普佑克冠状动脉溶栓在高血栓负荷急性ST段抬高型心肌梗死急诊经皮冠状动脉介入治疗中易化作用的临床研究

Clinical study on the facilitation effect of Puyouke coronary artery thrombolysis in emergency percutaneous coronary intervention for acute ST segment elevation myocardial infarction with high thrombotic load

目的研究普佑克冠状动脉溶栓在高血栓负荷急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)中易化作用。方法回顾性分析2020年5月至2021年5月于鹰潭市人民医院治疗的120例高血栓负荷STEMI患者的临床资料,按照治疗方法不同分为A组、B组与C组,每组40例。A组采用血栓抽吸(TA)和替罗非班联合PCI治疗,B组采用普佑克和替罗非班联合PCI治疗,C组采用TA和普佑克及替罗非班联合PCI治疗,比较3组治疗前后心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]、6 min步行实验(6 MWD)、慢血流/无复流、主要不良心血管事件(MACE)发生率及出血并发症发生情况。结果治疗前,3组LVEF、LVEDD及6 MWD比较差异无统计学意义;治疗后,3组LVEF、6 MWD均高于治疗前,LVEDD均短于治疗前,且C组LVEF、6 MWD均高于A组、B组,LVEDD低于A组、B组,差异有统计学意义(P<0.05),A组与B组LVEF、LVEDD及6 MWD比较差异无统计学意义。3组慢血流/无复流及MACE发生率比较差异有统计学意义(P<0.05);A组、B组慢血流/无复流及MACE发生率比较差异无统计学意义;C组慢血流/无复流及MACE发生率均低于A组、B组,差异有统计学意义(P<0.05)。3组出血并发症发生率比较差异无统计学意义。结论普佑克冠状动脉溶栓用于高血栓负荷STE-MI急诊PCI中,能改善患者心功能,减少慢血流/无复流的发生,降低MACE发生率,且未增加出血并发症发生率,值得临床推广应用。

Objective To study the facilitation effect of Puyouke coronary artery thrombolysis in emergency percutaneous coronary intervention(PCI)for acute ST segment elevation myocardial infarction with high thrombotic load.Methods the clinical data of 120 patients with high thrombot-ic burden STEMI treated at Yingtan People's Hospital from May 2020 to May 2021 were retrospectively analyzed.They were divided into the group A,group B,and group C according to different treatment methods,with 40 cases in each group.Group A was treated with thrombus aspiration(TA)and tirofiban combined with PCI,Group B was treated with Puyouke,tirofiban combined with PCI,and Group C was treated with TA,Puyouke,and tirofiban combined with PCI.The cardiac function indicators(left ventricular ejection fraction[LVEF],left ventricular end diastolic diameter(LVEDD),6-minute walking test[6 MWD]before and after treatment,slow blood flow/no reflow,the incidence of major adverse cardiovascular events(MACE)and the incidence of bleeding complications were compared among the three groups.Results Before treatment,there were no statis-tically significant differences in the LVEF,LVEDD,and 6 MWD among the three groups;after treatment,the LVEF and 6 MWD among the three groups were higher than before treatment,LVEDD were shorter than before treatment,LVEF and 6 MWD in the group C were higher than those in the group A and group B,LVEDD was shorter than that in the group A and group B,and the differences were statistically significant(P<0.05),there were no statistically significant differences in the LVEF,LVEDD,and 6 MWD between the group A and group B.There were statistically significant differ-ences in the incidence of slow blood flow/no reflow and MACE among the three groups(P<0.05);there was no statistically significant difference in the incidence of slow blood flow/no reflow and MACE between the group A and group B;the incidence of slow blood flow/no reflow and MACE in the group C was lower than that in the groups A and group B,and the differences were statistically significant(P<0.05).There was no statistically sig-nificant difference in the incidence of bleeding complications among the three groups.Conclusion The use of Puyouke coronary thrombolysis in emergency PCI treatment for high thrombotic burden STEMI can improve patient cardiac function,reduce the occurrence of slow blood flow/no re-flow,lower the incidence of MACE,and do not increase the incidence of bleeding complications.It is worthy of clinical promotion and application.