急性心肌梗死介入治疗靶血管内给予尿激酶原对心肌微灌注的影响

Effects of intravascular administration of prourokinase in target vessels on myocardial microperfusion in acute myocardial infarction

目的观察急性心肌梗死(AMI)行经皮冠状动脉介入治疗(PCI)靶血管内注射尿激酶原对心肌微灌注的影响。方法选择河北北方学院附属第二医院心血管内科2016年1—12月收治的AMI患者60例,均进行了急诊PCI治疗,将患者随机分为研究组、对照组,每组30例。对照组患者在支架置入后利用OTW球囊向血管病变处注射山莨菪碱,3 min/1次,200μg/次,共注射3次。研究组利用OTW球囊向血管病变处先注射山莨菪碱200μg,之后注射尿激酶原5 mg,最后每隔3 min注射1次山莨菪碱,共注射2次。观察2组患者支架置入前冠脉造影情况(梗死相关动脉、TIMI血流分级、血栓积分、病变长度)、支架置入后即刻与末次造影校正的TIMI帧计数(CTFC)的差值,统计2组住院期间出血并发症发生情况。结果2组患者支架置入前冠脉造影情况比较差异均无统计学意义(P均>0.05);研究组患者末次造影与支架置入即刻造影CTFC差值为[4.00(4.82)],对照组差值为[2.00(3.00)],2组患者CTFC差值比较差异有统计学意义(P<0.05);住院期间研究组3例、对照组2例发生轻度出血,2组比较差异无统计学意义(P>0.05)。结论利用OTW球囊向AMI患者靶血管内注射尿激酶原,有利于改善心肌微循环灌注不足,并且安全可靠。

Objective It is to observe the effect of intravascular injection of prourokinase into the target vessel after percutaneous coronary intervention(PCI)on myocardial microperfusion in acute myocardial infarction(AMI).Methods A total of 60 AMI patients who were admitted to the Department of Cardiology,the Second Affiliated Hospital of Hebei North University from January to December 2016 were selected and treated with emergency PCI.The patients were randomly divided into a study group and a control group,with 30 cases in each group.After the stent was implanted,an OTW balloon was used to inject anisodamine into the vascular lesions of the patients in the control group,3 minutes/1 time,200ug/time,for a total of 3 injections.An OTW balloon was used to inject 200μg anisodamine into the vascular lesions of the patients in the study group,then inject 5mg prourokinase,and finally inject anisodamine every 3 minutes for a total of 2 injections.The coronary angiography(infarction-related artery,TIMI blood flow classification,thrombus score,lesion length)before stent placement,and the difference of TIMI frame count(CTFC)between the immediately after stent placement and the last angiography correction were observed in the patients in the two groups,and the bleeding complications occurred in the 2 groups during hospitalization were counted.Results There was no significant difference in coronary angiography before stent placement between the two groups(P>0.05);the difference of CTFC between the last angiography and the immediate stent placement in the study group was[4.00(4.82)],the control group was[2.00(3.00)],and the difference in CTFC difference between the two groups was significant(P<0.05);3 patients in the study group and 2 in the control group had mild bleeding during hospitalization,there was no statistical difference between the two groups(P>0.05).Conclusion Inject prourokinase by OTW balloon into the target vessel of AMI patients is beneficial to improve myocardial microcirculation hypoperfusion,and is safe and reliable.