基层医院尿激酶静脉溶栓治疗急性心肌梗死128例临床观察

Thrombolysis therapy by intravenous administering of urokinase in 128 patients with acute myocardial infarction at elementary hospital

目的探讨基层医院早期尿激酶静脉溶栓治疗急性心肌梗死的临床效果。方法回顾性分析128例以尿激酶静脉溶栓治疗的急性心肌梗死患者的临床资料,根据发病时间将患者分为3组(<3h组,3～6h组及6～12h组),比较3组经溶栓治疗后的再通率。结果 128例急性心肌梗死患者接受溶栓治疗,总再通率71.09%,无死亡患者。<3h组再通率显著高于3～6h组[93.33%(28/30)vs.68.49%(50/73),P<0.05]及6～12h组[93.33%(28/30)vs.52.00%(13/25),P<0.05],差异有统计学意义。溶栓后2h内出现心律失常30例(23.43%),溶栓24h出现上消化道出血2例(1.56%),低血压2例(1.56%),急性左心衰6例(4.68%),经对症治疗未造成严重后果。结论尿激酶早期溶栓治疗急性心肌梗死患者能有效地挽救濒死心肌,改善患者的预后,是一种有效治疗方法。

Objectives To investigate the clinical effect of urokinase for treating acute myocardial infarction（AMI）.Methods One hundred and twenty eight patients with AMI underwent thrombolysis therapy by intravenous administering of urokinase were enrolled by retrospective analysis.They were assigned to three groups according to the time of morbidity：inner 3 hours group,3 to 6 hours group and 6 to 12 hours group.The recanalization rate after thrombolysis therapy were compared among the 3 groups.Results The total recanalization rate of the 128 cases who received the treatment of urokinase thrombolysis was 71.09%,and no dead case occured.Recanalization rate in inner 3 hours group was significantly higher than those of 3 to 6 hours group[93.33% （28/30） vs.68.49% （50/73）,P0.05] and 6 to 12 hours group [93.33% （28/30） vs.52.00% （13/25）,P0.05].There were 30 cases （23.43%） with arrhythmias in 2 hours after thrombolysis,and there were 2 case （1.56%） with upper gastrointestinal bleeding,2 case（1.56%）with hypotension and 6 cases（4.68%）with acute heart failure in 24 hours after thrombolysis,respectively.All of them were cured by symptomatic treatments.Conclusions The urokinase in treating AMI is an effective treatment,and it can retrieve the cardiac muscle on the brink of death and improve the prognosis of the patients.