发病时间不确切的心肌梗死患者静脉溶栓可行性探讨

Intravenous Thrombolysis Therapy for Patients with Acute Myocardial Infarction Without Exact Time of Onset

目的探讨发病时间不确切的急性心肌梗死(AMI)患者静脉溶栓可行性。方法治疗组15例,在心电图初步诊断基础上符合以下条件1条或1条以上者。①反复胸闷痛发作以持续时间最长为发病时间,且<24h;②入院时仍持续胸痛;③心电图ST段抬高与高尖T波成单向曲线;④根据心脏酶系升高时间规律。排除禁忌症后行静脉溶栓。对照组选择以前因发病时间不确切而未溶栓者19例,比较临床疗效。结果治疗组溶栓再通7例,再通率46.67%,两组住院死亡各1例,病死率、心功能改善级别,差异无显著性(P>0.05),平均住院天数差异显著(P<0.05)。结论AMI发病时间不确切患者,经选择进行静脉溶栓治疗可改善心功能、缩短住院时间。

Objective To probe into the feasibility of intravenous thrombolysis therapy for acute myocardial infarction （amI） patients without exact time of onset. Methods 15 patients with AMI in treatment group were diagnosed by ECG and one of following items： ①recurrent onset of chest pain in less than 24 hours. ②persistent chest pain on admission. ③ST segment elevation with monophasic curve. ④regular elevation of serum myocardial enzymes. Intravenous thrombolytic therapy was performed in patients without contraindication. AMI patients in control group （n=19） haven＇t received thrombolytic therapy, because of no exact time of onset. Clinical efficacy between treatment group and control group was compared. Results In treatment group,7 patients （46.67%） developed thrombolytic reperfusion. There was a dead patient in each group. There was no significant difference of death rates between the two groups （ P 〈 0.05 ）. There were significant differences of improvement of cardiac class, days of average hospitalization between the two groups （ P 〈 0.05 ）. Conclusions It will do good to AMI patients who have no exact time of onset to receive intravenous thrombolytic therapy.