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ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)是临床常见的急危重症。其发病机制多为冠脉内不稳定斑块破裂、糜烂及继发血栓形成,导致冠脉持续、完全闭塞,最终引起心肌组织缺血坏死。经皮冠状动脉介入术(percutaneous coronary intervention,PCI)是及时有效开通闭塞血管的最佳方法。但部分患者PCI术后心肌灌注欠佳,可能与梗死相关血管微循环水平血栓栓塞有关。既往临床研究表明经冠脉内靶向给予溶栓药物,可降低血栓负荷,改善心肌灌注。随着新型药物的研发,如重组人尿激酶原(recombinant human prourokinase,rh-pro UK),进一步提高了冠脉内溶栓的安全性及有效性。本文就近年来冠脉溶栓治疗改善STEMI心肌灌注的研究进展予以综述。
ST-segment elevation myocardial infarction (STEMI) is a common clinical critical illness. Its pathogenesis and more unstable intraluminal plaque rupture, erosion and secondary thrombosis, leading to continuous coronary artery, complete occlusion, eventually causing myocardial ischemia and necrosis. Percutaneous coronary intervention (percutaneous coronary intervention, PCI) is the best way to effectively open and occlude blood vessels in time. However, some patients with poor myocardial perfusion after PCI may be related to infarct-related vascular microcirculation level of thromboembolism. Previous clinical studies have shown that the intracoronary thrombolytic drugs can reduce the thrombus load and improve myocardial perfusion. With the development of new drugs, such as recombinant human prourokinase (rh-pro UK), to further improve the safety and efficacy of intra-coronary thrombolysis. This review summarizes the research progress of coronary thrombolysis in improving myocardial perfusion of STEMI in recent years.