35例心肺复苏后急性心肌梗死患者静脉溶栓治疗的分析

Analysis of thrombolytic therapy on 35 patients with acute myocardial infarction after cardiopulmonary resuscitation

目的：观察心肺复苏（ＣＰＲ）后急性心肌梗死（ＡＭＩ）患者静脉溶栓的疗效及存在的问题。方法：对３５例ＣＰＲ后ＡＭＩ患者（ＣＰＲ组）尿激酶静脉溶栓治疗情况进行回顾性分析，并与同期４２例无ＣＰＲＡＭＩ患者（对照组）静脉溶栓情况进行对比分析。结果：ＣＰＲ组发病至心脏停搏时间平均为（８４．０±３３．６）分钟，ＣＰＲ时间（７．７±３．０）分钟，平均溶栓时间为（９３．６±４８．８）分钟〔与对照组（１６３．１±６９．２）分钟比较，Ｐ＜０．００１〕；冠脉再通率为７４．３％（与对照组６６．７％比较，Ｐ＞０．０５），ＣＰＲ组无一例发生胸内出血，但有８例（２２．９％）发生上消化道出血，其中１例严重出血（与对照组上消化道出血７．１％比较，Ｐ＜０．０５）。结论：对ＣＲＰ成功后无创ＡＭＩ患者迅速进行静脉溶栓治疗不仅安全有效，而且可适当扩大溶栓治疗的“时间窗”；ＣＰＲ后需注意预防机体应激性反应，尤其是上消化道出血的发生。

Objective :To observe the effect of thrombolytic therapy on patients with acute myocardial infarction (AMI) after cardiopulmonary resuscitation (CPR). Methods :A retrospective investigation was made in two groups:patients after CPR were assigned in CPR group (n=35),and patients without CPR were in the control group (n=42). Results :Patients in CPR group received thrombolytic therapy much earlier than those in control group (936488)min vs.(1631692)min,P<0001,and coronary reperfusion rate in CPR group was higher compared with controls (743% vs.667%,P>005).However,the incidence of bleeding complications in upper gastrointestinal tract in CPR was significantly higher than in the control group (229% vs .71%,P<005). Conclusions :Thrombolytic therapy for non invasive patients with AMI after CPR is both feasible and safe,the time window of thrombolytic therapy may be extended properly.It is very important to prevent and treat bleeding complications induced by stress response on gastrointestinal tract afte