急性心肌梗死几种溶栓药物治疗比较

Effect of thrombolysis on acute myocardial infarction

目的比较尿激酶(Urokinase,UK)、链激酶(Streptokinase,SK)和重组组织型纤溶酶原激活剂(Rearrangement tissue-type plasminogen activator,r-tPA)对急性心肌梗死患者进行静脉溶栓治疗的临床疗效。方法628例入选患者随机分为3组,UK组222例,SK组205例,R-tPA组201例。分别给予3种溶栓药物静脉输入,观察血管再通的临床指标,同时观察有无出血、心衰、休克等并发症。结果3组的再通率分别为R-tPA组81.3%,SK组66.1%,UK组58.7%。而死亡率则反之,即r-tPA组为8.7%,SK组为9.2%,UK组为10.3%。r-tPA组重度出血发生率明显高于SK组和UK组(依次为6.2%、1.5%、0.6%);而轻度出血以SK组和UK组多见。血管再通后,死亡率、休克、心力衰竭、严重心律失常及再缺血等并发症明显低于血管未通组。结论r-tPA再通率高,溶栓疗效好。如患者经济允许,对急性心肌梗死应首选,但对高血压及老年患者应慎重,以防重度出血的发生。

Objective To compare the effect of urokinase（UK）, streptokinase（SK） and rearrangement tissuetype plasminogen activator（r-tPA） on acute myocardial infarction patients. Methods Six hundred and twenty-eight patients were randomly divided into three groups（UK group 222 cases, SK group 205cases, r-tPA group 201cases）. They were treated by intravenous using UK, SK and rt-Pa, respectively. Then the reperfusion markers and the complication were analyzed. Results The reperfusion rates of three groups were 81.3 % （r-tPA group）, 66.1% （SK group）, 58.7 % （UK group）. Slight bleeding was more often in SK group and UK group. However, the mortalities were opposite （8.7 % ）, was 9.2 %, 0.3 %. In severe bleeding, incidence of r- tPA group （6.2 % ）, was higher than SK group （ 1.5 % ） and UK group（0.6 % ）. The occurrence of mortality, shock, heart failure, severe arrhythmia and re-ischemia in reperfusion group was lower than non-reperfusion group. Conclusion The reperfusion rate and the thrombolic effect of r-tPA is the highest and best among three thrombolic medicine. But be careful for hypertension and old patients in order to avoid severe bleeding.