| OBJECTIVE:Through emergency PCI reperfusion therapy for STEMI patients,low-dose recombinant human urokinase or sodium nitroprusside was injected into the coronary arteries,aiming to explore emergency PCI combined with intracoronary injection of a dose gradient of recombinant human urokinase or nitroprusside The effect of sodium on myocardial blood perfusion level and short-term prognosis in patients with STEMI.Methods:This study recruited the patients who diagnosed with acute ST-segment elevation myocardial infarction,and following underwent coronary angiography to indicate complete or subtotal occlusion of target diseased vessels and further received emergency PCI in the People's Hospital of Nanchang University from October 2018 to January 20,2020.Randomly divided into three groups:(1).PUK1 group(10 mg rhProUK,50 cases),puncture the balloon to the proximal vessel of the target lesion and give 10 mg recombinant human urokinase(rh-ProUK)before stent implantation;(2).PUK2 group(20 mg rh-ProUK,47 cases)give 20 mg rh-ProUK near the target lesion;(3).SN group(50ug sodium nitroprusside;48 cases)give 50 ug sodium nitroprusside near the target lesion.Subsequently,collect and collate the clinical data of the three groups of patients,and compare the clinical data of the three groups of patients,including:(1)clinical onset time,age,gender,BMI index,admission blood pressure,heart rate,previous medical history,coronary artery disease,laboratory Examination and color Doppler ultrasound,etc.;(2)the myocardial perfusion of the three groups of patients,including CTFC count,TIMI blood flow classification,incidence of no-reflow,TMPG classification,ST segment fallback and other indicators;(3)the three groups of patients The recovery of cardiac function after 1 month;(4)the MACE events and bleeding events during hospitalization of the three groups of patients,the MACE events at 1 month after discharge,and the cumulative survival rate at 1 month.All data were processed using IBM SPSS22.0,with P<0.05 indicating statistical difference.Result:1.A total of 145 patients were included in this study.The clinical baseline data of the three groups including age,gender,BMI index,blood pressure at admission,heart rate,history of hypertension,history of diabetes,history of hyperlipidemia,blood routine,liver and kidney function were analyzed.The blood lipid status,time of onset,coronary angiography,DB time,and number of stent implants were not statistical significant(P> 0.05)in the three groups.2.Comparison of myocardial blood perfusion among the three groups,CTFC count: [PUK1 group:(25.84 ± 6.1)frames,PUK2 group:(23.66 ± 5.77),(1)SN group:(28.46 ± 6.34);P <0.05],The PUK1 group and PUK2 group were respectively statistical different from the SN group(P <0.05),but there was no statistical difference between the PUK1 group and the PUK2 group(P> 0.05).(2)TIMI blood flow level 3: 45 cases in the PUK1 group(90%),45 cases(95.74%)in the PUK2 group,and 37 cases(77.08%)in the SN group.There were statistical differences between the above three groups(P <0.05),and there were statistical differences among the PUK1,PUK2 groups and SN(P <0.05).(3)TIMI myocardial perfusion grade 3,45 cases(90%)in PUK1 group,44 cases(93.61%)in PUK2 group,36cases(75.0%)in SN group,there were statistical differences among the three groups(P <0.05);there was a statistical difference between the PUK1 and PUK2 groups and the SN group(P <0.05);and there was no statistical difference between the PUK1 and PUK2 groups(P> 0.05).(4)the ST segment fall rate: There was no statistical difference between the three groups(P> 0.05).3.There was no statistically significant difference in cardiac color Doppler ultrasound,hospitalized MACE,severe bleeding event and MACE incidence at 1 month after discharge in the three groups(P> 0.05).Comparison of the 1-month cumulative survival rate,the survival rate of the PUK1 group was(90.0 ± 4.2)%,the survival rate of the PUK2 group was(95.7 ± 2.9)%,the survival rate of the SN group was(87.5 ± 4.8)%.The survival rate of the group PUK1,2 was higher than that of the SN group,but the difference was not statistically significant(P> 0.05).Conclusion:1.The use of recombinant human prourokinase in coronary arteries can improve coronary microcirculation and increase myocardial perfusion level in patients with acute STEMI during emergency PCI.The advantage trend of 20 mg rh-ProUK is significant.2.When employing emergency PCI combined with rh-ProUK,10 mg and 20 mg rh-ProUK does not increase the incidence of MACE and bleeding events,which demonstrates that treatment method is safe.3.When employing emergency PCI combined with rh-ProUK treatment in the coronary arteries,the rh-ProUK group wins an advantage in improving the patient's short-term survival rate,and the 20 mg rh-ProUK group has significant advantages. |
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