院前溶栓对急性S-T段抬高型心肌梗死患者的疗效分析

Curative Effect Analysis of Recombinant Tissue-type Plasminogen Activator in Pre-hospital Emergency Service for Patients with ST-segment Elevation Myocardial Infarction

目的评价院前应用重组组织型纤溶酶原激活剂(rt-PA)对急性S-T段抬高型心肌梗死(STEMI)患者的疗效及安全性。方法选择2007年4月至2011年4月因严重胸痛呼叫120的急性STEMI患者84例,随机分为试验组和对照组各42例。试验组院前急救中给予rt-PA,对照组常规治疗,两组入院后即刻行PCI术。收集所有病例的临床和冠状动脉造影资料,观察PCI术前、术后即刻罪犯血管(CV)的TIMI血流分级,术后6、12h肌酸激酶同工酶(CK-MB)的改变以及术后30d内的主要不良心脏事件(死亡、新近心肌梗死和顽固性缺血状态)、药物不良反应(出血、血小板减少)。结果试验组于院前应用rt-PA使PCI前梗死相关动脉(IRA)血流分级提高,与对照组比较差别有统计学意义(P<0.05);PCI术后即刻CV的TIMI血流分级、CK-MB值方面试验组明显优于对照组(P<0.01);住院期间不良心血管事件(MACE)发生率试验组低于对照组,但差异无统计学意义(P>0.05)。两组均未发生严重出血并发症(包括大量出血和颅内出血等),出血事件发生率试验组较对照组有增多趋势但差异无统计学意义(P>0.05)。结论院前应用rt-PA可改善STEMI患者梗死相关动脉(IRA)的TIMI血流,且安全有效,疗效优于常规治疗。

Objective To assess the efficacy and safety of recombinant tissue-type plasminogen activator（rt-PA） for patients with ST-segment elevation myocardial infarction in pre-hospital emergency service.Methods Eighty-four patients with STEMI（calling 120 because of serious chest pain） from April 2007 to April 2011 were divided into two groups,experimental group（rt-PA） 42 cases,control group（conventional intervention） 42 cases.The coronary reperfusion flow（TIMI grades） of vessel（CV） flow before and after operation cardiac enzyme changed 6 hours and 12 hours afterwards,major adverse cardiac events rates within 30 days（including death,new onset myocardial infarction,persistent myocardial ischemic state） and adverse drug effect（bleeding,platelet reduction） were observed in all cases after immediately PCI.Results By using rt-PA in pre-hospital emergency service improved TIMI flow before operation（P0.05）,TIMI flow of infarction related artery（IRA） in experimental group was higher as compared with control group（P0.01）.The average TIMI reperfusion grades and CK-MB levels at 6 hours and 12 hours after PCI were better in the experimental group than in the control group respectively.Reperfusion arrhythmia was less in experimental group（9.52% vs 21.43%,P-0.05）.MACE rates in hospital experimental group was lower than that in control group（4.76% vs 14.29%,P0.05）.There was no severe hemorrhage complications（severe hemorrhage or cerebral hemorrhage） in both groups.The bleeding events tended to be higher in experimental group（9.52% vs 7.14%,P0.05）.Conclusion rt-PA in pre-hospital emergency service may improve TIMI flow of the IRA in patients with STEMI and is a safe therapy,more efficacious than conventional intervention.