冠状动脉内靶向应用重组人尿激酶原联合经皮冠状动脉成形术治疗高负荷血栓急性心肌梗死临床疗效  

Clinical efficacy of intracoronally targeted recombinant human urokinase combined with percutaneous coronary intervention(PCI)in acute myocardial infarction(AMI)with high thrombus burden

作　　者：陈满新 张丙雨 戴敏 CHEN Manxin;ZHANG Bingyu;DAI Min(Department of Cardiology,The Second People's Hospital of Wuhu,Wuhu 241000,Anhui,China)

机构地区：[1]芜湖市第二人民医院心内科,安徽芜湖241000

出　　处：《中国临床药理学与治疗学》2023年第5期544-549,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：安徽省重点研究与开发计划(202104j07020059)。

摘　　要：目的:观察冠状动脉内靶向应用重组人尿激酶原联合经皮冠状动脉成形术(PCI)治疗高负荷血栓急性心肌梗死患者的临床疗效。方法:回顾性分析2020年11月到2022年11月因为急性心肌梗死伴高负荷血栓患者入住芜湖市第二人民医院心内科急诊行PCI手术的患者85例。根据患者治疗方案不同分为观察组(应用尿激酶原)37例,对照组(未用尿激酶原)48例。观察组在对照组常规药物及手术治疗基础上加用冠状动脉内靶向重组人尿激酶原。比较两组患者手术后24 h内心肌损伤标志物肌钙蛋白Ⅰ(cTnI)、肌酸激酶(CK)、手术后1 h心电图ST段回落50%比例、术中血流分级情况、住院不良心血管事件(MACE)发生率,及出院1个月心功能指标左室射血分数(LVEF)、左室短轴缩短率(FS)、左心室舒张末期内径(LVED)。结果:两组显示观察组心肌损伤标志物24 h内cTnI(69.35±16.31)ng/mL和CK水平(3136.27±1952.52)U/L,低于对照组(80.52±15.20)ng/mL和CK水平(4554.51±1982.34)U/L(P<0.05);同时术后心电图ST段回落50%比例、TIMI血流3级比率明显高于对照组(P<0.01);出院后1个月观察组心功能指标好于对照组LVEF(54.27±4.21)%vs.(48.20±3.12)%、FS(29.21±2.10)%vs.(21.52±1.80)%、LVED(47.27±4.15)mm vs.(56.67±4.30)mm,差异均有统计学意义(P<0.05)。MACE差异无统计学意义(P>0.05)。结论:冠状动脉内靶向应用重组人尿激酶原联合急诊PCI手术在急性心肌梗死中可改善患者冠状动脉血流,改善心肌灌注和心功能,减少心肌缺血,MACE事件未见增加。AIM:To study the effect of of intracor-onally targeted recombinant human urokinase com-bined with percutaneous coronary intervention(PCI)in acute myocardial infarction(AMI)with high thrombus burden.METHODS:In this retrospective analysis study,85 AMI patients with heavy throm-bus burden admitted to Wuhu Second people's Hos-pital for percutaneous coronary intervention(PCI)from November 2020 to November 2022 were di-vided into observation group(n=37)and control group(n=48)according to different treatment methods.Recombinant human urokinase were used for coronary intervention in observation group.The control group was not treated with recombinant hu-man urokinase.The myocardial injury markers tro-poninI(cTnI)and creatine kinase(CK)within 24 h af-ter PCI,the percentage of segment resolution≥50%1 h after PCI,intraoperative coronary lesions blood flow,the incidence of adverse cardiovascular events(MACE)during hospitalization,and cardiac function index[left ventricular end diastolic(LVED),fraction-al shortening(FS),left ventricular ejection fraction(LVEF)level change one month discharge were com-pared between the two groups after PCI.RESULTS:After PCI,the levels value of cTnI and creatine kinase in the observation group at within 24 h after PCI were(69.35±16.31)ng/mLvs.(80.52±15.20)ng/mL,(3136.27±1952.52)U/Lvs.(4554.51±1982.34)U/L,which were significantly lower than those in the control group(P<0.05);the postoperative TIMI blood flow level 3 was significantly higher than that in the control group(P<0.01),the percentage of segment resolution≥50%1 h after PCI were signifi-cantly higher than those control group(P<0.01);Co-mapared with control group,the the level of LVEF was[(54.27±4.21)%vs.(48.20±3.12)%],FS[(29.21±2.10)%vs.(21.52±1.80)%],which were significantly higher than that in the control group at one month discharge(P<0.05);which was significantly lower than that in the control group at one month dis-charge,LVED[(47.27±4.15)mm vs.(56.67±4.30)mm](P<0.05).There was no significant difference in the incidenc

关 键 词：冠状动脉高血栓负荷 经皮冠状动脉成形术(PCI) 重组人尿激酶 靶向治疗 

分 类 号：R542.22[医药卫生—心血管疾病]