链激酶静脉溶栓治疗早期急性心肌梗死疗效分析

目的 探讨链激酶静脉溶栓治疗急性心肌梗死的疗效。方法 在心电图监测下，对68例急性心肌梗死患者行链激酶静脉溶栓治疗。结果 68例患者中冠脉再通44例，再通率达64．7％；未再通24例，其中死亡4例，病死率为16．7％。不同时段溶栓时其并发症的发生率间差异有显著性（P〈0．005）。结论 早期溶栓治疗可减少并发症，降低病死率。     

Intracoronary streptokinase therapy in the coronary care unit for acute myocardial infarction

Intracoronary streptokinase was offered and preliminary coronary angiography performed in 14 patients who were seen with the clinical diagnosis of acute myocardial infarction within 4 h of onset of symptoms. The procedure was performed in the Coronary Care Unit (CCU) of St. Peter's Medical Center with the use of a portable C-arm fluoroscope. Angiography was recorded on video tape. Service was provided by an "on-call" team consisting of two physicians, a CCU nurse, and a radiology technician, on a 24-h service basis. Adequate visualization of coronary anatomy was obtained in all patients. Patency of occluded vessels was achieved in 10 of 11 patients who received intracoronary streptokinase. The initial streptokinase bolus was administered at a mean interval of 4.1 h from onset of symptoms. It is concluded that speedy and effective coronary thrombolytic therapy can be provided in the CCU on a 24-h service basis by an on-call team. The use of CCU for this purpose will make this therapy widely available across the country, without the need for Cardiac Catheterization Laboratory.     

链激酶静脉溶栓治疗急性心肌梗死的效果

1目的　探讨链激酶静脉溶栓治疗急性心肌梗死的效果。2方法　给予 2 3例急性心肌梗死病人 15 0万单位链激酶行静脉溶栓治疗 ,根据临床血管再通指标 ,比较溶栓开始不同时间 (<6 h和 6～ 12 h)和不同的给药速度 (30 m in和 6 0 min滴完 )对疗效的影响。通过择期冠状动脉造影 ,比较临床再通组与未通组冠脉再通率。通过超声心动图及左室造影 ,比较再通组与未通组心功能。3结果　 6 h内溶栓血管再通率 6 8.4% ,6～ 12 h溶栓血管再通率5 0 .0 % ,两者比较差异有显著意义 (χ2 =8.11,P<0 .0 1) ;两种给药速度血管再通率差异无显著意义 (χ2 =0 .0 3,P>0 .0 5 )。左室造影示再通组心功能明显好于未通组 (t=3.2 1,P<0 .0 1)。4结论　链激酶静脉溶栓治疗急性心肌梗死安全有效。     

国产重组链激酶、尿激酶对急性心肌梗死溶栓的疗效分析

目的　观察国产重组链激酶 (r-SK)和尿激酶 (UK)对急性心肌梗死 (AMI)溶栓的效果和不良反应。方法　自 2 0 0 1年 1月 - 2 0 0 3年 12月对 10 0例AMI患者随机分成两组 ,每组各 5 0例 ,一组予 15 0万单位r -SK溶栓 ,另一组予 15 0万单位UK溶栓治疗 ,观察两组溶栓再通率、急性期死亡率、并发症以及不良反应发生率。结果　(1)溶栓再通率r-SK组为 82 .0 % ,UK组为 6 4 .0 % ,r-SK组明显优于UK组 (P <0 .0 5 ) ;(2 ) 6小时内溶栓再通率r-SK组为 85 .7% ,UK组为 6 5 .8% ,两组间有显著差异 (P <0 .0 5 ) ;(3)发病 6小时以上溶栓再通率 ,r -SK组6 2 .5 % ,UK组为 5 5 .6 % ,两组无显著差异 (P >0 .0 5 ) ;(4 )两组间在 35天死亡率及皮肤黏膜轻度出血等方面无显著差异 ,无脑出血及严重出血发生 ;(5 )r-SK组一过性低血压发生率高于UK组 (14 .0 %和 4 .0 % ) ,但两组间无显著差异 (P >0 .0 5 ) ;(6 )r-SK组的过敏反应发生率为 4 .0 % ,UK组为 0 .0 %。结论　r-SK和UK都是治疗AMI的疗效肯定、安全的溶栓药物 ,r-SK的疗效明显优于UK ,溶栓时间越早其再通率越高。     

国产重组葡激酶对兔血小板及凝血、纤溶系统的影响

目的　观察国产重组葡激酶 (r SAK)对兔血小板及凝血、纤溶系统的影响。方法　新西兰兔 4 0只 ,随机分为以下 8组 :①对照组 (生理盐水 10ml,30min) ,②r SAK小剂量组 (1 5× 10 4U/kg ,30min) ,③r SAK中剂量组 (3 0× 10 4U/kg ,30min) ,④r SAK大剂量组 (6 0× 10 4U/kg ,30min) ,⑤r SAK单次静脉推注组 (3 0× 10 4U/kg ,2min) ,⑥联合肝素治疗组 (先静脉推注肝素 2 0 0U/kg ,继之予r SAK3 0× 10 4U/kg ,30min ,输注完毕予肝素 5 0U·kg 1·h 1静脉滴注至观察终点 ) ,⑦尿激酶 (UK)组 (3 0× 10 4U/kg ,30min) ,⑧重组链激酶 (r SK)组 (3 0× 10 4U/kg ,30min)。用球囊损伤法建立兔右股动脉血栓形成模型 ,继而用输液泵经兔耳缘静脉匀速注入上述溶栓药物。在给药前、给药后 30min、6 0min、12 0min取静脉血检测血小板计数、凝血酶原时间 (PT)、部分凝血活酶活化时间 (APTT)、凝血酶时间 (TT)、纤维蛋白原 (Fg)、纤溶酶原 (Plg)、α2 抗纤溶酶 (α2 AP)和D二聚体 (D dimer)。结果　各治疗组在给药前、后血小板计数较对照组均无显著差异。r SAK各剂量组、UK组和r SK组给药后血浆Fg均有显著下降。中、小剂量r SAK给药后 12 0minPT延长 (P <0 0 5 ) ;UK及r SAK单独治疗组给药后APTT和TT均无显著延长     

溶栓药APSAC的制备和鉴定

重组链激酶（ｒ－ＳＫ）由工程菌提取液经ＳｅｐｈａｃｒｙｌＳ－２００柱纯化，比活性达１０５ＩＵ／ｍｇ，十二烷基硫酸钠－聚丙烯酰胺凝胶电泳（ＳＤＳ－ＰＡＧＥ）显示分子量为７８．０２４７×１０－２４ｋｇ的一条带。人新鲜血浆经Ｌｙｓｉｎｅ－Ｓｅｐｈａｒｏｓｅ４Ｂ亲和层析，ＳｅｐｈａｄｅｘＧ－２５凝胶过滤制备纤溶酶原（ｐｌｇ），比活性达２３．７ＩＵ／ｍｇ，活性回收率为１３．６％，ＳＤＳ－ＰＡＧＥ显示分子量为１４７．７４８９×１０－２４ｋｇ的一条带。对－茴香酸－对－脒基ｒ－ＳＫ和ｐｌｇ的混合物经苯酯盐酸盐（ＡＰＡＮ）修饰后制备茴香酰纤溶酶原链激酶激活剂复合物（ＡＰＳＡＣ），产物经Ｌ－ｌｙｓｉｎｅＳｅｐｈａｒｏｓｅ４Ｂ亲和层析，ＳＤＳ－ＰＡＧＥ显示分子量为７８．０２４７×１０－２４ｋｇ和１４７．７４８９×１０－２４ｋｇ两条带，其拟一级水解速率常数为１．２６×１０－４ｓｅｃ－１。体外溶栓实验证明其有溶栓活性。     

溶栓药物纤维蛋白亲和力的简便测定

建立了一种简便可行的测定溶栓药物与纤维蛋白亲和力的方法，对我院自制的链激酶，尿激酶和对茴香酰纤溶酶原链激酶激活剂复合物进行测定，并作比较，所得结果与国外文献报道一致。     

Issues raised by GUSTO

The GUSTO trial raises several questions including the role of heparin in thrombolysis. The need for intravenous versus subcutaneous heparin with streptokinase (SK) has not been clarified in this trial. It is more likely that the superiority of tissue plasminogen activator (t-PA) was due to its accelerated administration rather than the accompanying heparin. Despite the improvement in survival, much is still to be achieved in obtaining optimal reper-fusion rates. (Aust NZ J Med 1993; 23: 739–741.)     

Management of acute myocardial infarction 1990: a perspective

Rising costs have reached a point at which physicians must assume a major role in dealing with the cost of medicine. Little information is available regarding actual practice at the community hospital level. In order to develop some insight on this issue, a survey of cardiovascular specialists was conducted regarding management of acute myocardial infarction in 1990. The results indicate a major lack of correlation between efficacy, cost, and practice patterns in terms of current knowledge. Perhaps legal concerns have contributed to these current practice patterns. Clearly, aside from choice of thrombolytic agent and/or PTCA, early treatment of acute myocardial infarction has emerged as a most important factor in reducing mortality.     

Thrombolysis with Streptokinase During Cardiopulmonary Resuscitation: A Single Center Experience and Review of the Literature

Objective: To report our experience with use of thrombolysis with streptokinase during cardiopulmonary resuscitation of patients with cardiac arrest due to myocardial infarction. Design: A case series. Methods: Thrombolytic therapy (streptokinase) was administered during cardiopulmonary resuscitation of 4 patients with suspected myocardial infarction as the cause of cardiac arrest. Results: 3 of the 4 patients survived and were discharged from the hospital without any major complications or neurological sequela. Conclusion: Thrombolysis with streptokinase during cardiopulmonary resuscitation of patients with suspected acute myocardial infarction is associated with reduced mortality and favorable neurological outcome.