PPCI术联合尿激酶原及尼可地尔对ST段抬高型心肌梗死患者的疗效观察

Curative effect of PPCI combined with urokinase and nicorandil in patients with STEMI

目的:探讨直接经皮冠状动脉介入(primary percutaneous coronary intervention,PPCI)术联合尿激酶原及尼可地尔对ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的治疗效果。方法:选取我院在2016年12月—2017年6月期间收治的132例STEMI患者作为研究对象,按照简单随机法将患者分为3组,分别为尿激酶原组、尼可地尔组和联合用药组,每组44例。3组患者均行PPCI术治疗,并将药物注射至病变血管处。比较3组患者的病变血管血流、心肌再灌注、心功能水平以及心血管事件发生情况。结果:3组患者术后病变血管血流情况均明显改善(P<0.05);联合用药组患者治疗后病变血管血流情况明显优于尿激酶原组和尼可地尔组(P<0.05)。联合用药组患者术后2 h ST段回落率、矫正TIMI帧数及心肌灌注分级明显优于尿激酶原组或尼可地尔组(P<0.05)。3组患者治疗后左室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)和左心室射血分数(left ventricular ejection fraction,LVEF)均较治疗前有改善(P<0.05);在术后1个月和3个月,联合用药组患者的LVEDD和LVEF明显优于尿激酶原组或尼可地尔组(P<0.05);术后6个月,3组患者的LVEDD和LVEF无统计学差异(P>0.05)。联合用药组不良心血管事件发生率明显低于尿激酶原组或尼可地尔组(P<0.05)。结论:冠脉注射尿激酶原和尼可地尔可改善STEMI患者冠脉病变血管血流及心肌灌注,提高心功能水平,降低患者治疗后不良心血管事件的发生风险,具有值得应用于临床的前景。

Objective： To explore the curative effect of PPCI combined with urokinase and nicorandil in patients with STEMI. Methods： From December 2016 to June 2017,132 cases of STEMI patients was studied in our hospital. According to simple randomization method the patients were divided into three groups,i. e.,urokinase group,nicorandil group,and combined treatment group,with 44 patients in each group. The patients in the three groups all underwent PPCI and received drug injection into the lesion vessels. The blood flow,myocardial reperfusion,cardiac function and cardiovascular events were compared between the three groups. Results： The blood flow of lesion vessels were improved in the three groups of patients（ P〈0. 05）; the patients in the combination group had significantly better blood flow than those in the urokinase group or nicorandil group after treatment（ P〈0. 05）. The ST-segment resolution,adjusted TIMI frames and myocardial perfusion grade at 2 h post-surgery in the combination group were better than urokinase group or nicorandil group（ P〈0. 05）. The left ventricular end-diastolic dimension（ LVEDD） and left ventricular ejection fraction（ LVEF） of the patients in the three groupswere all improved after treatment（ P〈0. 05）; at 1 month and 3 months after surgery,the LVEDD and LVEF of the patients in the combined treatment group were significantly better than the urokinase group or nicorandil group; at 6 months after surgery,the LVEDD and LVEF in the three groups were not statistically significantly different（ P〈0.05）. The incidence of adverse cardiovascular events in the combination group was significantly lower than those in urokinase group or nicorandil group（ P〈0. 05）. Conclusion： Intracoronary injection of urokinase and nicorandilcan improve the blood flow and myocardial perfusion of the coronary artery in patients with STEMI,improve heart function,reduce the risk of adverse cardiovascular events,which is worthy of clinical application in the future.