血栓抽吸并经血栓抽吸导管注射尿激酶原对ST段抬高型心肌梗死患者经皮冠状动脉介入治疗效果的影响

Impact of Thrombus Aspiration Combined with Thrombolytic Catheter Injection of Prourokinase on PCI Effect in Patients with STEMI

目的探讨血栓抽吸并经血栓抽吸导管注射尿激酶原对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)效果的影响。方法选取2015年9月—2017年6月邯郸市第一医院心血管内科收治的STEMI患者102例,采用随机数字表法分为对照组53例和观察组49例。对照组患者仅行PCI;观察组患者于PCI前行血栓抽吸,待造影检查显示无明显血栓影后经血栓抽吸导管注射尿激酶原。比较两组患者PCI前后TIMI血流分级、TIMI心肌灌注分级(TMPG)及校正的TIMI帧数(c TFC),PCI前及PCI后1周心功能指标;随访3个月,观察两组患者主要不良心血管事件发生情况。结果 PCI前两组患者TIMI血流分级、TMPG及c TFC比较,差异无统计学意义(P>0.05);PCI后观察组患者TIMI血流分级和TMPG优于对照组,c TFC少于对照组(P<0.05)。PCI前两组患者左心室射血分数(LVEF)及血清脑钠肽(BNP)、肌钙蛋白I(Tn I)水平比较,差异无统计学意义(P<0.05);PCI后1周观察组患者LVEF高于对照组,血清BNP、Tn I水平低于对照组(P<0.05)。随访3个月,观察组患者主要不良心血管事件发生率低于对照组(P<0.05)。结论血栓抽吸并经血栓抽吸导管注射尿激酶原能有效改善STEMI患者PCI后心肌血流灌注及心功能,降低主要不良心血管事件发生风险。

Objective To investigate the impact of thrombus aspiration combined with thrombolytic catheter injection of prourokinase on PCI effect in patients with STEMI.Methods From September 2015 to June 2017,a total of 102 patients with STEMI were selected in the Department of Cardiology,the First Hospital of Handan,and they were divided into control group(n=53)and observation group(n=49)according to random number table.Patients in control group received PCI only;patients in observation group received thrombus aspiration before PCI and thrombolytic catheter injection of prourokinase after confirmation of non-appearance of obvious thrombus shadow by contrast examination.TIMI flow grades,TMPG and cTFC before and after PCI,index of cardiac function before PCI and 1 week after PCI,and incidence of MACEs during the 3-month followup were compared between the two groups.Results No statistically significant differences of TIMI flow grades,TMPG or cTFC was found between the two groups before PCI(P>0.05);after PCI,TIMI flow grades and TMPG in observation group were statistically significantly better than those in control group,while cTFC in observation group was statistically significantly less than that in control group(P<0.05).No statistically significant differences of LVEF,serum level of BNP or TnI was found between the two groups before PCI(P<0.05);1 week after PCI,LVEF in observation group was statistically significantly higher than that in control group,while serum level of BNP and TnI in observation group were statistically significantly lower than those in control group(P<0.05).Incidence of MACEs in observation group was statistically significantly lower than that in control group during the 3-month follow-up(P<0.05).Conclusion Thrombus aspiration combined with thrombolytic catheter injection of prourokinase can effectively improve the myocardial blood flow perfusion and cardiac function,reduce the risk of MACEs in postoperative STEMI treated by PCI.