重组人尿激酶原联合硝普钠替罗非班冠状动脉内注射对高血栓负荷STEMI患者行PCI疗效的影响  

Effect of recombinant human prourokinase combined with sodium nitroprusside and tirofiban by intracoronary injection on the efficacy of PCI in the STEMI patients with high thrombus load

作　　者：韩风杰 郑海军[1] 王中明[1] 邱翠婷 曾辉[1] 晋辉[1] 刘静[1] 周庆庆 朱艳霞[1] Han Feng-jie;Zheng Hai-jun;Wang Zhong-ming;Qiu Cui-ting;Zeng Hui;Jin Hui;Liu Jing;Zhou Qing-qing;Zhu Yan-xia(The First Ward of Cardiovascular Medicine,Jiaozuo People′s Hospital,Jiaozuo 454002,China)

机构地区：[1]焦作市人民医院心血管内科一区,河南焦作454002

出　　处：《中国急救医学》2021年第12期1028-1034,共7页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金资助项目(81570274)。

摘　　要：目的探讨重组人尿激酶原(rh-proUK)联合硝普钠、替罗非班冠状动脉内注射对高血栓负荷急性ST段抬高型心肌梗死(STEMI)患者行直接经皮冠状动脉介入治疗(PCI)后心肌血流灌注及预后的影响。方法选取2018年1月至2020年9月在焦作市人民医院心血管内科病房住院的高血栓负荷STEMI并行PCI的患者120例,采用分层随机化分组法分为尿激酶原组(60例)和对照组(60例)。尿激酶原组患者冠状动脉内依次注射rh-proUK(20 mg)、硝普钠(200μg)、替罗非班(10μg/kg);对照组患者冠状动脉内依次注射硝普钠(200μg)、替罗非班(10μg/kg)。随后常规进行PCI。监测PCI术前及手术完成时心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)、校正TIMI血流计帧数(cTFC)、术后90 min心电图ST段回落率(STR);监测肌酸激酶同工酶(CK-MB)和心型肌钙蛋白I(cTnI)术前水平、术后峰值及其出现峰值时间;术前及术后1周末、3个月末检测血清N末端脑钠肽前体(NT-proBNP),同时应用超声检测左心室舒张末期内径(LVEDD)及左心室射血分数(LVEF);记录住院期间出血事件;随访术后6个月内的主要不良心血管事件(MACEs)。结果PCI术后即刻尿激酶原组TIMI血流分级、TMPG分级、cTFC帧数及STR均优于对照组(Z=-2.005,Z=-2.103,t=3.353,Z=-2.237;P=0.045、0.035、0.001、0.025);PCI术后尿激酶原组心肌损伤指标(cTnI、CK-MB)术后峰值均低于对照组(t=2.071、2.554,P=0.041、0.012),尿激酶原组心肌损伤指标(cTnI、CK-MB)峰值时间均短于对照组(t=2.252、3.516,P=0.026、0.001);PCI术前后各不同时间点尿激酶原组心功能指标(NT-proBNP、LVEDD、LVEF)优于对照组(F_(组间)=6.210、7.074、21.320,P_(组间)=0.014、0.009、<0.001);术中及术后24 h内两组患者出血事件发生率比较,差异无统计学意义(Fisher检验,P=1.000);PCI术后6个月内尿激酶原组MACEs发生率低于对照组(χ^(2)=4.615,P=0.032)。结论高血栓负荷STEMI患者行PCIObjective To investigate the effect of recombinant human prourokinase(rh-proUK)combined with sodium nitroprusside and tirofiban by intracoronary injection on the myocardial perfusion and the prognosis after percutaneous coronary intervention(PCI)in the acute ST-segment elevation myocardial infarction(STEMI)patients with high thrombus load.Methods From January 2018 to September 2020,120 STEMI patients with high thrombus load accepted PCI in Cardiovascular Internal Medicine Ward of Jiaozuo People′s Hospital were selected,and were randomly divided into rh-proUK group(60 cases)and control group(60 cases)according to the stratified random grouping method.The rh-proUK group were successively injected with rh-proUK(20 mg),sodium nitroprusside(200μg),tirofiban(10μg/kg)in coronary artery;The control group were successively injected with sodium nitroprusside(200μg)and tirofiban(10μg/kg)in coronary artery.PCI was then routinely performed.Thrombolysis test in myocardial infarction(TIMI)blood flow grade,TIMI myocardial perfusion grade(TMPG),calibrated TIMI hemometer frame number(cTFC),postoperative ST-segment drop rate(STR)for 90 min were monitored before and after PCI;Preoperative creatine kinase isoenzyme(CK-MB)and(heart-shaped)troponin I(cTnI)levels,postoperative peak values and their peak times were monitored;Serum N-terminal brain natriuretic peptide precursor(NT-pro BNP)was detected at the end of 1 weekend and 3 months after surgery and before surgery,at the same time,left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were measured by ultrasound;Bleeding events during the hospitalization were recorded;Major adverse cardiovascular events(MACEs)were observed within 6 months after surgery.Results TIMI blood flow grade,TMPG,cTFC and STR in the rh-proUK group were better than those in the control group immediately after PCI(Z=-2.005,Z=-2.103,t=3.353,Z=-2.237;P=0.045,0.035,0.001,0.025);The peak values of myocardial injury indexes(cTnI,CK-MB)in the rh-proUK group were lower than tho

关 键 词：ST段抬高型心肌梗死(STEMI) 高血栓负荷 经皮冠状动脉介入治疗(PCI) 冠状动脉内给药 重组人尿激酶原(rh-proUK) 硝普钠 替罗非班 

分 类 号：R542.22[医药卫生—心血管疾病]