PCI术后重组人尿激酶原靶血管注射对高血栓负荷急性心肌梗死患者的疗效  

Efficacy of target vessel injectionof recombinant human prourokinase after percutaneous coronary interventionon patients with acute myocardial infarction and high thrombus burden

作　　者：卜秀娟 林芳 王宝磊 张金忠 BU Xiujuan;LIN Fang;WANG Baolei;ZHANG Jinzhong(Department of Cardiovascular Medicine,Jiaozhou Central Hospital of Qingdao,Qingdao Shandong 266300,China)

机构地区：[1]青岛市胶州中心医院心血管内科,山东青岛266300 [2]青岛市胶州中心医院妇科,山东青岛266300 [3]青岛市胶州中心医院急诊科,山东青岛266300

出　　处：《中国急救复苏与灾害医学杂志》2024年第7期926-930,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：青岛市医药卫生科研指导项目(编号:2023-WJZD141)。

摘　　要：目的 探究冠状动脉介入(PCI)术后重组人尿激酶原靶血管注射对高血栓负荷急性心肌梗死(AMI)患者的疗效。方法 回顾性分析2020年3月—2023年2月期间青岛市胶州中心医院心血管内科急诊收治经PCI高血栓负荷的急性ST段抬高型心肌梗死(STEMI)患者,依据患者不同的治疗方法分为观察组与对照组,观察组在常规PCI术后冠状动脉靶血管注射重组人尿激酶原,对照组在常规PCI术后冠状动脉靶血管注射等量生理盐水,根据倾向性匹配评分排除基线资料混杂因素(卡钳值0.02),最终两组各得51例患者。比较两组手术前后血流分级(TIMI)、心肌组织灌注、治疗前后心肌损伤指标、治疗前与治疗后1个月心功能,院内不良心血管事件(MACE)与再出血发生率。结果 术后,观察组TIMI分级显著优于对照组,矫正TIMI帧数计数(CTFC)及靶血管慢血流率显著低于对照组,而术后1h ST段回落50%率显著高于对照组(均P<0.05);治疗后,观察组患者心肌损伤标志物、左室舒张末期内径(LVED)均显著低于对照组,左室射血分数(LVEF)、左室短轴缩短率(FS)显著高于对照组(P<0.05);观察组MACE发生率显著低于对照组(P<0.05),而术后6个月内,两组再出血发生率比较差异无统计学意义(P>0.05)。结论 PCI术后重组人尿激酶原靶血管注射可改善STEMI患者PCI术后心肌血流灌注,降低心肌损伤,恢复心功能,安全性高。Objective To investigate the efficacy of recombinant human prothrombinase target vessel injection after percutaneous coronary intervention(PCI) in patients with high thrombotic load acute myocardial infarction(AMI).Methods Retrospective analysis was performed on patients with acute ST-segment elevation myocardial infarction(STEMI) who showed high thrombus burden during emergency PCI in department of cardiology of Jiaozhou Central Hospital of Qingdao were included from March 2020 to February 2023.Divide the patients into observation group and control group according to the treatment method.The observation group was given intracoronary target vessel injection normal salineafter routine PCI,whereas the control group received intracoronary target vessel injection of recombinant human prourokinase,excluding confounding factors in baseline data based on propensity matching score(clamp value0.02),thus 51 patients were obtained in each group.The blood flow grading(TIMI) and myocardial tissue perfusion before and after surgery,myocardial injury indicators before and after treatment,cardiac function before treatment and at 1 month after treatment and incidence rates of in-hospital major adverse cardiovascular events(MACE) and rebleeding were compared between the two groups.Results After surgery,the TIMI grading in the observation group was significantly better than that in control group,the corrected TIMI frame count(CTFC) and target vessel slow blood flow rate were significantly lower than that in control group,the ST-segment resolution 50% rate at 1 hour after surgery was significantly higher than that in control group(P<0.05).After treatment,the myocardial injury markers in observation group were significantly lower than that in control group,the left ventricular end diastolic diameter(LVED)was lowed in control group,left ventricular ejection fraction(LVEF) and left ventricular short axis shortening rate(FS)were higher than that in control group(P<0.05).The incidence rate of MACE was significantly lower in observation g

关 键 词：重组人尿激酶原 高血栓负荷急性心肌梗死 心肌血流灌注 

分 类 号：R542.22[医药卫生—心血管疾病]