重组链激酶在猪急性脑栓塞模型中溶栓作用的实验研究

研究颈内动脉灌注重组链激酶对脑血栓的溶化作用及安全性.制成猪急性血栓性脑栓塞模型,4h后自颈内动脉灌注重组链激酶(对照组用5%葡萄糖溶液),脑血管造影观察血栓是否溶化.井测凝血系统指标,24h后作病理检查.结果表明,实验组6例中4例血管再通,对照组6例均未再通;实验组凝血酶元时间、凝血酶时间延长,纤维蛋白原、纤溶酶原明显下降.病理未见脑出血.结论:颈内动脉灌注重组链激酶能溶化脑血栓,对凝血功能有一定的影响.但未见出血并发症.     

A COMPARATIVE STUDY OF INTRAVENOUS ACCELERATED STREPTOKINASE DOSE REGIMEN WITH CONVENTIONAL DOSE REGIMEN FOR CORONARY THROMBO

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Prehospital thrombolysis in a rural community: Short- and long-term survival

Summary In order to assess the feasibility and outcome of using prehospital thrombolysis in acute myocardial infarction in a rural community, we performed an open randomized study of patients with symptoms of acute myocardial infarction of less than 6 hours. One hundred and forty-five patients with acute myocardial infarction were allocated to receive IV streptokinase prehospital by means of a mobile coronary care unit (MCCU) (n=43) or to receive IV streptokinase in hospital (n=102). The mean delay time to treatment was 138 minutes (MCCU group) and 172 minutes (hospital group) (p<0.02). Reperfusion time was 88 minutes for the MCCU group and 92 minutes for the hospital group. Mortality at 14 days was 2.3% for the MCCU group and 11.7% for the hospital group (p<0.05). Six month mortality was 4.9% for the MCCU group and 17.3% for the hospital group (p=0.03). Mortality at 1 year was 6.1% for the MCCU group and 20.0% for the hospital group (p=0.04). There were no significant adverse events in either treatment group. Thus, prehospital thrombolysis by streptokinase is feasible and allows significant reduction in the delay time to treatment initiation. There are encouraging improvements in both short- and long-term survival with no apparent reduction in safety profile.     

The role of the lysine binding sites of human plasminogen in the fibrinogen stimulated rate of active site formation in the streptokinase-plasminogen equimolar complex

The effect of various concentrations of -amino caproic acid (EACH) on the rate of active site formation in the human plasminogen moiety of the streptokinase-plasminogen equimolar complex has been studied in the absence and presence of human fibrinogen fragment D₁(FD₁). In the absence of FD₁, the pseudo first order rate constant (k_obs) for active site development in this complex ranges from 8.4–17.9 × 10⁻³ sec⁻¹ with Glul-plasminogen (Glul-Pg), Lys₇₇-plasminogen (Lys₇₇-Pg), and Val₄₄₂-plasminogen (Val₄₄₂-Pg) at levels of EACA from 0–25 mM. In the presence of 2 μM FD₁, the k_obs for active site formation in the SK·Glu₁-Pg complex, of 60.1 × 10⁻³ sec⁻¹, was not altered significantly as the EACA level was increased to 25 mM. Similarly, in the SK· Lys₇₇-Pg complex, the k_obs for active site formation, of 62.1 × 10⁻³ sec⁻¹, was essentially unchanged as the EACA level was increased to 25 mM. Finally, the k_obs for active site formation in the SK·Val₄₄₂-Pg complex, of 113.6 × 10⁻³ sec⁻¹, was also unaffected at levels of EACA up to 5 mM, with a slight inhibition at 25 mM EACA.

These results show that the stimulation of active site formation in the equimolar SK·Pg complex by fibrinogen fragment D₁ is mediated by sites separate from the lysine binding sites of plasminogen.     

Experience with intracoronary streptokinase in 36 patients with acute evolving myocardial infarction

Acute angiography was performed in 36 consecutive patients withevolving myocardial infarction admitted within 3 h after onsetof symptoms. No fatal complication occurred. Angiography revealeda total occlusion in 32 patients (89%), a subtotal stenosisin three (8%), and a 90% stenosis in one patient (3%). Anteriorinfarction was exclusively related to left anterior descending,and inferior infarction to right coronary or circumflex obstruction.After identification of the ‘infarct-vessel’, nifedipine10 mg was administered sublingually. In no patient was anterogradeflow affected with this treatment. In 35 patients an attempt to lyse clot was made with intracoronarystreptokinase; an infusion of 2000–4000 U/min, precededby a bolus of 10 000–20 000 U was infused into the ‘infarct-vessel’. In 26 patients (74%) reperfusion was achieved, two combinedwith guidewire perforation. The mean duration of onset of symptomsto reperfusion was 3.6 h (range 1.8–5.6). The mean durationof lysis was 1.2 h (range 0.3–3), and the mean dosageof streptokinase was 200 000 U (50 000–400 000 U]. In25 out of 26 patients (96%) a high degree of obstruction remainedimmediately after lysis and at repeat angiography 6–8weeks after the acute event. Despite treatment with aspirin200 mg daily and nifedipine 30 mg daily four re-occlusions occurred.Coronary bypass surgery was performed electively in five patients. Thus, we conclude that in patients with evolving myocardialinfarction, the infarct-vessel can be recanalized in 74% ofpatients by intracoronary streptokinase. The true benefit ofthis treatment must await a controlled study.     

体外治疗性超声对药物诱发兔耳小血管损伤后再出血的影响

评价超声促进血栓溶解的有效性，并观察超声促进血栓溶解（超声助溶）的作用与超声强度、血栓形成时间的关系。用手术刀将免耳全层割穿，出血停止1h及4h后随机分组。对照组给予超声；单药组给予重组链激酶；药加超声用重组链激酶加超声。超声的频率为0．8MHz，强度分为1．2w／cm2、2．2w／cm2、。结果：1及4h切口，链激酶加超声组兔耳再出血时间明显短于单药组，P＜0.001。链激酶加超声组4h切口的再出血时间均明显短于单药组1h切口的再出血时间。1.2w／cm2组与2．2w／cm2组1h切口的再出血时间无显著差别（P＞0．05），但两组4h切口的再出血时间有显著差别（P＜0.001）。单用超声，观察2h兔耳无再出血。结论：超声有促进药物溶解血栓的作用，从而缩短再通时间。单用超声，无溶栓作用。     

Effective use of streptokinase for peritoneal catheter failure

The fibrinolytic enzyme streptokinase (streptase) was infused into the peritoneal catheter in 19 episodes of catheter failure in 16 patients. Intraabdominal bleeding prior to infusion was seen in seven of these episodes. Fibrin strands and clots were present in four additional successful cases. Streptokinase successfully relieved the obstruction in 13 episodes in 11 patients. The procedure failed in two cases of omental ingrowth and in another with catheter malposition. Streptokinase infusion also failed in two patients with Pseudomonas aeruginosa and one patient with Staphylococcus epidermidis peritonitis. Intraperitoneal streptokinase infusion is simple and free of side effects. Its use should be considered in peritoneal catheter failure, particularly in cases where bleeding or fibrin accumulation may play a role.     

Cardiac rupture following intracoronary streptokinase

Thrombolytic dissolution of coronary artery thrombus has added new dimensions to early myocardial infarction treatment. Reperfusion via streptokinase infusion has been shown to be beneficial; however, adverse effects are being noted. We present the case of a patient so treated who subsequently developed left ventricular free wall rupture.