AMI患者尿激酶与组织型纤溶酶原激活剂治疗结果的对比

The Comparison of Intravenous Thrombolytic Therapy with Urokinase and Tissue Plasminogen Activator in Patients with Acute Myocardial Infarction.

比较31例尿激酶(UK)及14例组织型纤溶酶原激活剂(t-PA)静脉溶栓辅以阿斯匹林及肝素治疗急性心肌梗塞(AMI)的疗效.t-PA组与UK组相比较:血管再通率分别为78.6%与58.1%(P>0.05);脑、消化道及呼吸道出血并发症在t-PA组稍多,而UK组以局部皮肤出血较多.血管再通组心力衰竭、严重性心律失常、室壁瘤及梗塞后心绞痛的发生率较低,但两组间均无显著性差异;再通组病人心脏破裂的发生明显低于未再通组(0与17.6%P<0.05).本研究提示静脉t-PA溶栓治疗血管再通率高于静脉UK,有条件者可以首选t-PA.溶栓再通可以减少心力衰竭、室壁瘤、心梗后再缺血的发生,特别是心脏破裂的发生,从而改善病人的预后.

We compared the effectiveness of intravenous thrombolytic therapy with urokinase (UK) and tissue plasminogen activator (t-PA) in patients within 6 hours after onset of acute my-ocardial infarction (AMI) in this study. The patients were treated with either UK(31 patients) or t-PA(14 patients)plus intravenous or subcutaneous heparin and oral Aspirin. The clinical reperfusion rate was 78. 6% and 58-1% in t-PA group and UK group(P>0. 05) ,respectively. The in-hos-pital mortality rates were 14. 3% and 9. 7% (P>0. 05)in patients treated with t-PA and UK. 2 patients in t-PA group and no patient in UK group (14. 2% vs 0%,P>0. 05) developed gastrointestinal or respiratory bleeding. One patient in t-PA group and no patient in UK group (7. 1% vs 0%,P>0.05) developed intracerobral bleeding. 2 patients in clinical reperfusion group and 3 patients in non-perfusion group (7. 1% vs 17. 6% ,P>0. 05) died during hospitalization. The major complications including heart failure, arryhmias, aneurym and cardiac shock were higher in non-reperfusion patients,but the difference was not significant. 3 patients in non-perfusion group and no patient in perfusion group(17. 6% vs 0%,P<0. 05) developed cardiac rupture diagnosed by e-cho study or postmortem. We concluded that AMI patients treated with t-PA had higher reperfusion rate and lower in-hospital mortality comparing those treated with UK. The in-hospital mortality and incidence of major complications in patients who had clinical reperfusion in either t-PA or UK were lower than those of non-reperfusion.