注射用重组人尿激酶原冠状动脉内注射在急性心肌梗死急诊经皮冠状动脉介入治疗中应用价值研究

Value of recombinant human urokinase for injection in emergency percutaneous coronary intervention in acute myocardial infarction

目的探讨注射用重组人尿激酶原冠状动脉内注射在急性心肌梗死急诊经皮冠状动脉介入治疗中的应用价值。方法选取淮南市新华医疗集团新华医院2019年1—12月收治的接受急诊经皮冠状动脉介入治疗的60例急性心肌梗死患者为研究对象,根据治疗方式不同,将患者分入A组(n=24)和B组(n=36)。A组患者急诊经皮冠状动脉介入治疗前给予300 mg阿司匹林肠溶片+180 mg替格瑞洛片;B组在A组基础上,即刻经导管冠状动脉内注入注射用重组人尿激酶原。比较两组患者的TIMI血流分级、超声心动图指标及30 d内主要心血管事件发生率。结果治疗前,A、B两组患者TIMI血流分级0级、1级、2级、3级所占比例比较,差异无统计学意义(P>0.05)。治疗后,A组患者TIMI血流分级0级1例(4.2%)、1级3例(12.5%)、2级12例(50.0%)、3级8例(33.3%),B组患者0级0例(0)、1级1例(2.8%)、2级8例(22.2%)、3级27例(75.0%),两组TIMI血流分级0级、1级所占比例比较,差异无统计学意义(P>0.05),2级、3级所占比例比较,差异有统计学意义(P<0.05)。治疗前,A、B两组患者室间隔厚度、左室后壁厚度、左室射血分数、左室舒张末内径比较,差异均无统计学意义(P>0.05)。治疗后,B组患者室间隔厚度、左室后壁厚度、左室舒张末内径均较治疗前减小,且小于A组,差异有统计学意义(P<0.05);同时,左室射血分数较治疗前升高,且高于A组,差异有统计学意义(P<0.05)。A组和B组主要心血管事件发生率比较(25.0%比5.6%),差异有统计学意义(P<0.05)。结论注射用重组人尿激酶原冠状动脉内注射在急性心肌梗死急诊经皮冠状动脉介入治疗中的应用能够显著改善患者心肌微循环灌溉,延缓心肌受损速度,降低不良心血管事件发生风险,减少慢血流和无复流发生率。

Objective To investigate the effect of recombinant human urokinase for injection in emergency percutaneous coronary intervention(PCI)of acute myocardial infarction and its effect on slow or no reflow after PCI.Methods A retrospective study was performed on 60 cases of patients with acute myocardial infarction who were admitted from January to December 2019.Patients were divided into the Group A(n=24)and Group B(n=36)according to different treatment methods.Patients in Group A were given 300 mg aspirin enteric-coated tablets+180 mg tegrilol tablets before emergency PCI.On the treatment basis of Group A,patients of Group B were immediately injected with recombinant human urokinase for injection through the catheter coronary artery.The TIMI blood flow grade,echocardiographic index and incidence of major cardiovascular events within 30 days were compared between the two groups.Results Before treatment,the proportion of TIMI blood flow grade 0,1,2 and 3 in patients of Group A and Group B was compared,and the difference was not statistically significant(P>0.05).After treatment,in Group A of TIMI flow,grade 0 was 1 case(4.2%),grade 1 was 3 cases(12.5%),grade 2 was 12 cases(50.0%),grade 3 was 8 cases(33.3%);in Group B of TIMI flow,grade 0 was 0(0),grade 1 was 1 case(2.8%),grade 2 was 8 cases(22.2%),grade 3 was 27 cases(75.0%).There was no statistically significant difference in the proportion of TIMI blood flow grade 0 and 1(P>0.05),while there was a statistically significant difference in the proportion of TIMI blood flow grade 2 and 3(P<0.05).Before treatment,there were no statistically significant differences in ventricular septal thickness,left ventricular posterior wall thickness,left ventricular ejection fraction,and left ventricular end-diastolic diameter between Groups A and Group B(P>0.05).After treatment,the thickness of ventricular septum,posterior wall of the left ventricle,and end-diastolic diameter of the left ventricle in Group B were all reduced compared with that before treatment,and were smaller than those in Group A,with statistically significant differences(P<0.05).At the same time,the left ventricular ejection fraction was higher than that before treatment(P<0.05).The incidence of major cardiovascular events between Group A and Group B(25.0%versus 5.6%)was statistically significant different(P<0.05).Conclusion Recombinant human urokinase for injection during acute myocardial infarction can significantly improve myocardial microcirculation irrigation,slow the rate of myocardial damage,reduce adverse cardiovascular events,and reduce the incidence of slow blood flow and no reflow.