冠状动脉内溶栓在老年急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗中的应用

The application of intracoronary thrombolytic therapy during primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction

目的观察在老年急性ST段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）中应用冠状动脉内溶栓的有效性及安全性。方法前瞻性研究，连续入组2016年9月至2017年9月在商丘市第一人民医院心血管内科诊断STEMI并行直接PCI的患者106例，数字抽签随机将患者分为溶栓组（冠状动脉内溶栓）54例和对照组（冠状动脉内盐水）52例，溶栓组通过球囊导管于病变处给予注射重组尿激酶原10mg（10ml），对照组给予注射生理盐水10ml。比较两组术中慢血流发生率，术后3d出血率、术后90d左心室射血分数（LVEF）及左心室舒张末内径（LVEDD），术后90d主要不良心血管事件（MACE）发生率。结果溶栓组较对照组术中慢血流发生率降低[7例（13．0％）比15例（28．8％），x^2=4．06，P=0．044]；两组术后3d出血率比较差异无统计学意义（x^2=0．71，P〉0．05）；溶栓组较对照组术后90dLVEF增加，差异有统计学意义（t=2．95，P〈0．05）；溶栓组较对照组术后90dLVEDD减小（t=2．86，P〈0．05）；两组术后90dMACE发生率比较差异无统计学意义（x^2=1．46，P〉0．05）。结论老年STEMI患者在直接PCI中应用冠状动脉内溶栓可降低术中慢血流的发生率、改善左心室功能及大小，同时不增加出血的发生率。

Objective To evaluate the efficacy and safety of intracoronary thrombolysis during primary percutaneous coronary intervention（PCI）in elderly patients with acute ST segment elevation myocardial infarction（STEMI）. Methods This prospective study was conducted at the Department of Cardiology of Shangqiu First People＇s Hospital. Elderly patients diagnosed with STEMI and undergoing primary PCI were consecutively recruited from September 2016 to September 2017. Of all recruited patients, 106 patients were successfully followed up and were randomly divided into a treatment group（intracoronary thrombolysis group, n = 54） and a control group （intracoronary saline group, n= 52）. Patients in the treatment group received an injection of 10 mg recombinant prourokinase （10 ml）via a balloon catheter while patients in the control group were injected with 10 mL saline instead. The incidences of slow flow, bleeding in 3 days after operation,left ventricular ejection fraction （LVEF）, left ventricular end diastolic diameter（LVEDD）, and major adverse cardiovascular events （MACE） in 90 days after operation were compared between the two groups. Results Compared with the control group, the treatment group had a decreased incidence of slow flow （x^2 = 4.06, P〈 0.05）. The incidence of bleeding in 3 days after operation showed no difference between the two groups（ x^2 =0.71, P〉0.05）. The treatment group also had an elevated incidence of LVEF（ t=2.95, P 〈0.05）and a decreased incidence of LVEDD in 90 days after operation（ t=2.86, P〈0.05） ,compared with the control group. No significant difference in the incidence of MACE in 90 days after operation was observed between the two groups（x^2= 1.46, P〉0.05）. Conclusions In elderly patients with STEMI,intracoronary thrombolysis during primary PCI can reduce the incidence of slow flow during operation,and improve the function and size of left ventricle without increasing the incidence of bleeding.