【摘要】 目的 探讨冠状动脉内应用不同剂量重组人尿激酶原对急性ST段抬高型心肌梗死（STEMI）行急诊经皮冠状动脉介入治疗（PCI）术后心肌灌注的影响。方法 本研究包括江西省人民医院和宜春市人民医院2018年5月至2022年10月420例行急诊PCI的STEMI患者，在急诊PCI术中患者采用不透明信封进行随机化分组，按照2:1:1的比例根据纳入和排除标准，共纳入379例患者分为生理盐水组201例、10mg重组人尿激酶原组99例、20mg重组人尿激酶原组79例。主要终点是术后90min罪犯血管导联ST段回落率（STR），次要终点是术后心肌梗死溶栓治疗试验（TIMI）血流计数帧数（CTFC）、术后TIMI血流分级、主要不良心血管事件（MACE）发生率；安全性评价是住院期间出血事件，以TIMI出血分级为标准。结果 3组患者的术后90 min的STR≥70%发生率分别是31.0%、47.7%、57.1%(P=0.001)；进行两两比较后，生理盐水组和10 mg重组人尿激酶原组、20 mg重组人尿激酶原组相比STR≥70%发生率的差异均有统计学意义（P=0.010、P=0.002），且生理盐水组术后导联ST段不回落发生率高于20 mg重组人尿激酶原组（21.8%比7.1%,P=0.046）。3组患者的术后CTFC、术后TIMI血流分级、MACE比较，差异均无统计学意义（均P>0.05）。在安全性事件上，20 mg重组人尿激酶原组发生了更多的出血事件，主要在轻微出血事件方面（P=0.002）。结论 冠状动脉内应用重组人尿激酶原可显著改善患者的心肌灌注，但随着重组人尿激酶原剂量的增加，术后轻微出血事件发生率也随之增加。更多还原

【Abstract】 Objective To investigate the effects of different doses of recombinant human prourokinase on myocardial perfusion after emergency percutaneous coronary intervention(PCI) in patients with acute ST-segment elevation myocardial infarction(STEMI). Methods A total of 420STEMI patients with emergency PCI in Jiangxi Provincial People’s Hospital and Yichun People’s Hospital from May 2018 to October 2022 were randomly injected with normal saline, recombinant human pro-urokinase 10mg or recombinant human pro-urokinase 20mg during emergency PCI. The primary end point was the fall rate of ST segment in lead ST of postoperative 90 min culprit vessel(STR), and the secondary end point was postoperative TIMI flow count frame(CTFC), postoperative(thrombolysis in myocardial infarction,TIMI) flow grade and the incidence of MACE events. The safety evaluation was the bleeding event during hospitalization, and the TIMI bleeding grade was taken as the standard.Results According to the standard of Inclusion and exclusion, a total of 379 patients were included in this study. The complete fall rate of ST segment of 90 min in the recombinant human urokinase group was significantly higher than that in the control group(P=0.001), but there was no significant difference in postoperative CTFC value, postoperative TIMI blood flow grade and the incidence of MACE among the three groups. The incidence of postoperative bleeding events in the recombinant human prourokinase group was significantly higher than that in the control group(P=0.010,P=0.002), and there were more mild bleeding events in the 20 mg recombinant human urokinase group(P=0.002). Conclusions Intracoronary administration of recombinant human prourokinase can significantly improve myocardial perfusion, but the incidence of postoperative mild bleeding increases with the increase of recombinant human prourokinase dose.更多还原