| Objective To investigate the effects on myocardial perfusion and early cardiac function after applicating recombinant human urokininogen combined with tirofiban in the coronary emergency PCI in patients with acute ST-segment elevation myocardial infarction（STEMI）.Methods From January 2020 to December 2020,91 patients attending our hospital for emergency PCI for STEMI were selected by lottery,and all met the PPCI inclusion criteria and agreed to undergo the procedure.All patients enrolled were divided into two groups using random number grouping method of SPSS software,while the experimental group was tirofiban + PUK,totaling 47 patients,and the control group continuously was divided into two groups,totaling 44 patients.The method of drawing lots was used,with 22 people in each group,one group for the application of tirofiban alone and two groups for the application of PUK alone（replaced by Arabic numbers below）.After delivering the pre-expanded balloon to dilate the coronary artery to appear blood flow and after the distal end of the coronary vessel was visualized,all three groups passed the finger-guided wire over the coronary lesion to the distal end and then sent the microcatheter to the end of the diseased vessel,while one group injected tirofiban through the microcatheter at the lesion and two groups injected PUK through the microcatheter at the lesion.After finishing the above operation,the experimental group continued to give 10 mg of Puyoquel by pushing after the infusion of tirofiban.In the control group,5 m L of saline was injected at the same location from the lesion and at the same time,and PCI was performed afterwards in the control group.Patients were followed up for 2 months,and then the immediate TIMI flow classification,a week to two months’ s left ventricular short-axis shortening（FS）,left ventricular ejection fraction（LVEF）,left ventricular end-diastolic diameter（LVDd）,operative CK-MB before and after 24 hours,ultrasensitive troponin,and NT-pro BNP values were recorded after surgery.Results Compared to the control group,there was a statistically significant difference in the composition ratio of the number of patients with TIMI flow grade 3 in the experimental group（P<0.05）,and patients in the experimental group had better postoperative perfusion than the control group.The proportion of patients with anterior descending lesions in the experimental group with postoperative TIMI flow grade three was higher than at other lesions.After operation,the postoperative elevation of ultrasensitive troponin,CK-MB’s ascending range and NT-pro BNP falling range were higher in the experimental group than in the control group.In the experimental group,the changes of laboratory indexes in the lesion of the anterior descending branch（LAD）were better than those in other lesions（P < 0.05）.There were no significant differences in the values of LV short-axis shortening（FS）and LV ejection fraction（LVEF）in the experimental group compared with the control group 1 week after surgery（P > 0.05）.Left ventricular short-axis shortening（FS）and left ventricular ejection fraction（LVEF）were higher in the experimental group than in the control group,and left ventricular end-diastolic internal diameter（LVDD）was lower than in the control group at 2 months after surgery（P < 0.05）.The left ventricular short axis shortening rate（FS）and left ventricular ejection fraction（LVEF）in patients with LAD lesions in the experimental group were higher than those in patients with other lesions within one week and two months,and the left ventricular end diastolic diameter（LVDD）was lower than those in other locations after operation.The incidence of postoperative bleeding and MACE in the experimental group was significantly lower than that in the control group（P < 0.05）.Conclusion Intracoronary local injection of recombinant human urokinase proliferator and tirofiban via guideline catheter is effective in reducing the occurrence of no-reflow phenomenon,while increasing myocardial perfusion levels in STEMI patients,enhancing near-term cardiac function and improving prognosis without increasing the incidence of postoperative cardiovascular events. |
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