经靶向灌注导管冠脉内应用重组人尿激酶原对STEMI并行急诊PCI患者的影响

发布时间：2018-06-24 10:19

本文选题：ST段抬高型心肌梗死 + 无复流　；参考：《中国新药杂志》2017年20期

【摘要】：目的:探讨在ST段抬高型心肌梗死(STEMI)患者急诊行经皮冠状动脉介入治疗(PCI)中,经靶向灌注导管冠脉内应用重组人尿激酶原对心肌血流灌注及预后的影响。方法:回顾性分析108例STEMI患者。其中,64例通过梗死相关动脉(IRA)应用采用靶向灌注导管于靶病变远段药物(重组人尿激酶原20 mg+硝酸甘油3μg·kg~(-1))后,再行常规PCI术(观察组);44例通过IRA采用靶向灌注导管于靶病变远段应用药物(替罗非班0.25 m L·kg~(-1)+硝酸甘油3μg·kg~(-1))后,再行常规PCI术(对照组);比较并观察2组患者的心肌血流灌注、心肌梗死范围(ST段抬高总和回落百分比)、临床预后[主要不良心脑血管事件(MACCE)]和安全性(严重出血事件的发生率)。结果:2组患者一般临床资料无统计学差异(P0.05);观察组心外膜冠状动脉灌注水平(c TFC)和心肌灌注水平(TMPG)优于对照组(P0.001);住院期间2组患者院内MACCE和出血事件发生率相当。结论:与靶向应用替罗非班相比,经靶向灌注导管在靶病变远端给予重组人尿激酶原可进一步改善STEMI患者心肌灌注水平,且不增加院内MACCE和出血事件的发生率。
[Abstract]:Objective: to investigate the effect of recombinant human urokinase on myocardial perfusion and prognosis in patients with St segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods: 108 patients with STEMI were retrospectively analyzed. Among them, 64 cases were treated with targeted perfusion catheter in distal segment of target lesion (recombinant human urokinase 20 mg nitroglycerin 3 渭 g kg ~ (-1) through infarct-associated artery (IRA). 44 patients in the observation group were treated with conventional PCI (control group), 44 patients were treated with targeted perfusion catheter in the distal segment of the target lesion (tirofiban 0.25 mL kg ~ (-1) and then 3 渭 g kg ~ (-1) nitroglycerin (control group), the myocardial blood flow perfusion of the two groups was compared and observed. Myocardial infarction size (percentage of St segment elevation total fall), clinical prognosis [major adverse cardiovascular and cerebrovascular events (MACCE)] and safety (incidence of severe bleeding events). Results there was no significant difference in general clinical data between the two groups (P0.05), the levels of epicardial coronary artery perfusion (c TFC) and myocardial perfusion (TMPG) in the observation group were higher than those in the control group (P0.001). Conclusion: compared with tirofiban, the administration of recombinant human urokinase at the distal end of the target lesion can further improve the myocardial perfusion level of STEMI patients, and does not increase the incidence of intrahospital MACCE and bleeding events.
【作者单位】：河南省焦作市人民医院心脏中心;
【分类号】：R542.22

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