尿激酶原局部注射在高血栓负荷急性ST段抬高型心肌梗死经皮冠状动脉介入术中的应用

Application of Local Injection of Prourokinase in Percutaneous Coronary Intervention for Acute ST-segment Elevation Myocardial Infarction with High Thrombus Burden

目的探讨尿激酶原局部注射用于高血栓负荷(high thrombus burden,HTB)急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)经皮冠状动脉介入术(percutaneous coronary intervention,PCI)的临床效果。方法选择2019年7月—2022年3月金昌市永昌县人民医院收治的HTB急性STEMI患者100例,随机分为对照组和观察组各50例。两组患者均常规接受PCI治疗,术中采用刺破球囊的方式局部给药,对照组用药为硝酸甘油和硝普钠;而观察组在其基础上加用尿激酶原。比较两组患者的心肌灌注[心肌梗死溶栓治疗(thrombolysis in myocardial infarction,TIMI)的心肌灌注分级(TIMI myocardial perfusion grade,TMPG)]和心肌酶学[肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)及肌钙蛋白I(troponic I,cTnI)]改善情况,并对主要不良心血管事件(major adverse cardiovascular events,MACEs)进行随访。结果两组患者血管开通后,TMPG分布差异有统计学意义(P<0.05);CK-MB、cTnI最高峰值及达峰时间差异有统计学意义(P<0.05)。随访1年,两组MACEs发生率差异无统计学意义(P>0.05)。结论在HTB急性STEMI患者PCI中,在常规应用硝酸甘油和硝普钠基础上,通过刺破球囊局部给药的方式应用尿激酶,可以进一步提高心肌血液灌注效果,并且减轻心肌损伤。

Objective To explore the clinical efficacy of local injection of prourokinase for percutaneous coronary intervention(PCI)in acute ST segment elevation myocardial infarction(STEMI)with high thrombotic burden(HTB).Methods A total of 100 acute STEMI patients with HTB admitted to Yongchang County People's Hospital in Jinchang City from July 2019 to March 2022 were randomly divided into a control group and an observation group with 50 cases each.Both groups of patients received routine PCI treatment,and local medication was administered through puncturing the balloon during surgery.The control group was treated with nitroglycerin and sodium nitroprusside,and the observation group added urokinase additionally.Compare the improvement of myocardial perfusion(TIMI myocardial perfusion grade,TMPG)and myocardial enzymology[creatine kinase isoenzyme(CKMB)and troponin I(cTnI)] in both groups,and follow up the major adverse cardiovascular events(MACEs).Results There was a significant difference in the distribution of TMPG between the two groups of patients after endovascular recanalization(P<0.05).There was a significant difference in the peak value and peak time of CK-MB and cTnI between the two groups after endovascular recanalization(P<0.05).After one-year follow-up,there was no significant difference in the incidence of MACEs between the two groups(P>0.05).Conclusion Based on the routine application of nitroglycerin and sodium nitroprusside,the local administration of urokinase through puncturing the balloon can further improve the myocardial blood perfusion effect and reduce myocardial injury in PCI of acute STEMI patients with HTB.