溶栓治疗老年人急性心肌梗死34例分析

Report on thrombolytic therapy in 34 elderly patients with acute myocardial infarction

目的观察老年人急性心肌梗死（ＡＭＩ）溶栓治疗的安全性和有效性。方法７１例７０岁以上老年ＡＭＩ患者分成溶栓组（３４例）和对照组（３７例），比较其临床结果。结果（１）梗死相关动脉（ＩＲＡ）的再通率溶栓组显著高于对照组（６１．８％及１３．５％，Ｐ＜０．０１）；（２）溶栓明显改善了老年ＡＭＩ患者的左室射血分数（６３％及５２％，Ｐ＜０．０５）；（３）溶栓显著降低了老年ＡＭＩ患者的住院病死率（３５．１％对１４．７％，Ｐ＜０．０５），降幅为２０．４％；（４）溶栓组发生出血并发症６例（皮肤淤斑４例，上消化道出血２例），无严重出血（无需输血）并发症及脑卒中发生。结论对无禁忌证的老年人ＡＭＩ进行溶栓治疗，可以增加其血管再通率、改善心功能及降低病死率。

Objective To investigate the efficacy and safety of thrombolytic therapy in the aged with acute myocardial infarction(AMI). Methods Seventyone elderly patients with AMI were divided into 2 groups:urokinase group (34 cases) and control group (37 cases) in order to observe clinical outcomes of the thrombolytic therapy. Results The data showed that: (1)The reperfusion rate was significantly higher in urokinase group than in control group (616% vs 135%,P<001)。(2)Left ventricular ejection fraction of elderly patients with AMI was improved by thrombolytic therapy (63% vs 52%,P<005). (3) Compared to control group, a 204% reduction of the mortality during 4 weeks of hospitalization was found in urokinase group (P<005). (4)Six cases had hemorrhagic complications, skin ecchymosis in 4 and mild gastrointestinal bleeding in 2, and no transfusion was necessary. No intracranial hemorrhage was noticed. Conclusions In the absence of contraindication, administration of intravenous urokinase to elderly patients with AMI results in increased reperfusion rate and improved left ventricular function as well as lower mortality.