小剂量重组组织型纤溶酶原激活剂静脉加速给药法治疗急性心肌梗死

Effects of accelerated intravenous low dose recombinant tissue type plasminogen activator on patients with acute myocardial infarction

目的评价小剂量重组组织型纤溶酶原激活剂(rt-PA)50 mg加速给药法对急性心肌梗死(AM I)溶栓的疗效及安全性。方法共入选符合条件的患者236例。随机分为观察组与对照组,观察组120例:小剂量rt-PA加速给药,rt-PA给予8 mg静脉注射,继之42 mg在60分钟内静脉滴注;对照组116例:rt-PA给予8 mg静脉注射,继之42mg在90分钟内静脉滴注;所有患者均给予静脉肝素治疗,以用药后临床2小时再通指标为主要终点。结果观察组冠脉再通率高于对照组(84.1%vs 70.7%,P<0.05)两组出血率无差别,两组各有1例颅内出血,但差异无统计学意义。结论小剂量rt-PA加速给药治疗AM I疗效更好,且同样安全。

Objective To evaluate the clinical efficacy and safety of thrombolytic therapy with accelerated intravenous low dose tissue type plasminogen activator（rt-PA） 50 mg on patients with acute myocardial infarction （AMI）. Methods Two hundred and thirty-six eligible patients were randomized into two groups： the test group （120 cases） and the control group（116 cases）. In the former group, rt-PA was given with an intravenous bolus of 8 mg followed by infusion of 42 mg over 60 minutes while in the control group, rt-PA was administered by an intravenous bolus of 8 mg followed by infusion of 42 mg over 90 minutes. Anticoagulation with heparin was given intravenously to all the patients. The primary end point was clinical 2 h-reperfusion rate. Results The reperfusion rate of coronary artery was higher in the test group than that in the control group（84.1% vs 70.7%, P 〈0.05）. There was no significant difference in bleeding incidence between the two groups. Stroke rate was the same for both groups （one patient in each group）. Conclusion Accelerated intravenous low dose rt-PA is effective and safe on patients with AMI.