冠状动脉内联合应用硝普钠与重组人尿激酶原对老年急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术中无复流的改善作用

目的:探讨急性ST段抬高心肌梗死(ST segment elevation myocardial infarction,STEMI)患者在急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)球囊扩张开通后,冠状动脉内联合应用硝普钠+重组人尿激酶原对术中冠状动脉无复流的改善作用。方法:选取2017年3月至2019年3月河北省胸科医院心内科收治的STEMI急诊PCI术中无复流患者60例作为研究对象,采用随机数表法对患者进行分组,观察组和对照组各30例。对照组患者单纯给予硝普钠治疗,观察组患者给予硝普钠+重组人尿激酶原治疗。对两组患者术后1周及术后1个月心功能参数、心肌梗死溶栓治疗(thrombolysis in myocardial infarction,TIMI)血流分级、术中及术后24 h出血情况及术后1个月内主要心脏不良事件(major adverse cardiac events,MACE)发生情况进行分析比较。结果:治疗后,观察组、对照组TIMI血流分级3级的患者分别为28例(93.33%)、20例(66.67%),在TIMI血流分级方面,观察组患者明显优于对照组,差异有统计学意义(P<0.05)。术后1个月,观察组患者左心室舒张末期内径较术后1周明显降低,且明显低于对照组同期;观察组患者左心室射血分数较术后1周明显升高,且明显高于对照组同期,差异均有统计学意义(P<0.05)。观察组、对照组患者术中及术后24 h出血率分别为16.67%(5/30)、10.00%(3/30),术后1个月内MACE发生率分别为6.67%(2/30)、20.00%(6/30),两组比较,差异均无统计学意义(χ²=0.144,P=0.704;χ²=2.401,P=0.254)。结论:冠状动脉内联合应用硝普钠与重组人尿激酶原能够有效增加STEMI急诊PCI术中无复流患者心肌灌注,改善患者的心功能。

Improvement of Combined Application of Sodium Nitroprusside and Recombinant Human Prourokinase in Coronary Artery on No-Reflow in Elderly Patients with Acute ST Segment Elevation Myocardial Infarction During Emergency Percutaneous Coronary Intervention

OBJECTIVE:To probe into the improvement of combined application of sodium nitroprusside and recombinant human prourokinase in coronary artery on no-reflow in elderly patients with acute ST segment elevation myocardial infarction(STEMI)during emergency percutaneous coronary intervention(PCI).METHODS:Totally 60 patients with no-reflow during STEMI emergency PCI admitted into our hospital from Mar.2017 to Mar.2019 were extracted to be divided into the observation group and the control group via the random number table,with 30 cases in each group.The control group was treated with sodium nitroprusside alone,while the observation group received sodium nitroprusside+recombinant human prourokinase.The cardiac function parameters after surgery of 1 week and1 month,TIMI blood flow grading,bleeding during surgery and after surgery of 24 h,major adverse cardiac events(MACE)after surgery of 1 month were compared between two groups.RESULTS:After treatment,the TIMI blood flow grading three of the observation group and the control group were respectively 28 cases(93.33%)and 20 cases(66.67%).In terms of TIMI blood flow grading,the observation group was significantly better than the control group,with statistically significant difference(P<0.05).After surgery of 1 months,the left ventricular end-diastolic diameter of the observation group was significantly lower than that after surgery of 1 week,and was significantly lower than that of the control group during the same period;the left ventricular ejection fraction of the observation group was significantly higher than that after surgery of 1 week,and was significantly higher than that of the control group during the same period,the difference was statistically significant(P<0.05).The rates of bleeding during surgery and after surgery of 24 h in the observation group and the control group were respectively 16.67%(5/30)and 10.00%(3/30),and the incidence of MACE after surgery of 1 month were respectively 6.67%(2/30)and 20.00%(6/30),the difference between two groups was not statistically significant(χ²=0.144,P=0.704;χ²=2.401,P=0.254).CONCLUSIONS:Combined application of sodium nitroprusside and recombinant human prourokinase in coronary artery can effectively increase myocardial perfusion in patients with STEMI during emergency PCI,and improve the cardiac function of patients.