急诊科内应用重组组织型纤溶酶原激活剂治疗急性心肌梗死44例临床分析

目的评价急诊科内应用重组组织型纤溶酶原激活剂（ｒｔ－ＰＡ）静脉溶栓治疗急性心肌梗死（ＡＭＩ）的疗效及安全性。方法４４例ＡＭＩ患者在急诊科内接受ｒｔ－ＰＡ静脉溶栓治疗。ｒｔ－ＰＡ总量原则为“三级剂量，开通则停”。即当临床显示血管再通时将剂量限制在５０ｍｇ、７５ｍｇ及１００ｍｇ，特殊情况适当加量。负荷量及余量输注速率视梗死部位而异。结果药物总量达５０ｍｇ、７５ｍｇ及１００ｍｇ时血管再通率分别为５９％、７７％及８４％。３例并发心源性休克患者剂量达１００ｍｇ后无再通且病情恶化，分别追加５０ｍｇ、５０ｍｇ及１００ｍｇ后血管再通且存活。总再通率为９１％。轻度出血率为２７％，无严重及颅内出血。结论提示在急诊科内应用ｒｔ－ＰＡ静脉溶栓治疗ＡＭＩ安全有效。

Use of recombinant tissue-type plasminogen activator in the treatment of acute myocardial infarction in the emergency department:A clinical analysis of 44 patients

Objective The aims of the study were to evaluate the efficacy and safety of the use of recombinant tissue plasminogen activator(rt-PA) in the treatment of acute myocardial infarction(AMI) in the emergency departmeent.Methods Forty-four patients with AMI were treated with rt-pa intravenously in the emergency department.When the clinical criterion showed reperfusion the doses of rt-PA were limited to 50mg,75mg and 100mg,but if needed,the doses were added.The infusion rate of the loading and remaining doses varied with infarct sites.Results When the doses with 50mg,75mg and 100mg in forty-one cases the reperfusion rate were 59%,77% and 84%,respectively there were no any signs of reperfusion when the doses reached 100mg in another three cases with cardiac shock.Thirty minutes later 50mg were added in two and 100mg in one of the three cases.The reperfusion was gotten in the three cases and they all survived.The total reperfusion rate was 91%.The mild bleeding occurred in 27%.There was no major bleeding and intracranial hemorrhage.Conclusions The use of rt-PA in the treatment of acute myocardial infarction(AMI) in the emergency department showed effective,reliable and safe.