小剂量替奈普酶对急性ST段抬高型心肌梗死直接经皮冠状动脉介入治疗患者心肌灌注的影响  

Effect analysis of thrombus aspiration combined with low dose teneplase in the treatment of acute myocardial infarction

作　　者：王嵬民[1] 杜馥曼[2] 张明亮 霍红[1] 李欣[1] Wang Weimin;Du Fuman;Zhang Mingliang;Huo Hong;Li Xin(Cardiovascular Center,Heilongjiang Provincial Hospital,Harbin 150036,China;Department of Endocrinology,Nangang Branch of Heilongjiang Provincial Hospital,Harbin 150001,China)

机构地区：[1]黑龙江省医院心血管中心,哈尔滨150036 [2]黑龙江省医院南岗分院内分泌科,哈尔滨150001

出　　处：《中国临床实用医学》2023年第2期1-5,共5页China Clinical Practical Medicine

基　　金：黑龙江省卫生健康委员会科研课题(20210303010358);黑龙江省卫生健康委员会科研课题(20220303060720)。

摘　　要：目的探讨冠状动脉给药小剂量替奈普酶对急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)患者心肌灌注的影响。方法本研究为随机对照研究,选取2021年12月至2022年10月黑龙江省医院心血管病中心收治的260例STEMI患者,男147例,女113例,年龄(56.7±15.2)岁,年龄范围为38~71岁。采用随机数表法将患者随机分为替奈普酶组(n=130)和替罗非班组(n=130),两组患者均行常规治疗及PCI后,替奈普酶组患者经抽吸导管于病变冠状动脉内推注替奈普酶,替罗非班组患者经抽吸导管于病变冠状动脉内推注替罗非班,比较两组患者临床基线资料、PCI术后相关指标、心功能结果、院内出血事件的发生情况及主要不良心血管事件的发生情况。结果两组患者基线资料比较,差异无统计学意义(P>0.05)。PCI术后,替奈普酶组心肌梗死溶栓治疗血流分级3级[80.8%(105/130)]、心肌组织灌注分级3级[83.8%(109/130)]患者比例高于替罗非班组[69.2%(90/130)、70.8%(92/130)];替奈普酶组超声心动图左室射血分数[(60.61±5.05)%]高于替罗非班组[(58.55±6.47)%]、左室收缩末期容积[(44.58±5.04)ml]低于替罗非班组[(46.24±6.32)ml],差异有统计学意义(P<0.05)。两组患者院内出血事件的发生情况及主要不良心血管事件的发生情况比较,差异无统计学意义(P>0.05)。结论STEMI患者行急诊PCI治疗时,血栓抽吸联合冠状动脉内注射替奈普酶优于替罗非班,并可获更好的心肌组织再灌注,且不增加出血风险。Objective To observe the effect of low-dose teteplase on myocardial perfusion in patients with acute ST-segment elevation myocardial infarction(STEMI)after direct percutaneous coronary intervention(PCI).Methods The study was a randomized controlled study,a total of 260 STEMI patients,including 147 males and 113 females,aged(56.7±15.2)years old,ranging in age from 38 to 71 years old,were randomly selected from December 2021 to October 2022 in the Cardiovascular Center of Heilongjiang Provincial Hospital.Randomized table method was used to divide patients into the teneplase group(n=130)and the tirofiban group(n=130).After conventional treatment and PCI,the teneplase group was injected with teneplase through a suction catheter in the affected coronary artery,and the tirofiban group was injected with tirofiban through a suction catheter in the affected coronary artery.Clinical baseline data,PCI relevant indexes after PCI,cardiac function indicators,the incidence of in-hospital bleeding events and major adverse cardiovascular events were compared between the two groups.Results There was no significant difference in baseline data between the two groups(P>0.05).After PCI,The proportions of thrombolysis in myocardial infarction(TIMI)grade 3[80.8%(105/130)]and TIMI myocardial perfusion grades 3[83.8%(109/130)]in teneplase group were significantly higher than those in tirofiban group[69.2%(90/130),70.8%(92/130)],the differences were statistically significant(P<0.05).The left ventricular ejection fraction in teneplase group[(60.61±5.05)%]was significantly higher than that in tirofiban group[(58.55±6.47)%],the difference was statistically significant(P<0.05).The left ventricular end systolic volume in teneplase group[(44.58±5.04)ml]was significantly lower than that in tirofiban group[(46.24±6.32)ml],the difference was statistically significant(P<0.05).There was no significant difference in the incidence of bleeding events and major cardiovascular adverse events between two groups(P>0.05).Conclusions Thrombus aspiration

关 键 词：急性心肌梗死 经皮冠状动脉 组织纤溶酶原激活剂 心肌梗死溶栓治疗 主要心血管不良事件 

分 类 号：R542.22[医药卫生—心血管疾病]