重组链激酶在急性心肌梗死溶栓时最佳滴速探讨

The best drop velocity of recombinant streptokinase for treatment of acute myocardial infarction

目的探讨重组链激酶在急性心肌梗死溶栓时的最佳滴速。方法将我院2005年8月至2008年8月204例住院应用重组链激酶溶栓的急性心肌梗死患者的疗效进行回顾性分析并统计。将这些患者按重组链激酶滴速回顾性分为30min组68例、40min组72例和50min组64例。观察3组冠状动脉再通率、恶性事件发生率及药物不良反应发生情况。结果30min左右滴完的患者冠状动脉再通率91．18％，但再灌注心律失常严重，多在滴完后10min左右出现；在40min左右滴完的患者冠状动脉再通率为88．89％，再灌注心律失常呈一过性，多在滴完后30min至1h内出现，一般不需要处理；在50min左右滴完的患者冠状动脉再通率为67．18％，再灌注心律失常多在滴完后1h-2h内出现，一般也不需要处理。3组各发生消化道出血1例，共3例；40min组和50min组各发生牙龈出血1例，共2例。这些患者经对症处理后1h症状消失。3组未出现脑出血，也无明显过敏症状发生，所有患者溶栓后24h及1周后查肝肾功能均无明显异常变化。结论急性心肌梗死患者应用充足重组链激酶进行溶栓，滴速限制在40min左右滴完较为安全，有效性较好。

Objective To discuss the best drop velocity of recombinant streptokinase for treatment of actue myocardial infarction. Methods Two hundred and four patients with acute myocardial infarction treated by recombinant streptokinase from August 2005 to August 2008 were reviewed. All patients were retrospectively divided into three groups by drop velocity. Results The coronary artery repantency rate in about 30 minutes after the recombinant streptokinase was 91. 18%. But the arrhythmia which mostly appeared about 10 minutes after the medicine was severe. The repantency rate in about 40 minutes was 88.89% and the arrhythmia was appeared about 30 minutes to one hour. But the arrhythmia was provisional and dont need to be treated. The repantncy rate in about 50 minutes was 67.18%, the arrhythmia was appeared about 1 to 2 hours and needed not to be treat. Conclusion The best safe drop velocity of recombinant streptokinase in treatment of acute myocardial infarction is about 40 minutes.