PCI前冠状动脉内溶栓治疗急性ST段抬高型心肌梗死患者的效果  

Effects of intracoronary thrombolysis before PCI in patients with acute ST segment elevation myocardial infarction

作　　者：张建国 ZHANG Jianguo(Department of Cardiology of Shunyi District Hospital,Beijing 101300,China)

机构地区：[1]北京市顺义区医院心内科,北京101300

出　　处：《中国民康医学》2023年第4期25-28,共4页Medical Journal of Chinese People’s Health

摘　　要：目的:观察经皮冠脉介入术(PCI)前行冠状动脉内溶栓治疗急性ST段抬高型心肌梗死(STEMI)患者的效果。方法:选取2020年11月至2021年10月该院收治的80例急性STEMI患者进行前瞻性研究,按照随机数字表法将患者分为对照组和观察组各40例。对照组直接行PCI治疗,观察组在PCI前行冠状动脉内尿激酶原溶栓治疗。比较两组术后心肌灌注指标[心肌梗死溶栓试验(TIMI)血流分级、无复流现象(NRP)、ST段回落率(STR)、校正TIMI帧数(cTFC)]、治疗前后心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及室壁运动积分指数(WMSI)]水平,术后30 d内出血事件和心脏不良事件发生率。结果:术后,观察组TIMI血流分级优于对照组,NRP发生率为5.00%(2/40),低于对照组的25.00%(10/40),差异均有统计学意义(P<0.05);两组STR比较,差异无统计学意义(P>0.05);两组术后即刻cTFC水平均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组LVEF水平均高于治疗前,且观察组高于对照组;两组LVEDD水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组WMSI水平均低于治疗前,差异有统计学意义(P<0.05),但组间比较,差异无统计学意义(P>0.05)。两组出血事件、心脏不良事件发生率比较,差异均无统计学意义(P>0.05)。结论:PCI前应用冠状动脉内溶栓能明显改善急性STEMI患者心肌再灌注和心功能,效果优于直接PCI治疗,且安全性良好。Objective:To observe effects of intracoronary thrombolysis before percutaneous coronary intervention(PCI)in patients with acute ST segment elevation myocardial infarction(STEMI).Methods:A prospective study was conducted on 80 patients with acute STEMI admitted to the hospital from November 2020 to October 2021.These patients were divided into control group and observation group according to the random number table method,40 cases in each.The control group was treated with PCI directly,while the observation group was treated with coronary prourokinase thrombolysis before PCI.The levels of myocardial perfusion indexes[thrombolysis in myocardial infarction(TIMI)flow grade,no-reflow phenomenon(NRP),ST-segment resolution(STR)2 h after the surgery,corrected TIMI frame count(cTFC)],the cardiac function index levels[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),and wall motion score index(WMSI)]before and after the treatment,the incidence of bleeding events within 30 days after the surgery,and the incidence of adverse cardiac events were compared between the two groups.Results:After the surgery,the TIMI blood flow grade of the observation group was better than that of the control group,and the difference was statistically significant(P<0.05).The incidence of NRP in the observation group was 5.00%(2/40),which was lower than 25.00%(10/40)in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the STR between the two groups(P>0.05).The cTFC levels of the two groups immediately after the surgery were lower than those before the surgery,that of the observation group was lower than that of the control group,and the differences were statistically significant(P<0.05).After the treatment,the LVEF levels of the two groups were higher than those before the treatment,and that of the observation group was higher than that of the control group;the LVEDD levels of the two groups were lower than those before the treatment,and that of t

关 键 词：急性心肌梗死 ST段抬高型 经皮冠脉介入术 冠状动脉内溶栓 尿激酶原 心肌灌注 心功能 

分 类 号：R542[医药卫生—心血管疾病]