摘要
目的探讨急性ST段抬高型心肌梗死患者(STEMI)急诊经皮冠状动脉介入(PCI)治疗中重组人尿激酶原(rhPro-UK)不同给药方式对心肌灌注及预后的影响。方法回顾性选取2017年8月至2022年8月中国人民解放军陆军第七十一集团军医院收治的行急诊PCI治疗的132例STEMI患者,根据其临床资料进行分析,A组66例为将导丝通过冠状动脉病变、球囊扩张及支架植入后分别注射rhPro-UK,B组66例为导丝通过冠状动脉病变后一次性注射rhPro-UK。对比两组患者PCI手术情况、靶血管灌注情况[校正心肌梗死溶栓试验(TIMI)血流帧数(CTFC)、TIMI血流分级]、心肌灌注情况[TIMI心肌灌注分级(TMPG)、术后90 min ST段回落率(STR)、无复流/慢血流(NR/SF)的发生率]、心脏功能指标[左室舒张末期容量(LVEDV)、左室收缩末期容量(LVESV)及左室射血分数(LVEF)]、主要不良心血管事件(MACE)发生率及出血事件发生情况。结果两组患者的罪犯血管分布、插管方式及支架植入数量比较差异无统计学意义(P>0.05);治疗后A组TIMI血流分级3级比例高于B组[99.97%(64/66)比87.88%(58/66)];治疗后两组CTFC均降低,且A组低于B组[(23.49±4.27)帧比(27.14±4.83)帧](P<0.05);治疗后A组TMPG 3级比例显著高于B组[95.45%(63/66)比83.33%(55/66)],差异有统计学意义(P<0.05);治疗后A组STR显著高于B组[95.45%(63/66)比83.33%(55/66)](P<0.05);治疗后A组NR/SF的发生率低于B组[3.03%(2/66)比14.29%(10/66)],差异有统计学意义(P<0.05);治疗前后两组患者LVEDV、LVESV比较差异无统计学意义(P>0.05)。治疗1个月后两组患者LVEF均提高,且A组高于B组[(71.08±6.38)%比(66.24±6.49)%],差异有统计学意义(P<0.05);治疗后A组MACE发生率低于B组[6.06%(4/66)比13.64%(9/66)](χ^(2)=2.13,P=0.144),A组发生微出血2例,小出血1例,B组发生微出血4例,小出血3例,两组出血事件发生率比较差异无统计学意义(P>0.05)。结论对于行PCI的STEMI患者,分次注射rhPro-UK较
Objective To investigate the effect of different administration methods of recombinant human prourokinase(rhPro-UK)during emergency percutaneous coronary intervention(PCI)on myocardial perfusion and prognosis of patients with acute ST segment elevation myocardial infarction(STEMI).Methods The clinical data of 132 patients with STEMI who underwent emergency PCI in the Military Hospital of the 71st Army Group of the Chinese People′s Liberation Army from August 2017 to August 2022 were analyzed retrospectively.Among them,66 patients treated with rhPro-UK injection after the guide wire passed through the coronary artery lesion,balloon dilation and stent placement were included in group A.The other 66 patients treated with rhPro-UK injection once after the guide wire passed through the coronary artery lesion were included in group B.The two groups were compared in terms of PCI conditions,target vessel perfusion status[corrected TIMI frame count(CTFC)and blood flow(thrombolysis in myocardial infarction,TIMI)grade],myocardial perfusion status[TIMI myocardial perfusion grade(TMPG),ST segment regression rate(STR)at 90 min after operation and the incidence of no reflow/slow flow(NR/SF)],cardiac function indicators[left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV)and left ventricular ejection fraction(LVEF)],the incidence of major adverse cardiovascular events(MACE),and the incidence of bleeding events.Results There were no statistically significant differences between the two groups in terms of the distribution of culprit blood vessels,intubation methods,and number of stents implanted(P>0.05).After treatment,the proportion of TIMI blood flow grade 3 in the group A was higher than that in the group B:99.97%(64/66)vs.87.88%(58/66).CTFC of the two tgroups decreased,and CTFC of group A was lower than that of group B:(23.49±4.27)frames vs.(27.14±4.83)frames(P<0.05).The proportion of TMPG grade 3 in group A was significantly higher than that in group B:95.45%(63/66)vs.83.33%(55/66)(P<0.
作者
孙亮
佟飞廷
段瑞雪
Sun Liang;Tong Feiting;Duan Ruixue(Department of Emergency,Military Hospital of the 71st Army Group of the Chinese People′s Liberation Army,Xuzhou 221000,China;Department of Laboratory,Military Hospital of the 71st Army Group of the Chinese People′s Liberation Army,Xuzhou 221000,China)
出处
《中国医师进修杂志》
2024年第2期117-122,共6页
Chinese Journal of Postgraduates of Medicine
关键词
心肌梗塞
心肌梗死
经皮冠状动脉介入治疗
重组人尿激酶原
心肌灌注
预后
Myocardial infarction
Percutaneous coronary intervention
Recombinant human prourokinase
Myocardial perfusion
Prognosis
