近15年溶栓药治疗急性心肌梗死的变化趋势

目的：分析近15年来治疗ST段抬高心肌梗死溶栓药数量和种类的变化趋势。方法：回顾性分析1994～1995年（A组）;1999～2000年（B组）;2004～2005年（C组）;2009年（D组）共4组879例发病24小时内的初发STEMI资料,分析4组患者溶栓药物的数量、种类及对比分析溶栓和直接冠状动脉成形术对住院死亡率的影响。结果：10年以前（A、B组）溶栓药物使用比例大,但药物种类单一（非纤维蛋白选择性制剂如尿激酶,链激酶等）。5年以前（C组）溶栓药种类多（非选择性与选择性并用如rt-PA,TNK-tPA,r-PA,Pro-UK等）且与冠状动脉造影及补救PCI并用。近年（D组）以直接PCI为主。与溶栓治疗相比,直接PCI组的住院死亡率较低。结论：STEMI的溶栓治疗率在下降,直接PCI有较低的住院死亡率。

Fibrinolytic Therapy for Patients with Acute Myocardial Infarction in Recent 15 Years

OBJECTIVE：To evaluate the changes in proportion and types of fibrinolytic agents in treatment of patients with ST-segment elevation acute myocardial infarction（STEMI） in recent 15 years.METHODS：We retrospectively analyzed the data of a total of 879 enrolled patients with initial onset（within 24h） of STEMI.The patients were divided into 4 groups according to different period：Group A（from 1994 to 1995）,Group B（from 1999 to 2000）,Group C（from 2004 to 2005）,and Group D（in 2009）.The proportion and types of fibrinolytic agents applied in the 4 groups were analyzed and the effects of the fibrinolytic therapy vs.coronary angioplasty on hospital mortality rate were compared among the 4 groups.RESULTS：Fibrinolytic agents showed a higher proportion 10 years ago（Group A and Group B） but with single type（non-fibrin selective inhibitor,urokinase and staphylokinase et al）.Various types of fibrinolytic agents were noted 5 years ago（Group C）,including non-selective used concurrently with selective drugs,such as rt-PA,TNK-tPA,r-PA,Pro-UK et al,and which were used concurrently with coronary angiography（CAG） and PCI（percutaneous coronary intervention） for remedy.In recent years（Group D）,direct PCI was performed predominantly.Compared to fibrinolytic therapy,patients undergoing direct PIC had lower hospital mortality.CONCLUSION：The proportion of fibrinolytic therapy in patients with STEMI is decreasing,and direct PCI has an advantage of lower hospital mortality.