硫酸镁对尿激酶静脉溶栓治疗急性心肌梗塞的影响

Effects of magnesium sulfate on thrombolytic therapy with intravenous urokinase in patients with acute myocardial infarction

目的：研究硫酸镁（ＭＳ）对尿激酶（ＵＫ）静脉溶栓治疗急性心肌梗塞（ＡＭＩ）的影响。方法：１００例ＡＭＩ住院患者随机分为ＭＳ＋ＵＫ组（ＭＵ组，５２例）和ＵＫ组（４８例）。ＭＵ组在静滴ＵＫ前后加用ＭＳ。结果：２组的再灌注率无显著性差异（Ｐ＞０．０５），但ＭＵ组的再灌注心律失常（ＲＡ）发生率、４周病死率显著低于ＵＫ组（Ｐ＜０．０１，Ｐ＜０．０５）；开始治疗后并发的严重心律失常（ＳＡ）、心力衰竭（ＨＦ）及梗塞后心绞痛（ＰＩＡ）的发生率显著低于ＵＫ组（Ｐ均＜０．０５）；休克、再梗塞（ＲＩ）及梗塞延展（ＩＥ）的发生率也均低于ＵＫ组（但Ｐ均＞０．０５）。结论：在ＵＫ静脉溶栓前后加用ＭＳ，可提高ＵＫ溶栓疗效，缩小梗塞面积，减少并发症，并有益于缺血再灌注损伤的防治。

Objective:To investigate the effects of magnesium sulfate(MS) on thrombolytic therapy with intravenous urokinase (UK) in patients with acute myocardial infarction(AMI).Methods:One hundred patients with AMI were randomly allocated to two groups.In the UK plus MS group (MU,n=52),MS was used before and after intravenous UK drip.In the UK group (UK,n=48),an equivalent dosage of UK was used.Results:It showed that reperfusion rates of infarctrelated artery within 2 hours were 76 9% and 75 0% in MU group and UK group respectively,and the difference was not significant ( P >0 05).However,mortality within 4 weeks (1 9% vs.12 5%, P <0 05) and frequency of reperfusion arrhythmia (57 5% vs.83 3%, P <0 01) were significantly reduced in MU group as compared with UK group.Similarly,in comparison with UK group,there was significant reduction in incidences of severe arrhythmia (9 6% vs.27 1%) ,left heart failure (11 5% vs.27 1%)and early postinfarction angina (1 9% vs.12 5%)in MU group after treatment(all P <0 05).Moreover,incidence of cardiogenic shock and reinfarction of infarct size were relatively low in MU group(all P >0 05).Conclusions:These results provide evidence that MS used before and after intravenous UK injection may improve therapeutic effectiveness,decrease infarct size,reduce complications,and prevent ischemiareperfusion injury in patients with AMI.