摘要
目的研究替罗非班联合不同剂量重组人尿激酶原治疗高血栓负荷急性ST段抬高型心肌梗死(STEMI)的有效性和安全性。方法前瞻性选取2021年2月至2023年10月河南省职工医院收治的70例高血栓负荷STEMI患者纳入研究,依据患者入院顺序进行编号,奇数纳入低剂量组,偶数纳入高剂量组,两组各35例。两组均经靶向灌注导管于梗死相关动脉远端推注替罗非班,在此基础上,低剂量组、高剂量组分别经靶向灌注导管于冠状动脉内缓慢注射重组尿激酶原10 mg、20 mg。比较两组患者术后即刻的心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMP)、校正TIMI血流计帧数(c TFC),术后90 min ST段回落指数、门球时间、血栓抽吸次数、置入支架数量,术前、术后每4 h的肌酸激酶同工酶(CK-MB)、心型肌钙蛋白(cTnI)水平,术前、术后1周、术后3个月N末端脑钠肽前体(NT-pro BNP)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)水平,术后24 h内出血率和术后6个月主要不良心血管事件(MACE)。结果低剂量组TIMIⅢ级为91.43%、TMPⅢ级为94.29%、c TFC为(22.00±1.62)帧,与高剂量组的97.14%、97.14%、(21.56±1.30)帧比较差异均无统计学意义(P>0.05);低剂量组术后90 min ST段回落指数<30%、30%~70%、>70%分别为5.71%、54.29%、40.00%,与高剂量组的1%、16%、18%比较差异均无统计学意义(P>0.05);低剂量组心肌灌注有效率为94.29%,与高剂量组的97.14%比较差异均无统计学意义(P>0.05);低剂量组门球时间为(57.30±5.29)min、术中血栓抽吸次数为(2.01±0.48)次,均低于高剂量组的(68.45±8.11)min、(2.56±0.60)次,差异均有统计学意义(P<0.05);低剂量组置入1个支架、2个支架、多个支架占比分别为20.00%、54.29%、25.71%,与高剂量组的17.14%、62.86%、20.00%比较差异均无统计学意义(P>0.05);低剂量组CK-MB术后峰值、达峰时间分别为(392.52±41.18)U/L、(13.18±1.60)h,与高剂量组的(400.05±37.29)U/L、(12.96±1.25)h比较差异均无统计学意义(P>0.05);低剂量组c TnI术后峰值、达峰时间分别为(3.52±0.83)U/L、(14.63±1.97)h,与高剂量组的(3.38±0.71)U/L、(14.25±2.13)h比较差异均无统计学意义(P>0.05)。低剂量组术后3个月的NT-proBNP、LVEF、LVEDD水平分别为(426.00±65.77)ng/L、(50.94±3.38)%、(46.89±3.75)mm,与高剂量组的(417.25±58.46)ng/L、(52.00±4.35)%、(45.20±3.08)mm比较差异均无统计学意义(P>0.05);低剂量组微出血率、术后6个月MACE情况分别为2.86%、11.43%,与高剂量组的2.86%、5.71%比较差异均无统计学意义(P>0.05)。结论替罗非班联合重组人尿激酶原治疗能改善高血栓负荷STEMI患者的心功能,且低剂量重组人尿激酶原可减少抽吸次数、缩短门球时间,安全有效。
Objective To investigate the efficacy and safety of tirofiban combined with different doses of recombinant human prourokinase in treating acute ST-segment elevation myocardial infarction(STEMI)with high thrombus burden.Methods A prospective study was conducted on 70 STEMI patients with high thrombus burden admitted to Henan General Hospital from February 2021 to October 2023.The patients were numbered according to their admission order:patients with odd numbers were assigned to the low-dose group(n=35)and those with even numbers assigned to the high-dose group(n=35).Both groups of patients received tirofiban via a targeted infusion catheter at the distal end of the infarct-related artery.On this basis,patients in the low-dose group and high-dose group were slowly injected with recombinant prourokinase 10 mg and 20 mg,respectively,through a targeted infusion catheter into the coronary artery.The two groups were compared in terms of the immediate postoperative thrombolysis in myocardial infarction(TIMI)flow grade,TIMI myocardial perfusion grade(TMP),corrected TIMI flow frame count(cTFC),90-minute ST segment resolution index after surgery,door-to-balloon time,number of thrombus aspiration,number of stents implanted,pre-and post-operative levels of creatine kinase isoenzyme(CK-MB)and cardiac troponin I(cTnI)every four hours,as well as preand post-operative levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)at one week and three months after surgery,the bleeding rate within 24 hours after surgery,and adverse cardiovascular events(MACE)at six months after surgery.Results The low-dose group had a TIMIⅢgrade of 91.43%,TMPⅢgrade of 94.29%,and cTFC of(22.00±1.62)frames,which showed no significant difference compared with the high-dose group's 97.14%,97.14%,and(21.56±1.30)frames(P>0.05).The proportions of ST segment resolution index<30%,30%-70%,and>70%in the low-dose group were 5.71%,54.29%,and 40.00%at 90 minutes after surgery,respectively,which showed no significant difference compared with the high-dose group's 1%,16%,and 18%(P>0.05).The myocardial perfusion effective rate in the low-dose group was 94.29%,which showed no significant difference compared with that of the high-dose group(97.14%),P>0.05.The door-to-balloon time was(57.30±5.29)min and the number of thrombus aspiration during the operation was(2.01±0.48)times in the low-dose group,significantly lower than(68.45±8.11)min and(2.56±0.60)times in the high-dose group(P<0.05).The proportions of patients with 1 stent,2 stents,and multiple stents were 20.00%,54.29%,and 25.71%in the low-dose group,respectively,which showed no significant difference with 17.14%,62.86%,and 20.00%in the high-dose group(P>0.05).The postoperative peak value and time to reach the peak of CK-MB in the low-dose group were(392.52±41.18)U/L and(13.18±1.60)h,respectively,which had no significant difference with the high-dose group's(400.05±37.29)U/L and(12.96±1.25)h(P>0.05).The postoperative peak value and time to reach the peak of cTnI in the low-dose group were(3.52±0.83)U/L and(14.63±1.97)h,respectively,which had no significant difference with the high-dose group's(3.38±0.71)U/L and(14.25±2.13)h(P>0.05).The levels of NT-proBNP,LVEF,and LVEDD in the low-dose group at 3 months after surgery were(426.00±65.77)ng/L,(50.94±3.38)%,and(46.89±3.75)mm,respectively,which showed no significant difference with(417.25±58.46)ng/L,(52.00±4.35)%,and(45.20±3.08)mm in the high-dose group(P>0.05).The bleeding rate and incidence of MACE at 6 months after surgery in the low-dose group were 2.86%and 11.43%,respectively,which showed no significant difference with 2.86%and 5.71%of the high-dose group(P>0.05).Conclusion Tirofiban combined with recombinant human urokinaseogen therapy improves cardiac function in STEMI patients with high thrombus burden,and low-dose recombinant human prourokinase reduces the number of thrombus aspiration,shortens door-to-balloon time,and is safe and effective.
作者
陈未
王光公
陈晓杰
赵晓鹏
张应福
万海同
尚菊菊
仇盛蕾
CHEN Wei;WANG Guang-gong;CHEN Xiao-jie;ZHAO Xiao-peng;ZHANG Ying-fu;WAN Hai-tong;SHANG Ju-ju;QIU Sheng-lei(Department of Cardiovascular Medicine,Henan General Hospital,Zhengzhou 450002,Henan,CHINA;Department of Cardiovascular Medicine,Henan Provincial People's Hospital,Zhengzhou 450000,Henan,CHINA;Department of Cardiovascular Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,CHINA;College of Life Sciences,Zhejiang Chinese Medical University,Hangzhou 310000,Zhejiang,CHINA;Department of Cardiology,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,CHINA)
出处
《海南医学》
CAS
2024年第20期2889-2895,共7页
Hainan Medical Journal
基金
国家重点研发计划项目(编号:2019YFC1708602)。
关键词
高血栓负荷
心肌梗死
替罗非班
重组人尿激酶原
疗效
安全性
High thrombus burden
Miocardial infarction
Tilofiban
Recombinant human prourokinase
Therapeutic effect
Safety
作者简介
第一作者:陈未(1980-),女,副主任医师,主要研究方向为冠心病、心力衰竭、高血压病;通讯作者:张应福(1966-),男,主任医师,主要研究方向为冠心病、心力衰竭、高血压病、心律失常,E-mail:zhangyingfu1168@163.com。
