冠脉内应用重组人尿激酶原联合硝普钠在急性心肌梗死患者介入术中的疗效观察

The clinical efficacy of recombinant human prourokinase combined with sodium nitroprusside for the patients with STEMI undergoing PCI

目的探讨冠脉内应用重组人尿激酶原(rh-proUK)联合硝普钠在急性心肌梗死介入中的疗效。方法选取保定市第二中心医院在2018年4月至2019年4月诊断为急性心肌梗死并拟行PCI术的患者88例为研究对象。将88例患者随机分为重组人尿激酶原组(A组n=42)和重组人尿激酶原+硝普钠组(B组n=46),将rh-proUK 10 mg、rh-proUK 10 mg+硝普钠100~400μg分别通过刺破球囊注入2组患者中,然后植入支架。记录患者一般资料、血流恢复情况,心功能指标,主要心血管不良事件(MACE)发生率等。结果PCI术后,B组的TIMI分级、TMBG分级均优于A组,差异均有统计学意义(U值分别为2.0591、2.3455,P<0.05)。PCI术后,B组的STR>50%比例高于A组,CK-MB、cTnI的峰值时间均较A组提前,差异均有统计学意义(P<0.05)。2组LVEF均高于术前,差异均有统计学意义(P<0.05);术后7 d,B组LVEF高于A组,LVEDD、LVDs均低于A组,差异均有统计学意义(P<0.05)。PCI术后1月内,2组中,A组出现复发心绞痛2例,心律失常1例,心力衰竭2例,总发生率为11.9%;B组出现复发心绞痛1例,恶性心律失常1例,心力衰竭2例,总发生率为8.7%;2组MACE发生率比较,差异无统计学意义(P>0.05)。2组中,仅有少部分患者出现穿刺部位出血、皮肤淤斑等,均无内出血和脑出血等严重出血事件。结论与单纯重组人尿激酶原给药相比较,重组人尿激酶原联合硝普钠给药可进一步改善急性心肌梗死患者PCI术的溶栓效果及预后情况。

Objective To investigate the clinical efficacy of recombinant human prourokinase(rh-proUK)combined with sodium nitroprusside for the patients with ST-segment elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).Methods A total of 82 patients with STEMI who were scheduled to receive PCI in our hospital from March 2018 to March 2019 were enrolled in thestudy,who were randomly divided into two groups.The patients in group A(n=42)were treated by recombinant human prourokinase(rh-proUK 10mg),however,the patients in group B(n=46)were treated by recombinant human prourokinase combined with sodium nitroprusside(rh-proUK 10mg+sodium nitroprusside 100~400μg),then,the stents were implanted.The general clinical data,and recovery status of blood flow,cardiac function indexes,incidence of major adverse cardiovascular events(MACE)were observed and compared between the two groups.Results After PCI,the TIMI classification and TMBG classification in group B were superior to those in group A(P<0.05).And the postoperative blood flow recovery,electrocardiogram,myocardial necrosis markers,and cardiac function indexes were in both significantly improved,moreover,these indexes in group B were superior to those in group A(P<0.05).In addition there were no significant differences in the incidence rates of MACE and bleeding events between the two groups(P>0.05).Conclusion Compared with simple recombinant human prourokinase,the recombinant human prourokinase combined with sodium nitroprusside can further improve the thrombolytic effect and prognosis of patients with STEMI undergoing PCI.