| Objective:Acute coronary syndrome(ACS)is the complete or incomplete occlusion of coronary artery on the basis of coronary lesions,which causes myocardial ischemia and hypoxia.The definition of ACS is based on the definition of diagnosis and treatment guidelines,including three types of ST segment elevation myocardial infarction(STEMI),unstable angina pectoris(UA)and non ST segment elevation myocardial infarction(NSTEMI).Antithrombotic therapy runs through the acute stage and the whole life of ACS,which is the cornerstone of prevention and treatment of ACS.A number of clinical trials have confirmed that emergency interventional therapy for STEMI patients is a positive and effective treatment measure,with high success rate and safety,and satisfactory short-term and long-term clinical effect.Percutaneous coronary intervention(PCI)is a common method to treat coronary heart disease,especially for STEMI patients,it can open the infarct related artery as early as possible and effectively At present,the most effective way to treat AMI is to restore the blood perfusion of ischemic myocardium,improve the survival rate of patients and improve the prognosis.However,in course of PCI treatment,the opened narrow or occluded blood vessels(excluding the mechanical complications such as inner membrane tear,intercalation,epicardial vasospasm and so on)still cannot restore normal blood flow,that is,no reflow phenomenon.No reflow phenomenon is increasing with the increase of emergency interventional therapy,and the incidence of which is inconsistent(0.6%-14.0%).This phenomenon greatly reduces the clinical benefits of PCI.The incidence of serious adverse cardiovascular events such as sudden cardiac death,recurrent myocardial infarction and heart failure in patients with no reflow is much higher than that in patients without no reflow,which seriously affects the effect of interventional therapy.At present,more and more clinical studies at home and abroad show that high thrombus load increases the risk of no reflow during emergency PCI.As a new generation of thrombolytic drugs,recombinant human urokinase can make thrombus dissolve and reduce thrombus load.It will be possible to prevent no reflow during emergency PCI and not affect systemic coagulation.The purpose of this study was to investigate the effect of recombinant human urokinase on the improvement of no reflow phenomenon in patients with acute coronary syndrome during emergency percutaneous coronary intervention,and to explore the effect of recombinant human urokinase on major adverse cardiac events(MACE)in patients with STEMI.Methods:From January 1,2018 to December 31,2018,168 patients with STEMI diagnosed and treated in Zhangjiakou first hospital were selected.All patients were divided into routine group and study group according to the method of random number table.84 patients in each group were observed and compared with the general information(including gender,age,smoking history,hypertension,diabetes,etc.)of the two groups,and they were concerned about the implementation of the patients Rate,blood pressure,blood routine test,myocardial infarction markers and blood glucose were measured to observe the consistency of the general data of the two groups.The patients in the routine group were given nitroglycerin and heparin,among which the national standard of nitroglycerin was h44020569,and the heparin was produced by Tianjin Biochemical Pharmaceutical Co.,Ltd.,and the national standard of nitroglycerin was h12020505,The drugs given to the patients in the study group were recombinant human urokinase and heparin,among which the recombinant human urokinase was produced by Shanghai tianshili Pharmaceutical Co.,Ltd.with the national drug approval number of s20110003,and the selection of heparin was the same as that of the conventional group.Both groups were treated with aspirin and clopidogrel at the same time.Among them,aspirin was produced by Bayer medical and health Co.,Ltd.with the national drug approval number of j20160078,and clopidogrel was produced by Sanofi Pharmaceutical Co.,Ltd.with the national drug approval number of j20160083.The same recommended dose was used in both groups.The coronary angiography of the two groups was performed by Judkins method,and the coronary angiography was analyzed and TIMI blood flow grading was evaluated(the evaluation was conducted by two experienced senior interventional physicians respectively).Patients in the study group received 20 mg of recombinant human urokinase and received percutaneous coronary intervention.In addition,percutaneous coronary intervention was carried out by the researcher himself and the interventional physician with high professional knowledge and technical level in our hospital.Heparin was used as anticoagulant to observe TIMI blood flow classification of target vessels during and after operation.Results:(1)There was no significant difference in sex,age,smoking history,hypertension,type 2 diabetes and length of stay between the two groups(P>0.05).(2)The evaluation criteria of no reflow were TIMI blood flow grade < 3 and myocardial color rendering grade(MBG)< III.The results showed that the incidence of TIMI Level 3 in the study group was 92.86%,which was higher than that in the control group(73.81%)(P<0.05).The incidence of TIMI 0 ~ TIMI 2 in the study group was 7.14%,which was lower than that in the control group(26.19%)(P<0.05).(3)The results showed that the incidence of mild hemorrhage,massive hemorrhage and 1-month hemorrhagic stroke in the study group were 2.38%,2.38% and 2.38%,respectively,which were not significantly different from the incidence of the conventional group(4.76%,2.38%,4.76%),so there was no difference between the study group and the conventional group(P>0.05).(4)Left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD)and left ventricular end diastolic diameter(LVED)were measured during hospitalization Diameter and LVED scores were basically the same(P>0.05);three months after operation,LVEF,LVESD and LVED in the study group were better than those in the conventional group(P<0.05).(5)Three months later,the incidence of MACE events in the study group was significantly lower than that in the control group(P<0.05).Conclusions: Coronary artery injection of recombinant human urokinase can significantly reduce the incidence of no-reflow in patients with high-risk STEMI patients,and can play a significant role in the improvement of myocardial perfusion level and short-term recovery of cardiac function,while reducing the incidence of MACE events without increasing the risk of bleeding during the treatment.After that,In conclusion,Target intravascular injection of recombinant human urokinase could be a useful treatment for no-reflow in STEMI patients with emergency PCI. |
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