急性心肌梗死几种溶栓药物治疗比较

目的比较尿激酶(Urokinase,UK)、链激酶(Streptokinase,SK)和重组组织型纤溶酶原激活剂(Rearrangement tissue-type plasminogen activator,r-tPA)对急性心肌梗死患者进行静脉溶栓治疗的临床疗效。方法628例入选患者随机分为3组,UK组222例,SK组205例,R-tPA组201例。分别给予3种溶栓药物静脉输入,观察血管再通的临床指标,同时观察有无出血、心衰、休克等并发症。结果3组的再通率分别为R-tPA组81.3%,SK组66.1%,UK组58.7%。而死亡率则反之,即r-tPA组为8.7%,SK组为9.2%,UK组为10.3%。r-tPA组重度出血发生率明显高于SK组和UK组(依次为6.2%、1.5%、0.6%);而轻度出血以SK组和UK组多见。血管再通后,死亡率、休克、心力衰竭、严重心律失常及再缺血等并发症明显低于血管未通组。结论r-tPA再通率高,溶栓疗效好。如患者经济允许,对急性心肌梗死应首选,但对高血压及老年患者应慎重,以防重度出血的发生。

Effect of thrombolysis on acute myocardial infarction

Objective To compare the effect of urokinase(UK),streptokinase(SK) and rearrangement tissue-type plasminogen activator(r-tPA) on acute myocardial infarction patients.Methods Six hundred and twenty-eight patients were randomly divided into three groups(UK group 222 cases,SK group 205cases,r-tPA group 201cases).They were treated by intravenous using UK,SK and rt-PA,respectively.Then the reperfusion markers and the complication were analyzed.Results The reperfusion rates of three groups were 81.3%(r-tPA group),66.1%(SK group),58.7% (UK group).Slight bleeding was more often in SK group and UK group.However,the mortalities were opposite(8.7%),was 9.2%,0.3%.In severe bleeding,incidence of r-tPA group(6.2%),was higher than SK group(1.5%) and UK group(0.6%).The occurrence of mortality,shock,heart failure,severe arrhythmia and re-ischemia in reperfusion group was lower than non-reperfusion group.Conclusion The reperfusion rate and the thrombolic effect of r-tPA is the highest and best among three thrombolic medicine.But be careful for hypertension and old patients in order to avoid severe bleeding.