冠脉内注射组织型纤溶酶原激活剂对急性心肌梗死患者PCI术后冠脉血流水平及预后的影响  

Effects of intracoronary injection of recombinant tissue plasminogen activator on coronary blood flow and prognosis in patients with acute myocardial infarction undergoing PCI

作　　者：刘刚 张春德 宋家卫 唐碧 刘利军 LIU Gang;ZHANG Chun-de;SONG Jia-wei;TANG Bi;LIU Li-jun(Cardiovascular Department,the First Hospital of Anhui University of Science&Technology,Huainan 232000,Anhui,China)

机构地区：[1]安徽理工大学第一附属医院心血管内科,安徽淮南232000

出　　处：《广东医学》2025年第2期295-299,共5页Guangdong Medical Journal

基　　金：安徽省自然科学基金资助项目(2208085MH192)。

摘　　要：目的探讨冠脉内注射组织型纤溶酶原激活剂(rt-PA)对急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)后冠脉血流水平及预后的影响,以期为AMI患者寻求最佳治疗方式。方法研究对象为2023年4月至2024年4月行急诊PCI治疗的AMI患者共150例,根据患者再灌注方法的不同进行分组,观察组向冠脉内注射rt-PA后行冠脉支架植入,对照组进行常规球囊扩张后冠脉支架植入。记录两组手术前后的心肌梗塞溶栓治疗(TIMI)血流分级、心功能指标、炎症因子、凝血功能变化及不良心血管事件发生情况等。结果两组术后的TIMI分级分布情况接近(P>0.05)。相比对照组,观察组术后的无复流率明显更低,观察组术后的校正TIMI血流帧数(CTFC)值更低,ST段回落率更高(P<0.05)。两组术后30 d的左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)水平接近(P>0.05),术后的肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、C反应蛋白(CRP)、D-二聚体(D-D)水平接近(P>0.05),但相比对照组,观察组术后的N末端脑钠肽(NT-proBNP)及纤维蛋白原(FIB)水平明显更低(P<0.05)。观察组术后3个月内的主要不良心血管事件(MACE)总发生率明显比对照组更低(7.14%vs.17.50%,P<0.05)。结论急诊PCI配合冠脉内注射rt-PA治疗AMI有助于改善患者的冠脉血流灌注,保护心肌细胞,减少无复流的发生,降低不良心血管事件的发生风险,提高预后效果。Objective To investigate the effects of intracoronary injection of recombinant tissue plasminogen activator(rt-PA)on coronary blood flow levels and prognosis in patients with acute myocardial infarction(AMI)undergoing percutaneous coronary intervention(PCI).Methods A total of 150 AMI patients who underwent emergency PCI between April 2023 and April 2024 were included in the study.The patients were divided into two groups based on the reperfusion method:the observation group received intracoronary rt-PA injection followed by coronary stent implantation,while the control group underwent conventional balloon dilatation followed by coronary stent implantation.Preoperative and postoperative thrombolysis in myocardial infarction(TIMI)flow grades,cardiac function parameters,inflammatory markers,coagulation function changes,and major adverse cardiovascular events(MACE)were recorded and compared between the two groups.Results The postoperative TIMI flow grade distribution was similar between the two groups(P>0.05).Compared with the control group,the observation group demonstrated a significantly lower no-reflow rate,a lower corrected TIMI frame count(CTFC),and a higher ST-segment resolution rate(P<0.05).At 30 days post-operation,no significant differences were observed between the two groups in left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),or left ventricular end-systolic volume(LVESV)(P>0.05).Similarly,the postoperative levels of creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),C-reactive protein(CRP),and D-dimer(D-D)were comparable between the two groups(P>0.05).However,the observation group exhibited significantly lower levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)and fibrinogen(FIB)compared to the control group(P<0.05).Additionally,the total incidence of MACE within 3 months post-operation was significantly lower in the observation group compared to the control group(7.14%vs.17.50%,P<0.05).Conclusion Emergency PCI combined with intracoronary injection of rt-PA

关 键 词：组织型纤溶酶原激活剂 急性心肌梗死 经皮冠状动脉介入术 溶栓 无复流 

分 类 号：R453[医药卫生—治疗学] R542.2[医药卫生—临床医学]