重组人尿激酶原静脉溶栓治疗负荷STEMI患者对冠脉血流及心肌灌注的影响

Effects of Recombinant Human Prourokinase Intravenous Thrombolysis on Coronary Blood Flow in Patients with Stress STEMI and Myocardialperfusion

目的探讨重组人尿激酶原静脉溶栓治疗负荷STEMI患者对冠脉血流及心肌灌注的影响。方法选取2019年1月~2022年1月新疆生产建设兵团医院收治的120例高血栓负荷急性ST段抬高型心肌梗死(STEMI)患者,应用随机数表法分为观察组与对照组,每组60例。观察组患者给予重组人尿激酶原静脉溶栓治疗,对照组患者给予尿激酶治疗,对比两组患者的心功能指标、冠状动脉血流、心肌灌注以及不良心血管事件发生率。结果通过对比两组患者治疗前后心功能发现,两组患者治疗前左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)水平对比,差异无统计学意义(P>0.05),两组患者治疗后LVESD、LVEDD、LVEF心功能相关指标均明显改善,差异有统计学意义(P<0.05),治疗后两组间对比,差异无统计学意义(P>0.05);两组患者治疗前0~1级、2级、3级冠状动脉血流情况对比,差异无统计学意义(P>0.05),治疗后,观察组患者0~1级冠状动脉血流情况对比,差异无统计学意义(P>0.05),观察组2级动脉血流人数低于对照组,3级动脉血流人数高于对照组,差异具有统计学意义(P<0.05);两组患者治疗后,观察组ST段回落率、心肌染色分级(MBG)3级比例明显高于对照组,校正TIMI计帧数(CTFC)和无复流(NR)发生率明显低于对照组,差异有统计学意义(P<0.05);两组患者不良心血管事件总发生率对比,差异无统计学意义(P>0.05)。结论重组人尿激酶原静脉溶栓可提高患者血管再通情况,改善冠脉血流及心肌灌注,效果确切,安全性好,值得临床应用。

Objective To investigate the eff ects of intravenous thrombolysis with recombinant human urokinase on coronary blood fl ow and myocardial perfusion in patients with ST segment elevation myocardial infarction.Methods From January 2019 to January 2022,120 patients with high thrombotic load acute ST segment elevation myocardial infarction(STEMI)treated in Xinjiang production and Construction Corps Hospital were randomly divided into study group and control group,with 60 cases in each group.Patients in the study group were treated with recombinant human urokinase and patients in the control group were treated with urokinase.The cardiac function index,coronary blood fl ow,myocardial perfusion and the incidence of cardiovascular adverse events were compared between the two groups.Results There was no statistical signifi cant diff erence in left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDd)and left ventricular ejection fraction(LVEF)between the two groups before and after treatment(P>0.05).After treatment,LVESD,LVEDd and LVEF were signifi cantly improved(P<0.05),and there was no statistical signifi cant diff erence between the two groups(P>0.05);There was no statistical signifi cant diff erence in grade 0-1(P>0.05),grade 2 and grade 3 coronary artery blood fl ow between the two groups before treatment(P<0.05),and there was no signifi cant diff erence in grade 0-1 coronary artery blood fl ow between the observation group after treatment(P>0.05).The number of grade 2 coronary artery blood fl ow in the observation group was lower than that in the control group,and the number of grade 3 coronary artery blood fl ow in the observation group was higher than that in the control group(P<0.05);The rate of ST treatment decline and myocardial staining grade(MBG)3 in the two groups were signifi cantly higher than those in the control group(P<0.05),CTFC(corrected TIMI frame number)and NR(no refl ow)incidence were signifi cantly lower than those in the control group(P<0.05);There was no statistical signifi cant diff erence in the total incidence of adverse cardiovascular events between the two groups(P>0.05).Conclusion Intravenous thrombolysis with recombinant human urokinase can improve vascular recanalization,coronary blood fl ow and myocardial perfusion.The eff ect is positive and the safety is good.It is worthy of clinical application.