急诊经皮冠状动脉介入治疗术中硝普钠与替罗非班联合重组人尿激酶原冠状动脉内注射治疗高血栓负荷ST段抬高型心肌梗死患者的效果  

Effect of Sodium Nitroprusside,Tirofiban and Rh-proUK by Intracoronary Injection in STEMI Patient with High Thrombus Load During PCI

作　　者：贝晓娜 莫昌干[1] 韩辉[1] 韦利元[1] 夏景敏 韦颖[1] BEI Xiao-Na;MO Chang-Gan;HAN Hui;WEI Li-Yuan;XIA Jing-Min;WEI Ying(Department of Cardiovascular Medicine,Hechi People's Hospital,Hechi 547000,China)

机构地区：[1]河池市人民医院心血管内科,广西河池547000

出　　处：《中国药物经济学》2024年第7期48-52,共5页China Journal of Pharmaceutical Economics

基　　金：右江民族医学院2021年度校级科研课题(yy2021sk111)。

摘　　要：目的 探讨急诊经皮冠状动脉介入治疗(PCI)术中硝普钠、替罗非班联合重组人尿激酶原冠状动脉内注射治疗高血栓负荷ST段抬高型心肌梗死(STEMI)患者的临床疗效。方法 选取2022年11月至2023年11月于河池市人民医院心血管内科行PCI的86例高血栓负荷STEMI患者作为研究对象,按随机数字表法分为对照组和观察组,各43例。对照组依次冠状动脉内注射硝普钠、替罗非班,观察组依次冠状动脉内注射重组人尿激酶原、硝普钠、替罗非班。比较两组肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、TIMI血流分级、TIMI心肌灌注分级(TMPG)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、N末端脑钠肽前体(NT-proBNP)、主要不良心血管事件(MACE)及出血事件发生情况。结果 术后,观察组CK-MB、cTnI高于对照组(P<0.05);术后即刻,观察组TIMI血流分级、TMPG分级较对照组改善(P<0.05);术后3个月,两组LVEDD、LVEF比较差异无统计学意义(P>0.05),观察组NT-proBNP低于对照组(P<0.05);术后随访3个月,观察组MACE发生率低于对照组(P<0.05);两组出血事件发生率比较差异无统计学意义(P>0.05)。结论 急诊PCI术中重组人尿激酶原、硝普钠、替罗非班联合冠状动脉内注射,可改善高血栓负荷STEMI患者心肌灌注及心功能,降低MACE风险。Objective To explore the effect of sodium nitroprusside,tirofiban and rh-proUK by intracoronary injection in ST-elevation myocardial infarction(STEMI) patient with high thrombus load during percutaneous coronary intervention(PCI).Methods A total of 86 STEMI patients with high thrombotic load who underwent PCI in the cardiovascular Department of Hechi People's Hospital from November 2022 to November 2023 were selected as the study objects,and were divided into control group and observation group according to random number table method,with 43 cases in each group.The control group was successively injected with sodium nitroprusside and tirofiban in the coronary artery,while the observation group was successively injected with recombinant human urokinase,sodium nitroprusside and tirofiban in the coronary artery.Creatine kinase isoenzyme(CK-MB),troponin I(cTnI),TIMI blood flow grading,TIMI myocardial perfusion grading(TMPG),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),N-terminal brain natriuretic peptide precursor(NT-proBNP),and major adverse cardiovascular events(MACE) and the occurrence of bleeding events were compared between two groups.Results After operation,CK-MB and cTnI in observation group were higher than those in control group(P<0.05).Immediately after operation,TIMI blood flow grading and TMPG grading in observation group were improved compared with control group(P<0.05).Three months after surgery,there was no significant difference in LVEDD and LVEF between the two groups(P>0.05),and NT-proBNP in the observation group was lower than that in the control group(P<0.05).The incidence of MACE in the observation group was lower than that in the control group(P<0.05).There was no significant difference in the incidence of bleeding events between the two groups(P>0.05).Conclusion Recombinant human urokinase,sodium nitroprusside and tirofiban combined with intra-coronary injection during emergency PCI can improve myocardial perfusion and cardiac function and reduce the r

关 键 词：经皮冠状动脉介入治疗 高血栓负荷 重组人尿激酶原 ST段抬高型心肌梗死 

分 类 号：R541.4[医药卫生—心血管疾病] R972[医药卫生—内科学]