目的:探讨经靶向导管注入尼可地尔与重组人尿激酶原(rh-proUK)联合经皮冠状动脉介入术(PCI)治疗冠状动脉慢性完全闭塞(chronic total occlusion，CTO)的效果及对远期预后的影响。方法:收集2021年9月至2023年1月于我院成功进行PCI术的237例CTO患者为研究对象，开展回顾性研究。根据治疗方法不同进行分组，将经靶向导管注入尼可地尔联合PCI术治疗的患者纳入尼可地尔组(n=78)，将经靶向导管注入rh-proUK联合PCI术治疗的患者纳入rh-proUK组(n=78)，将经靶向导管注入尼可地尔与rh-proUK联合PCI术治疗的患者纳入联合组(n=81)。比较3组微循环指标[靶血管心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)、校正TIMI血流帧数(cTFC)]、心肌损伤指标[肌酐、肌酸激酶同工酶(CK-MB)、N末端脑钠肽前体(NT-proBNP)、肌钙蛋白(IcTnⅠ)]、心功能[左心室舒张末期内径(LVED)、室壁运动积分指数(WMSI)、左心室射血分数(LVEF)]、心肌微循环血流灌注情况[心肌灌注定量分析常数(k)]及不良心血管事件发生率。结果:联合组TMPG 3级占比高于尼可地尔组、rh-proUK组，cTFC低于尼可地尔组、rh-proUK组(P＜0。05);术后24h联合组CK-MB、肌酐、IcTnⅠ、NT-proBNP均低于尼可地尔组、rh-proUK组(P＜0。05);术后3个月 联合组LVEF高于尼可地尔组、rh-proUK组，LVED 低于尼可地尔组、rh-proUK组(P＜0。05);术后7d联合组基础态、负荷态心肌微循环血流灌注k值高于尼可地尔组、rh-proUK组(P＜0。05);3组术后6个月、12个月不良心血管事件总发生率比较无显著差异(P＞0。05)。结论:经靶向导管注入尼可地尔与rh-proUK联合PCI术治疗CTO患者可促进术后心肌微循环改善，有助于缓解术后心肌损伤、恢复心功能，改善远期预后。
Application of Nicardipine Combined with rh-proUK in Percutaneous Coronary Intervention for Chronic Total Occlusion of Coronary Artery
Objective:To investigate the effect of targeted intracoronary injection of nicardipine com-bined with recombinant human pro-urokinase(rh-proUK)on the treatment of chronic total occlusion(CTO)of coronary artery and its impact on long-term prognosis.Methods:A total of 237 cases of CTO patients who underwent PCI in our hospital from September 2021 to January 2023 were collected as the study objects and a retrospective study was carried out.Patients treated with nicodil combined with PCI through targeted catheter were included in Nicodil group(n=78),and patients treated with rh-proUK combined with PCI through a targeted catheter were included in the rh-proUK group(n=78).Patients treated with nicodil and rh-proUK combined PCI via targeted catheter were included in the combination group(n=81).The microcirculation in-dexes[TIMI blood flow grading,corrected TIMI blood flow frame count(cTFC),TIMI myocardial perfusion grading(TMPG)],myocardial injury indexes[creatinine,N-terminal brain natriuretic peptide precursor(NT-proBNP),creatine kinase isoenzyme(CK-MB),and troponin(IcTnⅠ)],cardiac function[left ven-tricular ejection fraction(LVEF),ventricular wall motion integral index(WMSI),left ventricular end-dias-tolic inner diameter(LVED)],myocardial microcirculation blood perfusion[myocardial perfusion quantita-tive analysis constant(k)],and incidence of adverse cardiovascular events were compared between the three groups.Results:The proportion of TMPG grade 3 in the combination group was higher than that in the Nicodil group and rh-proUK group,and cTFC was lower than that in the Nicodil group and rh-proUK group(P＜0.05).24h after the operation,CK-MB,creatinine,IcTnⅠ and NT-proBNP in the combination group were low-er than those in nicodil and rh-proUK groups(P＜0.05).Three months after the operation,LVEF in the combination group was higher than that in nicodil group and rh-proUK group,and LVED was lower than that in nicodil group and rh-proUK group(P＜0.05).The k value of myocardial microcirculation perfusion in bas-al state and load state in the combination group was higher than that in the nicodil group and rh-proUK group(P＜0.05).There was no significant difference in the total incidence of adverse cardiovascular events at 6 months and 12 months after surgery among 3 groups(P＞0.05).Conclusion:Targeted catheter injection of nicodil and rh-proUK combined PCI in the treatment of CTO patients can promote postoperative myocardial microcirculation improvement,help alleviate postoperative myocardial injury,restore cardiac function,reduce adverse cardiovascular events,and improve long-term prognosis.
Coronary artery chronic complete occlusionNicordilRecombinant human uroki-nasePercutaneous coronary intervention
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