尿激酶溶栓治疗高龄急性心肌梗塞的疗效观察

THE CLINIC STUDY OF THROMBOLYTIC THERAPY USING UROKINASE IN AGED PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

目的 为观察尿激酶天普洛欣（ＵＫＴＰ）静脉溶栓治疗高龄急性心肌梗塞（ＡＭＩ）的临床有效性和安全性。方法 收集５０２ 例ＡＭＩ患者，按年龄分为３ 组：≥７０ 岁组（１１７ 例），～６９ 岁组（１５２ 例）和＜ ６５ 岁组（２３３ 例），观察临床疗效，副作用及病死率等。ＵＫＴＰ剂量为２００ 万Ｕ 至３００ 万Ｕ，采用Ｂｏ－ｌｕｓ法３０ｍ ｉｎ 内给药。结果 ①按临床梗塞相关血管（ＩＲＡ）再通标准，再通率依次为７０．９％ ，７９．６％ 和８１．５％ ．≥７０ 岁组与＜ ６５ 岁组间比较差异有显著性（Ｐ＜ ０．０５），总再通率为７８．５％ ．②５ 周病死率为３．４％ ，３．３％ 和３．０％ ，３ 组间差异无显著性（Ｐ均＞ ０．０５），总病死率为３．２％ ．③轻度出血发生率为１７．９％ ，１６．４％ 和１６．３％ ，３ 组间亦无差异（Ｐ均＞ ０．０５），中度出血发生率为０．９％ ，０．７％ 和１．３％ ，３ 组间无差异（Ｐ均＞ ０．０５）。出血总发生率为１７．７％ ．④溶栓后第７ 日ＥＦ≥５０％ 者为４８．７％ ，６０．５％ 和６３．９％ ．≥７０ 岁组和～６９ 岁组均显著降低（Ｐ＜ ０．０１，０．０５）。结论 对高龄ＡＭＩ进行尿激酶静脉溶栓治疗安全有效。

Objective To observe the clinical efficacy and safety of introvenous thrombolytic therapy using urokinase techpool(UKTP) in elderly patients with acute myocardial infarction(AMI).Method Five hundred and two patients with AMI were treated with UKTP and divided into three groups:≥70 years(117 cases),～69 years(152 cases) and <65 years (233cases).The clinic therapeutic efficacy, side effects and mortality were analyzed in aged patients with AMI treated with UKTP (The dosage of UKTP was 200 million U to 300 million U intravenous infusion within 30 minutes according to Bolus method).Result ①The reperfusion rate in infarct related artery (IRA)by clinic standards in ≥70 years group was 70.9%,significantly lower than that of <65 years group(81.5%,P<0.05).Total reperfusion rate of 502 cases was 78.5%.②The mortality in first five weeks in ≥70 years group was 3.4%,～69 years group was 3.3% and in <65 years group was 3.0% (P>0.05). The total mortality was 3.2%.③The rate of minor bleeding was 17.9%, 16.4% and 16.3%(P>0.05 ), major bleeding was 0.9%,0.7% and 1.3% (P>0.05).The total rate of bleeding was 17.7%.④The rate of EF≥50% at seventh day after thrombolytic reperfusion was 48.7%,60.5% and 63.9% .In comparision of ≥70 years group ,with <65 years group and ～69 years group was respectively singificant (P <0.01,0.05).Conclusion The thromblytic therapy with UKTP is effective,reliable and safe for aged patients with AMI.