阿替普酶与尿激酶治疗急性心肌梗死的有效性与安全性

目的 探讨阿替普酶与尿激酶在急性心肌梗死中的溶栓有效性与安全性.方法 选取2011年1月～2014年7月在武汉大学人民医院心内科住院诊断急性心肌梗死的患者108例,将其随机分为阿替普酶组（试验组）54例和尿激酶组（对照组）54例.试验组：首先以普通肝素60 U/kg的用量静脉推注,再以阿替普酶15 mg静脉推注,其后30 min内静脉滴注50 mg,剩余35 mg在60 min内静脉滴注.溶栓后予以普通肝素每小时12 U/kg维持静滴48 h.对照组：尿激酶150万U于30 min内静脉滴注.溶栓开始后12h,皮下注射肝素7500 U,每12小时1次,持续3～5 d.统计患者基本临床资料及入院24h内实验室检查结果、超声心动图及溶栓期间动态心电图变化,并记录住院期间心律失常、心力衰竭、心源性休克、心源性猝死等主要不良反应发生率.分析两组溶栓再通率、不良事件发生率和出血并发症的发生率.结果 试验组溶栓治疗后30、60、90、120 min的总再通率分别为10例（19.61％）、20例（39.22％）、31例（60.78％）、42例（82.35％）.对照组溶栓治疗后30、60、90、120 min的总再通率分别为5例（10.20％）、8例（16.33％）、18例（36.73％）、30例（6l.24％）;试验组溶栓治疗后30、60、90、120 min的总再通率均高于对照组相应时间段的总再通率（P＜0.05）.试验组发生恶性心律失常4例、心力衰竭5例、心源性休克5例、心脏破裂2例、死亡3例;对照组发生恶性心律失常10例、心力衰竭14例、心源性休克9例、心脏破裂4例、死亡5例.试验组不良事件发生率低于对照组（P＜0.05）.试验组发生轻度出血5例、中度出血2例、严重或威胁生命的出血1例.对照组发生轻度出血11例、中度出血6例、严重或威胁生命的出血3例.试验组出血并发症的发生率低于对照组（P＜0.05）.结论 阿替普酶在急性心肌梗死治疗中的溶栓再通率高于尿激酶,并能有效降低不良

Efficacy and safety of Alteplase and urokinase in the treatment of patients with acute myocardial infarction

Objective To investigate the efficacy and safety of Alteplase and urokinase in the treatment of patients with acute myocardial infarction （AMI）. Methods 108 patients with acute myocardial infarction from January 2011 to July 2014 in Renmin Hospital of Wuhan University were divided into two groups, Aheplase group （experimental group） 54 cas- es and urokinase group （control group） 54 cases. Experimental group： first, heparin intravenous injection in accordance with the dosage of 60 U/kg, and then Aheplase 15 mg intravenous injection, then 30 rain intravenous infusion of 50 rag, the residual 35 mg in 60 rain intravenous infusion. After thrombolysis to heparin 12 U/kg per hour for intravenous drip of 48 h. Control group： urokinase 1 500 000 U intravenous infusion lasting for 30 min. In the 12 h after subcutaneous injection of heparin, 7500 U every 12 hours one times, continuous 3-5 days. The basic clinical data and laboratory re- suits were collected within 24 h. The cardiac function tests were performed for all the patients during the period of hos- pitalization after admission. Their echocardiographic parameters were analyzed, meanwhile the 24 h dynamic electro-cardiogram detection was performed. The incidence of major adverse cardiovascular events including malignant arrhythmia, heart failure, cardiogenic shock and sudden cardiac death was also observed and analyzed. Then the total recanalization rate at different times, fatality rate and incidence of complications of two groups were corn-pared. Results The total recanalization rate of 30, 60, 90, 120 min was 10 cases （19.61%）, 20 cases （39.22%）, 31 cases （60.78%）, 42 eases （82.35%） in experimental group. The total reeanalization rate of 30, 60, 90, 120 min was 5 cases （10.20%）, 8 cases （16.33%）, 18 cases （36.73%）, 30 cases （61.24%） in control group. The reeanalization rate by clinical Judgment at 30, 60, 90, 120 min was higher in experimental group than in control group, with statistically significant difference at