替罗非班联合尿激酶原预处理逆行溶栓对STEMI患者PCI后冠脉无复流的影响研究  

Effects of tirofiban combined with pro urokinase pretreatment on coronary non reflow after PCI in STEMI patients

作　　者：刘列勇 LIU Lie-yong(The Third People's Hospital of Yongzhou City,Yongzhou 425000,China)

机构地区：[1]永州市第三人民医院心血管内科,湖南永州425000

出　　处：《中国处方药》2024年第3期106-109,共4页Journal of China Prescription Drug

摘　　要：目的探讨替罗非班联合重组人尿激酶原(rhPro-UK)预处理逆行溶栓对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后冠脉无复流的影响研究。方法选择2021年5月~2023年2月间收治的行PCI治疗的STEMI患者86例。根据随机分组原则分为对照组和观察组,各组43例。两组均采取PCI治疗,术中给予普通肝素钠、替罗非班,对照组注入rhPro-UK进行常规溶栓。观察组由犯罪血管远端到近端注入rhPro-UK进行逆行溶栓。比较两组术后心肌梗死溶栓试验(TIMI)血流分级、2 h ST段回落率(STR)、冠脉无复流及慢血流(NR/SF)发生率,术后住院期间B型利钠肽(BNP)、肌钙蛋白(cTnI)、左室射血分数(LVEF),随访3个月,比较两组TIMI大出血事件及主要不良心血管事件(MACEs)发生率。结果观察组PCI术后TIMI血流分级优于对照组,STR回落率高于对照组,NR/SF发生率低于对照组(P<0.05);观察组术后住院期间BNP峰值、cTnI峰值均低于对照组,LVEF峰值高于对照组(P<0.05);两组随访期间均未发生TIMI大出血,观察组MACEs发生率(心衰再住院2例)低于对照组(心源性死亡1例,心衰再住院8例),差异有统计学意义(P<0.05)。结论替罗非班联合重组人尿激酶原预处理逆行溶栓可显著改善STEMI患者PCI术后血流复流情况及左室射血功能,降低冠脉无复流及慢血流与不良心血管事件等发生率,且不增加出血风险。Objective To investigate the effect of tirofiban combined with recombinant human pro urokinase(rhPro-UK)pretreatment retrograde thrombolysis on coronary non reflow after percutaneous coronary intervention(PCI)in patients with acute ST elevation myocardial infarction(STEMI).Methods 86 STEMI patients admitted to our hospital between May 2021 and February 2023 for PCI treatment were selected.The patients were randomly divided into the control group and the observation group,with 43 cases in each group.Both groups received PCI treatment,with regular heparin sodium and tirofiban administered during surgery,while the control group received routine thrombolysis with rhPro-UK.The observation group received retrograde thrombolysis by injecting rhPro-UK from the distal to the proximal end of the criminal vessel.The blood flow classification,2h ST segment regression rate(STR),coronary no reflow and slow flow(NR/SF)rates in the thrombolysis test for myocardial infarction(TIMI),the incidence of B-type natriuretic peptide(BNP),troponin(cTnI),and left ventricular ejection fraction(LVEF)were compared between the two groups after surgery,and the incidence of TIMI major bleeding events and major adverse cardiovascular events(MACEs)were compared after 3 months of follow-up.Results The TIMI blood flow grading after PCI in the observation group was better than that in the control group,the STR regression rate was higher than that in the control group,and the incidence of NR/SF was lower than that in the control group(P<0.05);The peak values of BNP and cTnI during postoperative hospitalization in the observation group were lower than those in the control group,while the peak values of LVEF were higher than those in the control group(P<0.05);During the follow-up period,no TIMI major bleeding occurred in both groups.The incidence of MACEs in the observation group(2 cases of re-hospitalization for heart failure)was lower than that in the control group(1 case of cardiac death and 8 cases of re-hospitalization for heart failure),and the di

关 键 词：替罗非班 尿激酶原 逆行溶栓 急性ST段抬高型心肌梗死 冠脉复流 

分 类 号：R542.22[医药卫生—心血管疾病] R969[医药卫生—内科学]