急诊PCI术中经冠脉内注入重组人尿激酶原的临床观察

Clinical Observation of Recombinant Human Rh-proUK Injected into Coronary Artery during Emergency PCI

目的探讨急诊PCI术中经冠脉内注入重组人尿激酶原对术后心肌血流灌注、心脏功能及安全性的影响。方法选取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,按随机数表法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10 mg重组人尿激酶原,随后行急诊PCI;对照组直接行急诊PCI。比较两组术后CK峰值、CK-MB峰值、肌钙蛋白峰值;两组术后ST段回落率;两组住院期间及术后3个月的左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及左室短轴缩短率(LVFS);两组住院期间及术后3个月的出血事件。结果两组CK峰值、CK-MB峰值及肌钙蛋白峰值对比,差异无统计学意义(P>0.05)。观察组术后ST段回落率>70%的有18例,对照组术后ST段回落率>70%的有7例,差异有统计学意义(P<0.05)。两组患者在住院期间LVEF、LVEDD、LVFS比较,差异无统计学意义(P>0.05)。观察组在术后3个月LVEF、LVEDD、LVFS均优于对照组,差异有统计学意义(P<0.05)。两组住院期间及术后3个月出血事件比较,差异无统计学意义(P>0.05)。结论急诊PCI术中经冠脉内注入重组人尿激酶原可以改善术后心肌血流灌注和心脏功能,且安全有效。

Objective To investigate the effect of intracoronary injection of rh-proUK on myocardial blood flow perfusion,cardiac function and safety after emergency PCI.Methods A total of 192 patients with acute ST segment elevation myocardial infarction(STEMI)who underwent emergency PCI in Bayannaoer Hospital from January 2020 to October 2021 were randomly divided into the observation group and the control group,with 96 cases in each group.The observation group injected 10mg of rh-proUK into the coronary artery before stent placement after balloon pre expansion,followed by emergency PCI,and the control group directly performed emergency PCI.The peak of CK,CK-MB and Troponin were compared between the two groups;Postoperative ST segment regression rate in both groups;Left ventricular Ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and left ventricular short axis shortening rate(LVFS)during hospitalization and 3 months after operation in both groups;Two groups of bleeding events during hospitalization and 3 months after surgery.Results There was no significant difference in CK peak,CK-MB peak and Troponin peak between the observation group and the control group(P>0.05);There were 18 cases in the observation group with a postoperative ST segment regression rate greater than 70%,and 7 cases in the control group with a postoperative ST segment regression rate greater than 70%,with a statistically significant difference(P<0.05);There was no statistically significant difference in LVEF,LVEDD and LVFS between the two groups of patients during hospitalization(P>0.05);The LVEF,LVEDD and LVFS in the observation group were better than those in the control group at 3 months after surgery,with statistically significant differences(P<0.05);There was no statistically significant difference in bleeding events between the two groups during hospitalization and 3 months after surgery(P>0.05).Conclusion Intracoronary injection of rh-proUK during emergency PCI can improve myocardial blood flow perfusion and cardiac function,and it is safe and effective.