重组链激酶静脉应用治疗急性脑栓塞脑血管造影的动态观察

目的　应用数字减影脑血管造影 (DSA) ,研究重组链激酶 (rSK)治疗幼猪急性脑栓塞的疗效。方法　幼猪 4 8头 ,随机分为对照组和 7个rSK组 (剂量 0 5～ 10万IU/kg) ;经颈内动脉注入体外血栓 ,建立幼猪急性脑栓塞动物模型 ;4h后静脉应用rSK ,对照组用安慰剂。治疗结束后 30、6 0、90min复查DSA。结果　随着rSK剂量增大和观察时间延长 ,DSA血管再通率升高 ;rSK 2万IU/kg或以上剂量组的血管再通率均大于对照组 (P <0 0 5 )。结论　静脉用rSK溶化脑血栓有明显量效关系 ,最低有效剂量为 2万IU/kg。     

Serum sickness complicating intravenous streptokinase therapy in acute myocardial infarction

A case of delayed serum sickness with transient renal impairmentis described in a patient who received early high dose intravenousstreptokinase following acute myocardial infarction. Reviewof the literature suggests that serum sickness after streptokinasemay occur independently of the dose or route of administration,and could potentially complicate intracoronary streptokinasetherapy.     

Effectiveness of intravenous streptokinase on infarct size and left ventricular function in acute myocardial infarction. Prospective and randomized study

Within 3 h after the onset of symptoms of myocardial infarction, 64 patients were randomly assigned to receive either a 1-h intravenous infusion of 1,500,000 IU of streptokinase (SK) or a conventional therapy. Infarct size was estimated in CK gram equivalent (CKg) by measurement of CK-MB every 3 hours during a 48-h period. Enzymatic study revealed that myocardial infarction of the SK group was significantly smaller (61.4 +/- 45 vs. 89.4 +/- 56 CKg, p less than .05). Angiograms were performed at early stage and five weeks after myocardial infarction. At first coronary angiogram, the infarct-related vessel was open in 82% in the SK group versus 12% in controls. The SK group had higher global ejection fraction at second angiogram (57 +/- 11% vs. 49 +/- 11%, p less than .02), but differences in regional wall motion were not significant. By analysis according to patency or occlusion of infarct-related vessel, global and regional ejection fractions were significantly better at first and at second angiograms in all patients and in anterior infarctions with a patent infarct-related coronary artery. There was no significant difference for inferior infarction. We conclude that intravenous streptokinase infusion early after the onset of myocardial infarction reduces infarct size and improves left ventricular function, chiefly in anterior infarction. This benefit appears to be closely correlated to patency of infarct-related vessels.     

Thrombolytic Therapy for Right-Sided Mechanical Pulmonic and Tricuspid Valves: The Largest Survival Analysis to Date

Data regarding thrombolytic treatment of right-sided mechanical valve thrombosis are almost nonexistent, and all current guidelines arise from very small case series. We retrospectively studied the in-hospital and long-term outcome data of a larger series of patients who had received, from September 2005 through June 2012, thrombolytic therapy for right-sided mechanical pulmonary valve or tricuspid valve thrombosis.We identified 16 patients aged 8–67 years who had undergone thrombolytic therapy for definite thrombotic mechanical valve obstruction in the tricuspid or pulmonary valve position (8 in each position). All study patients except one had subtherapeutic international normalized ratios. The 8 patients with pulmonary mechanical valve thrombosis had a 100% response rate to thrombolytic therapy, and their in-hospital survival rate was also 100%. The 8 patients with tricuspid mechanical valve thrombosis had a 75% response rate to thrombolytic therapy, with an in-hospital survival rate of 87.5%. The one-year survival rate for mechanical valve thrombosis treated with thrombolytic therapy (whether pulmonary or tricuspid) was 87.5%.On the basis of our data, we recommend that thrombolytic therapy remain the first-line therapy for right-sided mechanical valve thrombosis in adults or children—including children with complex congenital heart disease and patients with mechanical pulmonary valve thrombosis. Surgery should be reserved for patients in whom this treatment fails.     

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.     

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。     

急性心肌梗塞并发室性心律失常的救治与康复疗法研究

急性心肌梗塞并发室性心律失常是非常危重的急症之一,具有很高的短期内病死率,近年来这方面的研究进展甚快, 细胞电生理检查已从通过微电极测定发展到用电钳和斑片钳作深入的研究, 临床心脏电生理检查和心内外膜电位变化标测已推广应用于临床。阐明一些心律失常的发生机理和评价抗心律失常药物的作用,近年又用无创伤性方法记录室晚电位（ 碎裂电位） 以预测严重心律失常。以电化学方法治疗心律也从电复律、人工心脏起搏发展到心腔内除颤和电消蚀直至现今的冷冻、激光和射频电消蚀等, 用于消除折返通道治疗快速心律失常,外科手术也进入到治疗快速心律失常领域,打破了洋地黄统治近２００ 年的局面。文章重点就室性心律失常的预防用药与电除颤、室性心律失常的治疗、溶栓疗法、导管射频消融术治疗心律失常及康复疗法等问题进行了详细的论述。     

Interactions Between Endothelial Secretogogues

Among endothelial secretogogues prostacyclin (PGI₂), nitric oxide (NO) and tissue plasminogen activator (t-PA) play a crucial role in maintaining thromboresistance, tone and structure of the vascular wall. Most receptor agonists, such as B₂ kinin receptor agonists, or shear force produce a coupled release of all three secretogogues, and therefore interactions between them are to be expected. Essentially, PGI₂ is a platelet suppressant, NO a vasodilator and t-PA a fibrinolytic agent. These and other properties of endothelial secretogogues supplement each other in protecting the cardiovascular system from injuries. It is not surprising that disturbances of the secretory function of endothelial cells are associated with atherosclerosis, diabetes, thrombosis or hypertension. Traditionally, PGI₂, NO, t-PA or their substitutes are used individually for the treatment of peripheral arterial disease, angina pectoris or acute myocardial infarction. In light of recent findings, their joint administration can be advocated. For instance, NO donors will potentiate platelet-suppressant action of PGI₂ analogues, whereas exogenous PGI₂ or TXA₂ synthase inhibitors (i.e. following increase in endogenous PGI₂) will abolish a paradox of prothrombotic action of t-PA or streptokinase. The replacement therapy with PGI₂, NO or t-PA should match as closely as possible the physiologically coupled release of these secretogogues.