纤溶酶预处理对择期冠脉介入治疗的临床研究

孙百陆++孙晓斐

【摘要】目的 观察术前应用纤溶酶对急性心肌梗死择期经皮冠状动脉介入治疗（PCI）患者的临床疗效。方法 将130例超过急诊PCI时间窗（12 h）的急性心肌梗死患者随机分为对照组66例和试验组64例。2组患者均接受常规治疗且均在起病8～12天成功接受PCI手术。治疗组在此基础上予以纤溶酶治疗。比较两组臨床基线情况、PCI术中心肌梗死溶栓治疗临床试验（TIMI）血流分级、校正的TIMI帧数（CTFC）、无复流/慢血流情况、心脏彩超的变化及随访心血管事件的发生。结果 与对照组相比，纤溶酶组术中梗死相关动脉（IRA）开通后TIMI3级血流比例明显增加（分别为92.2%vs 63.6%；P均<0.05），CTFC明显改善[（21.0±5.1）帧vs（30.8±4.1）帧，P<0.001]，试验组术中无复流的发生率为5%明显少于对照组的14%；术后6个月心脏功能改善，主要心血管不良事件减少（P<0.05）。结论 对超过急诊PCI时间窗的急性心肌梗死患者术前进行纤溶酶预处理，可减少术中无复流/慢血流的发生率，改善心肌灌注，改善心功能且减少术后心血管不良事件发生率。

【关键词】纤溶酶；急性心肌梗死；无复流现象

【中图分类号】R542.2+2 【文献标识码】B 【文章编号】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.