瑞替普酶联合择期PCI治疗急性ST段抬高型心肌梗死的疗效观察

目的:观察瑞替普酶与尿激酶静脉溶栓联合择期经皮冠状动脉介入治疗(PCI)对急性心肌梗死的疗效及安全性。方法:按用药情况将72例急性ST段抬高型急性心肌梗死患者分为尿激酶组47例与瑞替普酶组25例。入选患者明确诊断后常规给予硫酸氢氯吡格雷、肠溶阿司匹林。瑞替普酶组静脉溶栓采用瑞替普酶治疗,18 mg(10 MU)分2次静脉注射,每次缓慢静脉注射2min以上,两次间隔30 min。尿激酶组采用尿激酶150万U静脉滴注,用药后12 h用低分子肝素5 000 u,q12h(连用,5⁷ d)。两组患者均于溶栓后37 d)。两组患者均于溶栓后3²4 h内进行血管造影,必要时PCI治疗,其他治疗相同。观察两组血管再通率和恶性心律失常、心力衰竭、出血、死亡发生率,以及冠脉造影及PCI后血管开通率和支架安置率。结果:瑞替普酶组与尿激酶组2 h内胸痛消失或缓解者分别占80.00%、61.70%(P<0.05),溶栓后2 h内ST回落>50%的患者分别占92.00%、65.96%(P<0.05),酶峰[心肌酶肌酸激酶(CK)及肌酸激酶同工酶(CK-MB)峰值]提前者分别占92.00%、53.19%(P<0.05),梗死相关动脉(IRA)再通率分别为92.00%、68.09%(P<0.05),IRA完全开通率分别为52.00%、31.91%(P<0.05)。瑞替普酶组的恶性心律失常、心力衰竭等并发症发生率及死亡率分别为36.00%、4.00%、4.00%、0,均低于尿激酶组(分别为51.06%、12.77%、10.64%、6.38%),差异均有统计学意义(P<0.05);瑞替普酶组支架安置率(36.00%)明显低于尿激酶组(53.19%)(P<0.05)。结论:瑞替普酶联合择期PCI治疗急性心肌梗死具有血管开通率高,时间短,恶性心律失常、心力衰竭、出血等并发症少,死亡率低的优点。

Efficacy Observation of Reteplase Combined with Selective PCI Treatment for Acute ST-segment Elevation Myocardial Infarction

OBJECTIVE： To observe therapeutic efficacy and safety of intravenous thrombolysis of reteplase and urokinase combined with selective PCI treatment for acute myocardial infarction （AMI）. METHODS： 72 cases of acute ST-segment selevation acute myocardial infarction were divided into urokinase group （47 cases） and reteplase group （25 cases）. After diagnosed, the enrolled patients were routinely given clopidogrel bisulfate and enteric coated aspirin. Reteplase group received intravenous thrombolysis therapy of reteplase, 18 mg （10 MU） in total for twice intravenous injection, over 2 min each time, at 30 min intervals. Urokinase group received 1.5 million U urokinase intravenously, and was given macromolecules low molecular weight heparin 5 000 u,q12h （5-7 d） 12 h later. Angiography was carried out in 2 groups within 3 to 24 h after thrombolysis, and they received PCI if necessary. Other treatments of them were the same to each other. The recanalization rate and the incidence of malignant arrhythmias, the incidence of heart failure and bleeding, mortality, coronary angiography and vessel patency rate after PCI and stent placement rates were observed in 2 groups. RESULTS： The chest pain relief or disappearance of reteplase group and urokinase group within 2 h accounted for 80.00% and 61.70% （P〈0.05）. The patients with ST-segment recovery 〉50% within 2 h after thrombolysis accounted for 92.00% and 65.96% （P〈0.05） ; the patients with premature enzymes peak （CK and CK-MB peak） accounted for 92.00% and 53.19% （P〈0.05）. The recanalization rates of infarct-related artery （IRA） were 92.00% and 68.09% （P〈0.05）, and IRA patency rate were 52.00% and 31.91%, respectively （P〈0.05）. The incidence of malignant arrhythmias, heart failure, ADR and mortality were 36.00%, 4.00%, 4.00% and 0 in reteplase group, which were all lower than urine kinase group （51.06%, 12.77%, 10.64% and 6.38% ） ; there was statistical significance （P〈0.05）. The stent placement rate of