冠状动脉内注射尿激酶原在ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术中的应用效果研究

Effect of Intracoronary Injection of Prourokinase in Emergency Percutaneous Coronary Intervention of Patients with ST Segment Elevation Myocardial Infarction

背景经皮冠状动脉介入术(PCI)是ST段抬高型心肌梗死(STEMI)的有效治疗手段,大多数患者术后能够恢复正常血供,少数患者心肌再灌注效果较难达到预期,冠状动脉内溶栓是救治此类患者的有效途径。尿激酶原在急性栓塞性疾病的救治中发挥积极作用,但关于其在STEMI患者PCI中的应用效果仍存在争议。目的观察冠状动脉内注射尿激酶原在STEMI患者急诊PCI中的应用效果。方法选取2019年1月至2020年1月北京航天总医院接受急诊PCI的STEMI患者86例为研究对象。依据患者治疗方法的不同,将其分为对照组、观察组,各43例。观察组术中在冠状动脉内注射尿激酶原进行治疗,对照组进行常规治疗。比较两组治疗前和治疗后12、24、36 h心肌损伤标志物〔肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)〕,治疗前和治疗后心肌组织灌注分级,治疗前和治疗后12、24、36 h心肌梗死面积,不良心血管事件发生率。结果治疗方法与时间在CK-MB、cTnI上存在交互作用(P<0.05);治疗方法、时间在CK-MB、cTnI上主效应显著(P<0.05)。观察组患者治疗后12、24、36 h CKMB、cTnI低于对照组(P<0.05)。对照组、观察组患者治疗后12、24、36 h CK-MB、cTnI分别高于本组治疗前,治疗后24、36 h CK-MB、cTnI分别低于本组治疗后12 h,治疗后36 h CK-MB、cTnI分别低于本组治疗后24 h(P<0.05)。观察组患者治疗后心肌灌注分级优于对照组(P<0.05)。治疗方法与时间在心肌梗死面积上存在交互作用(P<0.05);治疗方法、时间在心肌梗死面积上主效应显著(P<0.05)。观察组患者治疗后12、24、36 h心肌梗死面积小于对照组(P<0.05)。对照组、观察组患者治疗后12、24、36 h心肌梗死面积分别小于本组治疗前,治疗后24、36 h心肌梗死面积分别小于本组治疗后12 h,治疗后36 h心肌梗死面积分别小于本组治疗后24 h(P<0.05)。观察组患者不良心血管事件发生率低于对照组(P<0.05)。结论冠状动脉内注射尿激酶原在STEMI患者PCI中有明确的应用效果,其可减轻患者心肌损伤程度、改善血流灌注、缩小心肌梗死面积和降低不良心血管事件发生风险。

Background Percutaneous coronary intervention(PCI)is an effective treatment for ST segment elevation myocardial infarction(STEMI).Most patients can restore normal blood supply after operation,and a few patients are difficult to achieve the expected myocardial reperfusion effect.Intracoronary thrombolysis is an effective treatment for such patients.Prourokinase plays an active role in the treatment of acute embolic diseases,but its effect in PCI in STEMI patients is still controversial.Objective To observe the effect of intracoronary injection of prourokinase in emergency PCI of patients with STEMI.Methods A total of 86 patients with STEMI who underwent emergency PCI in Beijing Aerospace General Hospital from January 2019 to January 2020 were selected as the research subjects.They were divided into control group and observation group according to the treatment method,with 43 cases in each group.Patients in the observation group were treated with intracoronary injection of prourokinase during PCI,while patients in the control group were given conventional treatments.The myocardial injury markers[creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI)]before treatment and at 12,24 and 36 h after treatment,myocardial tissue perfusion classification before and after treatment,myocardial infarction area before treatment and at 12,24 and 36 h after treatment,and the incidence of adverse cardiovascular events were compared between the two groups.Results There was interaction effect between treatment method and time on CK-MB and cTnI(P<0.05);the main effects of treatment method and time on CK-MB and cTnI were significant(P<0.05).CK-MB and cTnI in the observation group were significantly lower than those in the control group at 12,24 and 36 h after treatment(P<0.05).In the control group and observation group,CK-MB and cTnI at 12,24 and 36 h after treatment were higher than those before treatment,CK-MB and cTnI at 24 and 36 h after treatment were lower than those at 12 h after treatment,CK-MB and cTnI at 36 h after treatment were lower than those at 24 h after treatment,respectively(P<0.05).The myocardial tissue perfusion classification of the observation group was better than that of the control group(P<0.05).There was interaction effect between treatment method and time on myocardial infarction area(P<0.05);the main effects of treatment method and time on myocardial infarction area were significant(P<0.05).The myocardial infarction area of the observation group was smaller than that of the control group at 12,24 and 36 h after treatment(P<0.05).In the control group and observation group,the myocardial infarction area at 12,24 and 36 h after treatment was smaller than that before treatment,the myocardial infarction area at 24 and 36 h after treatment was smaller than that at 12 h after treatment,and the myocardial infarction area at 36 h after treatment was smaller than that at 24 h after treatment,respectively(P<0.05).The incidence of adverse cardiovascular events in the observation group was lower than that in the control group(P<0.05).Conclusion Intracoronary injection of prourokinase has a clear application effect in PCI of STEMI patients.It can reduce the degree of myocardial injury,improve blood perfusion,reduce the area of myocardial infarction,and reduce the risk of adverse cardiovascular events.