ST段抬高型急性心肌梗死梗死相关血管靶向溶栓的效果观察  

Observation on the effect of targeted thrombolysis of infarct-related blood vessels in ST-segment elevation acute myocardial infarction

作　　者：王智勇 许志茹 杨发 高江峰 齐万涛 孟秀杰 Wang Zhiyong;Xu Zhiru;Yang F;Gao Jiangfeng;Qi Wantao;Meng Xiujie(Department of Cardiology,Inner Mongolia autonomous region people's Hospital,Hohhot 010017,China;Department of Cardiology,Inner Mongolia International Mongolian hospital,Hohhot 010075,China)

机构地区：[1]内蒙古自治区人民医院心内科,呼和浩特010017 [2]内蒙古国际蒙医医院心内科,呼和浩特010075

出　　处：《中国心血管杂志》2021年第6期536-539,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的观察ST段抬高型心肌梗死(STEMI)患者梗死相关血管(IRA)开通后冠状动脉内注射尿激酶原对心肌微循环等心肌挽救作用。方法纳入2015年7月1日至2018年6月30日我院就诊的发病12 h内的580例STEMI患者,急诊冠状动脉血栓抽吸血管开通后,随机分为尿激酶原组(289例)和对照组(291例)。所有患者均在IRA内注射200μg硝酸甘油或100μg硝普钠,而尿激酶原组还注射尿激酶原10 mg。主要观察术后即刻的TIMI血流状况和随访30 d的心功能情况。结果两组的基线资料相似,具有可比性(均为P>0.05)。尿激酶原组术后即刻慢血流和无复流的发生率显著低于对照组(0.3%比3.4%),TIMI 3级血流率(95.8%比91.8%)和ST段恢复率高于对照组(58.8%比44.3%)(均为P<0.05)。两组围术期内再次心肌梗死、轻度及严重出血、心原性死亡发生率无统计学差异(3.8%比4.5%)。随访30 d后,脑利钠肽和心功能均显著优于对照组(均为P<0.001)。结论 IRA内注射尿激酶原可显著降低STEMI患者术后即刻慢血流和无复流的发生率,并显著改善短期心功能。Objective To study the effect of prourokinase infused into the infarction related artery(IRA) on the improvement of myocardial microcirculation in patients with ST segment elevation myocardial infarction(STEMI) after opening of the culprit artery. Methods During primary coronary intervention therapy, patients with STEMI within 12 h were randomly divided into two groups: prourokinase group(n=289, administered with 200 μg nitroglycerin or 100 μg sodium nitroprusside and 10 mg of prourokinase into IRA) and control group(n=291, 200 μg nitroglycerin or 100 μg sodium nitroprusside administered into IRA). Results The baseline data of the two groups are similar and comparable(all P<0.05). The prourokinase group was associated with significantly lower rate of slow flow and no-reflow(0.3% vs. 3.4%),higher rate of TIMI grade 3 blood flow(95.8% vs. 91.8%) and ST-segment recovery rate(58.8% vs. 44.3%) compared with the control group(all P<0.05). There was no significant difference in the rates of recurrent myocardial infarction, mild and severe bleeding, and cardiac mortality between the two groups during the perioperative period(3.8% vs. 4.5%). After 30 d of follow up, levels of B-type natriuretic peptide and heart function were markedly improved in the prourokinase group than the control group(all P<0.001). Conclusions Prourokinase administered into IRA could significantly decrease the rates of slow flow and no-reflow and improve heart function.

关 键 词：ST段抬高型心肌梗死 罪犯动脉 尿激酶原 心肌挽救 

分 类 号：R542.22[医药卫生—心血管疾病]