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目的:探讨冠状动脉内靶向应用重组人尿激酶原联合替罗非班治疗ST段抬高型心肌梗死(STEMI)的效果。方法:本研究为随机对照研究，选取2021年1月至2023年3月西安市中心医院急诊科收治的90例STEMI患者，男50例，女40例，年龄(60.14±6.52)岁，年龄范围为40～80岁，采用随机数表法将患者随机分为替罗非班组与联合治疗组，每组45例。替罗非班组患者于靶病变血管近端推注替罗非班注射用浓溶液，联合治疗组患者于靶病变血管近段端推注替罗非班注射用浓溶液联合注射用重组人尿激酶原，比较两组患者心肌微循环血流灌注情况、心肌损伤标志物情况[肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白l(cTnl)、心脏脂肪酸结合蛋白(H-FABP)]、心功能情况[左室舒张末期内径(LVEDd)、左室质量指数(LVMI)、左室射血分数(LVEF)]、出血事件发生情况及心血管不良事件(MACE)发生情况。结果:联合治疗组患者基础态基底环、中部环、心尖环的心肌灌注时间常数 k值(1.39±0.09、1.41±0.10、1.39±0.08)均高于替罗非班组(1.34±0.07、1.36±0.08、1.32±0.06)；联合治疗组患者负荷态基底环、中部环、心尖环的心肌灌注时间常数 k值(1.48±0.12、1.51±0.11、1.54±0.07)均高于替罗非班组(1.43±0.09、1.44±0.08、1.49±0.06)；术后24 h，联合治疗组患者CK-MB、cTnl、H-FABP水平[(88.53±18.89)U/L、(3.88±0.87)μg/L、(17.43±3.78)μg/L]均低于替罗非班组[(101.25±20.55)U/L、(4.54±1.25)μg/L、(20.29±4.46)μg/L]；术后3个月，联合治疗组患者LVEDd、LVMI水平[(42.25±4.62)ml、(110.92±12.33)g/m 2]低于替罗非班组[(46.74±5.11)ml、(119.73±14.41)g/m 2]，LVEF水平[(58.52±6.03)%]高于替罗非班组[(53.88±5.34)%]，差异有统计学意义( P<0.05)。两组患者出血事件发生率、MACE发生率比较，差异无统计学意义( P>0.05)。 结论:冠状动脉内靶向联合尿激酶原与替罗非班应用于STEMI患者可改善心肌微循环血流灌注，减少心肌损伤，有助于恢复心脏功能，且术后MACE发生率少，安全性良好。

Objective:To explore the effect on patients with ST-segment elevation myocardial infarction (STEMI) undergoing intracoronary recombinant human prourokinase and tirofiban targeted therapy.Methods:This study was a randomized controlled trial study, a total of 90 patients with STEMI were selected from the department of Emergency in Xi ′an Central Hospital from January 2021 to March 2023, including 50 males and 40 females, aged (60.14±6.52) years old, ranging from 40 to 80 years old.The patients were randomized into tirofiban group and combined treatment group, with 45 cases in each group.Patients in the tirofiban group were injected with concentrated solution of tirofiban for injection at the proximal end of target diseased vessels, while the patients in the combined treatment group were injected with concentrated solution of tirofiban for injection combined with recombinant human urokinase for injection at the proximal end of target diseased vessels.The myocardial microcirculation perfusion, myocardial injury markers [creatine kinase isoenzyme (CK-MB), cardiac troponin l (cTnl), heart fatty acid binding protein (H-FABP)], cardiac function [left ventricular end-diastolic diameter (LVEDd), left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF)], occurrence of bleeding events and occurrence of major adverse cardiovascular events (MACE) were compared between both groups.Results:The myocardial perfusion time constant k values of basal ring, middle ring and apical ring in basic state in combined treatment group (1.39±0.09, 1.41±0.10, 1.39±0.08) were higher than in tirofiban group(1.34±0.07, 1.36±0.08, 1.32±0.06), and the k values in load state (1.48±0.12, 1.51±0.11, 1.54±0.07) were higher than in tirofiban group(1.43±0.09, 1.44±0.08, 1.49±0.06).At 24 h after surgery, the levels of CK-MB, cTnl and H-FABP in combined treatment group[(88.53±18.89) U/L, (3.88±0.87) μg/L, (17.43±3.78) μg/L] were lower than those in tirofiban group [(101.25±20.55) U/L, (4.54±1.25) μg/L, (20.29±4.46) μg/L]; at 3 months after surgery, LVEDd and LVMI [(42.25±4.62) ml, (110.92±12.33) g/m 2] in combined treatment group were lower than (46.74±5.11) ml, (119.73±14.41) g/m 2] in tirofiban group, LVEF [(58.52±6.03)%] was higher than tirofiban group[(53.88±5.34)%], the differences were statistically significant ( P<0.05).The incidence of bleeding events and MACE were compared between the two groups, the differences were not statistically significant ( P>0.05). Conclusions:Intracoronary targeted combination of human prourokinase and tirofiban for STEMI patients can improve myocardial microcirculation perfusion, reduce myocardial injury, and help to restore cardiac function, and it has low incidence rate of postoperative MACE and good safety.