纖溶酶預(yù)處理對擇期冠脈介入治療的臨床研究

孫百陸++孫曉斐

【摘要】目的 觀察術(shù)前應(yīng)用纖溶酶對急性心肌梗死擇期經(jīng)皮冠狀動脈介入治療（PCI）患者的臨床療效。方法 將130例超過急診PCI時間窗（12 h）的急性心肌梗死患者隨機分為對照組66例和試驗組64例。2組患者均接受常規(guī)治療且均在起病8～12天成功接受PCI手術(shù)。治療組在此基礎(chǔ)上予以纖溶酶治療。比較兩組臨床基線情況、PCI術(shù)中心肌梗死溶栓治療臨床試驗（TIMI）血流分級、校正的TIMI幀數(shù)（CTFC）、無復(fù)流/慢血流情況、心臟彩超的變化及隨訪心血管事件的發(fā)生。結(jié)果 與對照組相比，纖溶酶組術(shù)中梗死相關(guān)動脈（IRA）開通后TIMI3級血流比例明顯增加（分別為92.2%vs 63.6%；P均<0.05），CTFC明顯改善[（21.0±5.1）幀vs（30.8±4.1）幀，P<0.001]，試驗組術(shù)中無復(fù)流的發(fā)生率為5%明顯少于對照組的14%；術(shù)后6個月心臟功能改善，主要心血管不良事件減少（P<0.05）。結(jié)論 對超過急診PCI時間窗的急性心肌梗死患者術(shù)前進行纖溶酶預(yù)處理，可減少術(shù)中無復(fù)流/慢血流的發(fā)生率，改善心肌灌注，改善心功能且減少術(shù)后心血管不良事件發(fā)生率。

【關(guān)鍵詞】纖溶酶；急性心肌梗死；無復(fù)流現(xiàn)象

【中圖分類號】R542.2+2 【文獻標識碼】B 【文章編號】ISSN.2095-6681.2016.36.0.03

The pretreatment of fibrinolysin pretreatment is the clinical study of the selective coronary intervention of acute myocardial infarction

SUN Bai-lu， SUN Xiao-fei

（1. university of jinan， shandong academy of medical sciences，college of medicine and life science，ShanDong JiNan 250200，China； 2. Jining city first people's hospital affiliated to shandong academy of medical sciences of cardiology，ShanDong JiNing 272000，China）

【Abstract】Objective To observe the clinical efficacy of preoperative Fibrinogenase in patients with acute myocardial infarction （AMI） undergoing selective percutaneous coronary intervention （PCI）.Methods 130 patients with acute myocardial infarction （12h） were randomly divided into control group （n=66） and experimental group （n=PCI） in the experimental group （n=64）.2 groups of patients were treated with conventional therapy and all at the onset of 8～12D successfully underwent PCI surgery. The treatment group was treated with Fibrinogenase. Comparison of two clinical baseline， PCI myocardial infarction thrombolytic therapy in clinical trials （TIMI） blood flow grade， corrected TIMI frame count （CTFC） and no reflow/slow blood flow phenomenon， echocardiography and follow-up cardiovascular events.Results compared with the control group， the infarct related artery （IRA） in the group of plasmin TIMI3 flow ratio increased significantly after the opening （92.2%vs63.6%；P<0.05），the incidence rate was 5% was significantly less than the control group 14% no reflow test group； postoperative cardiac function 6 months improvement.Reduce major adverse cardiovascular events （P<0.05）.Conclusion Fibrinogenase pretreatment on patients with acute myocardial infarction in patients with emergency PCI over time window before， can reduce the intraoperative no reflow/slow flow phenomenon rate， improve myocardial perfusion， improve heart function and reduce the postoperative incidence of adverse cardiovascular events.