冠脉内应用尿激酶原溶栓联合PPCI对STEMI患者ST段回落率及心肌灌注分级的研究

Study of Intracoronary Prourokinase Thrombolysis Combined with PPCI on ST-segment Regression Rate and Myocardial Perfusion Grade in Patients with STEMI

目的:探讨冠脉内应用尿激酶原溶栓联合直接经皮冠状动脉介入术(PPCI)对STEMI患者 ST段回落率及心肌灌注分级的影响。方法:选取2019年4月-2020年3月宜都市第一人民医院收治的STEMI患者84例,依据治疗方案的不同将其分为对照组和研究组,每组42例。对照组采用PPCI治疗,研究组应用尿激酶原溶栓联合PPCI治疗。对比两组心肌灌注分级、ST段回落率、TIMI血流、cTFC水平、心功能及心肌酶水平。结果:研究组心肌灌注分级中2、3级占比均高于对照组(P<0.05)。研究组患者的cTFC水平低于对照组,ST段回落率及TIMI血流3级患者占比均高于对照组(P<0.05)。干预后,研究组LVEDD水平低于对照组,LVEF及E/A值均高于对照组(P<0.05)。干预后,两组CK、LDH水平较干预前均下降,肌钙蛋白水平较干预前上升,研究组CK、LDH水平均低于对照组,肌钙蛋白水平高于对照组(P<0.05)。结论:STEMI患者应用尿激酶原溶栓联合PPCI治疗可提升ST段回落率,改善心肌灌注分级,提升心功能,改善心肌酶水平,可考虑推广。

Objective:To investigate the effect of intracoronary Prourokinase thrombolysis combined with primary percutaneous coronary intervention (PPCI) on ST-segment regression rate and myocardial perfusion grade in patients with STEMI.Method:A total of 84 STEMI patients admitted to Yidu First People’s Hospital from April 2019 to March 2020 were selected and divided into control group and study group according to different treatment regimen,42 cases in each group.PPCI was used in the control group,and intracoronary Prourokinase thrombolysis combined with PPCI was used in the study group.Myocardial perfusion grade,ST-segment regression rate,TIMI blood flow,cTFC level,cardiac function and myocardial enzyme level were compared between the two groups.Result:The proportions of grade 2 and 3 in the study group were higher than those in the control group (P<0.05).The cTFC level in the study group was lower than that in the control group,and the ST-segment regression rate and the proportion of TIMI grade 3 patients were higher than those in the control group (P<0.05).After intervention,the level of LVEDD in the study group was lower than that in the control group,and LVEF and E/A values were higher than those in the control group (P<0.05).After intervention,the levels of CK and LDH in both groups decreased compared with before intervention,while the level of troponin increased,the levels of CK and LDH in the study group were lower than those in the control group,while the level of troponin was higher than that in the control group (P<0.05).Conclusion:Application of Prourokinase thrombolytic therapy combined with PPCI in STEMI patients can improve ST-segment regression rate,improve myocardial perfusion grade,improve cardiac function,and improve myocardial enzyme level,which can be considered for promotion.