急性ST段抬高心肌梗死患者急诊介入手术中联合使用替罗非班与尿激酶原行冠状动脉内溶栓的效果分析  

Therapeutic effect of intracoronary thrombolysis with tirofiban and prourokinase during emergency percutaneous coronary intervention for acute ST elevation myocardial infarction

作　　者：李世良 Li Shiliang(Cardiovascular Intensive Care Unit,Zhengzhou Yihe Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州颐和医院心血管内科重症监护室,郑州450000

出　　处：《中国实用医刊》2024年第20期87-91,共5页Chinese Journal of Practical Medicine

摘　　要：目的探讨联合使用替罗非班与尿激酶原行冠状动脉内溶栓在急性ST段抬高心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)手术中的临床疗效。方法队列研究。抽取2020年3月至2023年3月于郑州颐和医院治疗的82例急性STEMI患者,按照随机数字表法分为对照组和研究组,每组41例。对照组于急诊PCI手术时予以替罗非班行冠状动脉内溶栓,研究组于对照组治疗基础上联合使用尿激酶原溶栓。比较两组梗死相关动脉心肌梗死溶栓治疗(TIMI)血流分级、校正TIMI血流帧数(CTFC)、ST段回落情况、血清心肌损伤标志物[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)]水平、心功能[心排血量(CO)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)]及不良事件发生率。结果术后,研究组TIMI血流分级及CTFC优于对照组(P<0.05);术后2 h,研究组ST段回落≥50%者占90.24%(37/41),高于对照组的70.73%(29/41),P<0.05;研究组血清CK峰值、CK-MB峰值、cTnI峰值均低于对照组(P均<0.05)。术后,两组LVEF、CO均高于对照组,LVEDD均低于对照组,且研究组LVEF、CO高于对照组,LVEDD低于对照组(P<0.05)。两组术后出血事件和主要不良事件发生率比较差异均未见统计学意义(P均>0.05)。结论在对急性STEMI患者进行急诊PCI手术时,联用替罗非班与尿激酶原行冠状动脉内溶栓能够提高临床疗效且安全性高,在术后血流恢复、减轻心肌损伤、改善心功能等方面表现更好。Objective To investigate the clinical efficacy of intracoronary thrombolysis with tirofiban and prourokinase during emergency percutaneous coronary intervention(PCI)for acute ST elevation myocardial infarction(STEMI).Methods Eighty-two acute STEMI patients treated in Zhengzhou Yihe Hospital from March 2020 to March 2023 were selected for the cohort study.And they were divided into the control group and the study group by random number table method,with 41 cases in each group.The control group was treated by intracoronary thrombolysis with tirofiban during emergency PCI,and the study group was treated by thrombolysis with prourokinase based on the treatment of the control group.The infarction related artery thrombolysis in myocardial infarction(TIMI)blood flow grade,corrected TIMI frame count(CTFC),the ST segment regression,level of serum myocardial injury markers,including creatine kinase(CK),creatine kinase isoenzyme(CK-MB)and cardiac troponin I(cTnI),cardiac function assessed by cardiac output(CO),left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF),and incidence of adverse events of the two groups were compared.Results After surgery,TIMI blood flow grading and CTFC in the study group were superior to those in the control group(P<0.05).At 2 hours after surgery,the proportion of patients with ST segment regression≥50%in the study group was 90.24%(37/41),which was higher than the 70.73%(29/41)in the control group(P<0.05).The peak values of serum CK,CK-MB,and cTnI in the study group were all lower than those in the control group(all P<0.05).After surgery,LVEF and CO in the two groups increased,and LVEDD decreased(P<0.05);moreover,the study group had higher LVEF,higher CO and lower LVEDD compared with the control group after surgery(P<0.05).There was no significant difference in the incidence of postoperative bleeding events and major adverse events between the two groups(both P>0.05).Conclusions During emergency PCI surgery for patients with acute STEMI,intracoronary thrombo

关 键 词：ST段抬高心肌梗死 经皮冠状动脉介入 替罗非班 尿激酶原 

分 类 号：R542.22[医药卫生—心血管疾病]