尿激酶溶栓治疗高龄急性心肌梗死的临床研究

目的观察尿激酶天普洛欣(UKTP)静脉溶栓治疗高龄急性心肌梗死(AMI)患者的临床有效性和安全性。方法1994年1月至1999年2月我院急诊科收治的502例老年AMI患者，按年龄分为三组≥70岁组(117例)，65～69岁组(152例)和65岁组(233例)，观察临床疗效，副作用及病死率等。UKTP剂量为200万U至300万U，采用Bolus法30min内给药。结果(1)按临床梗塞相关血管(IRA)再通标准，三组再通率依次为70.9%，79.6%和81.5%，≥70岁组与65岁组间比较，差异有显著性(P<0.05)。总再通率为78.5%。(2)5周病死率分别为3.4%，3.3%和3.0%，三组间差异无显著性(P均>0.05)。总病死率为3.2%。(3)轻度出血发生率三组分别为17.9%，16.4%和16.3%，组间亦差异无显著性(P均>0.05)，中度出血发生率为0.9%，0.7%和1.3%，三组间差异无显著性(P均>0.05)。无脑出血者。出血总发生率为17.7%。(4)≥70岁组和65岁～69岁组EF均显著降低(P<0.01，0.05)。结论对高龄AMI患者进行尿激酶静脉溶栓治疗是安全有效。

The clinic study of thrombolytic therapy using urokinase in aged patients with acute myocardial infarction

Objective　To observe the clinical efficacy and safety of intravenous thrombolytic therapy using Urokinase Techpool (UKTP) in elderly patients with acute myocardial infarction (AMI).Methods　Five hundredn and two patients with AMI were treated with UKTP during January 1994 to February 1999, and divided into three groups: ≥70 years (117), 65 years-69 years (152) and <65 years (233). The clinic therapeutic efficacy, Side effects and mortality were analyzed in aged patients with AMI treated with UKTP 2 million U to 3 million U intravenous infusion within 30 minutes according to Bolus method. Results　(1) The reperfusion rate in infarct——related artery (IRA) by clinic standards in ≥70 group vears was 70.9%, stinificantly lower that of 502 cases was 78.5%. (2) The mortality in first five weeks in ≥70 years group was 3.4%, in 65 years to 69 years group was 3.3% and in <65 years group was 3.0% (all P>0.05). The total mortality was 3.2%. (3) The rate of bleeding was 17.9%, 16.4% and 16.3% mild bleeding was 0.9%, and 1.3% and 1.3% (P>0.05). The total rate of severe bleeding was 17.7% without intracranial hemorrhage. (4) EF respectively was 44.1±8.6, 46.2±6.6, 50.6±4.9 in three groups. In comparision of <65 years group, that of ≥70 years group and 65 years to 69 years group was respectively singificant (P<0.01, 0.05). Conclusion　The thromblytic therapy with UKTP is effective, and safe for aged patients with AMI.