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目的:探讨在ST段抬高型心肌梗死(STEMI)患者急诊行经皮冠状动脉介入治疗(PCI)中,经靶向灌注导管冠脉内应用重组人尿激酶原对心肌血流灌注及预后的影响。方法:回顾性分析108例STEMI患者。其中,64例通过梗死相关动脉(IRA)应用采用靶向灌注导管于靶病变远段药物(重组人尿激酶原20 mg+硝酸甘油3μg·kg~(-1))后,再行常规PCI术(观察组);44例通过IRA采用靶向灌注导管于靶病变远段应用药物(替罗非班0.25 m L·kg~(-1)+硝酸甘油3μg·kg~(-1))后,再行常规PCI术(对照组);比较并观察2组患者的心肌血流灌注、心肌梗死范围(ST段抬高总和回落百分比)、临床预后[主要不良心脑血管事件(MACCE)]和安全性(严重出血事件的发生率)。结果:2组患者一般临床资料无统计学差异(P>0.05);观察组心外膜冠状动脉灌注水平(c TFC)和心肌灌注水平(TMPG)优于对照组(P<0.001);住院期间2组患者院内MACCE和出血事件发生率相当。结论:与靶向应用替罗非班相比,经靶向灌注导管在靶病变远端给予重组人尿激酶原可进一步改善STEMI患者心肌灌注水平,且不增加院内MACCE和出血事件的发生率。
Objective: To investigate the effect of intracoronary recombinant human pro-urokinase on myocardial perfusion and prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) . Methods: A retrospective analysis of 108 cases of STEMI patients. Sixty-four patients were treated with targeted perfusion catheter through the distal infarction-related drug (recombinant human prourokinase 20 mg + nitroglycerin 3 μg · kg -1) through infarction-related artery (IRA) (Tirofiban 0.25 m L · kg -1 and nitroglycerin 3 μg · kg -1) were administered to the distal target lesion by using the targeted perfusion catheter through IRA. (Control group). The levels of myocardial perfusion, infarct size (percentage of total ST-segment elevation), clinical outcome (MACCE), and safety in the two groups were compared and observed (The incidence of a serious bleeding event). Results: There was no significant difference in the clinical data between the two groups (P> 0.05). The levels of epicardial coronary artery perfusion (cTFC) and myocardial perfusion (TMPG) in the observation group were better than those in the control group (P <0.001) The incidence of MACCE and bleeding in the two groups was comparable. CONCLUSION: Compared with targeted application of tirofiban, administration of recombinant human prourokinase distal to targeted lesions by targeted perfusion catheter can further improve myocardial perfusion in STEMI patients without increasing incidence of MACCE and bleeding in the hospital.