尿激酶原联合血栓抽吸对高血栓负荷的STEMI患者的疗效观察

目的 比较重组人尿激酶原与替罗非班对高血栓负荷的ST段抬高型心肌梗死患者的疗效。方法 选取2015年10月~2017年4月就诊于唐山工人医院行急诊冠状动脉造影术提示存在高血栓负荷的急性ST段抬高型心肌梗死患者90例患者为研究对象，随机分为A组（经皮冠状动脉介入治疗（PCI）术中经血栓抽吸导管于病变远端注射重组尿激酶原）44例与B组（在PCI术中经血栓抽吸后于病变近端注入替罗非班）46例。比较两组患者的一般资料、心肌组织灌注水平、住院及随访期间不良心血管事件和出血风险等发生情况。结果 在符合入选标准的90例研究对象中，平均年龄为61.53±8.53岁，男性63例（70.0%）。A、B两组患者一般资料差异均无统计学意义（P>0.05）；A、B两组患者在PCI术后恢复TIMI血流3级的比例方面比较差异无统计学意义（P>0.05），校正的心肌梗死溶栓治疗试验帧数、心肌组织灌注分级、术后2h内ST段回落率比较差异均具有统计学意义（P<0.05）；术后随访1个月发现，A、B两组左心室射血分数比较差异有统计学意义（P<0.05）；A、B两组患者再发心绞痛、再发心肌梗死、心力衰竭、死亡、出血的发生率比较差异均无统计学意义（P>0.05）。结论 高血栓负荷的STEMI患者在PCI时冠脉内注射重组人尿激酶原联合血栓抽吸较血栓抽吸联合冠脉内注射替罗非班，能进一步提高术后的心肌组织灌注水平，降低无复流的发生率，且不会增加心脏不良事件和出血事件的发生率。

Effect of rhPro-UK Combined with Thrombus Aspiration on STEMI Patients with High Thrombotic Burden

Objective To compare the curative effect of rh-prourokinase and tirofiban on patients with ST-segment elevation myocardial infarction with high thrombus load.Methods Ninety patients who had acute STEMI and high thromboembolic load were selected in the Tangshan worker''s hospital from October 2015 to April 2017. The selected patients were randomly divided into Group A (44 patients, the application of thrombus aspiration catheter to rh-prourokinase injection at the distal end of the lesion) and Group B (46 patients, the application of thrombus aspiration catheter to tirofiban injection at the proximal end of the lesion). The two groups were routinely treated with PCI after drug treatment. The basic characteristics, myocardial perfusion, the adverse cardiovascular events, the risk of bleeding during the hospitalization and follow-up were compared between two groups.Results Among the included 90 patients, the average age was 61.53±8.53 years old, and 63 (70%) patients were male. There were no significant differences (P>0.05) in basic characteristics between two groups; There was no significant difference (42 vs 41 P>0.05) in 3 levels of TIMI blood flow after PCI, while there were significant differences in the corrected TIMI frame count (cTFC) (25.73±3.23 vs 27.59±4.85, P=0.035), TIMI myocardial perfusion grade (TMPG) (41 vs 36, P=0.044) and ST segment fall rate (36 vs 28, P=0.028); Through the observation of 1-month follow-up after PCI, there was significant difference in left ventricular ejection fraction (56.43±3.38 vs 3.74±6.10, P=0.011) between two groups. Patients with recurrent angina pectoris, recurrent myocardial infarction, heart failure, death and bleeding rates in Group A were 4.7%, 2.3%, 2.3%, 2.3%, 4.7%, respectively. Patients with recurrent angina pectoris, recurrent myocardial infarction, heart failure, death and bleeding rates in Group B were 7%, 0, 7% 6.5% and 7%, respectively. There were no significant differences in above indexes between two groups (P>0.05).Conclusion Injection of rh-prourokinase by thrombus aspiration catheter in combination with thrombus aspiration significantly improved the myocardial perfusion level after PCI, reduced the incidence of no reflow, and decreased the incidence of cardiac adverse events and bleeding events.