小剂量阿替普酶对重度血栓负荷急性心梗患者PCI术中的影响

摘要

目的探究经冠状动脉(冠脉)内注射小剂量阿替普酶对重度血栓负荷急性心梗患者的影响.方法将2016年1月～2018年6月于江苏大学附属昆山医院接受急诊介入治疗的60例重度血栓负荷(血栓长度大于2倍血管内径)急性心梗患者作为研究对象,术前给予两组患者300 mg阿司匹林及180 mg替格瑞洛嚼服.随机数字表法分组,对照组30例,冠脉内注入5～10 mg生理盐水;观察组30例,冠脉内注射小剂量(5～10 mg)阿替普酶,溶栓后给予两组患者双联抗血小板聚集治疗,即让患者口服75 mg氯吡格雷+100 mg阿司匹林,1/d,持续1年.术后对β受体阻滞剂、他汀类等药物进行常规应用.比较两组术后TIMI血流分级情况、校正TIMI帧数改善情况、术后2 h ST段回落程度及出院后30 d KillipⅢ级以上、出血、恶性心律失常、心源性猝死等不良心血管事件发生情况.结果两组患者基线资料比较无明显差异(P＞0.05).其中观察组:男性21例,女性9例,年龄48～69岁,平均年龄(61.5±6.6)岁;对照组:男性22例,女性8例,年龄49～68岁,平均年龄(61.1±6.5)岁;另外两组在合并症方面比较无明显差异(P＞0.05);观察组患者术后TIMI血流分级情况明显优于对照组(P＜0.05),和治疗前相比其校正TIMI血流帧数得到明显改善,且显著低于对照组(P＜0.05);观察组患者术后2 h ST段回落50％比率高于对照组(83.3％vs.63.3％,P＜0.05);且观察组患者住院期间及出院后30 d不良心血管事件发生率均显著低于对照组(P＜0.05).结论在血栓负荷重的急性心肌梗死介入过程中,经血栓抽吸导管冠状动脉内注射小剂量阿替普酶可以进一步提高血流TIMI分级,减少校正TIMI帧数,降低心血管事件发生率,可广泛应用于临床.%Objective To study the influence of intracoronary injection of low-dose aletplase in patients with acute myocardial infarction (AMI) with severe thrombotic burden.Methods AMI patients (n=60) with severe thrombotic burden (length of thrombus being 2 times of vessel diameter) received emergency percutaneous coronary intervention (PCI) were chosen from Kunshan Hospital affiliated to Jiangsu University from Jan.2016to June 2018.The patients were given aspirin (300 mg) and ticagrelor (180 mg) before PCI.All patients were randomly divided into control group given intracoronary injection of normal saline (5 mg-10 mg), and observation group given intracoronary injection of low-dose aletplase (5 mg-10 mg, each n=30).After thrombolysis, dual antiplatelet therapy (DAPT) was used in 2 groups (clopidogrel in 75 mg and aspirin in 100 mg) once a day for 1 y, andβ-receptor blocker and statins were routinely administrated after PCI.The postoperative TIMI blood flow grading, improvement of corrected TIMI frame count (CTFC), degree of ST-segment depression 2 h after PCI, and postdischarge incidence of major adverse cardiovascular events (MACE, including Killip＞Ⅲgrade, bleeding, malignant arrhythmia and sudden cardiac death) were compared between 2 groups after 30 d.Results The baseline data had no significant difference between 2 groups (P＞0.05).There were 21 male cases and 9 female cases (aged from 48 to69 and average age=61.5±6.6) in observation group, and 22 male cases and 8 female cases (aged from 49 to 68 and average age=61.1±6.5) in control group.There was no significant difference in complications between 2 groups (P＞0.05).The postoperative TIMI blood flow grading was significantly better in observation group than that in control group (P＜0.05).The rate of 2-h ST-segment depression by 50％was higher in observation group than that in control group (83.3％vs.63.3％, P＜0.05).The incidence of MACE was lower in observation group than that in control group (P＜0.05) during in-hospital and 30 d after discharge.Conclusion During PCI in patients with AMI with severe thrombotic burden, intracoronary injection of low-dose aletplase can further improve TIMI flow grade and reduce incidence of MACE, which can be widely used in clinical practice.