经血栓抽吸导管注射重组人尿激酶原对高血栓负荷ST段抬高型心肌梗死患者急诊介入治疗效果的影响
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摘要
目的:探讨急诊经皮冠状动脉介入治疗(PCI)时,经血栓抽吸导管冠状动脉(冠脉)内注射重组人尿激酶原对高血栓负荷ST段抬高型心肌梗死(STEMI)患者心肌组织水平灌注和临床预后的影响。方法:将105例高血栓负荷的STEMI患者随机分为尿激酶原组54例和血栓抽吸组51例。尿激酶原组在血栓抽吸后经抽吸导管于冠脉内注射重组人尿激酶原20mg;血栓抽吸组只行血栓抽吸。比较两组患者术后心肌组织水平灌注情况、出血事件及术后30d内主要不良心血管事件(MACE)发生情况。结果:尿激酶原组术后慢血流/无复流和心肌灌注不良发生率显著低于血栓抽吸组(11.1%∶29.4%,P=0.027;13.0%∶33.3%,P=0.013),术后心电图ST段回落>50%比例显著高于血栓抽吸组(92.6%∶76.5%,P=0.029),术后30d内MACE发生率显著低于血栓抽吸组(3.7%∶19.6%,P=0.013),两组患者出血事件发生率差异无统计学意义。结论:对于行急诊PCI的高血栓负荷STEMI患者,血栓抽吸联合重组尿激酶原冠脉内注射与单纯血栓抽吸相比,可以获得更好的心肌组织水平灌注,减少术后MACE发生,且不增加术后出血风险。
Objective:To explore the impact of intracoronary recombinant human pro-urokinase injection through thrombus aspiration catheter on myocardial reperfusion and clinical prognosis in patients with ST-segment elevation myocardial infarction (STEMI)presenting with massive thrombus in primary percutaneous coronary intervention (PCI).Method:A total of 105 STEMI patients with massive thrombus were randomly divided into prourokinase group (n=54) and thrombus aspiration (TA) group (n=51).A dose of 20 mg recombinant human prourokinase was injected into coronary artery through thrombus aspiration catheter after thrombus suction in pro-urokinase group,and TA group received only thrombus suction.The myocardial perfusion,the incidence of hemorrhage and major adverse cardiac events (MACE) within 30 dafter PCI between two groups were compared.Result:Compared with TA group,pro-urokinase group showed decreased slow flow/no-flow rate and myocardial perfusion disorder rate after PCI (11.1%vs 29.4%,P=0.027;13.0%vs 33.3%,P=0.013),and increased rate of ST resolution >50% after PCI (92.6%vs 76.5%,P=0.029).The incidence of MACE within 30 dafter PCI in pro-urokinase group was lower than that in TA group (3.7% vs 19.6%,P=0.013).The difference of hemorrhage rate between two groups had no statistical significance.Conclusion:Compared with thrombus aspiration alone,intracoronary application of recombinant human pro-urokinase through thrombus aspiration catheter after thrombus aspiration is associated with an improvement of myocardial reperfusion and decrease of MACE without increasing hemorrhage complication in STEMI patients with massive thrombus in primary PCI.
Objective:To explore the impact of intracoronary recombinant human pro-urokinase injection through thrombus aspiration catheter on myocardial reperfusion and clinical prognosis in patients with ST-segment elevation myocardial infarction (STEMI)presenting with massive thrombus in primary percutaneous coronary intervention (PCI).Method:A total of 105 STEMI patients with massive thrombus were randomly divided into prourokinase group (n=54) and thrombus aspiration (TA) group (n=51).A dose of 20 mg recombinant human prourokinase was injected into coronary artery through thrombus aspiration catheter after thrombus suction in pro-urokinase group,and TA group received only thrombus suction.The myocardial perfusion,the incidence of hemorrhage and major adverse cardiac events (MACE) within 30 dafter PCI between two groups were compared.Result:Compared with TA group,pro-urokinase group showed decreased slow flow/no-flow rate and myocardial perfusion disorder rate after PCI (11.1%vs 29.4%,P=0.027;13.0%vs 33.3%,P=0.013),and increased rate of ST resolution >50% after PCI (92.6%vs 76.5%,P=0.029).The incidence of MACE within 30 dafter PCI in pro-urokinase group was lower than that in TA group (3.7% vs 19.6%,P=0.013).The difference of hemorrhage rate between two groups had no statistical significance.Conclusion:Compared with thrombus aspiration alone,intracoronary application of recombinant human pro-urokinase through thrombus aspiration catheter after thrombus aspiration is associated with an improvement of myocardial reperfusion and decrease of MACE without increasing hemorrhage complication in STEMI patients with massive thrombus in primary PCI.
引文
[1]李宏松,许向东,吴国林,等.ST段抬高型心肌梗死患者急诊PCI术中选择性使用血栓抽吸策略的研究[J].临床心血管病杂志,2017,33(10):946-949.
[2]谭金习,董梅,任法新.术前血小板-白细胞聚集体水平与STEMI患者急诊PCI术后心肌无复流的相关性[J].临床心血管病杂志,2016,32(5):455-458.
[3]马威,黄琨,孙淑娴,等.不同风险等级STEMI患者急诊PCI应用比伐卢定与肝素+替罗非班的疗效与安全性比较[J].临床心血管病杂志,2017,33(12):1180-1185.
[4]Jolly SS,Cairns JA,Yusuf S,et al.Outcomes after thrombus aspiration for ST elevation myocardial infarction:1-year follow-up of the prospective randomised TOTAL trial[J].Lancet,2016,387(10014):127-135.
[5]张大鹏,王乐丰,杜锦权,等.经血栓抽吸导管注射替罗非班和硝普钠对重度血栓负荷前壁急性心肌梗死患者急诊介入治疗效果的影响[J].中华心血管病杂志,2014,42(1):25-30.
[6]陈怡粤,余小平.介入治疗过程中联合应用血栓抽吸导管与替罗非班治疗急性心肌梗死高血栓负荷患者的疗效及安全性[J].中国老年学杂志,2015,35(11):2991-2993.
[7]Boscarelli D,Vaquerizo B,Miranda-Guardiola F,et al.Intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration[J].Eur Heart J Acute Cardiovasc Care,2014,3(3):229-236.
[8]韩梅,张驰,冯珺,等.重组人尿激酶原对老年性ST段抬高型心肌梗死患者近期心血管事件影响分析[J].中国心血管病研究,2018,16(5):411-415.
[9]刘晓健,顾顺忠.重组人尿激酶原治疗急性ST段抬高心肌梗死患者的疗效和安全性[J].安徽医学,2017,38(10):1324-1327.
[10]Hao C,Ding W,Xu X,et al.Effect of recombinant human pro-urokinase on thrombolysis in a rabbit model of thromboembolic stroke[J].Biomed Rep,2018,8(1):77-84.
[11]邓虹,王南,王旭,等.注射用重组人尿激酶原对急性ST段抬高型心肌梗死患者出血发生率及不良心血管事件发生率的影响[J].中国急救医学,2017,34(z1):318-319.
[2]谭金习,董梅,任法新.术前血小板-白细胞聚集体水平与STEMI患者急诊PCI术后心肌无复流的相关性[J].临床心血管病杂志,2016,32(5):455-458.
[3]马威,黄琨,孙淑娴,等.不同风险等级STEMI患者急诊PCI应用比伐卢定与肝素+替罗非班的疗效与安全性比较[J].临床心血管病杂志,2017,33(12):1180-1185.
[4]Jolly SS,Cairns JA,Yusuf S,et al.Outcomes after thrombus aspiration for ST elevation myocardial infarction:1-year follow-up of the prospective randomised TOTAL trial[J].Lancet,2016,387(10014):127-135.
[5]张大鹏,王乐丰,杜锦权,等.经血栓抽吸导管注射替罗非班和硝普钠对重度血栓负荷前壁急性心肌梗死患者急诊介入治疗效果的影响[J].中华心血管病杂志,2014,42(1):25-30.
[6]陈怡粤,余小平.介入治疗过程中联合应用血栓抽吸导管与替罗非班治疗急性心肌梗死高血栓负荷患者的疗效及安全性[J].中国老年学杂志,2015,35(11):2991-2993.
[7]Boscarelli D,Vaquerizo B,Miranda-Guardiola F,et al.Intracoronary thrombolysis in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration[J].Eur Heart J Acute Cardiovasc Care,2014,3(3):229-236.
[8]韩梅,张驰,冯珺,等.重组人尿激酶原对老年性ST段抬高型心肌梗死患者近期心血管事件影响分析[J].中国心血管病研究,2018,16(5):411-415.
[9]刘晓健,顾顺忠.重组人尿激酶原治疗急性ST段抬高心肌梗死患者的疗效和安全性[J].安徽医学,2017,38(10):1324-1327.
[10]Hao C,Ding W,Xu X,et al.Effect of recombinant human pro-urokinase on thrombolysis in a rabbit model of thromboembolic stroke[J].Biomed Rep,2018,8(1):77-84.
[11]邓虹,王南,王旭,等.注射用重组人尿激酶原对急性ST段抬高型心肌梗死患者出血发生率及不良心血管事件发生率的影响[J].中国急救医学,2017,34(z1):318-319.