早期静脉溶栓治疗对老年人急性心肌梗塞近期预后的影响

为探讨静脉溶栓治疗对老年（６０岁以上）急性心肌梗塞（ＡＭＩ）患者近期预后的影响。方法对比分析２０例尿激酶静脉溶栓治疗与３８例非溶栓治疗的老年人ＡＭＩ患者住院期间临床疗效。结果显示溶栓组住院期间４周内病死率明显低于非溶栓组（Ｐ＜０．０５），且心绞痛、心力衰竭及严重心律失常、泵衰竭的发生率明显低于非溶栓组（Ｐ＜０．０５）。临床判断梗塞相关血管（ＩＲＡ）再通率为７５．０％（１５／２０），０～６小时ＩＲＡ再通率为８３．３％（１０／１２），６～１２小时为６２．５％（５／８），溶栓组无一例发生颅内出血及过敏反应。结论　提示用尿激酶静脉溶栓治疗老年ＡＭＩ为一种安全有效的方法，ＡＭＩ后梗塞相关血管及时有效再灌注有利于改善心肌梗塞的近期预后。

The effect of rapid and effective reperfusion on the early prognosis of elderly acute myocardial infarction

Objective The aim of the study was to investigate the effect of rapid and effectivereperfusion of infarct-related coronary artery on the early prognosis of the early patients with acute myocardial infarction after intravenous thrombolytic therapy. Methods The clinical therapeutic effecticacy, side effects and mortality were anlyzed in 20 elderly patients with AMI with Urokinase therapy and38 elderly patients with AMI with non-thrombolytic therapy. Results The immediate mortality (within 4 weeks) in the thrombolytic groups was lower obviously than that in non-thrombolytic groups (P<0. o5). In thrombolytic groups, early complications such as heart failure, ventricular arrhythmia, angina, cardiogenic shock were lower obviously than that in non-thrombolytic groups (respectively, P<0.05). The reperfusion rate in the infart-related artery (IRA) was 75.0% (15/20) by clinical standards. The reperfusion rate in the multipex myocardial infarctions decreased (61. 5%, 5/13). Thereperfusion rates in the infenor infarcts or anteroseptal infarcts were 100%. The reperfusion rate in 0-6hour groups was 83. 3% (10/12), and that was 62.5 % (5/8) in 6-12 hour groups. No one had bleedingand allergy. Conclusion The rapid and effective reperfusion of infart-related artery in the elderly AMIby using Urokinase can improve the early prognosis of AMI.