三种冠状动脉内灌注用药方案对高血栓负荷急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后心肌灌注及短期预后的影响  

Effects of three intracoronary infusion regimens on myocardial perfusion and short-term prognosis in ST-segment elevation myocardial infarction patients with high thrombus burden after percutaneous coronary intervention

作　　者：晋辉[1] 郑献召 沈玲 曾辉[1] 王中明 韩风杰 杭晓阳 刘静[1] 周庆庆 朱艳霞 王晓飞 郑海军 Jin Hui;Zheng Xianzhao;Shen Ling;Zeng Hui;Wang Zhongming;Han Fengjie;Hang Xiaoyang;Liu Jing;Zhou Qingqing;Zhu Yanxia;Wang Xiaofei;Zheng Haijun(Department of Cardiology,Jiaozuo People’s Hospital Affiliated to Xinxiang Medical College,Jiaozuo 454000,China)

机构地区：[1]新乡医学院附属焦作市人民医院心内科,454000

出　　处：《中国心血管杂志》2024年第2期143-151,共9页Chinese Journal of Cardiovascular Medicine

基　　金：河南省医学科技攻关计划项目(202223004)。

摘　　要：目的探讨三种冠状动脉内灌注用药方案对高血栓负荷急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心肌灌注及短期预后的影响。方法前瞻性、单中心、随机对照研究。纳入2017年3月至2021年8月焦作市人民医院心内科高血栓负荷STEMI患者150例,按照分层区组随机化原则等分为三组各50例。A组:尼可地尔+替罗非班靶血管灌注;B组:尿激酶原+替罗非班靶血管灌注;C组:尼可地尔+尿激酶原+替罗非班靶血管灌注。于PCI术前、术后即刻检测记录梗死相关动脉(IRA)的心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)、校正的TIMI血流帧数(CTFC);于PCI术前、术后24 h记录心电图的ST段回落幅度;记录IRA开通后24 h内Curtis-Walker评分及恶性心律失常例数;于PCI术前、术后0 h、12 h、24 h、3 d及7 d检测血清高敏肌钙蛋白I(hs-cTnI);于PCI术前、术后24 h及7 d检测丙二醛(MDA)、超氧化物歧化酶(SOD);于PCI术前、术后7 d、术后1个月、术后6个月及术后12个月检测左心室射血分数(LVEF)。随访记录患者住院期间及出院后30 d内的出血事件及术后12个月内主要不良心血管事件(MACE)。结果(1)PCI术后即刻,C组患者的TIMI血流分级、TMPG均优于A组(Z=-16.610,P=0.023;Z=-18.400,P=0.015)和B组(Z=-15.130,P=0.046;Z=16.550,P=0.035);C组患者的CTFC帧数低于A组(P<0.001)和B组(P=0.001)。(2)PCI术后,C组患者的血清hs-cTnI水平低于A组和B组(均为P<0.001)。(3)PCI术后,C组患者的MDA水平低于A组和B组(均为P<0.001),SOD水平高于A组(P=0.004)和B组(P=0.024)。(4)PCI术后24 h,C组患者的ST段回落幅度大于A组(P=0.003)和B组(P=0.012),Curtis-Walker评分及恶性心律失常发生率低于A组(P=0.008、0.015)和B组(P=0.014、0.034)。(5)PCI术后,C组患者的LVEF水平高于A组和B组(均为P<0.001)。(6)住院期间及出院后30 d内,三组患者均未发生大出血,少量出血和微量出血的发生率比较无统计学�Objective To investigate the effects of three intracoronary infusion regimens on myocardial perfusion and short-term prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI)with high thrombus burden after percutaneous coronary intervention(PCI).Methods Prospective,single-center,randomized controlled study.From March 2017 to August 2021,a total of 150 STEMI patients with high thrombus burden were enrolled in the Department of Cardiology,Jiaozuo People’s Hospital.According to the principle of stratified block randomization,they were divided into three groups with 50 cases in each group.Group A:Nicorandil+Tirofiban target vessel perfusion;group B:Prourokinase+Tirofiban target vessel perfusion;group C:Nicorandil+Prourokinase+Tirofiban target vessel perfusion.Thrombolysis in myocardial infarction(TIMI)flow grade,TIMI myocardial perfusion grade(TMPG)and corrected TIMI frame count(CTFC)of infarct-related artery(IRA)were detected and recorded before and immediately after PCI.The ST-segment resolution was recorded before and 24 h after PCI.Curtis-Walker score and the number of malignant arrhythmia cases were recorded within 24 h after IRA opening.Serum high-sensitivity troponin I(hs-cTnI)was detected before PCI and at 0 h,12 h,24 h,3 d and 7 d after PCI.Malondialdehyde(MDA)and superoxide dismutase(SOD)were detected before PCI and at 24 h and 7 d after PCI.Left ventricular ejection fraction(LVEF)was measured before PCI and at 7 days,1 month,6 months and 12 months after PCI.Bleeding events during hospitalization and within 30 days after discharge and major adverse cardiovascular events(MACE)within 12 months after PCI were recorded.Results(1)Immediately after PCI,TIMI flow grade and TMPG in group C were better than those in group A(Z=-16.610,P=0.023;Z=-18.400,P=0.015)and group B(Z=-15.130,P=0.046;Z=16.550,P=0.035);The number of CTFC frames in group C was lower than that in group A(P<0.001)and group B(P=0.001).(2)After PCI,the serum hs-cTnI level in group C was lower than that in group A and group

关 键 词：急性ST段抬高型心肌梗死 高血栓负荷 经皮冠状动脉介入 尼可地尔 重组人尿激酶原 心肌灌注 

分 类 号：R54[医药卫生—心血管疾病]