改良溶栓对梗死后心绞痛的疗效及凝血指标观察

Effects of improved thrombolytic therapy on patients with myocardial postinfarction angina pectoris

目的 :分析梗死后心绞痛患者应用改良溶栓的疗效 ,为临床应用该疗法提供理论依据。方法 :选择 2 5例内科常规治疗包括硝酸酯、钙离子拮抗剂、β受体阻制剂及低分子肝素等效果不佳 ,活化部分凝血活酶时间、凝血酶原时间及纤维蛋白原含量异常 ,肌钙蛋白阳性且心肌酶升高的梗死后心绞痛患者 ,应用尿激酶 30万 U加入 0 .9%氯化钠 1 0 0 ml中 ,于 30 min内输完 ,每日 1次 ,连续应用 3d,溶栓前 1天及期间服用阿斯匹林 30 0 mg,观察心绞痛的发生频率及程度、肌钙蛋白与心肌酶学的变化。结果 :改良溶栓治疗后与治疗前相比较 ,心绞痛的发生频率及程度减轻、肌钙蛋白转为阴性、心肌酶降至正常。结论 :改良溶栓可使梗死后心绞痛缓解 ,临床上对于常规内科治疗效果不佳的病例可选用小剂量尿激酶治疗。

Objective: To analyze the effects of improved thrombolytic therapy in patients with postinfarction angina pectoris and supply the referent value for the clinical application of thrombolysis. Methods:25 patients of postinfarction angina pectoris were studied, who did not respond well to common medications including isosorbide nitrate,β-blocker,calcium channel blocker,anti-coagulation and anti-platelet. In addition, active partial thromboplastin time,fibrin and prothrombin time were all abnormal. Meanwhile, troponin was positive and myocardial enzymes were not normal. Urokinase 300,000U was added to 100ml normal saline and injected within 30 minutes once a day for 3 days. 300mg aspirin was administrated a day before and during urokinase applications. Frequency and severity of angina attack,serum myocardial enzymes and troponin were observed. Results: After treatment, frequency and severity of angina attack alleviated, troponin became negative, and myocardial enzymes recovered. Conclusion: Thrombolytic therapy of low dose urokinase can alleviate postinfarction angina pectoris. Improved thrombolytic therapy can be used in patients who did not respond well to common medications.