经皮冠状动脉介入治疗期间冠状动脉内输注阿替普酶对微循环功能的影响  

Effects of intracoronary alteplase infusion on microcirculatory function during percutaneous coronary intervention

作　　者：张莎 钟斌 卜曦 ZHANG Sha;ZHONG Bin;BU Xi(Department of Pharmacy,Ankang Traditional Chinese Medicine Hospital of Shaanxi Province,Ankang,Shaanxi,725000;Cardiovascular Department,Ankang Traditional Chinese Medicine Hospital of Shaanxi Province,Ankang,Shaanxi,725000;Preparation Room,Ankang Traditional Chinese Medicine Hospital of Shaanxi Province,Ankang,Shaanxi,725000)

机构地区：[1]陕西省安康市中医医院药剂科,陕西安康725000 [2]陕西省安康市中医医院心血管科,陕西安康725000 [3]陕西省安康市中医医院制剂室,陕西安康725000

出　　处：《实用临床医药杂志》2022年第24期66-70,共5页Journal of Clinical Medicine in Practice

基　　金：陕西省自然科学基金项目(2020-z-327)。

摘　　要：目的探讨直接经皮冠状动脉介入治疗(PCI)期间冠状动脉内输注阿替普酶对微循环功能急性侵入性参数的影响。方法选取心内科行急诊PCI的80例缺血时间≤6 h的急性ST段抬高型心肌梗死(STEMI)患者作为研究对象,采用随机数字表法分为阿替普酶组和对照组,每组40例。阿替普酶组于再灌注[心肌梗死溶栓试验(TIMI)血流分级≥2级]后将10 mg阿替普酶注入至冠状动脉罪犯血管中,然后植入支架;对照组于再灌注(TIMI血流分级≥2级)后立即植入支架。PCI后,检测2组微循环功能急性侵入性参数[微循环阻力指数(IMR)、阻力储备比(RRR)和血流储备分数(CFR)]。结果阿替普酶组、对照组的IMR分别为22.0(17.0,42.0)、33.0(17.0,57.0),差异无统计学意义(P>0.05);阿替普酶组的CFR、RRR分别为1.4(1.1,1.9)、1.6(1.4,2.6),对照组的CFR、RRR分别为1.3(1.1,1.8)、1.6(1.3,2.2),差异无统计学意义(P>0.05)。亚组分析显示,缺血时间和阿替普酶与IMR无交互作用(P=0.155),缺血时间和阿替普酶与CFR(P=0.014)、RRR(P=0.027)存在交互作用。在缺血时间<2 h的患者中,阿替普酶组CFR、RRR依次为2.0(1.7,2.3)、2.2(2.0,2.6),分别高于对照组的1.2(1.1,1.7)、1.5(1.3,1.9),差异有统计学意义(P<0.05)。结论直接PCI期间向冠状动脉罪犯血管中输注阿替普酶,对缺血时间≤6 h的急性STEMI患者PCI结束时罪犯血管微循环功能(IMR、CFR、RRR)无明显影响。Objective To investigate the effects of intracoronary alteplase infusion on acute invasive parameters on microcirculatory function during primary percutaneous coronary intervention(PCI).Methods A total of 80 acute ST-segment elevation myocardial infarction(STEMI)patients with ischemia time≤6 h who underwent emergency PCI in the Department of Cardiology were included as study objects.The patients were divided into alteplase group and control group according to method of random number table,with 40 cases in each group.In the alteplase group,10 mg of alteplase was infused into coronary criminal lesions after reperfusion[blood flow grade of thrombolysis test for myocardial infarction(TIMI)≥2],followed by stent implantation.The control group was implanted with stent immediately after reperfusion(blood grade of TIMI≥2).Acute invasive parameters of microcirculatory function[microcirculatory resistance(IMR),resistance reserve ratio(RRR),and flow reserve(CFR)]were measured after PCI.Results The IMR of the alteplase group and control group were 22.0(17.0,42.0)and 33.0(17.0,57.0),respectively,and there was no significant between-group difference(P>0.05).The CFR and RRR of the alteplase group were 1.4(1.1,1.9)and 1.6(1.4,2.6),respectively,and were 1.3(1.1,1.8)and 1.6(1.3,2.2),respectively in the control group,no significance between-group difference was observed(P>0.05).Subgroup analysis showed no interaction of ischemia time and alteplase with IMR(P=0.155).Interactions of ischemia time and alteplase with CFR(P=0.014)and RRR(P=0.027)were observed.In patients with ischemic times<2 h,the CFR and RRR of the alteplase group were 2.0(1.7,2.3)and 2.2(2.0,2.6),respectively,which were higher than 1.2(1.1,1.7)and 1.5(1.3,1.9)of the control group(P<0.05).Conclusion Infusion of alteplase to culprit artery microvascular has no significant effect on culprit artery microvascular function(IMR,CFR or RRR)during PCI in acute STEMI with ischemia time≤6 h.

关 键 词：经皮冠状动脉介入治疗 阿替普酶 微循环功能 急性ST段抬高型心肌梗死 急性侵入性参数 

分 类 号：R542.2[医药卫生—心血管疾病] R459.7[医药卫生—内科学]