急诊室内使用瑞替普酶治疗急性心肌梗死的疗效评价

目的比较第三代静注溶栓药物瑞替普酶(rPA)和阿替普酶(rt-PA)对急性心肌梗死(AMI)患者急诊静脉溶栓治疗的临床疗效。方法采用前瞻开放性临床研究方法,观察2004年3月至2006年12月期间在本院急诊室内接受rPA或rt-PA静脉溶栓治疗的AMI患者,共55例,其中rPA组24例,rt-PA组31例,观察血管再通率、死亡率、平均住院天数、心力衰竭及休克等并发症和出血不良反应。结果rPA和rt-PA组的再通率分别为87.50%和83.83%,(P>0.05)。溶栓后30d内心力衰竭、休克及再梗死发生率两组相当,(P>0.05);死亡率分别为8.33%(2例)和6.45%(2例),P>0.05;轻度出血发生率分别66.66%和48.38%,P>0.05;脑出血发生率为8.33%和9.68%,P>0.05;住院天数分别为(10.74±6.49)d和(13.09±13.36)d,P>0.05。结论瑞替普酶适合急诊室内急性心肌梗死患者的静脉溶栓治疗。     

阿替普酶与瑞替普酶治疗急性心肌梗死的疗效比较

目的：回顾性分析阿替普酶（rt-PA）和瑞替普酶（r-PA）治疗急性心肌梗死（AMI）患者的临床疗效。方法：观察使用阿替普酶全量加速给药或瑞替普酶静脉推注治疗的急性心肌梗死患者，分别统计两组胸痛至溶栓时间、再通率、出院前死亡率、治疗后并发症及再灌注心律失常发生率。结果：溶栓后，使用rt-PA的患者血管再通率84.6%，死亡率7.7%，出血率0%，再灌注心律失常发生率15.4%；使用r-PA的患者血管再通率90.9%，死亡率9.1%，出血率9.1%，再灌注心律失常发生率13.6%。结论：溶栓治疗急性心肌梗死rt-PA与r-PA两药比较疗效相当。     

阿替普酶与瑞替普酶治疗急性心肌梗死的疗效比较

目的:比较阿替普酶(rt-PA)和瑞替普酶(r-PA)治疗急性心肌梗死(AMI)的临床疗效。方法:35例AMI患者分为rt-PA组和r-PA组,分别使用rt-PA全量加速给药或r-PA静脉推注治疗,统计两组胸痛至溶栓时间、再通率、出院前病死率、治疗后并发症及再灌注心律失常发生率。结果:溶栓后,rt-PA组患者血管再通率84.6%,病死率7.7%,出血率0%,再灌注心律失常发生率15.4%。r-PA组患者血管再通率90.9%,病死率9.1%,出血率9.1%,再灌注心律失常发生率13.6%。两组比较差异均无显著性(P>0.05)。结论:rt-PA或r-PA治疗AMI疗效相当。     

rt-PA静脉溶栓联合依诺肝素钠注射液对急性ST段抬高型心肌梗死患者心电图变化及血管再通率的影响

目的分析阿替普酶(rt-PA)静脉溶栓联合依诺肝素钠注射液对急性ST段抬高型心肌梗死(ASTEMI)患者心电图变化及血管再通率的影响。方法选取我院2017年1月～2019年2月收治的ASTEMI患者104例。根据治疗方案不同分为观察组和对照组各52例。对照组采用rt-PA静脉溶栓治疗,观察组采用rt-PA静脉溶栓联合依诺肝素钠注射液治疗。比较2组血管再通率、治疗前后心电图变化、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)变化。结果治疗5d后,观察组血管再通率(78.85%)显著高于对照组的(59.62%),差异有统计学意义(P<0.05);观察组ST段偏移、Q波时、Q波/R波均低于对照组,差异有统计学意义(P<0.05);观察组LVEDV、LVESV显著低于对照组,LVEF显著高于对照组,差异有统计学意义(P<0.05)。结论 rt-PA静脉溶栓联合依诺肝素钠注射液治疗ASTEMI患者,能显著改善心电图,促进血管再通,提升心功能。     

瑞替普酶静脉溶栓治疗急性心肌梗死临床效果观察

目的观察瑞替普酶静脉溶栓治疗急性心肌梗死的疗效及安全性。方法27例急性心肌梗死患者应用瑞替普酶静脉溶栓,观察溶栓疗效及出血并发症。结果27例患者溶栓2h内血管再通率为88．9％（24／27）,出血发生率55．6％（15／27）,均为皮肤黏膜出血,并于1d内消失。结论急性心肌梗死患者静脉溶栓治疗中,瑞替普酶是一种安全有效的溶栓药物,其再通率高、血管开通时间短,给药方便,适合在基层医院临床使用。     

瑞替普酶治疗急性ST段抬高心肌梗死疗效观察

目的：比较急性ST段抬高心肌梗死（STEMI）患者应用瑞替普酶（重组人组织型纤溶酶原激酶衍生物）治疗与尿激酶治疗的临床疗效。方法：60例STEMI患者随机分为治疗组30例和对照组30例,治疗组给予静脉瑞替普酪栓,对照组给予尿激酶溶栓治疗。观察两组再通率。结果：治疗组120min的血管再通率为83．3％,对照组为63．3％,治疗组优于对照组（P〈0．05）。两组主要不良反应为出血,但发生率相似。结论：瑞替普酶是STEMI患者再灌注治疗的理想选择。     

急诊应用瑞替普酶尿激酶对急性心肌梗死溶栓的随机对照研究

目的 在急诊科观察瑞替普酶(r-PA)、尿激酶(UK)用于急性心肌梗死(AMI)溶栓治疗的疗效和不良反应.方法 对符合入选标准的87例AMI患者随机分为r-PA组和UK组,在急诊科分别给予r-PA和UK溶栓治疗,其中r-PA组41例,UK组46例,观察两组溶栓后相关冠状动脉再通率,急性期35 d内的死亡率、并发症和不良反应发生率.结果 2 h内溶栓再通率r-PA组36例(87.8%),UK组30例(65.2%),两组比较差异有统计学意义(P<0.05);两组在急性期35 d内死亡率、缺血再发生和并发症比较差异无统计学意义(P>0.05);r-PA组出血不良反应少于UK组,两组比较差异有统计学意义(P<0.05).结论 与UK相比,在急诊室给予AMI患者r-PA溶栓治疗,梗死相关动脉再通率更高,出血不良反应较少.     

阿替普酶静脉溶栓治疗急性心肌梗死46例临床观察

目的：探讨阿替普酶静脉溶栓治疗急性心肌梗死（AMI）的疗效及并发症发生情况。方法：将98例AMI患者随机分为观察组46例和对照组52例,观察组应用小剂量阿替普酶治疗,对照组给予尿激酶（UK）静脉溶栓治疗。观察两组疗效及并发症发生情况。结果：冠状动脉总再通率：观察组82.6%,对照组50.0%;患者在发病后6h内静脉溶栓治疗再通率：观察组89.3%,对照组60.0%。两组比较均有极显著差异性（P〈0.01）。5周病死率：观察组6.5%,对照组9.6%。两组并发症发生情况比较无显著性差异（P〉0.05）。结论：阿替普酶静脉溶栓治疗AMI临床疗效好,血管再通率高,尤其在发病后6h内进行静脉溶栓治疗效果更佳,是一种安全有效的溶栓剂。     

阿替普酶联合肝素钠治疗急性ST段抬高型心肌梗死中的疗效及对碱性成纤维生长因子影响的研究

目的探讨阿替普酶联合肝素钠在急性ST段抬高型心肌梗死(STEMI)中的应用价值与对碱性成纤维生长因子(b FGF)的影响。方法选取2017年2月～2018年2月在我院接受治疗的STEMI患者72例为研究对象,随机分成对照组和研究组各36例。对照组行尿激酶联合肝素钠治疗,研究组行阿替普酶联合肝素钠治疗,比较两组治疗效果及bFGF水平变化情况。结果研究组治疗总有效率、溶栓后1h和2h血管再通率、治疗后bFGF水平均高于对照组,差异有统计学意义(P0.05)。结论阿替普酶联合肝素钠治疗STEMI,有助于改善患者碱性纤维生长因子水平,提升临床疗效和血管再通率,应用效果显著。     

瑞替普酶静脉注射治疗急性心肌梗死52例疗效观察

目的：观察急性心肌梗死瑞替普酶静脉溶栓疗法的效果。方法：对52例急性心肌梗死患者用瑞替普酶静脉溶栓疗法进行治疗。结果：瑞替普酶临床再通率84．6％，4例出现上消化道出血，经治疗好转。结论：急性心肌梗死患者选用瑞替普酶静脉溶栓再通率高，是一种安全有效的再灌注疗法。     

重组链激酶与尿激酶治疗急性心肌梗死的疗效分析

目的：评价国产重组链激酶（r-SK)与尿激酶（UK）治疗急性心肌梗死（AMI）的疗效，并比较二者的差异。方法：146例AMI患者均采用静脉溶栓，分为UK治疗组（71例）和r-SK治疗组（75例）。结果：溶栓治疗后，梗死相关血管再通率r-SK组为72．0％（54／75），UK组为63．38％（45／71），P＜0．05差异显著，r-SK组住CCU时间及住院时间均低于UK组（P＜0．05），30d病死率r-SK组为5．33％（4／75），UK组为5．63％（4/71),差异不显著（P＞0．05），两组均未出现严重出血及其他并发症，但r-SK组过敏反应发生率为8．0％（6／75），低血压发生率为2．67％（2／75），结论：使用国产r-SK加速法治疗AMI，梗死相关血管再通率高于UK，病人住CCU时间和平均住时间缩短，30d病死率与UK相似，但过敏反应及低血压发生率r-SK较UK高，国产r-SK治疗AMI无严重出血，疗效确实，安全性好。     

小剂量重组织型纤溶酶原激活剂与尿激酶、链激酶治疗急性心肌梗死疗效观察

目的:观察小剂量重组织型纤溶酶原激活剂、尿激酶和链激酶静脉溶栓治疗急性心肌梗死的疗效及安全性。方法:112例急性心肌梗死患者随机分为纤溶酶原激活剂组40例,尿激酶组30例,链激酶组42例。分别应用重组织型纤溶酶原激活剂50mg、尿激酶75万u、链激酶75万u于30min内静脉输入。结果:小剂量加速静脉溶栓心肌梗死相关血管再通率,重组织型纤溶酶原激活剂组80%,尿激酶组53.5%,链激酶组50%。重组织型纤溶酶原激活剂组与尿激酶组、链激酶组疗效比较P<0.05。3组溶栓后出血及5周病死率比较无明显差异。结论:小剂量重组织型纤溶酶原激活剂治疗急性心肌梗死的疗效明显优于小量尿激酶和链激酶,不良反应无明显差异。     

常规剂量瑞替普酶治疗急性心肌梗死安全性分析

目的对比观察常规剂量（10U＋10 U）瑞替普酶（派通欣）用于国人急性心肌梗死（AMI）溶栓治疗的安全性.方法共有203例AMI患者入选本研究,随机接受常规剂量（10 U＋10 U）瑞替普酶或阿替普酶（艾通立）溶栓治疗,观察急性期病死率、心肌梗死并发症以及不良事件发生率.结果 35天时,瑞替普酶组死亡7例（6.80%）,阿替普酶组死亡9例（9.00%）（P〉0.05）;瑞替普酶组再发心肌梗死发生率0.97%,阿替普酶组为4.00%（P〉0.05）;瑞替普酶组脑出血的发生率为0.97%,阿替普酶组为3.00%（P〉0.05）;瑞替普酶组有28例（27.18%）患者发生不良事件,其中与药物有关的23例（22.33%）;阿替普酶组有23例（23.00%）患者发生不良事件,与药物有关的17例（17.00%）（P〉0.05）.结论常规剂量（10 U＋10 U）瑞替普酶可安全用于国人治疗AMI.     

小剂量重组组织型纤溶酶原激活物与重组链激酶治疗急性心肌梗死的对比研究

目的 评价小剂量重组组织型纤溶酶原激活物（r-TPA)与国产重组链激酶（r-SK)治疗急性心肌梗死（AMI）的疗效,并比较二者的差异。方法 71例AMI患者,均采用静脉溶栓,随机分为r-TPA治疗组（36例）和r-SK治疗组（35例）。结果 梗死相关血管再通率r-TPA组为77．78％（28／36）,r-SK组为74．29％（26／35）P＞0．05,差异不显著;4周病死率r-TPA组为5．56％（2／36）,r-SK组为5．71（2／35）％,差异不显著（P＞0．05）;两组均未出现严重出血。但r-SK组过敏反应发生率为8．57％（3／35）,低血压发生率为2．86％（1／35）。结论 加速法使用国产r-SK治疗AMI,梗死相关血管再通率、4周病死率r-TPA与r-SK相似,但过敏反应及低血压发生率r-SK较r-TPA高,国产r-SK治疗AMI安全有效,无严重出血,费用较r-TPA低,值得临床推广使用。     

Initiation of thrombolytic therapy for patients with acute myocardial infarction by emergency physicians: The Hong Kong experience

Abstract Objectives: To compare door-to-needle time and complications for eligible acute myocardial infarction patients receiving thrombolytic therapy in the emergency department and in the coronary care unit. Methods: A prospective study was performed involving all patients with acute myocardial infarction who received thrombolytic therapy either in the emergency department or the coronary care unit during the period January 1995 to March 1996. Patients’ time interval between registration in ED and receiving thrombolytic therapy (door-to-needle time) was the main audit parameter. Other emergency department information collected included inappropriate administration of thrombolytic therapy and the occurrence and management of complications of thrombolytic therapy. Results: In the United Christian Hospital, Hong Kong, 148 patients with acute myocardial infarction received thrombolysis. Sixty-eight cases (group A) received thrombolysis in the emergency department and 80 cases underwent thrombolysis in the coronary care unit. The 80 cases in the coronary care unit included 47 cases (group B) whose diagnosis of acute myocardial infarction and eligibility for thrombolysis were established in the emergency department, and 33 cases (group C) in which there were difficulties in diagnosis or exclusion of contraindications for thrombolysis. The mean door-to-needle times were 31.3 min in group A (95% CI, 27.6–35.1), 54 min in group B (95% CI, 47.8–60.2) and 171.8 min in group C (95% CI, 121.8–211.8). Inappropriate use of thrombolysis in the emergency department occurred in 2.9% of all cases. The most common complication of thrombolysis in the emergency department was hypotension (4.4%). All cases were successfully managed in the emergency department. There was one case of anaphylaxis during streptokinase infusion that required resuscitation in the emergency department. There were no deaths of patients receiving thrombolysis in the emergency department. Conclusion The initial experience of a regional hospital in Hong Kong supports the view that initiation of thrombolytic therapy in the emergency department can achieve a more favourable door-to-needle time without compromising the care of acute myocardial infarction patients.     

瑞替普酶院前溶栓治疗急性ST段抬高性心肌梗死临床疗效及安全性观察

目的观察瑞替普酶院前溶栓治疗急性ST段抬高性心肌梗死患者的临床疗效及安全性。方法回顾分析2010年9月-2012年12月收治的62例急性ST段抬高性心肌梗死患者,随机分为两组,其中院前组22例于120救护车上和（或）急诊科进行瑞替普酶溶栓,院内组40例于入院后进行溶栓治疗,比较两组溶栓治疗后60、120min再通率,并发各种不良反应发生率及复合终点事件发生率。结果溶栓后60、120min院前组临床判断再通率均明显高于院内组（P〈0．05）,住院4周内并发各种出血、心力衰竭、低血压及死亡发生率两组差异无统计学意义（P〉0．05）。结论瑞替普酶院前溶栓治疗急性ST段抬高性心肌梗死具有更好的临床疗效及安全性,值得基层医院临床推广。     

Comparative efficacy of thrombolytics in acute myocardial infarction: a systematic review

BACKGROUND: The comparative clinical effectiveness of new (reteplase, tenecteplase) vs. older (alteplase, streptokinase) thrombolytic agents in the treatment of acute myocardial infarction is uncertain. Aim: To examine 30-35 day mortality and major adverse effects of thrombolytic agents in the treatment of acute myocardial infarction. DESIGN: Systematic review of randomized controlled trials comparing the clinical efficacy of included drug regimens. METHODS: We searched MEDLINE, EMBASE, Science Citation Index/Web of Science from 1980 to December 2001, and the Cochrane Library (2001, Issue 4). Reference lists of included studies and a number of medical journals were hand searched. Randomized controlled trials that compared any two of the included drugs provided to patients in the early stages of acute myocardial infarction, were included. Outcome measures included: mortality, bleeding, stroke, reinfarction, allergy and anaphylaxis. RESULTS: We found 14 studies, total study population 142 907. For available comparisons (all alteplase vs. streptokinase, reteplase vs. streptokinase or alteplase, tenecteplase vs. alteplase), meta-analysis showed no significant differences in mortality at 30-35 days. The GUSTO-I study showed an apparent benefit of accelerated alteplase over streptokinase, but its inclusion or exclusion made little difference. Total stroke and haemorrhagic stroke rates were lower for streptokinase than for all alteplase combined (total stroke, OR 1.29, 95%CI 1.13-1.46; haemorrhagic stroke OR 1.83, 95%CI 1.14-2.93). DISCUSSION: All thrombolytic drugs appear to be of similar efficacy in reducing mortality, and the apparent benefits of accelerated alteplase in GUSTO-I are consistent with this. Whether accelerated alteplase is sufficiently different from other regimens of administering alteplase to be excluded from a meta-analysis, and whether more weight should be placed on a meta-analysis than on a single trial, are matters for debate.     

急诊应用HUTPA、rt-PA溶栓治疗STEMI临床比较

目的：观察急诊应用HUTPA和rt—PA治疗急性ST段抬高型心肌梗死（ST—elevationmyocardialinfarction,sTEMI）的疗效和安全性。方法：对发病在12h内的74例STEMI患者随机分为HUTPA组（n=37）和rt—PA组（n=37）,分别一次性静脉推注HUTPA25mg和静脉注射rt-PA100mg,在溶栓90min时行冠脉造影检查,评价梗死相关动脉开通率,监测溶栓30d不良事件发生率。结果：在STEMI发病3h内静脉应用HUT—PA和rt—PA梗死相关动脉开通率分别为95．65％和81．82％,发病12h内静脉应用HUTPA和rt—PA梗死相关动脉开通率为83．78％和81．08％,差异无统计学意义（P〉O．05）;在溶栓前、溶栓6h、溶栓12h及溶栓7d血浆纤维蛋白原两组无显著性差异（P〉O．05）;在30天出血、心律失常、心力衰竭、再梗塞及全因死亡不良事件两组差异无统计学意义（P〉O．05）。结论：与rt—PA比较HUPTA治疗STEMI病人同样安全有效,且使用方法简便、易操作。     

重组组织型纤溶酶原激活剂与尿激酶溶栓治疗急性心肌梗死的疗效比较

目的：观察小剂量（50mg)重组织型纤维酶原激活剂（rt-PA)与尿激酶（UK）溶栓治疗急性心肌梗死（AMI）的疗效及安全性,方法：将116例AMI患随机分为rt-PA组和UK组,分别应用rt-PA和UK溶栓治疗,结果：冠状动脉（冠脉）总再通率分别rt-PA组80．65％和UK组为51．85％,患在发病后6h内治疗,冠脉再通率分别为rt-PA组91．18％和UK组67．86％,前明显高于后,两组比较均有显差异（P＜0．01）,5wk住院病死率分别为rt-PA组6．5％和UK组11．1％,结论：小剂量（50mg)rt-PA用于AMI溶栓治疗的临床疗效明显优于UK,血管再通率高,尤其在发病后6h内进行治疗效果更佳.rt-PA溶栓并发症少,可降低闰 率,是一种安全有效的溶栓剂.     

Australian and New Zealand 1997 thrombolysis audit

Objectives : To describe patterns of revascularization techniques in acute myocardial infarction in Australasia, particularly time to thrombolysis, site of delivery, patient demographics, revascularization rates and outcomes. Methods : Seventy‐four Australasian emergency departments were surveyed. Data from 1997 were obtained on number of acute myocardial infarction patients, age, gender, time to revascularization, intracranial haemorrhage rate, mortality, location and rate of revascularization and angioplasty. Grouped data were analysed. Results : Thirty‐three hospitals responded (44.6%). Many others could not supply data. Of 2930 acute myocardial infarction patients, 29% received thrombolysis and 5% angioplasty. Tertiary hospitals thrombolysed more in coronary care units (24.2% versus 8.8%), while non‐tertiary hospitals used emergency departments more (16.2% versus 5.9%). Average emergency department door‐to‐needle time was 49.4 min (median 38.6) versus 63.9 min (median 66.8) in coronary care units. More patients had streptokinase than tissue‐type plasminogen activator. Inferior myocardial infarction accounted for 58% of cases. Primary angioplasty commenced on average 61.5 min (median 69.2) after arrival. Conclusions : Australasian revascularization procedure rates, times, mortality and intracranial haemorrhage rates are similar to internationally published values. Thrombolysis starts sooner if given in emergency departments. Hospitals thrombolysing patients in coronary care units should consider emergency department thrombolysis if median times are greater than 50 min.