冠脉内注射重组人尿激酶原溶栓联合PCI对急性心肌梗死患者冠脉血流水平、无复流发生率及预后的影响

Effect of intracoronary injection of recombinant human prourokinase thrombolysis combined with percutaneous coronary intervention on coronary blood flow，no-reflow incidence and prognosis in patients with acute myocardial infarction

摘要:

目的：分析冠脉内注射重组人尿激酶原溶栓联合经皮冠状动脉介入术（percutaneous coronary intervention，PCI）对急性心肌梗死（acute myocardial infarction，AMI）患者冠脉血流水平、无复流发生率及预后的影响。方法：将2017年12月至2018年6月郑州大学附属南阳医院收治的行急诊PCI治疗的139例AMI患者按再灌注治疗方式分为溶栓组（n=78）与血栓抽吸组（n=61），溶栓组靶血管病变部位逆向注射重组人尿激酶原，血栓抽吸组对闭塞血管行血栓抽吸，比较2组手术前后心肌梗死溶栓试验（thrombolysis in myocardial infarction，TIMI）血流分级、TIMI心肌灌注分级、术后校正TIMI血流帧数（corrected TIMI frame count，CTFC）及心功能变化，统计PCI术后无复流发生率、90 min内ST段回落率及近远期不良出血及心血管事件发生率，总结AMI患者PCI术后无复流的影响因素。结果：①２组术后TIMI血流分级比较，差异无统计学意义（P>0.05），溶栓组无复流率为5.13%，低于血栓抽吸组的16.39%（P<0.05）；②溶栓组CTFC低于血栓抽吸组（P<0.05），ST段回落率为94.87%，高于血栓抽吸组的78.69%（P<0.05）；③溶栓组术后30 d心功能指标均优于血栓抽吸组（P<0.05）；④２组术后30 d及随访1年出血事件、主要心血管不良事件发生率比较，差异无统计学意义（P>0.05）；⑤发病至入院时间、心肌缺血时间是AMI PCI术后无复流的危险因素（P<0.05），术中溶栓是其保护因素。结论：冠脉内注射重组人尿激酶原溶栓联合PCI可改善AMI患者血流灌注，降低无复流发生率，可能存在预后改善作用；而发病至入院时间、心肌缺血时间为AMI PCI术后无复流的危险因素，术中溶栓系其保护因子。

Abstract:

Objective：To analyze the effect of intracoronary injection of recombinant human prourokinase thrombolysis combined with percutaneous coronary intervention（PCI） on coronary blood flow，no-reflow incidence and prognosis in patients with acute myocardial infarction（AMI）. Methods：A total of 139 patients with AMI who underwent emergency PCI in Nanyang Central Hospital from Decem－ber 2017 to June 2018 were divided into the thrombolysis group（n=78） and the thrombus aspiration group（n=61） according to the reperfusion method. Recombinant human prourokinase was conversely injected into the target vascular lesion in the thrombolysis group，while the thrombus aspiration was performed in the thrombus aspiration group. Thrombolysis in myocardial infarction（TIMI） blood flow grading and TIMI myocardial perfusion grading before and after surgery，corrected TIMI frame count（CTFC） after surgery and cardiac function changes were compared between two groups. The no-reflow incidence after PCI，ST-segment resolution rate within 90 min，and the incidence of short-term and long-term adverse bleeding and cardiovascular events were statistically analyzed. Influencing factors of no-reflow after PCI in patients with AMI were summarized. Results：There was no significant difference in TIMI blood flow grading between two groups after surgery（P>0.05）. The no-reflow rate in the thrombolysis group was lower than that in the thrombus aspiration group（5.13% vs. 16.39%）（P<0.05）. CTFC in the thrombolysis group was lower than that in the thrombus aspiration group（P<0.05），and the ST-segment resolution rate was higher than that of the thrombus aspira－tion group（94.87% vs. 78.69%）（P<0.05）. Cardiac function indexes in the thrombolysis group at the 30th day after surgery were better than those in the thrombus aspiration group（P<0.05）. There was no significant difference in the incidence of bleeding events or major cardiovascular adverse events between two groups at the post-operative 30th day and during 1 year of follow-up（P>0.05）. The time from onset to admission and myocardial ischemia time were risk factors for no-reflow after PCI in AMI（P<0.05）. Intraoperative thrombolysis was the protective factor. Conclusion：Intracoronary injection of recombinant human prourokinase combined with PCI can improve the perfusion of patients with AMI，reduce the incidence of no-reflow，and may improve the prognosis. The time from onset to admission and myocardial ischemia time are risk factors for no-reflow after PCI in AMI，while intraoperative thrombolysis is a protec－tive factor.