重组人尿激酶原治疗急性心肌梗死的疗效及安全性评价

目的:探讨重组人尿激酶原(rhPro-uk)溶栓治疗急性心肌梗死(AMI)的疗效及安全性。方法:选择77例急性心肌梗死患者为研究对象,分为观察组39例和对照组38例,观察组采用rhPro-UK溶栓治疗,对照组采用UK溶栓治疗。分析不同溶栓方法治疗的效果及不良反应情况。结果:①观察组溶栓后再通率明显高于对照组(P<0.05);②溶栓后两组并发症比较发现,两组均未出现死亡病例,再次心肌梗死及心力衰竭比较,两组间差异无统计学意义,梗死后心绞痛及出血发生率比较差异有统计学意义(P<0.05)。结论:rhPro-uk溶栓治疗急性心肌梗死成功率高,副作用小,更有益于急性心肌梗死的早期急性治疗。     

瑞替普酶在急性ST段抬高型心肌梗死抢救中的应用体会

目的 比较分析瑞替普酶(reteplase ,r-PA)与尿激酶(urokinase ,UK)静脉溶栓在急性ST段抬高型心肌梗死(ST-segment acute myocardial infarction,STEMI)抢救中的效果和安全性.方法 选择2006年6月-2009年6月收治的AMI患者116例,随机分为UK治疗组和r-PA治疗组各58例,观察2组患者溶栓再通时间、住院时间、再通率、ST段回落率、出血发生率、急性期病死率等.结果 6、12h再通率r-PA治疗组分别为86.21%、89.66%,UK治疗组为72.41%、77.59%,2组比较差异有统计学意义(P<0.05).2组之间的出血率、急性期病死率、ST段回落率差异均有统计学意义(P<0.05).r-PA治疗组和UK治疗组住院时间分别为(8.25±1.08)d、(8.48±1.55)d,差异无统计学意义 (P>0.05).结论 r-PA对AMI的溶栓总体效果优于UK,可以有效减少出血率并缩短溶栓时间,且r-PA具有给药方便的优点,是一种比较安全有效的溶栓药物.     

经皮冠状动脉内支架置入术治疗急性ST段抬高型心肌梗死的临床疗效观察

目的:观察经皮冠状动脉内支架置入术治疗急性ST段抬高型心肌梗死的临床疗效。方法:选取急性ST段抬高型心肌梗死患者46例,根据治疗方法的不同分为观察组和对照组,每组各23例。两组患者的基础治疗方式相同。观察组患者行经皮冠状动脉内支架置入术治疗;对照组患者行溶栓治疗。对两组患者的临床治疗效果,不良反应发生率及预后情况进行对比分析。结果:观察组患者的治疗总有效率明显高于对照组,差异具有统计学意义(P<0.05),而不良反应发生率、复发率及死亡率明显低于对照组,差异具有统计学意义(P<0.05)。结论:对急性ST段抬高型心肌梗死患者采取经皮冠状动脉内支架置入术治疗的效果优于溶栓治疗。     

瑞替普酶与尿激酶治疗急性ST抬高型心肌梗死临床疗效观察

目的探讨瑞替普酶与尿激酶治疗急性ST抬高型心肌梗死的疗效及安全性.方法46例急性ST段抬高心肌梗死患者随机分为观察组24例和对照组22例,分别采用瑞替普酶和尿激酶溶栓治疗,对比两组疗效及安全性.结果观察组治疗总有效率为83.3%,对照组为50%(P<0.05);观察组死亡率为4.2%,对照组为13.6%(P<0.01).结论瑞替普酶治疗急性ST段抬高型心肌梗死的效果可靠,出血率、死亡率低、主要终点事件发生率更低、预后更好.     

急性心肌梗死溶栓治疗后ST段再抬高的临床分析

目的:探讨急性心肌梗死(AMI)静脉溶栓治疗后ST段再抬高的临床特点.方法:将AMI患者90例,根据溶栓后有无ST段再抬高分为ST段抬高组(A组)和ST段未抬高组(B组),比较两组间伴发疾病、冠脉病变、再通率、心律失常、心功能变化(Killp分级等).结果:A组伴发糖尿病、高血压病、高脂血症、冠脉多支病变、心功能不全、心律失常发生率均高于B组,而冠脉再通率明显低于B组.结论:溶栓治疗后ST段再抬高与患者并发糖尿病、高血压病、高脂血症密切相关,冠状动脉存在多支病变,该类患者溶栓再通率低,心肌受损严重,心功能不全、心律失常发生率高.     

瑞替普酶与尿激酶在急性ST段抬高型心肌梗死溶栓治疗中的临床对比分析

目的 观察和分析对急性ST段抬高型心肌梗死患者在溶栓治疗中分别应用瑞替普酶和尿激酶的临床治疗效果和情况.方法 随机抽取该院心内科收治的126例急性ST段抬高型心肌梗死患者进行了尿激酶和瑞替普酶进行溶栓治疗的疗效分析.结果 观察组的溶栓再通率(46.2%)、再通时间以及并发症发生率(5.97%)显著优于对照组(16.7%,10.17%),两组比较差异有统计学意义(P<0.05).结论 同尿激酶相比,采用瑞替普酶对急性ST段抬高型心肌梗死患者进行溶栓治疗,其治疗效果更高,安全性更好,因而更具有临床应用价值.     

静脉溶栓疗法在急性ST段抬高型心肌梗死中的应用分析

目的:探究瑞通立溶栓疗法与尿激酶溶栓治疗对于治疗急性ST段抬高型心肌梗死的作用,确定两种静脉溶栓疗法在急性ST段抬高型心肌梗死中的意义。方法:对168例急性ST段抬高型心肌梗死患者进行研究,随机分为对照组与试验组,每组84例。对照组采用静脉尿激酶溶栓方法进行治疗,试验组采用静脉瑞通立溶栓疗法进行治疗,比较治疗效果(患者不良反应、溶栓后冠状动脉血管再通率以及再通时间)。结果:瑞通立溶栓疗法的不良反应发生率为4.76%,血管开通率为71.43%,血管开通平均时间(1.08±0.35)h;尿激酶溶栓疗法的不良反应发生率为10.71%,血管开通率为51.19%,血管开通平均时间(1.89±0.43)h。瑞通立溶栓疗法与尿激酶溶栓疗法的治疗效果比较,差异有统计学意义(P<0.05)。结论:瑞通立溶栓疗法与尿激酶溶栓治疗对于治疗急性ST段抬高型心肌梗死都有积极作用,瑞通立溶栓疗法效果更好,静脉溶栓疗法对于急性ST段抬高型心肌梗死治疗意义重大。     

普通肝素或低相对分子质量肝素联合瑞替普酶治疗急性心肌梗死的对比研究

目的观察对比普通肝素钠（UH）或国产低相对分子质量肝素钠（LMWH）抗凝联合瑞替普酶静脉溶栓治疗ST段抬高型急性心肌梗死（AMI）的疗效及安全性。方法 50例ST段抬高型AMI患者,随机分为UH组（25例）和LMWH组（25例）,分别在常规瑞替普酶（10 mu＋10 mu）静脉溶栓基础上接受UH钠或国产LMWH钠抗凝治疗,观察溶栓后48 h内两组患者的溶栓再通率、出血发生率及出血相关死亡率。结果 48 h内,两组溶栓再通率比较无统计学差异（P〉0.05）;UH组出血发生率为100%,出血直接导致的死亡率为20%;LMWH组出血发生率为4%,无1例因出血并发症死亡者。结论 LMWH钠联合瑞替普酶治疗ST段抬高型AMI疗效确切,在降低出血并发症方面较UH钠有明显的优势（P〈0.05）。     

重组组织型纤溶酶原激活剂与尿激酶静脉内溶栓治疗急性心肌梗死的比较研究

目的:比较重组组织型纤溶酶原激活剂(rt-PA)与尿激酶(UK)静脉内溶栓治疗急性心肌梗死(AMI)的临床疗效和安全性.方法:40例急性心肌梗死患者随机分为两组,分别经外周静脉给予重组组织型纤溶酶原激活剂(rt-PA组,18例)与尿激酶(UK组,22例)溶栓治疗,记录两组患者发病至溶栓时间、溶栓后各阶段症状、心电图和心肌酶谱变化、24 h内的并发症发生率及半年后的心功能状况.结果:rt-PA组患者冠脉再通率较UK组高(P<0.05);rt-PA组发生轻度出血7例(38.89%),UK组2例(9.55%),两组比较,有显著性差异(P<0.05);两组患者均无严重过敏反应发生,再灌性心律失常的发生率无显著性差异:心肌梗死溶栓后再通患者6个月后,rt-PA组与UK组左室射血分数及6 min步行距离比较,无显著性差异(P>0.05).结论:rt-PA在梗死冠脉血管开通率高于UK,但出血发生率亦高于UK.两者均可改善患者心功能,提高生活质量.     

替罗非班对急性ST段抬高型心肌梗死介入治疗的临床研究

目的 探究替罗非班对急性ST段抬高型心肌梗死介入治疗的临床应用价值.方法 选取2019年5月至2020年9月本院收治并实施介入治疗的急性ST段抬高型心肌梗死患者106作为研究对象,随机分为对照组与研究组,每组53例.对照组采用常规经皮冠脉介入治疗(PCI),研究组在对照组基础上采用替罗非班药物治疗,比较两组TIMI分级、疗效、不良反应发生率及血小板聚集率.结果 研究组血流3级占比高于对照组,差异有统计学意义(P<0.05).研究组7 d ST段回落占比高于对照组,出血现象占比低于对照组,差异有统计学意义(P<0.05).研究组不良反应发生率为7.55％,明显低于对照组的22.64％,差异有统计学意义(P<0.05).干预前,两组血小板聚集率比较差异无统计学意义;干预24、48、72 h,研究组血小板聚集率均低于对照组,差异有统计学意义(P<0.05).结论 PCI干预下采用替罗非班药物治疗急性ST段抬高型心肌梗死患者效果显著,患者生理状态明显改善,值得临床推广应用.     

瑞替普酶治疗急性心肌梗死疗效观察

目的 观察瑞替普酶(r-PA)和尿激酶(UK)溶栓治疗急性心肌梗死(AMD的疗效及安全性.方法 将65例AMI患者随机分为两组:r-PA组32例,r-PA 36 mg分两次静脉推注,每次18 mg,间隔30 min;UK组33例,以UK 150万U 30 rnin静脉滴注完.比较两组的开通率、开通时间及出血等不良反应的发生率.结果 两组患者的血管开通率分别为81.25％和57.58％,开通时间分别为(1.54±0.65)h和(2.01±0.73)h(P＜0.05);两组出血等不良反应发生率差异无统计学意义(P＞0.05).结论 与UK相比,r-PA静脉溶栓治疗AMI能更早地开通梗死相关血管,有较高的血管开通率,是一种安全有效的溶栓药物.     

国产重组链激酶溶栓治疗急性心肌梗塞的临床观察

目的:观察国产重组链激酶(rSK)在急性心肌梗塞(AMI)静脉溶栓治疗的临床疗效和不良反应。方法:79例符合溶栓治疗的AMI患者,按用药情况分为rSK组30例和尿激酶(UK)组49例,观察冠状动脉再通率,出血并发症以及rSK的不良反应。结果:rSK组的临床血管再通率76.67%,显著高于UK组的55.10%(P<0.05)。两组出血并发症无显著性差异(P>0.05)。rSK组发生轻微过敏反应6.7%,低血压10.0%,对症治疗后迅速好转。结论:国产rSK溶栓治疗AMI,血管再通率高,不良反应发生率低,程度轻,为一安全有效的溶栓药物。     

A comparative study on the effects of low dose of tPA and differentregimens of intravenous urokinase in acute myocardial infarction

Objective　To compare the effects of low dose of recombinant tissue-type plasminogen activator(tPA) with those of conventional dose of urokinase (UK) and assess the influence of different regimens of intravenous UK in patients with acute myocardial infarction (AMI). Methods　Eighty patients with AMI were randomized to 50 mg of tPA (Group Ⅰ; n=26) using an accelerating approach or 1.0-1.5 million U of UK (Group Ⅱ; n=54). UK was administered as a single bolus injection of whole dose (Group Ⅱa; n=26) or half dose bolus injection followed by half dose infusion (Group Ⅱb; n=28). All patients underwent coronary arteriography 90 min after the initiation of intravenous thrombolysis, and the infarct-related coronary artery (IRA) patency was evaluated. Cardiac events during hospitalization were recorded and predischarge left ventricular function was determined by two-dimensional echocardiography. Results　The IRA patency rate was significantly higher in Group Ⅰ (88.4%) than in Group Ⅱ (53.7%) (P&lt;0.01). Group Ⅰ patients had less cardiac events during hospitalization (11.5% vs 33.3%) and greater improvement in left ventricular function than Group Ⅱ patients. However, these angiographic, left ventricular functional and prognostic parameters did not significantly differ between Group Ⅱa and Group Ⅱb. Conclusions　Thrombolysis after AMI with low dose of intravenous tPA exerts better angiographic and clinical effects than that with conventional dose of UK. The thrombolytic effects of UK were not affected by different regimens of intravenous administration of the agent.     

早期应用低分子肝素在急性心肌梗死患者溶栓治疗中的疗效观察

目的：探讨早期应用低分子肝素在急性心肌梗死患者溶栓治疗中的效果。方法：将我院收治的80例急性心肌梗死患者随机分为两组,观察组于入院后溶栓治疗前30～60 min予低分子肝素5 000 IU腹壁皮下注射,对照组于溶栓治疗后6 h给予低分子肝素5 000 IU腹壁皮下注射,对比两组冠脉再通及不良反应情况。结果：观察组冠脉再通率为85%,对照组再通率为65%,两组比较差异有统计学意义（P〈0.05）;观察组再通时间为（1.50±0.71）h,对照组为（2.10±0.92）h,差异有统计学意义（P〈0.05）;两组出血发生率比较差异无统计学意义（P〉0.05）。结论：溶栓治疗前早期应用低分子肝素治疗对于提高急性心肌梗死患者冠脉再通率、缩短再通时间有积极意义,且安全性良好。     

急性心肌梗塞尿激酶溶栓治疗结果分析

37例发病24小时内的首次急性心肌梗塞患者,随机分为溶栓组和对照组,溶栓组用尿激酶、肝素及阿斯匹林治疗,并采用创伤性和非创伤性冠脉再通指标观察两组治疗效果。结果提示:溶栓组冠脉再通率优于对照组(P<0.05),近期死亡率较对照组低(分别为5.3%与21.1%);溶栓组内,发病时间<6b与6～24h两组疗效无显著差异。故认为急性心肌梗塞溶栓治疗的时机可延长至发病后24h。     

急性心肌梗死伴心衰、心源性休克病人经皮冠状动脉介入治疗近中期疗效

OBJECTIVE: To observe the short- and mid-term effects of percutaneous coronary intervention (PCI) in patients with ST-segment elevation acute myocardial infarction (AMI) complicated by heart failure and/or cardiogenic shock . METHODS: Altogether 90 patients with AMI were recruited, of whom 58 were treated by PCI, 20 by thrombolytic therapy, and the other received general treatment without reperfusion therapy. The length of hospital stay, major adverse cardiac events (MACE) and left ventricular ejection fraction (LVEF) were compared between PCI and thrombolysis groups. The relationship between the patency time of the infarct-related artery (IRA), thrombolysis in myocardial infarction (TIMI) grade after PCI and prognosis were analyzed in PCI group. RESULTS: The patency rate of IRA was significantly improved in patients receiving PCI therapy in comparison by those with thrombolytic therapy (98.3% vs 65.0%, P<0.01), and the LVEF was also higher in PCI group with lower mortality (6.9% vs 25.0%, P<0.05) during in-hospital and follow-up period. CONCLUSION: PCI can be a more effective therapy than thrombolytic therapy in the treatment of ST-segment elevation AMI accompanied with heart failure and/or cardiogenic shock.     

静脉溶栓和直接经皮冠脉腔内成形术治疗发病3h后急性心肌梗死的疗效比较

目的对比静脉尿激酶溶栓(UK)和直接冠状动脉内介入治疗(PCI)治疗发病3h后急性心肌梗死(AMI)的临床疗效。方法 109例发病3h后AMI患者,61例接受静脉溶栓治疗,48例接受PCI治疗。比较两组住院期间临床结果及超声心动图结果。结果直接PCI组:IRA开通率(95.9%)高于UK组(61.2%),P﹤0.05;心衰发生率12.1%,严重心律失常发生率8.1%,心源性休克发生率2.7%,病死率2.7%,均低于PCI组(分别为25.0%,20.0%,10.0%,11.1%,两组比较有显著差异,P﹤0.05)。UCG检查:室壁矛盾运动发生率直接PCI组为2.7%,低于UK(12.7%),P﹤0.05;而左室射血分数LVEF%直接PCI组为56.8±8.3),高于UK组51.2±10.4,两组比较P﹤0.05。而两组中出血率、再发心绞痛率和再闭塞率无明显差别(P0.05)。结论与UK治疗相比,直接PCI治疗发病3h后AMI疗效更佳,可减少心衰及心脏恶性事件发生率和病死率,改善预后。     

高龄急性心肌梗塞溶栓治疗的临床评价

目的：评价高龄急性心肌梗塞患者溶栓治疗的疗效和安全性。方法：９５例发病≤１２ｈ的急性心肌梗塞患者中,年龄≥７０岁３４例为高龄组,〈７０岁为低龄组,均符合溶栓条件,入院后给ＵＫ或ｒＳＫ静脉溶栓,１２０ｍｉｎ内观察再通指标;记录住院期间心脏事件发生率、病死率、出血并发症。结果：高龄组与低龄组溶栓治疗后冠状动脉再通率、出血并发症、住院期间病死率无显著性差异（Ｐ〉０．０５）,心脏事件中高龄组发生率高龄组发     

Thorombolytic therapy with rescue percutaneous coronary intervention versus primary percutaneous coronary intervention in patients with acute myocardial infarction: a multicenter randomized clinical trial

Background Although thrombolytic therapy with rescue percutaneous coronary intervention （PCI） is a common treatment strategy for ST-segment elevation acute myocardial infarction （STEMI）, scant data are available on its efficacy relative to primary PCI, and comparison was therefore the aim of this study. Methods This multicenter, open-label, randomized, parallel trial was conducted in 12 hospitals on patients （age 〈70 years） with STEMI who presented within 12 hours of symptom onset （mean interval 〉3 hours）. Patients were randomized to three groups： primary PCI group （n=101）; recombinant staphylokinase （r-Sak） group （n=-104）; and recombinant tissue-type plasminogen activator （rt-PA） group （n=-106）. For all patients allocated to the thrombolytic therapy arm, coronary angiography was performed at 90 minutes after drug therapy to confirm infarct-related artery （IRA） patency; rescue PCI was performed in cases with TIMI flow grade 〈2. Bare-metal stent implantation was planned for all patients. Results After randomization it required an average of 113.4 minutes to start thrombolytic therapy （door-to-needle time）and 141.2 minutes to perform first balloon inflation in the IRA （door to balloon time）. Rates of IRA patency （TIMI flow grade 2 or 3） and TIMI flow grade 3 were significantly lower in the thrombolysis group at 90 minutes after drug therapy than in the primary PCI group at the end of the procedure （70.5% vs. 98.0%, P 〈0.0001, and 53.0% vs. 85.9%, P 〈0.0001, respectively）. Rescue PCI with stenting was performed in 117 patients （55.7%） in the thrombolytic therapy arm. Rates of patency and TIMI flow grade 3 were still significantly lower in the rescue PCI than in the primary PCI group （88.9% vs. 97.9%, P=-0.0222, and 68.4% vs. 85.0%, P=0.0190, respectively）. At 30 days post-therapy, mortality rate was significantly higher in the thrombolysis combined with rescue PCI group than in primary PCI group （7.1% vs. 0, P=0.0034）. Rates of death/MI and bleeding complications were significantly higher in the thrombolysis with rescue PCI group than in the primary PCI group （10.0% vs. 1.0%, P=-0.0380, and 28.10% vs. 8.91%, P=-0.O001, respectively）. Conclusions Thrombolytic therapy with rescue PCI was associated with significantly lower rates of coronary patency and TIMI flow grade 3, but with significantly higher rates of mortality, death/MI and hemorrhagic complications at 30 days, as compared with primary PCI in this group of Chinese STEMI patients with late presentation and delayed treatments.     

急诊PCI对高危急性心肌梗死近期病死率的影响

目的：明确急诊经应穿刺冠状动脉介入治疗（PCI）对高危急性心肌梗死（AMI）近期病死率的影响。方法：637例经临床确诊的ST段上抬型、发病时间〈12h的AMI患者被分为急诊PCI（105例）、溶栓治疗（94例）、药物治疗（348例）三组，依据logistic回归方程高危AMI患者的P值，各组更分为高危、低危两个亚组。以Timi血流分级判断急诊PCI梗死相关冠状动脉（IRA）开通、血栓、慢复流、无复流情况；记录住院期间临床事件；4周后用二维超声心动图测定左心室射血分数（LVEF）；统计各组及亚组28天病死率。结果：PCI级IRA开通率为100％，支架率为99．0％。高危与低危两个亚组术中冠脉内血栓发生率分别为25．0％和20．0％；慢复流发生率分别30．0％和25.0％；无复流发生率分别4．0％和o．0％。临床事件中，三组及亚组间出血发生率无显著性差异（P〉0．05）；药物组及其亚组心衰发生率显著高于PCI组和溶栓组及亚组（P均〈0.01）；溶栓组及亚组心绞痛和再梗死发生率较PCI组和药物纽及亚组高（P〈0.05或P〈0．01）；PCI组及其亚组住院天数明显短缩（P〈0．01）；药物组及其亚组LVEF较PCI组和溶栓组及亚组下降（P均〈0.05）；PCI组、溶栓组和药物组的28天病死率分别为0％、7.4％和18．7％（P〈0．05或P〈0.01），且死亡者均为高危亚组患者，溶栓组和药物组的高危亚组痛死率分别为10．4％和26．0％（P〈0．05或P〈0．01）。结论：急诊PCI较尿激酶静脉溶栓及单纯药物治疗AMI更能充分开通IRA，改善心功能，减少临床事件，短缩住院天数；可进一步降低高危AMI病死率。