瑞替普酶和重组组织型纤溶酶原激活剂治疗急性心肌梗死的临床研究

目的对比观察瑞替普酶与重组组织型纤溶酶原激活剂(rt-PA)用于急性心肌梗死(AMI)静脉溶栓治疗的效果及安全性。方法将122例发病12h内的AMI患者随机分为两组,瑞替普酶组60例,瑞替普酶20mU间隔30min分2次静脉推注;rt-PA组62例,rt-PA8mg静脉推注,42mg,90min内静脉滴注。观察两组溶栓再通率、急性期病死率、心肌梗死并发症和不良事件发生率。结果溶栓后30、60、90和120min瑞替普酶组临床判断再通率均高于rt-PA组,两组60和90min2个时间段比较,差异有显著性意义(P<0.01,P<0.05)。90min瑞替普酶组48例行冠状动脉造影,42例显示梗死相关血管再通为87.5%,rt-PA组42例行冠状动脉造影,29例显示梗死相关血管再通为69.05%(P<0.01);35天瑞替普酶组死亡2例(3.33%),rt-PA组死亡3例(4.84%);两组均无脑出血病史;不良事件发生率瑞替普酶组为23.3%,rt-PA组为25.6%。结论瑞替普酶静脉溶栓治疗AMI比较安全,较rt-PA能更早地使梗死相关血管开通,并有较高的血管开通率及较低的急性期病死率。     

瑞替普酶与尿激酶治疗急性心肌梗死的临床疗效比较

目的：比较瑞替普酶与尿激酶治疗急性心肌梗死（ AMI）的临床疗效。方法选取我院2012年10月—2014年2月收治的AMI患者136例，随机分为对照组和观察组，每组68例。对照组患者采用尿激酶静脉溶栓治疗，观察组患者采用瑞替普酶静脉溶栓治疗。比较两组患者治疗后0.5h、1.0h、2.0h血管再通率，住院期间不良临床事件（包括出血、过敏反应、心律失常、低血压等）发生率、病死率、不良反应发生率及住院时间等。结果观察组患者治疗后0.5 h、1.0 h、2.0 h血管再通率均高于对照组（ P＜0.05）。两组患者住院期间出血、过敏反应、心律失常、低血压发生率及病死率比较，差异均无统计学意义（ P＞0.05）。对照组患者住院期间不良反应发生率为17.65％，观察组为10.29％，差异无统计学意义（ P ＞0.05）。观察组患者住院时间为（8.5±1.2） d，短于对照组的（11.0±1.6） d （P＜0.05）。结论瑞替普酶有助于提高AMI患者血管再通率、缩短血管再通时间，且不增加不良临床事件及不良反应等的发生风险，是一种高效而安全的静脉溶栓药物。     

瑞替普酶与尿激酶治疗急性心肌梗死的临床疗效比较

目的：比较瑞替普酶与尿激酶治疗急性心肌梗死（ AMI）的临床疗效。方法选取我院2012年10月—2014年2月收治的AMI患者136例,随机分为对照组和观察组,每组68例。对照组患者采用尿激酶静脉溶栓治疗,观察组患者采用瑞替普酶静脉溶栓治疗。比较两组患者治疗后0.5h、1.0h、2.0h血管再通率,住院期间不良临床事件（包括出血、过敏反应、心律失常、低血压等）发生率、病死率、不良反应发生率及住院时间等。结果观察组患者治疗后0.5 h、1.0 h、2.0 h血管再通率均高于对照组（ P＜0.05）。两组患者住院期间出血、过敏反应、心律失常、低血压发生率及病死率比较,差异均无统计学意义（ P＞0.05）。对照组患者住院期间不良反应发生率为17.65％,观察组为10.29％,差异无统计学意义（ P ＞0.05）。观察组患者住院时间为（8.5±1.2） d,短于对照组的（11.0±1.6） d （P＜0.05）。结论瑞替普酶有助于提高AMI患者血管再通率、缩短血管再通时间,且不增加不良临床事件及不良反应等的发生风险,是一种高效而安全的静脉溶栓药物。     

瑞替普酶治疗44例急性心肌梗死的疗效观察

目的探讨瑞替普酶治疗急性心肌梗死（AMI）的临床疗效及其安全性。方法将2011年11月-2013年5月我科收治的88例急性心肌梗死患者随机分为观察组和对照组,每组44例。观察组采用瑞替普酶溶栓治疗,对照组采用尿激酶溶栓治疗,观察比较两组患者溶栓再通率、出血发生率以及死亡率。结果观察组溶栓再通率（93．18％）显著高于对照组（72．73％）,溶栓再通时间,观察组明显短于对照组,差异有统计学意义（P〈0．05）;溶栓后观察组出血率为11．36％,对照组出血率为34．09％,观察组出血率低于对照组,差异有统计学意义（P〈0．05）。结论瑞替普酶能够显著提高溶栓再通率,降低出血率,对于急性心肌梗死的临床疗效确切。     

依诺肝素两种用法联合瑞替普酶与尿激酶治疗AMI的疗效与安全性比较

目的 比较依诺肝素两种用法联合瑞替普酶（r-PA）与尿激酶（UK）静脉溶栓治疗急性ST段抬高型心肌梗死（STEMI）的疗效与安全性,探讨CRUSADE评分系统对溶栓出血风险评估的价值.方法 选择2010年6月至2014年3月我院CCU病房收治的183例首次STEMI接受溶栓治疗的患者,其中r-PA组121例,UK组62例.r-PA组按是否给予静脉依诺肝素负荷随机分为r-PA 1组（负荷组）61例、r-PA 2组（无负荷组）60例.依诺肝素用法：r-PA 1组溶栓前先静脉推注30 mg,溶栓结束后即刻1 mg/kg皮下注射;r-PA 2组溶栓前1 mg/kg皮下注射;之后两组均每12 h一次皮下注射,疗程5～8 d.选择同时间段应用UK治疗的62例STEMI患者定为UK组.比较三组患者溶栓30、60、90 min临床再通率及出血并发症.将183例患者进行CRUSADE评分,分析出血与评分的关系.结果 30、60、90 min临床再通率r-PA 1组为32.9％、75.4％、90.2％,r-PA 2组为13.3％、46.7％、78.3％,UK组为3.2％、16.1％、48.4％.r-PA 1组和r-PA 2组各时间段再通率均高于UK组,差异有统计学意义（P＜0.01）;r-PA 1组各时间段再通率均高于r-PA 2组,差异有统计学意义（P＜0.05）.出血发生率r-PA 1组为18.0％,r-PA 2组为16.7％,UK组为14.5％,三组比较未见统计学差异（P＞0.05）.CRUSADE评分≥32分者,溶栓后消化道出血及脑出血发生率（40.0％）明显高于32分以下的患者（7.0％）,差异有统计学意义（P＜0.01）.结论 瑞替普酶溶栓疗效明显优于尿激酶.瑞替普酶溶栓前静脉给予30 mg依诺肝素负荷量,可明显加快冠脉再通时间,提高再通率.应用CRUSADE评分对溶栓后消化道出血及脑出血具有良好的评估价值.     

瑞替普酶治疗急性心肌梗死的作用及干预措施与血管再通率分析

目的 分析瑞替普酶治疗急性心肌梗死（AMI）的作用及干预措施与血管再通率。方法 选取我院收治的60例AMI患者进行随机分组,分为对照组与干预组,对照组选用尿激酶作为静脉溶栓治疗药物,干预组选用瑞替普酶作为静脉溶栓治疗药物。比较两组的一般资料、血管再通率与不良反应率。结果 两组的平均年龄、性别、合并症等一般资料无明显差异（P>0.05）,干预组的血管再通率高于对照组（P<0.05）,两组的出血、心律失常不良反应率无明显差异（P>0.05）。结论 瑞替普酶治疗AMI的应用效果显著,能提升血管再通率,安全性较高,值得推广应用。     

瑞替普酶治疗急性心肌梗死临床观察

目的比较瑞替普酶（Reteplase、r-PA）与艾通立（重组组织型纤溶酶原激活剂rt-PA）用于急性心肌梗死治疗的疗效和安全性。方法将60例冠心病急性心肌梗死患者分为瑞替普酶和艾通立两组,进行溶栓治疗,观察溶栓再通率、急性期病死率、并发症和不良反应发生率。结果溶栓后90分钟冠状动脉造影显示梗死相关血管再通有效率（TIMI 2级＋TIMI 3级）瑞替普酶组为90.0％,艾通立组为80.0％,出血发生率（主要为黏膜、皮下出血）瑞替普酶组为53.3％,艾通立组为26.7％（P〈0.05）,35天时,两组严重不良事件的发生率瑞替普酶组为3.3％,艾通立组为6.7％（P〉0.05）,两组中均未发生冠状动脉再闭塞、脑出血等并发症。结论瑞替普酶是治疗急性心肌梗死有效、安全的溶栓药物,疗效优于艾通立。     

急性心肌梗死患者溶栓后序贯抗凝过μ程中出现肝素抵抗的临床观察

急性心肌梗死（AMI）是一种发病急，致死率高的疾病。通过静脉溶栓治疗等血运重建手段及时开通梗死相关动脉可以挽救濒死心肌和降低死亡率。但在应用瑞替普酶溶栓后常规应用普通肝素维持静滴剂量达到25μkat／h，但患者的APTT（活化部分凝血活酶时间）仍然〈50秒，不能达到治疗目标，提示该患者存在明显的肝素抵抗现象。最终导致冠状动脉再次闭塞，溶栓失败。本研究回顾性分析了11例AMI溶栓后应用普通肝素抗凝过程中出现肝素抵抗的原因及如何避免出现肝素抵抗，对指导溶栓治疗具有一定价值。     

重组链激酶溶栓治疗急性心肌梗死30例

目的 探讨重组链激酶（r-SK）静脉溶栓治疗急性心肌梗死（AMI）的疗效及安全性。方法 选择30例ST段抬高型AMI患者，应用青岛国大生物制药股份有限公司生产的r-SK进行静脉溶栓治疗，观察临床症状、心电图及心肌酶的变化，判断冠状动脉的再通率。结果 （1）30例AMI患者冠脉再通25例，再通率83.3％（25／30）。其中发病〈6h溶栓再通率88．5％（23／26）；发病6-18h溶栓再通率50．0％（2／4），两者相比差异有显著性（P〈0．05）。（2）≤65岁患者的再通率及不良反应的发生率较〉65岁组相比差异无显著性（P〉0．05）。结论 r-SK静脉溶栓治疗AMI是一种安全有效的方法，值得提倡。对于〉65岁患者如无禁忌证，也是安全可行的治疗手段。     

爱通立静脉溶栓治疗急性心肌梗死46例临床观察

将98例急性心肌梗死（AMI）患者随机分为观察组46例和对照组52例．分别应用小剂量（50mg）爱通立（rT—PA）和尿激酶（UK）静脉溶栓治疗。结果冠状动脉总再通率观察组为82．6％、对照组为50．0％．发病后6h内静脉溶栓治疗再通率分别为89．29％、60％，两组比较P均〈0．01；5周病死率分别为6．5％和9．6％；P〉0．05。认为小剂量rT—PA静脉溶栓治疗AMI疗效优于UK,发病后6h内治疗效果更佳，且并发症少。     

Clinical perspectives and therapeutics of thrombolysis

Reperfusion therapy with thrombolytic agents has been a significant advancement in the management of patients with acute ST elevation myocardial infarction. The outcome of acute myocardial infarction has significantly improved by early application of thrombolytic therapy. Intracoronary streptokinase has been used for >30 years, but reawakening interest occurred in the early 1980s in the use of thrombolytic therapy to establish rapid reperfusion during an acute myocardial infarction. Initial studies aimed at direct intracoronary thrombolysis, but owing to its cumbersome process and requirement of an active round the clock cardiac catheterization laboratory, it has been replaced by regimens of intravenous thrombolytic therapy which is as efficacious as intracoronary administration. Consideration of thrombolytic therapy has become a standard treatment for patients presenting with acute ST elevation myocardial infarction and various well-controlled trials have demonstrated the importance of both early and full reperfusion in improving clinical outcome in the setting of acute myocardial infarction. The subject of intravenous thrombolysis is perhaps the most rapidly evolving area in the management of acute myocardial infarction patients in the past decade. The current review focuses on the thrombolysis in the treatment of myocardial infarction and other conditions.     

急性心肌梗死不同时间段溶栓治疗的效果观察

目的观察急性心肌梗死不同时间段溶栓效果。方法选取50例不同时间段急性心肌梗死者给予溶栓治疗,同时对血管再通等进行观察与相关数据统计分析。结果血管再通率≤3h者占81.25%、3～6h者占71.43%、6～12h者占46.15%,且溶栓时间越早患者恢复越快（P〈0.05）。结论溶栓治疗急性心肌梗死效果明显,且溶栓越早血管再通率越高、心肌梗死面积越小、患者预后越好。     

Evaluation of patients for the need of thrombolytic therapy in the prehospital setting

Maximum benefit from thrombolytic therapy in acute myocardial infarction is obtained with early therapy. The earliest possible time to treat is during the initial evaluation of the patient in the home or ambulance, which requires accurate diagnosis of acute myocardial infarction in the prehospital setting. In our study, paramedics evaluated patients who had chest pain with a 12-lead ECG transmitted by cellular telephone and a checklist for inclusion and exclusion criteria for thrombolytic therapy. This information was transmitted to a hospital-based telemetry physician who diagnosed or excluded acute myocardial infarction and made a mock decision to withhold or administer a thrombolytic agent. Forty-eight patients with chest pain were evaluated. Six were diagnosed as having overt acute myocardial infarction by the hospital-based telemetry physician. All six patients had the diagnosis substantiated by both ECG and enzyme studies on hospital admission. Based on the data supplied by paramedics, two of these six patients were considered eligible for thrombolytic therapy by the physician. Hospital evaluation confirmed the prehospital decision to treat with a thrombolytic agent. In addition, all other patients were appropriately diagnosed as ineligible. Prehospital ECG diagnosis resulted in two patients going directly to the catheterization lab, thereby bypassing the emergency department. Overt acute myocardial infarction can be accurately identified by a prehospital-acquired 12-lead ECG transmitted to a hospital-based physician. Our study demonstrates that in conjunction with specially trained paramedics, the hospital physician can decide whether to administer thrombolytic therapy to such patients in the prehospital setting.     

急性ST段抬高型心肌梗死溶栓治疗的最新进展

经皮冠状动脉介入（PCI）已经成为普遍接受的治疗急性ST段抬高型心肌梗死（STEMI）的首选方案。但是,由于人才、技术、设备等条件的限制,急诊PCI仍不能普及或及时。近年来,随着药物的改进和更新,溶栓的治疗效果不断进步,使其成为基层再灌注治疗的一个不可或缺的手段。溶栓治疗实施的越早,其治疗获益就越大。根据实际情况因地制宜的选择合适的溶栓方案及溶栓药物对于改善STEMI患者的预后大有裨益。本文将对现有溶栓药物的特点,及其优劣进行综述,以期获得最合理的利用。     

Percutaneous treatment of spontaneous left main coronary artery dissection extending to the left anterior descending and circumflex arteries possibly triggered by thrombolytic therapy

Spontaneous coronary artery dissection is a rare cause of myocardial infarction and the role of thrombolytic therapy in this setting is not known. A case of acute ST elevation myocardial infarction is presented, with initial positive response to thrombolytic therapy and subsequent marked worsening of ST elevation due to extensive dissection, possibly triggered by thrombolytic therapy, which was successfully treated with percutaneous coronary intervention.     

HEMORRHAGIC MYOCARDIAL INFARCTION COMPLICATED BY FREE WALL-RUPTURE: A CASE ASSOCIATED WITH UNUSUAL CLINICAL FEATURES FOLLOWING INTRAVENOUS THROMBOLYTIC THERAPY

A patient is described who developed a systolic murmur soon after she was administered intravenous thrombolytic therapy for acute myocardial infarction. She died and autopsy revealed extensive hemorrhagic myocardial infarction and a free-wall rupture. A review of the literature suggests that this may be an unusual complication of thrombolytic therapy.     

Left Ventricular Function Following Thrombolytic Therapy for Myocardial Infarction

The introduction of thrombolytic therapy to treat eligible patients with acute infarction has markedly reduced deaths from left ventricular (LV) failure. Following reperfusion therapy for acute myocardial infarction (MI), LV function remains the single most significant prognostic factor. Three trials have shown that LV function and survival improved in concert, following randomization to receive thrombolytic therapy. The Global Utilization of Strategies to Open Occluded Coronary Arteries study (GUSTO-1) showed that end-systolic volume at 90 minutes (or 180 minutes) after starting thrombolytic therapy correlates with early thrombolysis in myocardial infarction (TIMI) flow grades as well as survival.     

Embolic cerebral infarction and gastrointestinal hemorrhage following thrombolytic therapy for acute myocardial infarction

We report an unusual case of cerebral embolization that occurred after intravenous thrombolytic therapy for myocardial infarction. Direct observation by serial echocardiograms in this patient confirmed that the thrombolytic treatment induced lysis and fragmentation of thrombus, and the subsequent dislodging and embolization of preexisting cardiac thrombi, which caused the cerebral infarction. It is suggested that an echocardiogram, if instantly available, be performed before considering thrombolytic therapy whenever acute anterior wall myocardial infarction is impressed.     

Fibrinolytic parameters and hemostatic monitoring: identifying and predicting patients at risk for major hemorrhagic events.

The use of thrombolytic therapy has dramatically altered the treatment of acute myocardial infarction and is rapidly spreading from large medical centers to community hospitals throughout the country. The widespread use of thrombolytic therapy will benefit a wide range of people, but the potential risks of this form of therapy must be understood. Hemorrhage is one of the major risks of thrombolytic therapy. This review will focus on the data available from a number of recent, large trials of thrombolytic therapy for acute myocardial infarction with respect to laboratory parameters that may predict hemorrhagic complications and/or help with their management. We will discuss both conclusions drawn from currently available data and address future research directions.     

Age-Specific Differences in the Use of Thrombolytic Therapy and Hospital Outcomes in Patients with Acute Myocardial Infarction: A Community-Wide Perspective

Background: Relatively limited information is available about recent, and trends over time, use of thrombolytic therapy in patients of different ages hospitalized with acute myocardial infarction and the association between use of thrombolytic therapy and hospital outcomes. Methods: We conducted an observational study of 5601 residents of the Worcester, Massachusetts, metropolitan area (1990 census = 437,000) with confirmed acute myocardial infarction in all local hospitals during 6 one-year periods between 1990 and 1999. Results: Despite relatively stable use of thrombolytic therapy between 1990 and 1995, decreases in the use of thrombolytic therapy in all patients with acute myocardial infarction were observed in 1997 and 1999. There was a 1.6 fold decrease in the use of thrombolytic therapy between 1990 and 1999 in patients <65 years. Patients 65–74 years (33.7% 1990; 11.7% 1999) and those 75 years and older (10.8% 1990; 6.7% 1999) experienced marked decreases in the receipt of thrombolytic therapy over time. Use of thrombolytic therapy was associated with reduced hospital mortality in each of the four age-specific groups under study (<55, 55–64, 65–74, 75) through the degree of benefit on hospital death rates associated with the use of thrombolytic therapy was attenuated after adjustment for additional confounders. Conclusions: Our findings indicate recent declines in the use of thrombolytic therapy in middle-aged and elderly patients with acute myocardial infarction. The impact of thrombolytic therapy on hospital outcomes was observed in each of our age strata under study though the magnitude of absolute and relative benefit varied according to age. Miniabstract. Declines in the use of thrombolytic therapy were observed between 1900 and 1999 in a population-based sample of patients with acute myocardial infarction. Use of thrombolytic therapy was associated with improved hospital survival to varying degrees in each of the age groups under study.