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经皮腔内冠状动脉成形术联合尿激酶原对急性心肌梗死患者心肌再灌注和预后的影响

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目的 探讨经皮腔内冠状动脉成形术(PTCA)联合尿激酶原对急性心肌梗死(AMI)患者心
肌再灌注及预后的影响。方法 连续入选2017年6月至2018年2月于南阳市中心医院心内科收治的AMI患者
98例,随机分为PTCA组与联合组,每组49例。PTCA组给予PTCA治疗,联合组先行尿激酶原注射,后行
PTCA治疗。评价两组患者术后心肌梗死溶栓(TIMI)血流分级、心肌灌注分级(TMP),检测肌酸激酶
同工酶(CK-MB)水平。另外观察住院期间和出院后6个月发生主要不良心脏事件的情况。结果 联合组
PTCA后TIMI血流分级、TMP分级均显著优于PTCA组(P均<0.05)。与术前比较,两组术后12 h、24 h血清
CK-MB水平均显著上升(P均<0.05);联合组术后12 h血清CK-MB水平显著低于PTCA组(P<0.05)。住
院期间联合组再发心绞痛发生率4.08%,显著低于PTCA组的18.37%(P<0.05),出血率两组比较无显著差
异(P>0.05)。联合组出院后6个月恶性心律失常发生率显著低于PTCA组(P<0.05)。结论 PTCA联合尿
激酶原能明显改善AMI患者心肌再灌注,且不增加出血风险,可有效减少不良心脏事件发生。

Abstract:

Objective To investigate the influence of percutaneous transluminal coronary angioplasty (PTCA)
combined with prourokinase on myocardial reperfusion and prognosis in patients with acute myocardial infarction
(AMI). Methods AMI patients (n=98) were chosen from Department of Cardiovascular Medicine in Central
Hospital of Nanyang City from June 2017 to Feb. 2018, and then randomly divided into PTCA group and combined
group (each n=49). The PTCA group was treated with PTCA, and combined group was treated with prourokinase
injection followed by PTCA. The indexes of TIMI flow grades, grades of TIMI myocardial perfusion (TMP) and
level of creatine kinase-MB isoenzyme (CK-MB) were reviewed in 2 groups after PTCA. The incidence of major
adverse cardiovascular events (MACE) was observed in 2 groups during hospitalization period and 6 months after
discharged. Results The post-operative TIMI flow grades and TMP grades were significantly superior in combined
group to those in PTCA group after PTCA (all P<0.05). Compared with before PTCA, the level of serum CK-MB
increased significantly in 2 groups after PTCA for 12 h and 24 h (all P<0.05). The level of serum CK-MB was
significantly lower in combined group than that in PTCA group after PTCA for 12 h (P<0.05). The incidence rate
of re-attack angina pectoris was 4.08% in combined group and 18.37% in PTCA group (P<0.05), while bleeding
rate had no significant difference between 2 groups (P>0.05) during hospitalization period. The incidence rate of
malignant arrhythmia was significantly lower in combined group than that in PTCA group (P<0.05) after discharged
for 6 months. Conclusion PTCA combined with prourokinase can significantly improve myocardial reperfusion
without increasing bleeding risk and effectively reduce MACE in AMI patients.

基金项目:

郑州大学第一附属医院跨学科协同攻关博士科研团 队基金(2016-BSTDJJ-19)

参考文献:

[1] 王怀新,曹清涛,童雨田,等. 序贯再通冠脉介入治疗对急性心肌梗

死再灌注心律失常的影响[J]. 中国急救医学,2014,34(7):618-21.

[2] Welsh RC,Van de Werf F,Westerhout CM,et al. Outcomes of a
phamacoinvasive strategy for successful versus failed fibrenolysis
and primary percutaneous intervention in acute myocardial
infarction(from the STrategic Reperfusion Early After Myocardial
Infarction[STREAM]study)[J]. Am J Cardiol,2014,114(6):811-9.
[3] 杨柠溪. 急性心肌梗死行PTCA+支架术患者的临床叙事分析[J].
医学与哲学,2015,36(24):68-71.
[4] 李景瑞,李宇婷. PCI术前应用替罗非班对急性心肌梗死患者相关
指标的影响[J]. 中国药房,2017,28(20):2823-6.
[5] 耿二冬,秦宇红. 阿替普酶静脉溶栓对急性心肌梗死患者心肌损
伤标志物及心功能的影响[J]. 广东医学,2017,38(z1):256-8.
[6] 张伯亨,张亚静,岳博成,等. 尿激酶原联合血栓抽吸对高血栓负荷
的STEMI患者的疗效观察[J]. 医学研究杂志,2018,47(5):179-82.
[7] 顾磊,李振华,王晓田,等. 急性ST段抬高型心肌梗死尿激酶原溶
栓后早期介入与直接介入疗效对比研究[J]. 中国心血管病研
究,2017,15(5):433-6.
[8] 沈卫峰,张奇,张瑞岩. 2015年急性ST段抬高型心肌梗死诊断和治
疗指南解析[J]. 国际心血管病杂志,2015,42(4):217-9.
[9] Kleiman NS. Will measuring vasodilator-stimulated phosphoprotein
phosphorylation help us optimize the loading dose of clopidogrel?[J].
J Am Coll Cardiol,2008,51(14):1412-4.
[10] van 't Hof AW,Liem A,Suryapranata H,et al. Angiographic
assessment of myocardial reperfusion in patients treated with
primary angioplasty for acute myocardial infarction:myocardial blush
grade. Zwolle Myocardial Infarction Study Group[J]. Circulation,
1998,97(23):2302-6.
[11] 廖周国. PTCA与静脉溶栓治疗急性心肌梗死的近期及远期疗效
观察[J]. 现代中西医结合杂志,2014,23(10):1077-9.
[12] Briguori C,De Gregorio J,Nishida T,et al. Polytetrafluoroethylenecovered
stent for the treatment of narrowings in aorticocoronary
saphenous vein grafts[J]. Am J Cardiol,2000,86(3):343-6.
[13] 刘丕栋,曲秀芬,陈桂英,等. 联合溶栓和介入治疗对急性心肌梗
死患者预后的影响[J]. 中国急救医学,2003,23(6):42-3.
[14] 汪贵忠,赵胜,许恩文,等. 重组人尿激酶原冠状动脉内注射对行
经皮冠状动脉介入术的急性心肌梗死患者的影响研究[J]. 实用
心脑肺血管病杂志,2018,269(6):19-23.
[15] 毛文苹,王辰,杨媛华,等. 重组尿激酶原治疗对大鼠肺血栓栓塞症
后血浆纤溶因子的影响[J]. 军事医学,2014,38(12):948-51.
[16] 郝清卿,王立立,安少波,等. 重组尿激酶原联合替罗非班在急性
心肌梗死介入治疗中的作用[J]. 中国临床药理学杂志,2017,
33(21):2098-100.
[17] 王丽英,王国军,张彦玲,等. 注射用重组人尿激酶原溶栓治疗急
性心肌梗死的临床效果观察[J]. 临床误诊误治,2015,28(5):107-9.
[18] 吴丹勇,李景悦. 注射用重组人尿激酶原临床安全性和有效性评
价[J]. 中西医结合心脑血管病杂志,2017,15(17):2221-2.
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