院前与冠心病监护病房联合应用重组组织型纤溶酶原激活剂与尿激酶溶栓治疗急性心肌梗死的对比分析

Comparative analysis of application of recombinant tissue-type plasminogen activator or urokinase in patients with acute myocardial infarction during pre- and coronary care unit hospitalized stage

目的探讨院前与院内联合快速处理急性心肌梗死（AMI）的方法。方法在院前与院内密切配合的情况下，由“120”急诊医师将AMI患者以最快捷的方式直接送入冠心病监护病房（CCU），应用重组组织型纤溶酶原激活剂（rt—PA）与尿激酶（UK）静脉溶栓治疗，对比分析rt—PA和UK治疗AMI的疗效。结果rt—PA组冠状动脉（冠脉）总再通率明显高于UK组[80．0％（48／60）比59．0％（36／61），P〈0．013；在发病〈3h溶栓治疗中，rt—PA组冠脉再通率也明显高于UK组[88．9％（32／36）比68．4％（26／38），P〈0．053。rt—PA组4周住院病死率明显低于UK组[6．7％（4／60）比13．1％（8／61），P〈0．053。结论rt—PA溶栓疗效优于UK，尤其是在患者发病3h内进行溶栓治疗效果更佳，住院病死率低。

Objective To investigate the combined rapid treatment for patients with acute myocardial infarction （AMI） at pre- and hospitalized stage. Methods Under the situation of close association between pre- and hospitalization, ＂ 120＂ emergency physicians immediately sent patients with AMI directly to the coronary care unit （CCU） in the quickest way, applied recombinant tissue-type plasminogen activator （rt-PA） or urokinase （UK） intravenous thrombolytic therapy for them, analyzed and compared the therapeutic effects between rt-PA and UK for treatment of AMI. Results The total re-canalization rate of coronary artery in rt-PA group was significantly higher than that in UK group [80%（48/60） vs. 59.0% （36/61）, P〈0.01] ; in the group the thrombolytic therapy applied within 3 hours after onset of AMI, the total coronary re-canalization rate of rt-PA group was significantly higher than that in UK group [88.9% （32/36） vs. 68.4% （26/38）, P〈0.05]; the mortality in 4 weeks during hospitalization in the rt-PA group was significantly less than that in the UK group [6.7% （4/60） vs. 13.1% （8/61）, P〈0.05]. Conclusion The thrombolytic action of rt-PA is more effective than that of UK, and the therapeutic effect is particularly better when the former agent is applied within 3 hours after the onset of AMI, and a lower mortality can be obtained during the hospitalization.