注射用重组人尿激酶原溶栓后早期PCI与延迟PCI治疗急性ST段抬高型心肌梗死的对比研究  

Comparative study on early PCI and delayed PCI in treatment of acute ST-segment elevation myocardial infarction after thrombolysis with recombinant human prourokinase for injection

作　　者：王晓宇 范西真 王喆 岳萃涛 Wang Xiaoyu;Fan Xizhen;Wang Zhe;Yue Cuitao(Department of General Medicine,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,Anhui,China)

机构地区：[1]中国科学技术大学第一附属医院(安徽省立医院)全科医学科,安徽合肥230001

出　　处：《实用检验医师杂志》2024年第4期315-318,共4页Chinese Journal of Clinical Pathologist

摘　　要：目的对急性ST段抬高型心肌梗死(STEMI)患者给予注射用重组人尿激酶原(rhPro-uk)进行溶栓治疗,比较溶栓后联合早期经皮冠状动脉(冠脉)介入治疗(PCI)与延迟PCI对STEMI患者的安全性和有效性。方法选择2020年12月—2023年12月安徽省多医学中心的146例STEMI患者作为研究对象,给予注射用rhPro-uk进行溶栓治疗,将溶栓后24 h内行PCI治疗的88例患者作为研究组,超过24 h行PCI治疗的58例患者作为对照组。比较两组ST段回落>50%、胸痛完全缓解、PCI术支架植入的占比以及出院前和出院后1个月的心脏彩超指标〔左心房内径(LAD)、左室舒张期末内径(LVEDD)、左室射血分数(LVEF)〕,记录并分析在院期间全部出血事件发生率和主要不良心血管事件(MACCE)、净临床不良事件(NACE)发生情况。结果研究组胸痛完全缓解占比显著高于对照组(80.7%比51.7%,P<0.05),PCI术支架植入占比显著低于对照组(64.8%比98.3%,P<0.05),研究组和对照组ST段回落>50%占比差异无统计学意义(87.5%比86.2%,P>0.05)。研究组出院前LVEF水平显著高于对照组〔54.50%(44.00%,55.50%)比52.50%(42.00%,55.00%),P<0.05〕;两组出院前LAD、LVEDD差异均无统计学意义。研究组出院后1个月LAD、LVEDD均显著低于对照组,LVEF显著高于对照组〔LAD(mm):37.45(35.00,39.45)比38.80(36.75,41.00);LVEDD(mm):46.55(43.25,52.85)比51.00(46.15,55.50);LVEF:56.00%(53.00%,59.75%)比50.50%(46.00%,55.50%);均P<0.05〕。两组院内均未出现心源性猝死和再发心肌梗死事件,所有出血发生率差异无统计学意义;研究组MACCE、NACE、充血性心力衰竭及严重心律失常发生率均显著低于对照组(MACCE:9.1%比24.1%;NACE:9.1%比27.6%;充血性心力衰竭:3.4%比13.8%;严重心律失常:3.4%比13.8%;均P<0.05)。结论STEMI患者给予注射用rhPro-uk溶栓后24 h内行PCI治疗能显著改善患者心肌重构,减少支架植入数量,不良事件发生率更低,且出血风险无显著增加。注射用rhPrObjective To compare the safety and efficacy of early percutaneous coronary intervention(PCI)and delayed PCI after thrombolysis in patients with acute ST-segment elevation myocardial infarction(STEMI)by giving recombinant human prourokinase(rhPro-uk)for injection.Methods A total of 146 patients with STEMI in multiple medical centers in Anhui Province from December 2020 to December 2023 were selected as study subjects,and rhPro-uk for injection was given for thrombolysis.The 88 patients who underwent PCI treatment within 24 hours after thrombolysis were selected as research group,and 58 patients who underwent PCI treatment after 24 hours were selected as control group.The proportions of ST segment regression>50%,complete relief of chest pain and PCI stent implantation were compared between the two groups,as well as cardiac color ultrasound indicators[left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)]before and after 1 month of discharge between two groups were compared.The incidences of all bleeding events in hospital,major adverse cardiovascular events(MACCE)and net clinical adverse events(NACE)were recorded and analyzed.Results The proportion of complete relief of chest pain in research group was higher than that in control group(80.7%vs.51.7%,P<0.05),the proportion of PCI stent implantation in research group was lower than that in control group(64.8%vs.98.3%,P<0.05),and the proportion of ST segment regression>50%was not significantly different between two groups(87.5%vs.86.2%,P>0.05).The level of LVEF before discharge in research group was significantly higher than that in control group[54.50%(44.00%,55.50%)vs.52.50%(42.00%,55.00%),P<0.05].There was no significant difference in LAD and LVEDD between two groups before discharge.One month after discharge,the LAD and LVEDD in research group were lower than those in control group,and LVEF was higher than that of control group[LAD(mm):37.45(35.00,39.45)vs.38.80(36.75,41.00);LVEDD(mm):46.55(43.25,52.8

关 键 词：急性ST段抬高型心肌梗死 重组人尿激酶原 溶栓治疗 经皮冠状动脉介入治疗 

分 类 号：R54[医药卫生—心血管疾病]