急诊应用瑞替普酶、重组链激酶溶栓治疗ST段抬高型心肌梗死临床分析

Comparison of Curative Effect of Reteplase and Recombinant Streptokinase in the Patients with ST-Elevation Myocardial Infarction

目的比较第三代静注溶栓药物瑞替普酶和重组链激酶对ST段抬高型心肌梗死患者进行静脉溶栓治疗的临床疗效。方法静脉溶栓治疗ST段抬高型心肌梗死患者40例,其中瑞替普酶组22例,重组链激酶组18例,观察血管再通率、死亡率、心力衰竭及休克等并发症和出血不良反应。结果瑞替普酶组和重组链激酶组的临床再通率分别为86.36%和66.66%,其中60 m in及90 m in再通率瑞替普酶组高于重组链激酶组,差异有统计学意义(P<0.05)。溶栓后30 d内再闭塞率、心力衰竭及梗死后心绞痛发生率两组差异无统计学意义(P>0.05),死亡率分别为4.55%和5.55%,差异有统计学意义(P<0.05),出血发生率瑞替普酶组高于重组链激酶组,差异有统计学意义(P<0.05)。结论瑞替普酶、重组链激酶均适合急诊室内急性心肌梗死患者的静脉溶栓治疗,瑞替普酶早期再通率高于重组链激酶。

Aim To observe the curative effect of reteplase （ rPA ） and recombinant streptokinase （ r-SK ） in the patients with ST-elevation myocardial infarction （STEMI）. Methods Forty patients with STEMI had accepted rPA（22 cases） or r-SK （ 18 cases） , The patency of infarct-related coronary artery was assessed by unified clinical criteria. The re- vascularization rate, mortality, cardia failure, shock and incidence of bleeding complications were observed. Results 120 minutes after thrombolysis, the revascularization rate were 86.36% , 66.66% in rPA group and r-SK group respectively. The early reperfusion rates （ 60 minutes and 90 minutes） of rPA group is higher than those of r-SK group. The differences was statically significant （ P 〈 0.05 ）. The rates of recurrent myocardial infarctions, heart failure, cardiac shock, postinfarction angina pectorls showed no differences in two groups 30 days after thrombolysis （ P 〉 0.05 ）. The mortalities of two groups were 4.55% in rPA group, 5.55% in r-SK group （P 〈 0.05）. Bleeding incidence was more often in rPA group than in r-SK group （ P 〈 0.05 ）. Conclusion Reteplase and recombinant streptokinase are all effective and safe thrombolytic agents in the treatment of STEMI in emergency department. The early reperfusion rate of reteplase is higher than that of recombinant streptokinase.