急性心肌梗塞尿激酶临床应用研究（1138例）

Aclinicalstudyonthrombolysiswithintravenousurokinasein1138casesofacutemyocardialinfarc-tionColaborative

为探讨急性心肌梗塞（ＡＭＩ）静脉法应用国产尿激酶（ＵＫ）不同剂量的疗效和副作用，以及延迟用药的疗效。（１）对１０２３例发病６小时以内的ＡＭＩ患者随机分为：低剂量组［１．７万Ｕ（２．２万ＩＵ）／ｋｇ］５３９例和高剂量组［２．３万Ｕ（３．０万ＩＵ）／ｋｇ］４８４例。两组血管再通率分别为６７．３％和６７．８％，４周病死率分别为９．５％和８．７％，各种严重并发症差异均无显著性，说明两组疗效相似，出血并发症在高剂量组略高于低剂量组，但差异无显著性。值得指出的是，在高剂量组有２例发生了致命性脑出血。认为１．７万Ｕ（２．２万ＩＵ）／ｋｇ是安全有效的剂量。（２）延迟治疗的效果，发病后６～１２小时ＡＭＩ患者１１５例［应用ＵＫ２．０万Ｕ（２．６万ＩＵ）／ｋｇ］与发病６小时内用药组相比：血管再通率低（４０．０％对６７．５％，Ｐ＜０．００１），４周病死率较高（１３．９％对９．１％，但Ｐ＞０．０５）；重度心力衰竭发生率也较高（１３．０％对６．６％，Ｐ＜０．０２）。说明延迟治疗组疗效明显低于发病６小时内治疗者。

Aclinicalstudyonthrombolysiswithintravenousurokinasein1138casesofacutemyocardialinfarctionwasreported.Inordertoinvestigatetheefectsofdiferentdosesofurokinase:1023casesofacutemyocardialinfarctiontreatedbythrombolyticagentswithin6hoursafteronsetweredividedrandomlyintotwogroups,539casesinlowdosegroup[urokinase,UK17000(22000IU)/kg,totaldosenolowerthan900000(1170000IU)]and484casesinhighdosegroup[23000U(30000IU)/kg,totaldosenomorethan1800000U(2340000IU)].Thepatencyofinfarct-re-latedcoronaryarterywasasesedbyuniformclinicalcriteria.Thepatencyrateswere67.3%and67.8%respectively(P>0.05).Four-wekmortalitywas9.5%and8.7%respectively(P>0.05).Frequencyofvariousseverecomplicationshadnostatisticalsignificancebetwenthetwogroups.Theefectsofdiferentdosesweresimilar.Adversebleedingactionswerealitlemoreinhighdosegroupthaninlowdosegroup(P>0.05).But,2casesoffatalcerebralhemorhageoccuredinthehighdosegroup.So,thelowdoseUKwasequalyefectiveandmaybesafer.(2)Efectsofdelayedthrombolytictherapy(6-12hoursafteronsetwithurokinase[20000U(26000IU)/kg]in115casesofacutemyocardialinfarctionwerestudied.Incomparisonwiththosetreatedwithin6hoursthepa-tencyrateofinfarct-relatedarterywaslower(40.0%vs67.5%,P<0.001);four-weekmortalitywashigher(13.9%vs9.1%,P>0.05);frequencyofseverecongestiveheartfailurewashigher(13.9%vs6.6%,P<0.02).Sothrombolyticagentshouldbestartedasearlieraspossibleaftertheonsetofacutemyocardialinfarctionifnotcontraindication.