低剂量重组人尿激酶原在急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术中的应用效果研究  

Application Effect of Low-dose Recombinant Human Prourokinase in Emergency Percutaneous Coronary Intervention in Patients with Acute ST-segment Elevation Myocardial Infarction

作　　者：赵景宏[1] 乔彦[2] 刘涛[1] 张荣驿 邓建平[1] ZHAO Jinghong;QIAO Yan;LIU Tao;ZHANG Rongyi;DENG Jianping(Department of Cardiology,the Second Affiliated Medical College of North Sichuan Medical College/Nanchong Central Hospital,Nanchong 637000,China;Department of Endocrinolog,the Second Affiliated Medical College of North Sichuan Medical College/Nanchong Central Hospital,Nanchong 637000,China)

机构地区：[1]川北医学院第二临床医学院•南充市中心医院心内科,四川省南充市637000 [2]川北医学院第二临床医学院•南充市中心医院内分泌科,四川省南充市637000

出　　处：《实用心脑肺血管病杂志》2021年第9期77-81,93,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：南充市市校科技战略合作项目(18SXHZ0446);川北医学院校级科研发展计划项目(CBY18-A-ZD04)。

摘　　要：背景经皮冠状动脉介入术(PCI)为临床救治急性ST段抬高型心肌梗死(ASTEMI)患者的重要措施,可及早开通动脉,有效恢复心肌灌注,抑制病情进展,改善患者预后,但动脉血管中的斑块或血栓可形成栓塞,致使血流缓慢,进而影响PCI治疗效果和患者预后,因此需要寻找一种辅助治疗措施来改善整体效果。目的探讨低剂量重组人尿激酶原在ASTEMI患者急诊PCI中的应用效果。方法选取2019-2020年南充市中心医院收治的ASTEMI患者100例为研究对象,采用随机数字表法分为研究组(n=50)、对照组(n=50)。对照组经导管推注替罗非班及硝酸甘油后实施PCI;研究组在对照组基础上经导管向梗死相关动脉推注10 mg重组人尿激酶原后实施PCI。比较两组患者术后即刻心肌灌注情况〔包括心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)〕,术前、术后1周超声心动图参数〔包括左心室射血分数(LVEF)、心脏指数(CI)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)〕,无复流、ST段回落<50%发生率,不良反应发生率,术后3个月主要不良心血管事件(MACE)发生率。结果研究组患者术后即刻TIMI血流分级为3级、TMPG为3级者所占比例高于对照组(P<0.05)。研究组患者术后1周LVEF、CI高于对照组,LVEDD、LVESD小于对照组(P<0.05)。对照组、研究组患者术后1周LVEF、CI分别高于本组术前,LVEDD、LVESD分别小于本组术前(P<0.05)。两组患者无复流、ST段回落<50%发生率比较,差异无统计学意义(P>0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。研究组患者术后3个月MACE发生率低于对照组(P<0.05)。结论ASTEMI患者急诊PCI中应用低剂量重组人尿激酶原,可有效改善患者术后即刻血流分级及心功能,且不会增加不良反应,并能降低MACE发生风险,对改善患者预后具有重要意义。Background Percutaneous coronary intervention(PCI)is an important measure for the clinical treatment of acute ST-segment elevation myocardial infarction(ASTEMI).It can open the artery early,effectively restore myocardial perfusion,and inhibit disease progression,and improve the prognosis of patients,but plaque or thrombus in arteries can form embolism,resulting in slow blood flow,which affects the effect of PCI treatment and the prognosis of patients.Therefore,it is necessary to find an adjuvant treatment measure to improve the overall effect.Objective To explore the application effect of low-dose recombinant human prourokinase in emergency PCI in patients with ASTEMI.Methods A total of 100 ASTEMI patients admitted to Nanchong Central Hospital from 2019 to 2020 were selected as the research objects and divided into study group(n=50)and control group(n=50)by random number table method.In the control group,PCI was performed after intracatheter bolus of tirofiban and nitroglycerin.In the study group,PCI was performed after intracatheter bolus of 10 mg recombinant human prourokinase in the infarct-related artery on the basis of the control group.The immediate postoperative myocardial perfusion[including thrombolysis in myocardial infarction(TIMI)blood flow grade,TIMI myocardial perfusion grade(TMPG)],echocardiographic parameters[including left ventricular ejection fraction(LVEF),cardiac index(CI),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)]before operation and 1 week after operation,the incidence of no reflow and ST segment depression<50%,the incidence of adverse reactions,and the incidence of major adverse cardiovascular events(MACE)3 months after operation were compared between the two groups.Results The proportion of patients with TIMI grade 3 and TMPG grade 3 immediately after operation in the study group was higher than that in the control group(P<0.05).One week after operation,LVEF and CI of the study group were higher than those of the control group,while LVEDD

关 键 词：ST段抬高型心肌梗死 重组人尿激酶原 经皮冠状动脉介入治疗 血流分级 心功能 

分 类 号：R542.22[医药卫生—心血管疾病]