急性心肌梗死静脉溶栓时间窗与疗效

The Clinical Efficacy of Intravenous Thrombolysis at Different Starting Time of Treating AMI

目的通过对急性心肌梗死病人不同时间静脉溶栓后疗效（临床间接指征）的观察，说明早期静脉溶栓的重要性。方法96例急性心肌梗死病人，根据发病后静脉溶栓时间分成≤4h组、4—6h组和6～12h组。比较再通后苫ST段下降率时间、胸痛缓解时间、再灌注心律失常出现时间及CK—MB酶峰提前时间的变化，同时比较再通率及4周病死率。结果3组比较∑ST下降率时阃分别为（80．4±23．2）min、（110．2±28．9）min及（124．8±27．6）min（3组相比，均有显著性差异，P〈0．05）；胸痛缓解时间分别为（120．6±18．7）min、（130．4±16．6）min及（160．3±15．9）min（3组相比，均有显著性差异，P〈0．05）；再灌注心律失常出现时间分别为（90．5士30．1）min、（92．1±27．8）min及（91．4±28．3）min（3组比较，均无显著性差异，P〉0．05）；CK—MB酶峰提前时间分别为（540±30．9）rnin、（600±28．7）min及（700±29．4）min（3组相比，有显著性差异，P〈0．05）。3组血管再通率分别为71．4％、69．1％及42．3％（3组相比，有显著性差异，P〈0．05）；4周病死率分别为0、4.8％及7．7％。结论急性心肌梗死静脉溶栓时间越早越好，4h内静脉溶栓效果最好。

Objective We can demonstrate the importance of thrombolysis early - time through the observation of evaluation of inderect clinical at different - time after thrombolysis to acute myocardial infarction（AMI） .Methods 96 cases weredivided into 3 groups, ≤4 hour,4 - 6 hour and 6 - 12 hour, according to the different starting time of thrombolysis after onset of symptoms, in order to campare the reduction rate time of ST after thrombelysis,the lysis time of pain in chest,the time of arrhythmia reperfuion,the advance time of CK- MB and contrast the recanalization rate and the dead rate of 4 week. Results The reduction rate time of ∑ST was 80.4 ± 23.2 min, 110.2 ± 28.9 min and 124.8 ± 27.6 min in three groups. （ Having significantly difference in the three goups P 〈 0.05）. The lysis time of pain in chest was 120.6 ± 18.7 min, 130. 4 ± 17.2 min and 160.3 ± 15.9 min （Having significantly difference in the three groups P 〈 0.05） .The time of arrhythinia of repeffusion was 90.5 ± 30.1 min,92.1 ± 27.8 min and 91.4 ± 28.3 min（There were not significantly difference in the three gonps P 〉 0.05）. The advance time of CK - MB was 540 ± 30.9 min,600 ± 28.7 min and 700 ± 29.4 min （Having significantly difference in the three groups P 〈 0.05）. The recanalization rate was 71.4%,69.1% and 42.3% in the three groups （Having significantly difference P 〈 0.05）.The dead rate of 4 week was 0,4.8% and 7.7% .Conclusion It has the best effect on recanalization that thrombelytic therapy within 4 hour after the onset of AMI.