| Objective:There is a correlation between the phenomenon of no-reflow and the poor clinical prognosis and high mortality for the acute STEMI patients with PCI.It is considered to be a dynamic process involving multiple pathophysiological mechanisms.The purpose of this study was to investigate the efficacy of the combination of thrombus aspiration and recombinant human prourokinase for the prevention of pPCI in STEMI patients.Methods:a total of 268 patients with acute STEMI in Dongguan branch,affiliated hospital of yan ’an university,were included in this study from August 2016 to October 2017,and 56 patients were excluded from the sample,a total of 212 patients were enrolled.On the basis of no reflow risk score model(score ≥14 points).In this study,there were 128 cases and 84 cases with low risk and high risk of no-reflow,including 75 males and 9 females,with an average age of 57.49±12.69 years.According to random number table method,it was randomly divided into thrombus aspiration + coronary artery recombinant human prourokinase group(test group,n=42)and simple thrombus group(control group,n=42).The basic clinical data characteristics of the two groups were compared,as well as the incidence of postoperative no reflow,the occurrence of hemorrhage in the hospital,cardiac function and MACE after operation during hospital and follow-up six months.Results:1.Compared with the basic clinical data of the experimental group and the control group,the number of patients with onset of balloon dilation(h),heart rate and neutrophils were respectively 6.95±3.26% vs 5.11±2.52,P <0.01;68.67±14.91 vs 75.71±16.34,P =0.04;8.56±3.41 vs 10.91±5.25,P =0.02.The difference was statistically significant.but there was no statistically significant difference between the two groups in age,gender,angina pectoris before infarction,hypertension,diabetes,medication before myocardial infarction,smoking history,blood pressure,blood sugar,CK-MB,blood lipid,etc(P >0.05).2.There were 128 patients in the no-reflow low-risk group,and 8 of them(6.3%)had the phenomenon of no-reflow.The incidence rate of TIMI blood flow grade 3 in the post-PCI test group was higher than that in the control group(92.9% vs.73.8%,P =0.02).The incidence rate of TIMI blood flow grade 0 to 2 was lower than that of the control group(7.1% vs 26.2%,P =0.02).The incidence of no-reflow in the experimental group was 7.1%,which is similar to the low risk group(6.3%),significantly lower than that of the control group(26.2%)(P <0.05).3.There was no statistical significance to the incidence of hemorrhage between the test group and the control group(P >0.05).The incidence of ischemic stroke in the experimental group was 4.8% in the first month after the operation and 2.4% in the control group,although the experimental group was higher than the control group,the statistical analysis showed no significance(P >0.05).4.The statistical analysis of LVEF,LVESD and LVEDD in two groups of patients during hospital showed no significance.Echocardiography index LVEF,LVESD and LVEDD were better than those in the hospital,and the results were statistically significant.In the control group,echocardiography index LVEF,LVESD and LVEDD were similar to those in hospital in June,and the statistical analysis was significance.LVEF in test group is greater than the control group in 6 months after operation [(61.93 + 10.16)% vs(53.40 + 9.84)%,P<0.001],LVESD is smaller than the control group [(29.21 + 4.14)mm vs(31.40 + 4.99)mm,P=0.03),LVEDD is smaller than the control group [(43.40 + 4.42)mm vs(46.00 + 6.24)mm,P =0.03),the results is statistically significant.5.During hospital after operation,MCE occurred in patients such as malignant arrhythmia,recurrent myocardial infarction,target vascular regeneration,congestive heart failure,cardiogenic shock and cardiac death,and the statistical analysis is no significant between the two groups(P >0.05).During the follow-up period of 6 months,the incidence of malignant arrhythmia,recurrent myocardial infarction and cardiac death in the test group was lower than that in the control group(7.1% vs 26.2%,P =0.02).2.4% vs 19.0%,P =0.03;0 vs 14.3%,P =0.03),the difference between the two groups is statistically significant.However,in target vessel regeneration,congestive heart failure and cardiogenic shock,the test group was lower than that in the control group,and the statistical analysis showed no significance(P >0.05).Conclusion:For high-risk patients,the combination of thrombus suction and recombinant human urokinase can reduce the incidence of no-reflow,improve myocardial blood supply,cardiac systolic function and reduce the incidence of cardiovascular adverse events,meanwhile,it does not increase the incidence of hemorrhage events and ischemic stroke. |
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