急诊PCI靶血管注射小剂量替罗非班和尿激酶对血流和近期预后的影响

摘要

目的 分析急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术中选择性靶血管内注射小剂量替罗非班和尿激酶对梗死相关血管冠脉血流(TIMI)和近期预后的影响.方法 选择我院2012年1月至2014年10月行STEMI急诊PCI术患者125例,根据PCI术中是否选择性靶冠脉内注射小剂量替罗非班和尿激酶分为A组(非注药组,60例)和B组(注药组,65例).比较两组患者PCI术后梗死相关血管的TIMI分级、出血并发症发生率、1个月时左室射血分数(LVEF)和6个月时主要心血管事件发生率(MACE).结果 B组患者PCI术后TIMI 3级血流获得率明显高于A组(96.9%vs 90.6%),差异有统计学意义(P<0.05);术后1个月B组患者LVEF高于A组[(56.3±8.6)vs(51.2±8.7)],差异有统计学意义(P<0.01);6个月后MACE低于A组(3.1%vs 8.3%),差异有统计学意义(P<0.05);轻中度出血并发症发生率高于A组(9.2%vs 8.4%),但差异无统计学意义(P>0.05).结论 STEMI急诊介入治疗中选择性靶血管内注射小剂量替罗非班和尿激酶明显改善PCI术后的冠脉血流、LVEF及近期临床预后.%Objective To evaluate the effect and short-term prognosis of percutaneous coronary intervention (PCI) assisted with infarct-related artery (IRA) injection of low-dose tirofiban and urokinase in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods From January 2012 to October 2014, a total of 125 pa-tients with STEMI, who underwent emergency PCI in our hospital, were chosen and divided into A group (non-IRA in-jection, n=60) and B group (IRA injection of low-dose tirofiban and urokinase, n=65). The TIMI flow grade following PCI operation, the left ventricular ejection fraction (LVEF) one month after PCI, the bleeding condition and major ad-verse cardiac events (MACE, including death, re-infarction and target vessel revascularization) in 6 months after dis-charge from hospital were observed and compared.Results B group showed significantly higher TIMIⅢflow degree than A group (96.9%vs 90.6%, P<0.05). Compared with A group, LVEF one month after PCI in B group was significant-ly higher [(56.3±8.6) vs (51.2±8.7), P<0.01]. The occurrence of MACE within 6-month follow-up in A group was signifi-cantly higher than B group (3.1% vs 8.3%,P<0.05), while there was no significant difference in the complication of bleeding between B group and A group (9.2%vs 8.4%,P>0.05). Conclusion Emergency PCI assisted with infarct-relat-ed artery (IRA) injection of low-dose tirofiban and urokinase in patients with STEMI was safe and effective in improv-ing postoperative TIMI of IRA and prognosis within 6-month follow-up.