急性心肌梗塞冠状动脉内溶栓26例临床分析

Analysis of 26 cases of Intracoronary Thrombolysis in Patients with Acute Myocardial Infartion

本文对２６例急性心肌梗塞患者，经冠状动脉造影后确定部位及患支，以先轻后重的原则，单纯使用日本国产尿激酶１２～４８单位，进行冠状动脉内注射溶栓，其中２１例再灌注达到ＴⅠＭⅠ的Ⅱ或Ⅲ级标准。再通率达８０．８％，胸痛等症状消失，心电图多数回到等电位，心肌酶谱无明显高峰前移。再灌注性心律失常率为８５．７％（１８／２１）一般毋需处理，数分钟后可自行缓解，如持续存在，可静滴利多卡因、溴苄胺、胺碘酮等药物，没有直接观察到再灌注而加重心肌损伤所致的临床效应所引起新的细胞损害。冠状动脉内溶栓其方法较简便、安全性高、用药量小，发病时间越短，其疗效越高，能快速溶解血栓，加速血管再灌注，迅速改善局部心肌缺血状态，减少和避免冠状动脉内早期血栓的再闭塞，未发现药物的毒副作用及其它方面的合并症。

To determine the po-sition and extent of the corlnary artery disease,26 patients with acute myocardial infarction (AMI)underwent coronary an-giography.Then they were rveated with intracoronary urokinase(Urokinase,made in Japan,12～48 Units were given depending on the severity of the coronary artery disease).The rate of veperfusionwas 80.8%(21/26) according to TIMI Ⅱor Ⅲ standard.Chest pain and othersymptoms disappeared , ST segmentdeviation retumed. The peak of myocar-dial enzyme spectras did not move for-ward.The incidence of reperfusion ar-rhythmia was 85.7%,(18/21).Majorityof the arrhvthmias need no treatment.Ifarrhythmia continued,lidocaine、bretyliumtosylate and amiodarone could be used.No obvious clinical effect and new celldamage related to reperfusion myocardialdamage were observed.The method of in-tra coronary thrombolytic therapy is rela-tivey simpl and safe,needs small dosage of vrokinase. In the early stage of AMI,the method shows more effective,throm-bus in coronary artery could be dissolved quickly,and reperfusion be aaeleratedal-so. local myocardial ischenmia might be improved,and Coronary artery renarrow-ing could be decreased or avoidedas well. No adverse effects of Urokinase and other complications were found.