论文部分内容阅读
目的探讨尿激酶对直接经皮冠状动脉介入治疗(PCI)术后无复流(NF)的疗效。方法将71例急性心肌梗死(AMI)直接PCI术后NF患者随机分成尿激酶组(35例)和对照组(36例),尿激酶组PCI术后即刻予25万U尿激酶冠状动脉内注射,15 min后行冠状动脉造影,观察心肌梗死溶栓研究(TIMI)和Blush血流分级改变情况,术后第1天起再予尿激酶25万U静脉滴注,共3 d。两组术中均根据血压情况予必要的常规处理,比较两组一般临床特征、心功能及随访心血管事件的发生率。结果①尿激酶组TIMI及Blush血流较治疗前无明显改善,术后1 h ST段抬高下降幅度≥50％者占42．8％,与对照组(30．5％)的差异无显著性(P>0．05),术后72 h ST段抬高下降幅度≥50％者占77．1％,与对照组(52．8％)的差异有显著性(P<0．05)。②尿激酶组术后10 d梗死心肌节段心肌灌注积分为(3．00±1．25)分,显著低于对照组的(3．77±1．36)分(P<0．05)。③住院期间尿激酶组与对照组的左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、室壁运动积分(WMSI)和左室射血分数(LVEF)的差异均无显著性(P值均>0．05)。但尿激酶组随访期间的LVEDV、LVESV、WMSI较住院期间显著降低,LVEF则显著增加(P值均<0．05);对照组LVEDV、LVESV及WMSI较住院期间显著增加,LVEF则显著降低(P值均<0．05)。④尿激酶组在住院期间及随访期间恶性心律失常和心力衰竭的发生率较对照组显著下降(P值均<0．05);不稳定心绞痛、再次心肌梗死、再次血运重建及死亡发生率的差异无显著性(P值均>0．05)。结论应用小剂量尿激酶能改善心肌梗死后的左室重构,减少心脏事件的发生,对改善AMI直接PCI后NF的不良影响有一定作用。
Objective To investigate the effect of urokinase on no-reflow (NF) after direct percutaneous coronary intervention (PCI). Methods Seventy-one patients with acute myocardial infarction (AMI) were randomly divided into urokinase group (n = 35) and control group (36 patients). The urokinase group was given intracoronary 250 000 urokinase , 15 min after coronary angiography, myocardial infarction thrombolysis study (TIMI) and Blush blood flow grading changes, and then on the first day after the urokinase 25 000 U intravenous infusion, a total of 3 d. The two groups were based on blood pressure to the necessary routine treatment, the general clinical features of two groups, cardiac function and follow-up of the incidence of cardiovascular events. Results ① The blood flow of TIMI and Blush in urokinase group had no significant improvement compared with those before treatment. The drop of ST segment elevation ≥50% at 1 h after operation was 42.8%, but there was no significant difference with that of control group (30.5%) (P> 0.05). The ST segment elevation at 72 h postoperatively was more than 50% (77.1%), which was significantly different from that of the control group (52.8%) (P <0.05) . ② The score of myocardial perfusion in myocardial infarction group was (3.00 ± 1.25) points 10 d after operation, which was significantly lower than that in control group (3.77 ± 1.36) (P0.05) . ③ There was no significant difference in LVEDV, LVESV, WMSI and LVEF between Urokinase group and control group during hospitalization (P> 0.05). However, LVEDV, LVESV and WMSI during the follow-up period of urokinase group were significantly lower than those during hospitalization while LVEF was significantly increased (all P <0.05). LVEDV, LVESV and WMSI in control group were significantly increased during hospitalization while LVEF was significantly decreased P <0.05). ④ The incidence of malignant arrhythmia and heart failure in the urokinase group during hospitalization and follow-up were significantly lower than those in the control group (all P <0.05); unstable angina pectoris, myocardial infarction, revascularization and death The difference was not significant (P> 0.05). Conclusions The application of low-dose urokinase can improve left ventricular remodeling after myocardial infarction and reduce the incidence of cardiac events, and play an important role in improving the adverse effects of NF after PCI.