小剂量尿激酶溶栓联合经皮冠状动脉介入术治疗ST段抬高型心肌梗死疗效观察

Effect of low-dose urokinase thrombolysis combined with percutaneous coronary intervention on ST-elevation myocardial infarction

目的探讨小剂量尿激酶溶栓联合经皮冠状动脉介入(PCI)治疗ST段抬高型心肌梗死(STEMI)的临床效果。方法选择2016年1月至2017年6月河南省省立医院收治的STEMI患者116例为研究对象,根据治疗方法分为观察组和对照组,每组58例。2组患者均给予常规治疗措施,在常规治疗基础上,观察组患者给予小剂量尿激酶溶栓联合PCI治疗,对照组患者给予PCI治疗。观察2组患者治疗后即刻心肌灌注水平,分别于治疗前及治疗1周后检测2组患者血清一氧化氮(NO)、超敏C反应蛋白(hs-CRP)和内皮素-1(ET-1)水平,术后随访6个月,观察2组患者主要不良心血管事件(MACE)发生情况。结果观察组患者治疗后心肌灌注水平显著优于对照组(P<0.05)。2组患者治疗前血清NO、hs-CRP及ET-1水平比较差异均无统计学意义(P>0.05);与治疗前比较,治疗后1周2组患者血清NO、hs-CRP水平升高,ET-1水平降低(P<0.05);治疗1后周,观察组患者NO水平高于对照组,hs-CRP及ET-1水平低于对照组(P<0.05)。观察组和对照组患者MACE发生率分别为6.90%(4/58)、20.69%(12/58),观察组患者MACE发生率显著低于对照组(χ~2=4.641,P<0.05)。结论小剂量尿激酶溶栓联合PCI治疗可以显著改善STEMI患者心肌灌注水平和内皮功能,减轻炎症反应,降低MACE发生率。

Objective To investigate the clinical effect of low-dose urokinase thrombolysis combined with percutaneous coronary intervention(PCI)in the treatment of ST-elevation myocardial infarction(STEMI).Methods A total of 116 patients with STEMI in Henan Provincial Hospital from January 2016 to June 2017 were selected as the subjects.The patients were divided into observation group and control group according to the treatment method,58 cases in each group.The patients in the two groups were treated with routine treatment.On the basis of routine treatment,the patients in the observation group were treated with low-dose urokinase thrombolysis combined with PCI,and the patients in the control group were treated with PCI.The level of myocardial perfusion of the patients in the two groups was observed immediately after treatment.The levels of serum nitric oxide(NO),high-sensitivity C-reactive protein(hs-CRP)and endothelin-1(ET-1)were detected before and one week after treatment.The patients were followed up for 6 months,and the occurrence of major adverse cardiovascular events(MACE)was observed.Results The level of myocardial perfusion in the observation group was significantly higher than that in the control group after PCI(P<0.05).There was no significant difference in serum NO,hs-CRP and ET-1 levels between the two groups before treatment(P>0.05).Compared with before treatment,serum NO and hs-CRP levels increased and ET-1 level decreased in the two groups at one weeks after treatment(P<0.05).After one weeks of treatment,the level of NO in the observation group was higher than that in the control group,and the levels of hs-CRP and ET-1 were lower than those in the control group(P<0.05).The incidence of MACE in the observation group and the control group was 6.90%(4/58)and 20.69%(12/58)respectively,the incidence of MACE in the observation group was significantly lower than that in the control group(χ2=4.641,P<0.05).Conclusion Low-dose urokinase thrombolysis combined with PCI can significantly improve myocardial perfusion level and endothelial function,alleviate inflammation and reduce the incidence of MACE in patients with STEMI.