冠状动脉内联合应用硝普钠及重组人尿激酶原对急诊PCI术中无复流患者心功能及预后的影响

doi:10.3969/j.issn.1006-6233.2020.07.026

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Abstract Objective: To explore the clinical efficacy of intracoronary injection of sodium nitroprusside plus recombinant human pro-urokinase in the treatment of acute ST elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI) without reflow and its effect on the cardiac function and prognosis in patients. Methods: The subjects, 60 STEMI patients who did not see reflow during emergency PCI in our hospital from March 2017 to March 2019, were divided into observation group (n=30) and control group (n=30) on the basis of random number table. The observation group was treated with intracoronary injection of sodium nitroprusside plus recombinant, and the control group, sodium nitroprusside in the coronary arteries. The two groups were compared in blood flow classification of thrombolysis in myocardial infarction (TIMI) before and after treatment, bleeding complication rate during and within 24h hrs after the operation, cardiac function parameters [left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) ] on the 7th day and at the end of the 1st month after the operation as well as the occurrence of major adverse cardiac events (MACE) within 1 month after operation. Results: After treatment, 28 patients from the observation group (93.33%) and 20 patients from the control groups (66.67%) were grade 3 in TIMI blood flow classification (93.33%). The observation group saw much better TIMI blood flow classification than the control group did (P<0.05). At the end of the 1st month after the operation, both groups witnessed remarkably lower LVEDD but higher LVEF as compared with those on the 7th day after the operation (P<0.05), and at the end of the 1st month after the operation, the observation group had obviously lower LVEDD but higher LVEF than the control group did over the same period (P<0.05). The bleeding rate of the observation group during and within 24h after the operation was 16.67% (5/30), seeing no big difference from 10.00% (3/30) of the control group (P>0.05). The incidence of MACE of the observation group within 1 month after the operation was 6.67% (2/30) which was lower than 20.00% (6/30) of the control group, but the difference was not statistically significant (P>0.05). Conclusion: In the treatment of acute STEMI after emergency PCI without reflow, the application of intracoronary injection of sodium nitroprusside plus recombinant can effectively restore coronary blood flow and myocardial reperfusion in patients and improve their cardiac function and prognosis, proved to be safe and reliable.

Key words： Emergency percutaneous coronary intervention Recombinant human pro-urokinase Sodium nitroprusside Acute ST elevation myocardial infarction

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2020.07.026 OR http://www.hbyxzzs.cn/EN/Y2020/V26/I7/1165

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