90分钟冠状动脉造影评价急性心肌梗塞血管开通及临床再通指标价值

通过经静脉溶栓开始后９０分钟冠状动脉造影（ＣＡＧ），观察国产尿激酶（天普洛欣，ＵＫＴＰ）静脉溶栓治疗急性心肌梗塞（ＡＭＩ）血管开通疗效，并评价临床再灌注标准的判断价值如何。方法：从ＵＫＴＰ多中心治疗ＡＭＩ１４０６例中，汇集其中所行冠状动脉造影（ＣＡＧ）共１２４例资料。结果提示：（１）１２４例ＡＭＩ患者，在溶栓开始后９０分钟时的梗塞相关血管的血流达ＴＩＭＩⅢ级者５２例（４１．９％）、Ⅱ级３８例（３０．７％），梗塞相关血管再开通率为７２．６％；（２）溶栓距起病时间愈早，具有愈高的开通趋势，但差异无统计学意义；（３）以ＣＡＧ为金标准，临床标准对血管开通判断敏感性为８８％，特异性为６９％，准确性为８３％。结论：ＵＫＴＰ静脉溶栓治疗ＡＭＩ血管开通疗效肯定，临床标准判断血管再通的敏感性较高，但特异性欠佳，有待提高。

Evaluation on the patency of infarct related artery by coronary angiography (CAG) 90 minutes after intravenous thrombolysis in acute myocardial infarction

Objective: To observe the efficacy of intravenous thrombolytic therapy on acute myocardial infarction (AMI), and evaluate the predictive values of clinical Creteria of reperfusion. Methods: From the multicentre therapy on 1 406 cases of AMI with Urokinase Techpool (UKTP) (Guangdong Techpool Biochemical Pharmaceutical Co. Ltd., Guangzhou, China) from November 1994 to April 1996, 124 cases undergone CAG. Among them UKTP 1.5 million IU (111 cases), or 2.0 million IU (10 cases) or 1.0 million IU (3 cases) were intravenously infused within 30 minutes. CAG were performed 90 minutes after the initiation of thrombolysis. Results: (1) The coronary flows 90 minutes after thrombolysis initiation were graded TIMI 3 in 52 cases (41.9%), TIMI 2 in 38 (30.7%), So the patency rate of infarct related artery (IRA) was 72.6%. (2) In the 90/124 of reperfused IRAS, LAD was 53/74 (71.6%), RCA 30/42 (71.4%), LCX 6/7(85.7%) and LMC 1/1 (all P >0 05).(3) There was a tendency showing that the earlier thrombolysis initiated, the higher vessel patency rates (but P >0.05). (4)By using CAG as a gold standard, the reperfusion rate of IRA judged by cliniclal criteria had certain predictive value, its sensitivity was 88%, specificity 69% and accuracy 83%. Conclusions: The reperfusion efficacy of intravenous thrombolytic therapy on AMI with UKTP is reliable. For predicting reperfusion of IRA by clinical criteria, the sensitivity is higher, but the specificity is not ideal which remains to be improved.