目的 探讨冠状动脉（以下简称冠脉）内联合应用罂粟碱与比伐芦定对急性ST段抬高型心肌梗死（STEMI）急诊经皮冠状动脉介入治疗（PCI）术中慢血流/无复流患者血清心肌损伤标志物、高迁移率族蛋白B1 （HMGB1）、内皮素-1（ET-1）及转化生长因子-β1（TGF-β1）水平和近期预后的影响。方法 回顾性分析新乡市第一人民医院2018年1月—2021年12月收治的90例急诊STEMI行PCI术中慢血流/无复流STEMI患者的临床资料，根据治疗方案不同分为对照组与试验组，每组各45例。两组均常规行冠脉造影与PCI治疗，经球囊预扩张后植入支架。在发生慢血流/无复流时，对照组于冠脉内注入注射用比伐芦定0.375 mg·kg^-1，试验组在对照组基础上于冠脉内注射盐酸罂粟碱注射液，每次3～5 mg，体质量60 kg以下给予3 mg，体质量60 kg以上给予5 mg，如果无复流，3～5 min重复1次，重复2～3次，总剂量≤20 mg。比较两组术后即刻心肌梗死溶栓实验（TIMI）血流分级3级患者占比、校正的TIMI血流帧数（cTFC）、术后24 h ST段完全回落率。分别于PCI术前和术后24 h、7 d时检测两组患者血清心肌损伤标志物［肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）］、HMGB1、ET-1及TGF-β1水平。术后1个月内统计两组不良心脑血管事件及临床出血事件发生情况。结果 试验组术后即刻TIMI 3级患者占比、术后24 h ST段完全回落率均显著高于对照组（P<0.05）；术后即刻cTFC显著低于对照组（P<0.05）。两组术后24 h血清CK-MB、cTnI水平均较本组术前显著升高（P<0.05），术后7 d较术后24 h均显著降低（P<0.05）；且试验组术后24 h、7 d时血清CK-MB、cTnI水平均显著低于同期对照组（P<0.05）。两组术后24 h血清HMGB1、ET-1及TGF-β1水平均较本组术前显著升高（P<0.05），术后7 d较术后24 h均显著降低（P<0.05）；且试验组术后24 h、7 d时血清HMGB1、ET-1和TGF-β1水平均显著低于同期对照组（P<0.05）。术后1个月内，试验组不良心脑血管事件发生率显著低于对照组（4.44% vs 17.78%，P<0.05）；试验组与对照组临床出血事件发生率对比（15.56% vs 13.33%），差异无统计学意义（P>0.05）。结论 冠脉内联合应用罂粟碱与比伐芦定治疗急诊PCI术中慢血流/无复流能有效改善患者冠脉血流情况，减轻心肌损伤与内皮损伤，缓解机体炎症反应，改善患者近期预后。

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.

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