急性心肌梗死尿激酶溶栓治疗开始时间对疗效的影响

Influence of Different Starting Time of Urokinase The Rapy After Onset of Acute Myocardial Infarction on the Efficacy of Thrombolysis

目的：为探讨治疗在急性心肌梗死（ＡＭＩ）发病后各不同时间开始用尿激酶（静脉法）对疗效的影响。方法：３７所协作医院收治的ＡＭＩ患者１１３８例按统一的治疗方案应用尿激酶，血管再通采用统一的临床间接指标标准判定。比较发病后不同时间开始用药患者的血管再通率和４周病死率。结果：发病后２小时内、２～４小时内、４～６小时内和６～１２小时开始用尿激酶的患者分别为１２８例、４６１例、４３４例和１１５例。其血管再通率分别为７１．９％、７０．１％、６３．６％和４０．０％；４周病死率分别为７．０％、６．５％、１２．２％和１３．９％。发病后２小时内和２～４小时内组血管再通率与４周病死率均无统计学差异，故合并为４小时内组，与４～６小时内组和６～１２小时组比较，血管再通率（７０．５％）都显著高于后两组，Ｐ均＜０．００１；４周病死率（６．６％）都明显低于后两组，Ｐ均＜０．０１。４～６小时内组与６～１２小时组比较：血管再通率前者显著高于后者，Ｐ＜０．００１；４周病死率无显著性差异。

Objective:To investigate the influence of different starting time of intravenous urokinase after onset of acute myocardial infarction on the efficacy of thrombolysis. Methods:One thousand one hundred thirty eight cases of acute myocardial infarction(AMI) admitted in 37 collaborative hospitals were given intravenous urokinase with a standard program. Patency of infarct related coronary artery was assessed by uniform clinical criteria. Patency rate and 4 week mortality in groups of different starting times of urokinase administration after acute onset were compared. Results:According to the starting time of urokinase administration after acute onset,the 1138 cases were divided into 4 groups:128 cases were within 2 hours,461 within 2 4 hours,434 within 4 6 hours and 115 within 6 12 hours. The patency rates were 71 9%,70 1%,63 6% and 40 0%,respectively and the 4 week mortalities were 7 0%,6 5%,12 2% and 13 9%,respectively. The patency rates and 4 week mortalities between the groups within 2 hours and within 2 4 hours were not statistically significant, so these two groups were combined into one,i.e. within 4 hours. The patency rate of the group within 4 hours(70 5%)was very significantly higher than those of the groups within 4 6 hours and 6 12 hours (all p <0 001). The 4 week mortality of the group within 4 hours (6 6%) was obviously lower than those of the other two groups(all p <0 01). The patency rate was higher ( p <0 001),but the 4 week mortality was not statistically significant of the group within 4 6 hours vs those within 6 12 hours. Conclusion:Intravenous urokinase starting within 4 hours after onset of acute myocardial infarction is of the best efficacy.