The Effect And Observation For Securing Of Using Recombinant Human Prourokinase For Injection To Cure Acute St Segment Elevation Myocardial Infarction

Objective: The effect and observation for securing of using recombinant human prourokinase for injection to cure acute ST segment elevation myocardial infarction.Methods: 72 STEAMI patients were selected from 2014.1 to 5 in Yanan(the Affiliated Hospital of Yanan and hospitals from surrounding counties). Set up the patients who given recombinant human pro-urokinase and urokinase to the group of pro-uk and urokinase.Group of pro-uk: put 50 mg recombinant human provrokinase into 100 ml saline, then first 10 ml is used by intravenous injection and the surplus 90 ml must be finished by intravenous drip in thirty minutes.Group of urokinase: put1.5 million units of urokinase into 100 ml saline, the first 10 ml is used by intravenous injection and the surplus 90 ml is used by intravenous drip in thirty minutes. Compare the thrombolysis in myocardial infarction trial(TIMT),the ST-Segment change of the two groups,the occurrence of reperfusion arrhythmias,the cardiac biomarkers index detection,the major adverse cardiovascular events(MACE)and the hemorrhagic complications of two group.Result:1.Comparing two groups of the coronary artery patency after thrombolysis: The rate of passing(TIMI2+TIMI3) of infarct-related artery. IRA in pro-uk group is 86.84%, obviously higher than urokinase group(61.76%),(χ2=6.02.P=0.01); and the rate of completely passing(TIMI3) is76.32%, obviously higher than urokinase group(47.06%),(χ2=6.55,P=0.01).There are significant differences in two groups(P<0.05).2.Comparing two groups of the ST segment changes within two hour of thrombolytic therapy:The most significant decline in the ST-segment elevation lead is ranged in 50%-75% of pro-uk group within two hours after thrombolysis,which of the incidence is 44.12%, obviously higher that urokinase group(17.65%),(χ2=4.14,P=0.04);the occurrence rate of 75% falling range is55.26%.obviously higher than urokinase group(26.47%),(χ2=6.12,P=0.01).There are significant differences in two groups(P<0.05).3.Comparing two groups of the reperfusion arrhythmia within two hours after thrombolysis: The occurrence rate of reperfusion arrhythmia of pro-uk group in two hours after thrombolysis is73.68%,obviously higher than urokinase group(44.12%),(χ2=6.52,P=0.01).There are significant differences in two groups(P<0.05).4.Comparing two groups of the CK-MB after thrombolysis: The occurrence of CK-MB peak with fourteen hours after thrombolysis in pro-uk group is 84.21%,which is obviously higher than urokinase group(61.76%),(χ2=4.65,P=0.03); The time for pro-uk group to reach peak is(11.20±2.83),obviously shorter than urokinase group(13.64±2.83),(χ2=-3.37,P=0.001).There are significant differences in two groups(P<0.05).5.Comparing two groups of the MACE: In pro-uk group,one patient died(2.63%), two patients had occured myocardial infarction(5.26%), without reascularization of crime vascular, there patients had occured frequent anginas(7.89%).In urokinase group,two patient died(5.88%), five patients had occured myocardial infarction(14.71%), one patient had crime vascular reascularized(2.94%), seven patients had occured frequent anginas(20.59%). There aren’t significant difference between two groups(P>0.05).6.Comparing two groups of the hemorrhage after thrombolysis: Both two groups didn’t occur the bleeding of the serious and important parts.In pro-uk group,there patients had mild bleeding(7.89%),including one urinary(2.63%) and two mucocutaneous hemorrhage(5.26%); In urokinase group,five patients had mild bleeding(14.71%), including two urinary(5.88%), two mucocutaneous(5.88%) and one digestive tract(2.94%). There aren’t significant difference in the bleed places and degrees of two groups(P>0.05).Conclusion: Pro-uk is characterized by high specificity, high rate of the coronary recanalization,early reperfusion, low occurrence rate of hemorrhage complication and cruor disorder, so it gets more and more attention.