重组人尿激酶原对STEAMI患者急诊PCI术中无复流的影响

Study on Recombinant Human Urokinase on Prevention of No-reflow in Emergency PCI of STEAMI Patients

目的观察重组人尿激酶原（Pro-uk）对急性ST段抬高型心肌梗死（STEAMI）患者急诊经皮冠状动脉介入（PCI）术中发生冠状动脉无复流的影响。方法选择2013年9月至2014年12月延安大学附属心脑血管病医院收治的急诊行PCI的STEAMI患者120例为研究对象,采用随机数字表法分为Pro-uk溶栓组和单纯PCI组,各60例。Pro-uk溶栓组PCI前使用50 mg重组人尿激酶原,前20 mg静脉注射,剩余30 mg溶于100 m L生理盐水中30 min内静脉滴注,随后急诊行PCI;单纯PCI组单纯行急诊PCI。观察两组患者在急诊PCI术后无复流现象发生情况,术后并发症以及术中及随访30 d内主要不良心血管事件（MACE）发生情况。结果 PCI术中,Pro-uk溶栓组属于TIMI 0~1级患者的例数少于单纯PCI组,属于TIMI 2~3级患者的例数多于单纯PCI组。Pro-uk溶栓组出血并发症发生情况与单纯PCI组比较差异无统计学意义（P〉0.05）。Pro-uk溶栓组住院期间有2例发生了MACE,发生率为3.3%（2/60）及随访30 d内有1例发生MACE,发生率为1.7%（1/60）,均低于单纯PCI组9例（15.0%）和7例（11.7%）,差异有统计学意义（P〈0.05）。结论 STEAMI患者急诊PCI前使用Pro-uk溶栓可以减少患者在急诊PCI术中梗死相关动脉无复流现象的发生,并不增加出血风险,且可降低住院期间及随访30 d内MACE事件的发生率,值得临床推广应用。

Objective To observe the efficacy and safety of Pro-uk on coronary no-reflow in emergency percutaneous coronary intervention（ PCI） for patients with acute ST segment elevation myocardial infarction（ STEAMI）. Methods Total of 120 STEAMI patients from Cardiovascular and Cerebrovascular Hospital Affiliated to Yan’an University during Sep. 2013 and Dec. 2014 were included in the study. The patients were divided into the Pro-uk thrombolysis group and simple PCI group according to random number table method,60 cases each. 50 mg Pro-urokinase was used before PCI in Pro-uk thrombolysis group,the first 20 mg by intravenous injection,the remaining 30 mg dissolved in 100 m L saline intravenous drip within 30 minutes;simple PCI group received only emergency. The no-reflow phenomenon occurrence,the intraoperative and postoperative MACE events within the 30 days follow-up of two the groups were observed. Results In PCI,the patients with TIMI level 0-1 of the Pro-uk thrombolysis group were less than simple PCI group,the patients with TIMI level 2-3 of the Pro-uk thrombolysis group were more than the simple PCI group. The hemorrhage rate of the Pro-uk thrombolysis group had no statistically significant difference with PCI group（ P 〉0. 05）. The MACE rate of Pro-uk thrombolysis group during hospital stay and 30 days follow-up were two cases（ 2 /60,3. 3%） and one case（ 1 /60,1. 7%）,which were lower than PCI group 9 cases（ 15. 0%） and 7 cases（ 11. 7%）,and the differences were statistically significant（ P 〈 0. 05）. Conclusion Application of Pro-uk before emergency PCI can reduce the no-reflow phenomenon without reducing the risk of hemorrhage,and reduce MACE event incidence during hospital stay and within 30 d of follow-up,thus is worthy of clinical popularization and application.