急诊PCI术中经罪犯血管注入溶栓药的临床观察

Clinical Observation of Injecting Thrombolytic Drug through Culprit Vessel during Emergency PCI

目的探讨急诊PCI术中经罪犯血管注入溶栓药对术后心肌血流灌注、远期预后及安全性的影响。方法选自2020年1月至2021年10月巴彦淖尔市医院收治的行急诊PCI的192例急性ST段抬高型心肌梗死(STEMI)患者,按随机数字表分为观察组和对照组,每组96例,观察组在球囊预扩张后支架置入前于冠脉内注入10mg重组人尿激酶原,随后行急诊PCI,对照组直接行急诊PCI。比较两组在急诊PCI术后TIMI血流分级、住院期间及术后1个月的出血情况、住院期间及术后6个月心血管不良事件发生情况。结果观察组术后TIMI血流0~2级患者明显低于对照组,术后TIMI血流3级患者明显高于对照组,差异有统计学意义(P<0.05);两组住院期间心血管不良事件比较,差异无统计学意义(P>0.05),观察组术后6个月发生心血管不良事件发生情况明显低于对照组,差异有统计学意义(P<0.05);两组在住院期间及术后1个月出血事件比较,差异无统计学意义(P>0.05)。结论急诊PCI术中经罪犯血管注入溶栓药可以降低术后无复流及慢血流发生率,术后心血管不良事件发生率低,并不增加出血风险,值得推广应用。

Objective To explore the effect of injecting thrombolytic drugs through the culprit vessel during emergency PCI on postoperative myocardial blood perfusion,long-term prognosis and safety.Methods A total of 192 patients with acute ST-segment elevation myocardial infarction(STEMI)admitted to Bayannaoer City Hospital were selected from January 2020 to October 2021 who underwent emergency PCI and divided into observation group and control group according to a random number table with 96 cases in each group.The observation group was injected with 10 mg Recombinant Human Prourokinase for Injection into the coronary artery between the balloon was expanded and the stent was implanted,followed by emergency PCI.The control group received emergency PCI directly.The TIMI blood flow classification,bleeding during hospitalization and 1 month after surgery,and the occurrence of adverse cardiovascular events during hospitalization and 6 months after surgery between the two groups was compared.Results The postoperative TIMI blood flow level 0~2 of the observation group was significantly lower than that of the control group,and postoperative TIMI blood flow level 3 patients were significantly higher than that of the control group.The difference was statistically significant(P<0.05).The difference in adverse events between the two groups during hospitalization was not statistically significant(P>0.05).The incidence of cardiovascular adverse events in the observation group at 6 months after surgery was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in bleeding events during the hospitalization and 1 month after the operation(P>0.05).Conclusion Injecting thrombolytic drugs through the culprit vessel during emergency PCI can reduce the incidence of postoperative no-reflow and slow blood flow.The incidence of postoperative cardiovascular adverse events is low and does not increase the risk of bleeding.It is worthy of popularization and application.