300万U尿激酶溶栓治疗急性心肌梗塞231例的临床初步总结

目的为观察３００万Ｕ尿激酶（ＵＫ，由广州天普洛欣生物制品厂生产）静脉溶栓治疗急性心肌梗塞（ＡＭＩ）的临床疗效和安全性。方法对６１１例ＡＭＩ患者进行ＵＫ静脉溶栓治疗，Ｂｏｌｕｓ法给药。随机分为Ａ组（３００万Ｕ）、Ｂ组（２５０万Ｕ）和Ｃ组（１５～２００万Ｕ）。对比观察三组患者临床疗效、副作用、５周病死率、左室射血分数（ＥＦ）、再通时间、各种严重并发症发生率和心肌断层显像（ＳＰＥＣＴ）及心肌缺血面积（ＩＭＡ）定量分析。结果按临床判定标准，Ａ组和Ｂ组梗塞相关血管（ＩＲＡ）再通率各为８１．８％和７４．１％，均显著高于Ｃ组（６９．０％，Ｐ＜０．０１，０．０５）。三组５周病死率分别为３．０３％、４．１５％和８．５６％，Ａ组显著降低（Ｐ＜０．０５）。Ａ组和Ｂ组比Ｃ组轻度出血和中重度出血发生率略有增高，但差异无显著性（Ｐ＞０．０５），三组均未发生脑出血。Ａ组和Ｂ组ＥＦ≥５０％者所占比率显著增高Ｃ组。Ａ组各种严重并发症发生率均显著降低（Ｐ＜０．０５或０．０１）。Ａ组和Ｂ组再通时间均显著缩短［（９９．６３±９．２４）ｍｉｎ对（１５２．６１±１０．９２）ｍｉｎ，Ｐ＜０．００１；（１１２．２１±７．２２）ｍｉｎ对（１５２．６１±１０

The report on thrombolytic therapy using 300 million U urokinase in 231 cases with acute myocardial infarction

Objective To observe the clinical efficacy and safety of intravenous thrombolytic therapy using 300 million U (MU) uroknase Tech-Pool (UKTP) in patients with acute myocardial infarction(AMI). Methods Six hundred and eleven patients with AMI were treated with UKTP according toBolus adminition from January 1994 to March 1999. All cases were divided into three groups randomly:A group (3.0 MU) .B group (2.5 Mu) and C group (1.5 MU~2. 0 MU). The clinical therapeutic efficacy, side effects, morality and frequency of various severe complications were compared among threegroups. Results The reperfusion rate of infarct-related coronary artery (IRA) assessed by clinical criteria was signifiantly higher in A group (81. 8% vs 68. 98%, P<0. 01 ) and in B group (74. 09% vs68. 98%, P<0.05) than that of C group. The morality in the first 5 weeks was successively 3.03%.4.15 % and 8.56 %, A group being obviously decreased (3.03 % vs 8.56%, P<0. 05). The rate of minor and major bleeding were little more in A group than in C group (P>0.05). No cerebral hemorrhage occurred in three groups. The rate of ejection fraction (EF)R50% was significantly increased inA group and B group than that of C group. Frequencies of various severe complications in A group weremuch lower than in C group, Such as heat failure, shock, ventricular fibrillation, bundle branch block(P < 0.05, 0.01 ). The time of IRA reperfusion (from starting thrombolytic therapy to IRAreperfusion) was shortened in A group (99.63 9.24 min vs 152.61 10. 92 min, P<0. 001) and Bgroup (112.21 7. 22 min vs 152. 61 10. 92 min, P<0.01 ) that of C group. The myocardial ischemicarea (IMA) than were significantly associated with the dose of UKTP (P<0.01 ).' Conclusions Thehigh dose UKTP may obviously increase the rate of IRA reperfusion, and enhance the heart function ofpatients with AMI, but not increased the rate of bleeding. 300 MU chinese UKTP is more effective andsafe for AMI and could by afforded by most patients in our country.