重组人尿激酶原联合硝酸甘油对急性ST段抬高型心肌梗死经冠脉介入后无复流的疗效

目的探讨重组人尿激酶原联合硝酸甘油对急性ST段抬高型心肌梗死(STEMI)患者经冠状动脉介入(PCI)后无复流的疗效。方法选取2017年5月至2019年5月收治的急性STEMI患者82例,以随机数字表法分为对照组与观察组,各41例。对照组于梗死动脉的远端通过靶向灌注导管注入替罗非班联合硝酸甘油,后实施PCI治疗。观察组则于梗死动脉的远端通过靶向灌注导管注入硝酸甘油与重组人尿激酶原混合液,后实施PCI治疗。心肌梗死溶栓实验(TIMI)血流≤Ⅱ级判断为无复流,对比两组心肌灌注情况、心功能、心脏不良事件及住院期间出血事件。结果观察组TIMI分级优于对照组(Z=2.338,P=0.019),无复流发生率低于对照组(7.32%vs 26.83%,χ²=5.513,P=0.019),ST段回落>70%的发生率高于对照组(95.12%vs 78.05%,χ²=5.145,P=0.023)。治疗后观察组左室收缩末期容积、左室舒张末期容积均低于对照组,左心室射血分数高于对照组(P<0.01)。观察组心脏不良事件总发生率低于对照组(4.88%vs 21.95%,χ²=4.770,P=0.029)。两组住院期间出血事件总发生率比较差异无统计学意义(P>0.05)。结论相比替罗非班,在PCI中于梗死动脉远端经靶向灌注导管注入重组人尿激酶联合硝酸甘油,可增强急性STEMI患者的心肌灌注水平,改善无复流情况与患者心功能,降低心脏不良事件与出血事件发生风险。

Effect of recombinant human prourokinase combined with nitroglycerin on no-reflow after percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction

Objective To explore the effects of recombinant human prourokinase(rhPro-Uk)combined with nitroglycerin on no-reflow after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Eighty-two patients with acute STEMI admitted to hospital from May 2017 to May 2019 were enrolled and randomly divided into control group and observation group(n=41,each).In control group,tirofiban with nitroglycerin was injected through a targeted perfusion catheter at the distal end of infarcted artery,and then PCI was performed.In observation group,nitroglycerin combined with rhPro-uk was injected through a targeted perfusion catheter at the distal end of infarcted artery,followed by PCI.No-reflow was judged as TIMI(Thrombolysis in Myocardial Infarction Trail)blood flow≤gradeⅡ.Myocardial perfusion,cardiac function,adverse cardiac events and bleeding events during hospitalization were compared between two groups.Results Compared with control group,TIMI flow grade was better(Z=2.338,P=0.019)and the incidence of no-reflow in observation group was lower(7.32%vs 26.83%,χ²=5.513,P=0.019),and the incidence of ST segment reduction>70%was higher(95.12%vs 78.05%,χ²=5.145,P=0.023)in observation group.Compared with control group,left ventricular end-systolic volume and left ventricular end-diastolic volume decreased,and left ventricular ejection fraction increased in observation group(P<0.01).The total incidence of adverse cardiac events in observation group was significantly lower than that in control group(4.88%vs 21.95%,χ²=4.770,P=0.029).There was no statistical difference in the incidence of bleeding events during hospitalization between two groups(P>0.05).Conclusion Compared with tirofiban,rhPro-UK combined with nitroglycerin injected through a targeted perfusion catheter to the distal end of infarcted artery in PCI for acute STEMI patients can canenhance the myocardial perfusion level,improve no-reflow condition and cardiac function,also reduce the risk of adverse cardiac events and bleeding events.