急诊应用不同溶栓药物治疗ST段抬高型心肌梗死回顾性分析

Comparison of curative effect of different intravenous thrombolytic medications in the patients with ST-elevation myocardial infarction

目的比较使用瑞替普酶（rPA）、阿替普酶（rt—PA）和重组链激酶（r—SK）对ST段抬高型心肌梗死（STEMI）患者进行静脉溶栓治疗的临床疗效。方法自2003—02～2006—12我院急诊科72例STEMI患者接受静脉溶栓治疗，其中rPA组24例，rt—PA组31例，r—SK组17例，统计治疗后血管再通率、死亡率及观察有无出血、心力衰竭、心源性休克等并发症。结果血管再通率：rPA组87.50％、rt—PA组83．87％及r—SK组70．59％，其中60min及90min再通率rPA组、rt—PA组高于r—SK组。溶栓后30d内再闭塞率、心力衰竭等并发症发生率三组比较差异无统计学意义（P〉0．05）。死亡率：rPA组8．33％、rt—PA组6．45％及r—SK组11．76％。出血发生率：rPA组、rt—PA组高于r—SK组。结论rPA、rt—PA及r—SK均适合急诊科内STEMI患者的静脉溶栓治疗，rPA、rt—PA早期再通率高于r—SK。

Objective To observe the curative effect of reteplase（rPA） , aheplase （rt -PA） and recombinant streptokinase（ r - SK） in the patients with ST - elevation myocardial infarction （ STEMI ） in emergency department. Methods 72patients with STEMI admitted tO our department during February 2003 to December 2006 had accepted rPA （ 24 cases ） , rt - PA （ 31 cases ） or r - SK （ 17 cases ）, The patency of infarct - related coronary artery was assessed by unified clinical criteria. The mortality, various complications of myocardial infarction and adverse events were observed. Results Two hours after thrombolysis, the rates of reperfusion were 87.50% in rPA group, 83.87% in rt- PA group, 70.59% in r- SK group, but there were no significant differences in three groups （ P 〉 0.05 ）. The early reperfusion rates （ 60 minutes and 90 minutes ） of rPA group and rt - PA group were higher than those of r - SK group （ P 〈 0. 05 ）. The mortalities of three groups were 8.33% in rPA group, 6.45% in rt - PA group, and 11.76% in r - SK group （ P 〉 0.05 ）. Bleeding incidence was more often in rPA group and rt - PA group than in r - SK group. The rates of recurrent myocardial infarctions, cardiac shock, heart failure, and hypotension showed no differences in three groups 30 days after thrombolysis. Conclusion Reteplase, aheplase and recombinant streptokinase are all effective and safe thrombolytic agents in the treatment of STEMI in emergency department. The early reperfusion rate of reteplase and aheplase are higher than that of recombinant streptokinase.