吴天予,张文豪,陈彭生,李宸,吴添,吕展,王彤,刘琨,陶志文,龚晓璇,袁亮,李勇,陈波,陈新,陈增光,杨乃全,桑园园,王晓彦,礼拜红,朱莉,王国余,赵昕,卢川,蒋峻,郝睿娜,李春坚

• 1:南京医科大学第一附属医院心血管内科
• 2:丰城市人民医院心血管内科
• 3:徐州市中心医院心血管内科
• 4:盐城市第一人民医院心血管内科

摘要(Abstract)：

目的 探讨预计120 min内可行经皮冠状动脉介入治疗（PCI）的急性ST段抬高型心肌梗死（STEMI）患者接受半剂量重组葡激酶（r-SAK）易化PCI的有效性及安全性。方法 纳入2021年10月29日至2022年8月14日在8家中心就诊的200例STEMI患者，按1﹕1随机分入r-SAK组或生理盐水对照组。所有患者溶栓前均口服负荷剂量的阿司匹林、替格瑞洛及静脉推注普通肝素。比较两组PCI术后60～90 min罪犯血管相关导联ST段回落率（STR）、术后第5天病理性Q波比例及转归、起病12 h内超敏肌钙蛋白T(hs-cTnT)到达峰值比例。安全性评价为住院期间以出血学术研究联合会（BARC）分级标准判定的BARC≥3型大出血。结果 与对照组相比，r-SAK组显著提高了PCI术后60～90 min STR≥70%的比例（58.3%比40.3%,P=0.009）;r-SAK组病理性Q波比例显著降低（59.1%比74.1%,P=0.040）;Q波进展比例更低（14.8%比43.2%,P<0.001）;Q波消失比例更高（12.5%比3.7%,P=0.027）；起病12 h内hs-cTnT到达峰值比例r-SAK组显著高于对照组[31/40(77.5%)比17/33(51.5%),P=0.027]。住院期间BARC≥3型大出血发生率组间比较，差异无统计学意义（P>0.05）。结论 在STEMI起病12 h内，预计120 min内可接受PCI的患者，接受半剂量r-SAK易化PCI可显著提高术后STR≥70%比例、减少病理性Q波形成、缩短hs-cTnT到达峰值时间，且不增加患者出血风险，是值得进一步研究的再灌注治疗策略。

关键词(KeyWords)： 急性ST段抬高型心肌梗死;经皮冠状动脉介入治疗;溶栓;重组葡激酶

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划项目(2022YFC2402404);; 江苏省人民医院临床能力提升工程项目(JSPH-MA-2022-3);; 国家自然科学基金项目(82170351)

作者(Author): 吴天予,张文豪,陈彭生,李宸,吴添,吕展,王彤,刘琨,陶志文,龚晓璇,袁亮,李勇,陈波,陈新,陈增光,杨乃全,桑园园,王晓彦,礼拜红,朱莉,王国余,赵昕,卢川,蒋峻,郝睿娜,李春坚

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