冠状动脉内溶栓对急性ST段无偏移型心肌梗死患者治疗效果的分析

Effect of thrombolytic therapy with acute ST segment unoffset myocardial infarction

目的探讨冠状动脉内溶栓能否使急性ST段无偏移型心肌梗死(ST segment unoffset myocardial infarction,STUMI)患者受益。方法连续纳入2018年10月—2021年1月就诊于河南省人民医院、且接受急诊经皮冠状动脉内介入治疗(primary percutaneous coronary intervention,pPCI)的46例STUMI患者为研究对象,应用随机数表,根据入组的先后顺序,分配随机号,将患者分为冠状动脉内溶栓治疗组(n=23)与盐水灌注组(n=23)。溶栓治疗有效被定义为血栓负荷减轻即TIMI血栓0-2级。结果溶栓组中18例(78.3%)患者有效,溶栓组CK、CK-MB峰值较对照组低[(1316.45±323.87)U/L vs(2372.62±297.45)IU/L、(142.39±18.37)IU/L vs(194.74±35.49)IU/L,(P<0.05)],溶栓组左室射血分数较对照组明显升高[(55.36±12.58)vs(46.65±10.62),(P<0.05)],心肌呈色分级(myocardial blush grade,MBG)3级均明显高于对照组(82.6%vs 52.2%),(P<0.05)。结论冠状动脉内溶栓治疗可有效改善STUMI患者的心肌灌注,同时降低心肌损伤程度。

Objective To investigate whether intracoronary thrombolysis can benefit patients with acute ST segment unoffset myocardial infarction(ST segment unoffset myocardial infarction,STUMI).Methods This study enrolled 46 STUMI patients admitted to the emergency department of Henan people’s Hospital from October 2018 to January 2021 who received emergency percutaneous coronary intervention(primary percutaneous coronary intervention,pPCI).They were randomly divided into two groups:intracoronary thrombolysis group(n=23)and saline infusion group(n=23).The effectiveness of thrombolysis is defined as thrombus load reduction,that is,TIMI thrombus grade 0-2.Results eighteen patients in the thrombolysis group were effective(78.3%).The peak value of CK and CK-MB in the thrombolysis group was lower than that in the control group[(1316.45±323.87)U/L vs(2372.62±297.45)IU/L,(142.39±18.37)IU/L vs(194.74±35.49)IU/L,(P<0.05)].The left ventricular ejection fraction[(55.36±12.58)vs(46.65±10.62),(P<0.05)]and myocardial blush grade 3 were significantly higher than those in the control group(82.6%vs 52.2%)department(P<0.05).Conclusion Intracoronary thrombolysis can effectively improve myocardial perfusion and reduce the degree of myocardial injury in patients with STUMI.