提高急性心肌梗塞溶栓治疗比率的探讨

Approch the ratio and effect or thrombolysis in acute myocardial infarction

为探讨放宽急性心肌梗塞(AMI)溶栓指征后.对疗效、安全性及提高溶栓比率影响.观察408例AMl且患者中,进行溶栓治疗的201例选择的主要指征变化及疗效.结果:(1)在按照中华心血管病杂志编委会1991年所推作的AMI济栓方案基础上,进一步放宽入选距发病时间从≤6小时至≤12小时,年龄由≤65岁变为不限,使获选溶栓者占总的AMI患者比率达到49.3%,比未放宽前(28.4%,P<0.001)及GISSl-2(32.8%,P<0.001)等一些大规模临床试验较高.(2)32例AMI在发病>6小时而≤12小时之间溶栓比169例≤6小时,仍有相近的血管再通率(62.5%对71.0%)、及病死率(3.1%对6.5%,P>0.05),比不溶组明显下降(18.4%,P<0.05);(3)69例老年(≥65岁)AMI溶栓患者,比与之匹配的92例未溶栓者的心功能较好及病死率较低(11.6%vs28.3%,P<0.025).提示:AMI溶栓在国人使川链激酶、冰激酶可放宽至年龄起病至溶栓时间≤12小时,可使更多的忠者受益,安全而有效.

To inquire into the influence on effect, safety and receiving rate of thrombolysis in acute myocardial infarction (AMI) after extending its selective indications. We observed the main indication changes and effect of 201 cases of AMI receiving thrombolytic therapy who from 108 patients with AMI. Results: (1)On basis of the thrombolytic scheme recommended by the committee of Chinese Journal of Cardiology in 1991,further extend the time of onset to medication from ≤6 hr. to ≤12 hour,age from ≤65 yr,to all yr, unlimited. The ratio of cases receiving thrombolysis/all AMI is 49. 3%, more than before extending indications (28. 1% ,P<0. 001) as well as GISSI-2 (32. 8% ,P<0. 001) etc. (2)There arc not obviously differencies in reperfused rates (62.5% vs. 71. 0%) and mortality after reperfused (3. 1% vs. 6. 5% ,P>0. 05) between group 6- 12 hr,medication (n- 32) and ≤6 hr's (n= 169) ,but its mortality in both groups above is significantly lower than group non-thrombolysis (18. 4%,both P<0. 05). (3)The mortality of 69 cases of ≥ 65 yr. receiving thrombolysis is lower than 92 matched non-thrombolysis' (11.4% vs. 28. 3% ,P<0. 025). The thrombolysis in Chinese AMI cases with streptokinase and urokinase is safe and effective;extending its selective indications to unlimited ages and ≤12 hr starting medication ets,will save more livies and/or benefit more patients.