重组人尿激酶原治疗ST段抬高型心肌梗塞患者的临床研究

目的探究冠状动脉内应用重组人尿激酶原对ST段抬高型心肌梗塞(STEMI)患者冠状动脉微循环再灌注水平的影响。方法将2018年6月至2020年5月我院急诊收治的84例高血栓负荷STEMI患者随机分为对照组44例和试验组40例。对照组在冠状动脉介入术(PCI)中经血栓抽吸后冠状动脉内应用血小板GPIIb/IIIa受体阻滞药注射替罗非班(10μg·kg-1),再行常规PCI术;试验组在PCI术中经血栓抽吸后冠状动脉内应用替洛非班(10μg·kg-1),而后冠状动脉内注射重组人尿激酶原(20 mg),再行常规PCI术,比较2组患者手术时间节点、术后心肌血流灌注、心功能、心电图ST段变化以及药物不良反应。结果术后,对照组和试验组PCI术后恢复心肌梗死溶栓治疗(TIMI)3级的比例分别为93.18%(41例/44例)和97.50%(39例/40例),差异无统计学意义(P>0.05);校正的TIMI血流帧数(CTFC)分别为24.64±6.69和20.05±3.20,TIMI心肌灌注分级(TMPG)等于3级比例分别为68.18%(30例/44例)和90.00%(36例/40例),术后2 h的ST段回落率分别为86.36%(38例/44例)和92.50%(37例/40例),差异均有统计学意义(均P<0.05);术后,对照组出现心力衰竭5例,心律失常3例,出血事件2例,药物不良反应发生率为22.72%(10例/44例);试验组出现心力衰竭3例,心律失常3例,出血事件1例,药物不良反应发生率为17.50%(7例/40例),差异无统计学意义(P>0.05)。结论与替罗非班比较,冠状动脉内应用重组人尿激酶原可进一步改善术后心肌组织灌注水平,改善冠状动脉微循环障碍,减低无复流的发生率,且不增加药物不良反应。

Recombinant human urokinase in the treatment of ST segment elevation myocardial infarction

Objective To investigate the effect of intracoronary application of recombinant human prourokinase on the level of coronary microcirculation reperfusion in patients with ST segment elevation myocardial infarction(STEMI).Methods 84 STEMI patients with high thrombus load admitted to our hospital were randomly divided into control group(44 cases) and treatment group(40 cases) from June 2018 to May 2020.In the control group, the platelet GPIIb/IIIa receptor blocker was injected with tirofiban(10 μg·kg-1) into the coronary artery after thrombus aspiration during percutaneous coronary intervention(PCI), followed by routine PCI;In the treatment group, tilofiban(10 μg·kg-1) was injected into the coronary artery after thrombus aspiration during PCI,and then recombinant human prourokinase(20 mg) was injected into the coronary artery,followed by routine PCI.Time node,postoperative myocardial blood perfusion,cardiac function,ST segment changes of electrocardiogram,and adverse drug reactions were compared in two groups.Results After the operation,the proportion of the control group and the treatment group who resumed myocardial infarction thrombolytic therapy(TIMI)level 3 after PCI was 93.18%(41/44) and 97.50%(39/40) respectively,the difference was not statistically significant(P > 0.05);The corrected TIMI blood flow frames(CTFC) were 24.64 ± 6.69 and 20.05 ± 3.20,respectively,the proportion of TIMI myocardial perfusion grade(TMPG) equal to grade 3 was 68.18%(30/44) and90.00%(36/40) respectively,the rate of ST-segment fall in two hours after operation was 86.36%(38/44) and92.50%(37/40) respectively,differences in the above indicators were statistically significant(P < 0.05);After operation,the incidence of adverse drug reactions in the control group was 22.72%(10/44) with 5 cases of heart failure,3 cases of arrhythmia,2 cases of bleeding events included,the incidence of adverse drug reactions in the treatment group was 17.50%(7/40) with 3 cases of heart failure,3 cases of arrhythmia,1 case of bleeding events included,the difference of adverse drug reactions in two grup was not statistically significant(P > 0.05).Conclusion Compared with Tirofiban,intracoronary application of recombinant human urokinase can further improve myocardial perfusion level,improve coronary microcirculation disturbance,reduce the incidence of no-reflow,and would not increase adverse drug reactions.