经靶向灌注导管应用重组人尿激酶原对行急诊PCI术的急性ST段抬高型心肌梗死患者心肌血流灌注的影响

摘要

目的 探讨经靶向灌注导管在ST段抬高型心肌梗死(STEMI)患者冠脉内选择性应用重组人尿激酶原对防治急诊行经皮冠状动脉介入治疗(PCI)时冠脉无复流/慢血流的有效性及安全性.方法 回顾性分析83例未行再灌注治疗TIMI血流0~1级的STEMI患者的临床资料,其中44例通过梗死相关动脉(IRA)靶病变应用靶向灌注导管于冠脉远段应用药物(重组人尿激酶原+硝酸甘油)后再行常规PCI术(靶向导管给药组),39例经指引导管注入药物(重组人尿激酶原+硝酸甘油)后再行常规PCI术(指引导管给药组),比较并观察两组患者心肌血流灌注、心肌梗死范围、临床预后、安全性评价.结果 两组患者一般临床资料比较差异未见统计学意义(P>0.05);靶向导管给药组心外膜冠状动脉灌注水平和心肌灌注水平显著优于指引导管给药组(P<0.01);住院期间两组患者院内主要不良心脑血管事件和出血事件发生率相当.结论 与指引导管给药组相比,靶向导管给药组在靶病变远端给药能明显改善STEMI患者心肌灌注水平,且不增加院内主要不良心脑血管事件和出血事件发生率.%Objective To investigate the effectiveness and safety of coronary no reflow/slow flow in percutaneous coronary intervention in the prevention and treatment of emergency for the ST segment elevation myocardial infarction (STEMI) patients applying topro urokinase selectively with targeted perfusion catheter.Methods Retrospectively analyzed the 83 cases of STEMI patient with no reperfusion therapy for TIMI blood flow 0-1.Among them, 44 cases were treated with the normal PCI operation after the application of targeted perfusion catheter in the coronary artery distal segment of the coronary artery (IRA) by means of the infarct related artery (recombinant human Pro urokinase) was used to investigate the application of the drug in the distal segment of the coronary artery (group A);39 cases were treated with the normal PCI operation after the injection of the drug (recombinant human Pro urokinase plus nitroglycerin) (group B).The myocardial perfusions (cTFC, TMPG), myocardial infarct size (ST segment elevation sum down percentage), clinical prognosis (MACCE event) and safety evaluation (the incidence of severe bleeding events) were observed.Results There was no significant difference in the general clinical data of the two groups (P>0.05);Epicardial coronary artery perfusion(cTFC)and myocardial perfusion level (TMPG)of targeted infusion catheter delivery group were better than guided catheter delivery group (P<0.01);during the hospitalization period, the MACCE and incidence of severe bleeding events of the two groups in hospitalization period were almost the same.Conclusions Compared with guided catheter delivery group, the targeted delivery of the catheter in the target lesion distal to the drug can improve myocardial perfusion in patients with STEMI and don't increase the MACCE and incidence of severe bleeding events within the hospital.