急性心肌梗死不同溶栓药物疗效探讨

目的在急诊科比较尿激酶(UK)、链激酶(SK)和重组组织型纤溶酶原激活剂(r-tPA)对急性心肌梗死患者进行静脉溶栓治疗的临床疗效。方法随机分为三组,UK组222例,SK组205例,r-tPA组201例。给予三种溶栓药物静脉输入,观察血管再通的临床指标,同时观察有无出血、心衰、休克等并发症。结果三组的再通率分别为:r-tPA组为81.3%,SK组为66.1%,UK组为58.7%。而病死率则反之,即r-tPA组为8.7%,SK组为9·2%,UK组为10.3%。r-tPA组重度出血发生率明显高于SK组和UK组(6.2%,1.5%,0.6%),而轻度出血以SK组和UK组多见。血管再通后,病死率、休克、心力衰竭、严重心律失常及再缺血等并发症明显低于血管未通组。结论r-tPA再通率高,溶栓疗效好。但对高血压及老年患者应慎重,以防重度出血的发生。

Effect of thrombolysis on acute myocardial infarction in emergency department

Objective To compare the effect of urokinase(UK), streptokinase(SK) and rearrangement tissue-type plasminogen activator(r-tPA) on acute myocardial infarction patients. Method 628 patients were randomly divided into three groups(Uk group 222cases,Sk group 205cases,r-tPA group 201cases). They were treated by intravenous using UK,SK and rt-PA, respectively. Then the reperfusion markers and the complication were analyzed.Results The reperfusion rates of threegroups were 81.3%( r-tPA group), 66.1%(SK group), 58.7% (UK group). Slight bleeding was more often in SK group and UK group. However, the mortalities were opposite ,that is, r-tPA group was 8.7%,SK group 9.2%, Uk group 10.3%. In severe bleeding, incidence(6.2% )of r-tPA group was higher than SK group(1.5%) and UK group( 0.6%).The occurrence of mortality, shock, heart failure, severe arrhythmia and re-ischemia in reperfusion group was lower than non-reperfusion group.Conclusion The reperfusion rate and the thrombolic effect of r-tPA is the highest and best among three thrombolic medicine. But be careful for hypertension and old patients in order to avoid severe bleeding.