AMI患者尿激酶与组织型纤溶酶原激活剂治疗结果的对比

比较31例尿激酶(UK)及14例组织型纤溶酶原激活剂(t-PA)静脉溶栓辅以阿斯匹林及肝素治疗急性心肌梗塞(AMI)的疗效.t-PA组与UK组相比较:血管再通率分别为78.6%与58.1%(P>0.05);脑、消化道及呼吸道出血并发症在t-PA组稍多,而UK组以局部皮肤出血较多.血管再通组心力衰竭、严重性心律失常、室壁瘤及梗塞后心绞痛的发生率较低,但两组间均无显著性差异;再通组病人心脏破裂的发生明显低于未再通组(0与17.6%P<0.05).本研究提示静脉t-PA溶栓治疗血管再通率高于静脉UK,有条件者可以首选t-PA.溶栓再通可以减少心力衰竭、室壁瘤、心梗后再缺血的发生,特别是心脏破裂的发生,从而改善病人的预后.

The Comparison of Intravenous Thrombolytic Therapy with Urokinase and Tissue Plasminogen Activator in Patients with Acute Myocardial Infarction.

We compared the effectiveness of intravenous thrombolytic therapy with urokinase (UK) and tissue plasminogen activator (t-PA) in patients within 6 hours after onset of acute my-ocardial infarction (AMI) in this study. The patients were treated with either UK(31 patients) or t-PA(14 patients)plus intravenous or subcutaneous heparin and oral Aspirin. The clinical reperfusion rate was 78. 6% and 58-1% in t-PA group and UK group(P>0. 05) ,respectively. The in-hos-pital mortality rates were 14. 3% and 9. 7% (P>0. 05)in patients treated with t-PA and UK. 2 patients in t-PA group and no patient in UK group (14. 2% vs 0%,P>0. 05) developed gastrointestinal or respiratory bleeding. One patient in t-PA group and no patient in UK group (7. 1% vs 0%,P>0.05) developed intracerobral bleeding. 2 patients in clinical reperfusion group and 3 patients in non-perfusion group (7. 1% vs 17. 6% ,P>0. 05) died during hospitalization. The major complications including heart failure, arryhmias, aneurym and cardiac shock were higher in non-reperfusion patients,but the difference was not significant. 3 patients in non-perfusion group and no patient in perfusion group(17. 6% vs 0%,P<0. 05) developed cardiac rupture diagnosed by e-cho study or postmortem. We concluded that AMI patients treated with t-PA had higher reperfusion rate and lower in-hospital mortality comparing those treated with UK. The in-hospital mortality and incidence of major complications in patients who had clinical reperfusion in either t-PA or UK were lower than those of non-reperfusion.