静脉溶栓治疗老年急性心肌梗死的临床分析

Intravenous thrombolytic therapy in senile patients with acute myocardial infarction

目的探讨老年（≥75岁）急性心肌梗死患者静脉溶栓的疗效及安全性。方法将62例老年急性心肌梗死患者随机分为溶栓组和常规治疗组；溶栓组32例，采用尿激酶静脉溶栓加皮下注射小剂量低分子肝素钙。常规治疗组30例，除不用尿激酶及小剂量低分子肝素钙外，其余治疗均与溶栓组相同。结果冠状动脉再通率溶栓组为65．6％（21／32），常规治疗组为16．7％（5／30），两组比较差异具有显斋性（P〈0．05）；溶检组病死率6．3％（2／32），而常规治疗组病死率为23．3％（7／30），两组比较具有显著差异性（P〈0．05）；两组无严重出血并发症，出血并发症比较差异无显著性（P〉0．05）。结论尿激酶静脉溶栓治疗老年急性心肌梗死可以提高冠状动脉再通率，降低死亡率和改善预后，是可行性治疗措施。

Objective To investigate the intravenous thrombolytic efficacy and safety in senile patients（ ≥ 75 years of age） with acute myocardial infarction. Methods Sixty-two senile patients with acute myocardial infarction were randomly divided into thrombolysis group （32 cases） and the conventional therapy group （30 cases）; the cases in thrombolysis group gave intravenous thrombolysis with urokinase and low-dose subcutaneous injection of low-molecular-weight heparin calcium, in the conventional therapy group except urokinase, and small dose of low-molecular-weight heparin calcium, the other therapeutic programmes were the same. Results The coronary artery patency rate was 65.6% （21/32） in thrombolysis group, the conventional treatment group only 16.7% （5/30）, there were remarkable difference between the two groups （P 〈 0.05）. In thrombolysis group the mortality was 6.3% （2/32）, while the conventional therapy group 23.3%（7/30） also had a significantly different （P 〈 0.05）, but there was no serious bleeding complications in the two groups （P 〉 0.05）. Conclusion Urokinase intravenous thrombolytic therapy in senile patients with acute myocardial infarction can increase coronary artery patency rate, lower mortality and improve the prognosis.