目的 探討冠狀動(dòng)脈（以下簡(jiǎn)稱冠脈）內(nèi)聯(lián)合應(yīng)用罌粟堿與比伐蘆定對(duì)急性ST段抬高型心肌梗死（STEMI）急診經(jīng)皮冠狀動(dòng)脈介入治療（PCI）術(shù)中慢血流/無(wú)復(fù)流患者血清心肌損傷標(biāo)志物、高遷移率族蛋白B1 （HMGB1）、內(nèi)皮素-1（ET-1）及轉(zhuǎn)化生長(zhǎng)因子-β1（TGF-β1）水平和近期預(yù)后的影響。方法 回顧性分析新鄉(xiāng)市第一人民醫(yī)院2018年1月—2021年12月收治的90例急診STEMI行PCI術(shù)中慢血流/無(wú)復(fù)流STEMI患者的臨床資料，根據(jù)治療方案不同分為對(duì)照組與試驗(yàn)組，每組各45例。兩組均常規(guī)行冠脈造影與PCI治療，經(jīng)球囊預(yù)擴(kuò)張后植入支架。在發(fā)生慢血流/無(wú)復(fù)流時(shí)，對(duì)照組于冠脈內(nèi)注入注射用比伐蘆定0.375 mg·kg^-1，試驗(yàn)組在對(duì)照組基礎(chǔ)上于冠脈內(nèi)注射鹽酸罌粟堿注射液，每次3～5 mg，體質(zhì)量60 kg以下給予3 mg，體質(zhì)量60 kg以上給予5 mg，如果無(wú)復(fù)流，3～5 min重復(fù)1次，重復(fù)2～3次，總劑量≤20 mg。比較兩組術(shù)后即刻心肌梗死溶栓實(shí)驗(yàn)（TIMI）血流分級(jí)3級(jí)患者占比、校正的TIMI血流幀數(shù)（cTFC）、術(shù)后24 h ST段完全回落率。分別于PCI術(shù)前和術(shù)后24 h、7 d時(shí)檢測(cè)兩組患者血清心肌損傷標(biāo)志物［肌酸激酶同工酶（CK-MB）、肌鈣蛋白I（cTnI）］、HMGB1、ET-1及TGF-β1水平。術(shù)后1個(gè)月內(nèi)統(tǒng)計(jì)兩組不良心腦血管事件及臨床出血事件發(fā)生情況。結(jié)果 試驗(yàn)組術(shù)后即刻TIMI 3級(jí)患者占比、術(shù)后24 h ST段完全回落率均顯著高于對(duì)照組（P<0.05）；術(shù)后即刻cTFC顯著低于對(duì)照組（P<0.05）。兩組術(shù)后24 h血清CK-MB、cTnI水平均較本組術(shù)前顯著升高（P<0.05），術(shù)后7 d較術(shù)后24 h均顯著降低（P<0.05）；且試驗(yàn)組術(shù)后24 h、7 d時(shí)血清CK-MB、cTnI水平均顯著低于同期對(duì)照組（P<0.05）。兩組術(shù)后24 h血清HMGB1、ET-1及TGF-β1水平均較本組術(shù)前顯著升高（P<0.05），術(shù)后7 d較術(shù)后24 h均顯著降低（P<0.05）；且試驗(yàn)組術(shù)后24 h、7 d時(shí)血清HMGB1、ET-1和TGF-β1水平均顯著低于同期對(duì)照組（P<0.05）。術(shù)后1個(gè)月內(nèi)，試驗(yàn)組不良心腦血管事件發(fā)生率顯著低于對(duì)照組（4.44% vs 17.78%，P<0.05）；試驗(yàn)組與對(duì)照組臨床出血事件發(fā)生率對(duì)比（15.56% vs 13.33%），差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 冠脈內(nèi)聯(lián)合應(yīng)用罌粟堿與比伐蘆定治療急診PCI術(shù)中慢血流/無(wú)復(fù)流能有效改善患者冠脈血流情況，減輕心肌損傷與內(nèi)皮損傷，緩解機(jī)體炎癥反應(yīng)，改善患者近期預(yù)后。

Objective To investigate the effects of papaverine combined with bivarutin administrated by intracoronary injection on serum myocardial injury markers, high mobility group box-1(HMGB1), endothelin-1(ET-1), transforming growth factor β1 (TGF-β1)and short-term prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). Methods The clinical data of 90 patients with slow flow/no reflow STEMI during emergency PCI admitted to the Xinxiang First People's Hospital from January 2018 to December 2021 were analyzed retrospectively. They were divided into control group and experimental group according to different treatment schemes, with 45 patients in each group. Coronary angiography and PCI were performed routinely in both groups, and stents were implanted after balloon pre dilation. In case of slow blood flow/no reflow, 0.375 mg·kg^-1 of Bivarutin for Injection was injected into the coronary artery in the control group, and the Papaverine Hydrochloride Injection was injected into the coronary artery in the experimental group on the basis of the control group, 3-5 mg per time, 3 mg per time for body weight below 60 kg, and 5 mg per time for body weight above 60 kg. If there was no reflow, it was repeated once within 3 to 5 minutes, 2 to 3 times, and the total dose was ≤ 20 mg. The proportion of patients with TIMI blood flow grade 3, corrected TIMI blood flow frames (cTFC), and the complete ST segment fall rate 24 hours after operation were compared between the two groups. Serum myocardial injury markers[creatine kinase isoenzyme (CK-MB), troponin I (cTnI)], HMGB1, ET-1 and TGF-β1 were detected before PCI and 24 hours and seven days after PCI. The adverse cardiovascular and cerebrovascular events and clinical bleeding events in the two groups were counted within one month after operation. Results The percentage of patients with TIMI grade 3 immediately after operation and the rate of complete ST segment regression 24 hours after operation in the experimental group were significantly higher than those in the control group (P<0.05). The cTFC immediately after operation was significantly lower than that in the control group (P<0.05). The levels of serum CK-MB and cTnI in the two groups at 24 hours after operation were significantly higher than those before operation (P<0.05), and at seven days after operation were significantly lower than those at 24 hours after operation (P<0.05). The levels of serum CK-MB and cTnI in the experimental group were significantly lower than those in the control group at 24 hours and 7 days after operation (P<0.05). The levels of serum HMGB1, ET-1 and TGF-β1 24 h after operation in both groups were significantly higher than that before operation (P<0.05), and at seven days after operation they were significantly lower than that of 24 hours after operation (P<0.05). In the experimental group, the levels of serum HMGB1, ET-1 and TGF-β1 at 24 h and 7 d after operation were significantly lower than that of the control group at the same time point (P<0.05). Within one month after operation, the incidence of adverse cardiovascular and cerebrovascular events in the experimental group was significantly lower than that in the control group (4.44% vs 17.78%, P<0.05). There was no significant difference in the incidence of clinical bleeding events between the two groups (15.56% vs 13.33%, P>0.05). Conclusion The combined use of papaverine and bivalirudin in the coronary artery for the treatment of slow/no reflow during emergency PCI can effectively improve the coronary blood flow, reduce myocardial injury and endothelial injury, alleviate the inflammatory reaction of the body, and improve the short-term prognosis of patients.

R972