阿替普酶溶栓治疗ST段抬高型心肌梗死的临床评价

目的探讨阿替普酶（rt-PA）静脉溶栓治疗急性ST段抬高型心肌梗死的临床疗效和安全性。方法将我院2010年1月～2014年1月收治的126例ST段抬高型心肌梗死患者随机分为阿替普酶（rt-PA）组和尿激酶（UK）组,两组均在予阿斯匹林、氯吡格雷双联抗血小板、阿托伐他汀及其他常规治疗的基础上,分别给予阿替普酶及尿激酶溶栓治疗,比较两组总的冠脉开通率、胸痛缓解率、出血不良反应发生情况。结果 rt-PA组的冠脉再通率为79.4%,明显高于UK组的54.0%（P〈0.05）；rt-PA组的胸痛缓解率明显高于UK组（P〈0.05）,而出血不良反应明显低于UK组（P〈0.05）。结论阿替普酶溶栓治疗急性ST段抬高型心肌梗死,比尿激酶具有更高的冠脉开通率,临床疗效更佳,出血不良反应更少,安全性好,更适合基层医院推广使用。

Clinical evaluation of thrombolysis with alteplase for ST-segment elevation myocardial infarction

Objective To explore the clinical effect of intravenous thrombolytic therapy with alteplase（ rt-PA） on acute ST segment elevation myocardial infarction（ STEMI） and the safety. Methods 126 cases with STEMI hospitalized in the period from Jan.,2010 to Jan.,2014 were randomly divided into 2 groups： group rt-PA and group UK; aspirin combined with clopidogrel for antiplatelet,atorvastatin and routine treatment were applied to cases in both groups,while thrombolytic therapy with rt-PA was added to cases in group rt-PA and thrombolytic therapy with urokinase was added to cases in group UK; a comparative study was made to the total coronary patency rate,the remission rate of chest pain,bleeding and other side effects between the 2 groups. Results The coronary patency rate in group rtPA was 79. 4%,much higher than that in group UK（ 54. 0%）（ P 0. 05）; the remission rate of chest pain in group rt-PA was obviously higher than that in group UK（ P 〈 0. 05）,and the bleeding and other side effects in rt-PA group were less than those in group UK（ P 〈0. 05）. Conclusions Alteplase thrombolytic therapy for acute STEMI is of higher coronary patency rate,better curative effect,less bleeding,less side effects and better safety than UK; it is more suitable for a wide application in primary hospitals.