去纤酶溶栓治疗急性心肌梗塞的临床观察

CLINICAL TRIAL OF DEFIBRASE THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTION

To investigate the thrombolytic effects of defibrace, 78 patients were on a trial therapy with defibrase against 70 patients on conventional therapy. Defibrase, 0.075U/kg in 100 to 200ml of normal saline was infused intravenously or in the coronary over a period of 60-90 min. Coronary ateriography was performed in some of the patients. Plasma CPK was measured serially since the onset of chest pain. LVEF by both 2D echocardiography and radionuclide ventriculography were performed 2 weeks after the treatment. Of 6 patients with total occlusion of the infarct-related artery (IRA), intracoronary defibrase resulted in recanalization in 2 while intravenous defibrase resulted re-canalization in 1. Of the 7 patients who underwent coronary arteriography 90 min after the intravenous defibrase, patent IRA was demonstrated in 5. Of the 16 patients undergoing coronary arteriography 2 weeks after intravenous defibrase, patent IRA was demonstrated in 13. In contrast, only 11 of 26 patients in the conventional group who had coronary arteriography 2 weeks after admission showed patent IRA. In comparision to the conventional therapy, the defibrase thrombolysis produced a more significant early peaking of CPK. The LVEF as determined by echocardiography was significantly higher in defibrase than in the conventional group. The LVEF determined by radionuclide ventriculography was slightly higher in defibrase than in the conventional group, but the difference was statistically insignificant. Infarction complication and mortality was higher in conventional group than in the defibrase group, with difference also insignificant. No serious spontaneous bleeding occured after defibrase thrombolysis. Significant bleedings were related to yearly catheterization after defibrase thrombolysis.