尿激酶原联合尼可地尔术前冠脉灌注对STEMI患者PCI术后心功能、炎性反应及MACE影响

[摘要]目的：探讨尿激酶原联合尼可地尔对ST段抬高型心肌梗死（STEMI）患者急诊直接经皮冠状动脉介入（PCI）术后心功能、炎性反应及心血管事件发生的影响。方法：入选2018年11月～2019年11月在我院心内科收治的126例行PCI的STEMI患者为研究对象，按照随机数表法分为观察组和对照组各63例，对照组给予尿激酶原（10mg）；观察组在对照组基础给予尼可地尔（12mg）治疗。比较两组患者术后心功能超声指标、炎症反应及不良心血管事件发生情况。结果：两组术后6个月心功能、炎性反应较本组术后1、3个月均有所改善（P<0.05）；观察组术后1、3个月LEVDD、LVESVI较对照组均有所下降（P<0.05)，术后6个月LEVDD（43.29±3.18vs.47.43±3.58 ）mm、LVESVI（32.86±6.43vs.38.17±6.93）ml/m2显著低于对照组，（P<0.05)；观察组术后1、3个月LEVF、PER较对照组有所提高（P<0.05)，术后6个LEVF(59.48±4.19vs.56.89±4.49)%、PER(1.91±0.19vs.1.82±0.24)EDV/s显著高于对照组，（P<0.05)；两组术后炎性反应CRP（12h、7d）、IL-6（12h）时点出现升高，术后其他时点均有所下降（P<0.05）；观察组术后6个月MPO（171.62±21.11vs.198.25±20.11）mg/L、CRP（3.08±0.86vs.4.23±0.51）mg/L、IL-6（2.51±0.44vs.3.08±0.95）mg/L、BNP（139.94±17.36vs.168.95±19.64）pg/ml显著低于对照组（P<0.05）；观察组靶血管血运重建、心绞痛、心力衰竭、再发心肌梗死比例均低于对照组，但差异无统计学意义(P＞0.05)，不良心血管事件（MACE）总发生率为（11.11%vs.28.57%）显著低于对照组（P<0.05）。结论：尿激酶原联合尼可地尔应用于行PCI术的STEMI患者，可进一步有效改善其心功能，抑制炎症反应，减少不良心血管事件的发生。

Effects of pre-urokinase combined with nicorandil coronary perfusion on cardiac function, inflammatory response and MACE after PCI in STEMI patients

[Abstract] Objective: To explore the effect of prourokinase combined with nicorandil on cardiac function, inflammatory response and cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI). Methods: A total of 126 patients with STEMI undergoing PCI who were admitted to the Department of Cardiology in our hospital from November 2018 to November 2019 were selected as the research object. They were divided into observation group and control group according to random number table method. (10mg); the observation group was given nicorandil (12mg) on the basis of the control group. The postoperative cardiac function ultrasound indexes, inflammatory response and the occurrence of adverse cardiovascular events were compared between the two groups. Results: The cardiac function and inflammatory response at 6 months after surgery in both groups were improved compared with those at 1 and 3 months after surgery (P<0.05); LEVDD and LVESVI in the observation group decreased 1 and 3 months after operation compared with the control group (P <0.05), 6 months after operation, LEVDD (43.29 ± 3.18 vs. 47.43 ± 3.58) mm, LVESVI (32.86 ± 6.43vs.38.17 ± 6.93) ml / m2 was significantly lower than that of the control group (P <0.05); the observation group had an increase in LEVF and PER at 1 and 3 months after the operation compared with the control group (P <0.05), 6 LEVF (59.48 ± 4.19 vs. 56.89 ± 4.49)%, PER (1.91 ± 0.19vs.1.82 ± 0.24) EDV / s is significantly higher than the control group, (P <0.05); postoperative inflammatory response CRP (12h, 7d), IL-6 (12h) in both groups There was an increase in the point, and there was a decrease in other points after the operation (P <0.05); MPO (171.62 ± 21.11vs.198.25 ± 20.11) mg / L, CRP (3.08 ± 0.86vs.4.23) after 6 months of observation group ± 0.51) mg / L, IL-6 (2.51 ± 0.44vs.3.08 ± 0.95) mg / L, BNP (139.94 ± 17.36vs.168.95 ± 19.64) pg / ml was significantly lower than the control group (P <0.05); observation The target vessel revascularization, angina pectoris, heart failure, and recurrent myocardial infarction were lower in the group than in the control group, but the difference was not statistically significant (P> 0.05). The total incidence of adverse cardiovascular events (MACE) was (11.11% vs .28.57%) was significantly lower than the control group (P <0.05). Conclusion: Prourokinase combined with nicorandil applied to STEMI patients undergoing PCI surgery can further effectively improve their cardiac function, inhibit inflammation and reduce the occurrence of adverse cardiovascular events.