD(49.37±3.14)mm、14 d的LVEDD(48.34±3.03)mm、7 d的LVESD(33.19±2.23)mm、14 d的LVESD(32.05±2.23)mm显著低于对照组治疗后7 d的LVEDD(50.64±3Objective To explore the effect of coronary injection of recombinant human prourokinase(rhPro-UK)during PCI for ST-segment elevation acute myocardial infarction(STEMI)patients.Methods A total of 124 STEMI patients treated in Tangshan Gongren Hospital,Hebei Province from November 2018 to November 2019 were selected as the research objects.They were simply randomized by random number table method into the observation group(63 cases)and the control group(61 cases).Thrombus aspiration was used.The control group was treated with 25μg/kg tirofiban,and the observation group was injected with 20 mg rhPro-UK into the coronary arteries.After that,both groups underwent emergency PCI treatment.The bleeding degree,myocardial microcirculation indexes,plasma fibrinolytic factor changes,vascular recanalization,ST segment fall of electrocardiogram and changes in left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF),cardiac index(CI)were recorded.Results The peak value of creatine kinase isoenzymes MB(CK-MB)(184.64±21.47)U/L and the peak time of CK-MB(14.32±2.02)h in the observation group were significantly lower than those in the control group((258.94±31.64)U/L,(16.58±2.09)h),the differences were statistically significant(t=15.345 and 6.123,all P<0.001).After treatment,human tissue plasminogen activator(t-PA)(0.85±0.28)kU/L in the observation group was significantly higher than that in the control group(0.74±0.24)kU/L,human plasminogen activator inhibitor(PAI-1)(0.16±0.05)kU/L.compared with the control group(0.32±0.08)kU/L significantly decreased(t=2.345,P=0.021;t=13.401,P<0.001);77.78%(49/63)of the ST-segment complete fall in observation group was significantly higher than 54.10%(33/61)of the control group(Z=7.758;P=0.005),and 4.76%(3/63)in the observation group without a fall in ST segment was significantly lower than 19.67%(12/61)of the control group(Z=6.480;P=0.011).The LVEDD at 7 days,14 days and the LVESD at 7 days and 14 days in the ob

关 键 词：急性ST段抬高型心肌梗死 重组人尿激酶原 出血程度 血浆纤溶因子 血管再通 

分 类 号：R542.22[医药卫生—心血管疾病]