The Effects Of Recombinant Human Prourokinase For Injection By Means Of Being Injected In Coronary Artery On Coronary Microcirculation Reperfusion Level In ST Elevation Myocardial Infarction In Patients

Objective:Through the study about a llitle of Recombinant Human Prourokinase for Injection(Pu You Ke)by means of being injected in Coronary Artery in the process of emergency interventional therapy for STEMI patients,I explore the impact of intravascular small doses of dissolving suppositories to coronary microcirculation reperfusion level and the security.Methods: All cases selected to the patients with STEMI,who accept emergency interventional therapy,found coronary occlusion or incomplete occlusion in coronary angiography and the high load thrombosis,from March 2016 to March 2017,in the first affiliated to henan university of Chinese medicine.According to the center random method of the computer system,all patients were randomly divided into Pu You Ke group of 13 cases and 15 cases control group.For the Pu You Ke group,platelet GPIIb/IIIa receptor blockers Tirofiban for 0.5 mg being given by means of being injected in Coronary Artery after the thrombus suction.Doctors observe for 10 minutes,and then give Recombinant Human Prourokinase for Injection for 20 mg,and push moderate contrast agent again after 5 minutes,then to observe coronary blood flow and to choose appropriate stent implantation according to the coronary vascular disease.For the control group,platelet GPIIb/IIIa receptor blockers Tirofiban for 0.5 mg being given by means of being injected in Coronary Artery after the thrombus suction.Doctors observe for 10 minutes,and then push moderate contrast agent again after 5 minutes,then to observe coronary blood flow and to choose appropriate stent implantation according to the coronary vascular disease.Two groups patients need to observe the following indicators:(1)To Compare two groups of patients in general clinical data,includeing age,sex,weight,height,admission heart rate,blood pressure,smoking history,past medical history(including the history of coronary heart disease,hypertension,diabetes,hyperlipidemia,cerebrovascular disease)and coronaryangiography results;(2)To compare with two groups of patients in postoperative TIMI flow grade and TMPFC counting,postoperative 1,24 h ST segment fell back,postoperative myocardial enzyme peak and enzyme peak time;(3)To compare two groups of patients in left ventricular ejection fraction(LVEF)and left ventricular end-diastolic volume(LVED)after 1,3,6 month reviewing cardiac color ultrasound;(4)to compare two groups of patients in major adverse cardiovascular events(MACEs)and bleeding events during one's hospitalization and after postoperative 1,3,6 month.Results:1 Comparison of the general clinical data of two groups patientsTwo groups patients compare the general clinical data,including to,age,BMI,admission heart rate and blood pressure,liver function,renal function,blood lipids,sex,smoking history,Killip classification,the history of coronary heart disease and stenting,hypertension,diabetes,cerebrovascular disease,hyperlipidemia,no statistical difference(P > 0.05),between the two groups being compared.Compared with the result of coronary angiography,there are no significant statistical difference between two groups of culprit vessel,Coronary vascular lesion,preoperative TIMI flow grade and numbers of stents,diameter and length of(P > 0.05).Compared with surgery related time nodes,there are no significant statistical difference between two groups for the come on time-FMC,D-to-B,the come on time-B,the operation time(P > 0.05).2 Evaluation of postoperative coronary blood flow between two groups patientsAccording to the results of TIMI flow grade after PCI,the proportion of patients in Pu You Ke group with TIMI3,is higher than the control group[TIMI3 level 13 cases(100%)VS 12 cases(80%),P = 0.14)],but the proportion of the data have no statistical difference between the two groups.According to the results of TMPFC counting after PCI,the proportion of patients in Pu You Ke group with TMPFC < 90,is significantly higher than the control group[TMPFC ? 90 13 cases(100%)VS 10 cases(66.7%),P = 0.02)],and the two groups have statistical difference.3 Comparison of the ST resolution(STR)between two groups patientsComparing with the first ECG in hospital,the proportion of patients in PuYouKe group with STR?50% in 1 hour after PCI,is higher than the control group [13 cases(100%)VS 10 cases(66.7%),P =0.02],and there is statistically significant difference between two groups;the proportion of patients in Pu You Ke group with STR?50% in 24 h after PCI,is higher than the control group[13 cases(100%)VS 14 cases(93.3%),P=0.35],but there is no statisticallysignificant difference between two groups.4 Comparison of the postoperative myocardial enzyme peak between two groups patientsCompared with control group,CK-MB peak [(63.97 ±18.43)ng/ml VS(79.42 ± 15.96)ng/ml,P = 0.015)] and the peak of c Tn I [(27.61 ±12.68)ng/ml VS(37.84 ± 10.66 ng/ml,P = 0.007)]in Pu You Ke are significantly lower,and there is statistically significant difference between two groups.Compared with control group,CK-MB in peak time [(8.00 ±2.83)h VS(10.40 ±2.03)h,P = 0.025)] and c Tn I peak time [(8.92 ±2.40)h VS(11.2 ±8.92)h,P = 0.029)] in Pu You Ke are significantly ahead of time,and there is statistically significant difference between two groups.5 Comparison of cardiac color ultrasound(UCG)in the postoperative follow-up period between two groups patientsComparing two groups of UCG 1 month after PCI,LVED in PuYouKe group and control group are relatively higher than hospitalization,and there are statistical significance between the two groups [(49.31 ±4.34)mm VS(53.67 ±6.31)mm,P = 0.046)].LVEF are increased for hospitalization,and there are statistical significance between the two groups [(48.31 ±3.84)mm VS(51.53 ±4.16)mm,P = 0.044)].Comparing two groups of UCG 3 month after PCI,LVED in PuYouKe group and control group are relatively lower than earlier,and there are statistical significance between the two groups [(47.71 ±5.38)mm VS(51.13 ±4.41)mm,P = 0.041)].LVEF are increased for earlier,but no statistical significance between the two groups [(53.08 ±4.35)mm VS(54.47 ±5.07)mm,P = 0.45)].Comparing two groups of UCG 6 month after PCI,LVED in PuYouKe group and control group are relatively lower than earlier,and there are statistical significance between the two groups [(45.77 ±2.71)mm VS(48.80 ±3.12)mm,P = 0.013)].LVEF are increased for earlier,and there are statistical significance between the two groups [(55.08 ±3.36)mm VS(58.47 ±4.70)mm,P = 0.040].6 Major adverse cardiac events and bleedingCompare the major adverse cardiac events(MACE)and bleeding events in hospital and 1,3,6 months follow-up period.Compared with the control group,the MACEs and bleeding events in hospital and 1,3 months follow-up period is lower,but no statistical significance between the two groups(P > 0.05).The bleeding events is similar betweet two group,but the incidence of MACE in control group is higher than Pu You Ke group,but no statistical significance between two groups in 6st months follow-up period(P > 0.05).Conclusions A llitle of Recombinant Human Prourokinase for Injection by means of being injected in Coronary Artery is likely to improve coronary microcirculation,improve the level of myocardial perfusion,reduce the area of myocardial infarction,reduce ventricular cavity volume,delay ventricular remodeling,improve heart function,and keep the incidence of MACEs and bleeding events Stable.It is safe and effective in a way.