急诊PCI术中冠脉内应用重组人尿激酶原的价值

Effect of intracoronary application of recombinant human prourokinase in emergency PCI on serum complement C4a level,electrocardiogram and myocardial perfusion in STEMI patients

目的探究急诊经皮冠状动脉介入术(PCI)术中冠脉内应用重组人尿激酶原对STEMI患者血清补体C4a水平、心电图及心肌灌注情况的影响。方法选取2018年7月~2020年6月于我院心内科就诊的110例STEMI患者,以随机数字表法分为观察组(55例)、对照组(55例)。两组均予以低分子肝素钙注射液、阿司匹林锌肠溶胶囊、硫酸氢氯吡格雷片及常规PCI术治疗,观察组在对照组基础上予以注射用重组人尿激酶原冠状动脉内注射。观察两组PCI术后12 h的心电图改善情况、心肌灌注情况,比较两组术前、PCI术后即刻、PCI术后12 h的血清补体C4a水平以及术前、PCI术后12 h的心功能。结果PCI术后12 h,观察组总有效率为90.91%,高于对照组(74.55%,P<0.05)。术前、PCI术后即刻、PCI术后12 h,观察组血清补体C4a水平逐渐降低,且低于对照组(P<0.05)。PCI术后12 h,观察组心肌梗死溶栓治疗临床试验(TIMI)III级率、ST段回落率>70%者所占比例为85.45%、94.55%,高于对照组(63.64%、78.18%,P<0.05);而矫正TIMI帧数(CTFC)低于对照组(P<0.05)。PCI术后12 h,两组左室射血分数(LVEF)、高于术前,且观察组高于对照组(P<0.05);而两组左室舒张末期内径(LVEDd)、左室收缩末内径(LVESd)低于术前,观察组低于对照组(P<0.05)。结论冠脉内应用重组人尿激酶原可降低STEMI患者急诊PCI术后血清补体C4a水平,减轻患者免疫炎症反应,有效改善患者心电图、心肌灌注情况及心功能。

Objective To explore the effect of recombinant human prourokinase(rhuk)on serum complement C4A level,electrocardiogram and myocardial perfusion in patients with STEMI during emergency percutaneous coronary intervention(PCI)..Methods From July 2018 to June 2020,110 patients with STEMI were selected and randomly divided into the observation group(55 cases)and the control group(55 cases).Both groups were treated with low molecular weight heparin calcium injection,aspirin zinc enteric-coated capsules,clopidogrel hydrogen sulfate tablets and conventional PCI,while the observation group was given intracoronary injection of recombinant human urokinase on the basis of the control group.The electrocardiogram improvement and myocardial perfusion were observed 12 h after PCI,and the serum complement C4a levels before,immediately after PCI and 12 h after PCI and the cardiac function before and 12 h after PCI were compared between the two groups.Results 12 h after PCI,the total effective rate in the observation group was 90.91%,which was higher than that in the control group(74.55%,P<0.05).Before operation,immediately after PCI and 12 h after PCI,the serum complement C4a level in the observation group decreased gradually,which was lower than that in the control group(P<0.05).At 12 h after PCI,the proportion of patients with clinical trial of thrombolytic therapy for myocardial infarction(TIMI)III rate and ST segment fall rate>70%in the observation group was 85.45%and 94.55%,which was higher than that in the control group(63.64%and 78.18%,P<0.05).Corrected TIMI frame number(CTFC)was lower than that of control group(P<0.05).12 h after PCI,the left ventricular ejection fraction(LVEF)of the two groups was higher than that before PCI,and that of the observation group was higher than that of the control group(P<0.05).The left ventricular end diastolic diameter(LVEDd)and left ventricular end systolic diameter(LVESd)in the two groups were lower than those before operation,and those in the observation group were lower than those in the control group(P<0.05).Conclusion Intracoronary application of recombinant human prourokinase could reduce the serum complement C4a level of STEMI patients after emergency PCI,alleviate the immune inflammatory reaction of patients,and effectively improve electrocardiogram,myocardial perfusion and heart function of STEMI patients.