急性ST段抬高性心肌梗死患者冠状动脉内尿激酶原不同给药方式的疗效观察

doi:10.3969/j.issn.1002-1949.2018.12.014

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摘要目的比较急性ST段抬高性心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者在急诊经皮冠状动脉介入（percutaneous coronary intervention, PCI）治疗中冠状动脉内分次注射与一次性注射重组人尿激酶原两种给药方式对术后心肌灌注及近期预后的影响。方法选择2016-08～2017-10本院连续入选的102例接受急诊PCI的STEMI患者并随机分为两组：A组49例于导丝通过冠状动脉病变后、球囊扩张后、支架置入后分别于冠状动脉内注射重组人尿激酶原4、3、3 mL（共20 mg），B组53例于导丝通过冠状动脉病变后一次性向冠状动脉内注射重组人尿激酶原10 mL（共20 mg）。联合术后心肌梗死溶栓试验（thrombolysis in myocardial infarction, TIMI）血流分级、TIMI心肌灌注分级（TIMI myocardial perfusion grade, TMPG）、术后90 min ST段回落率（ST-segment resolution, STR）及术后第1天和第7天左室射血分数（left ventricular ejection fraction, LVEF）评估心肌灌注水平，比较术后第7 天出血事件及术后3个月主要不良心脏事件（major adverse cardiac events，MACE）的发生。结果两组患者术前TIMI血流分级、TMPG及术后第1天LVEF比较差异无统计学意义（P>0.05）。梗死相关动脉（infarct-related artery, IRA）PCI术后，与B组比较，A组TIMI 血流分级（P=0.038）、TMPG（P=0.015）改善明显，术后90 min ST段回落明显（P=0.032），术后第7 天 LVEF也有所改善（P=0.001）。两组术后第7天出血事件及术后3个月MACE发生率比较差异无统计学意义（P>0.05）。结论对于行急诊PCI的急性STEMI患者，PCI术中分次给予重组人尿激酶原较一次性给予重组人尿激酶原能更好地改善心肌灌注，且不增加出血及MACE的发生率，最终改善预后。

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	曹亚丽
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	张晓光
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	殷洪山
	王涛

关键词 ：尿激酶原, 急性ST段抬高性心肌梗死（STEMI）, 经皮冠状动脉介入(PCI)治疗, 无复流, 微循环

通讯作者: 姜志安（1963-），男，博士，E-mail:doctorjiangzhian@163.com。

作者简介: 曹亚丽（1991-）,女，E-mail:710555953@qq.com。

引用本文:

曹亚丽，姜志安，陈涛，张晓光，赵淑健，殷洪山，王涛. 急性ST段抬高性心肌梗死患者冠状动脉内尿激酶原不同给药方式的疗效观察[J]. 中国急救医学, 2018, 38(12): 1081-1085.
Cao Ya-li, Jiang Zhi-an, Chen Tao, Zhang Xiao-guang, Zhao Shu-jian, Yin Hong-shan, Wang Tao. Efficacy of different intracoronary administration methods of prourokinase in patients with acute ST-segment elevation myocardial infarction. Chinese Journal of Critical Care Medicine, 2018, 38(12): 1081-1085.

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