尿激酶溶栓治疗老年人急性心肌梗死的研究

Effect of intravenous Urokinase on aged patients with acute myocardial infarction

目的 :评价尿激酶 (UK)静脉溶栓治疗老年人 (≥ 60岁 )甚至高龄 (>70岁 )急性心肌梗死 (AMI)患者的疗效及安全性。方法 :将 2 81例 AMI患者按年龄段分成〔<60岁 (1 1 8例 )、60～ 70岁 (99例 )、>70岁 (64例 )〕3组 ,并对其中 1 63例老年 AMI患者的近期预后进行分析 (以同期未接受溶栓治疗的 46例老年 AMI患者作为对照组 )。结果 :随年龄增加 ,血管再通率逐渐下降 (P >0 .0 5) ,而病死率和出血反应有升高趋势 (P >0 .0 5) ;对老年 AMI患者慎用 UK 2 0 0万 IU以免诱发脑出血 ;老年 AMI患者溶栓组的病死率及治疗后主要并发症均显著或非常显著地低于未溶栓组 (P <0 .0 5或 <0 .0 1 )。结论 :老年甚至高龄 AMI患者接受溶栓治疗可显著改善近期预后 。

Objective:To evaluate the efficacy and safety of intravenous Urokinase(UK) on elderly patients(aged>70 years as well as ≥60 years) with acute myocardial infarction(AMI).Method:According to the different ages of patients,281 cases of AMI treated with UK were divided into<60 years (n=118),60～70 years (n=99) and >70 years (n=64) groups,and the early prognosis of 163 aged patients of them was compared with that of 46 elderly cases in equal term without UK.Result:The patency rate within 3 hours assessed by clinical standard was decreased as the ages of patients were raised(but P> 0.05 ),whereas the mortality in 5 weeks and bleeding reactions were increased (all P> 0.05 ).In order to prevent UK causing cerebral hemorrhage,intravenous 2 million IU should be avoided in the elderly cases. The mortality in aged patients with thrombolytic therapy was 11.0 % versus 30.4 % in those without (P< 0.01 ).Moreover,the incidences of various major complications after treatment were also lower in aged patients undergone thrombolysis,such as left heart failure ( 19.0 % vs 39.1 %,P< 0.01 ),cardiogenic shock ( 6.1 % vs 15.2 %,P< 0.05 ),severe arrhythmias( 19.0 % vs 32.6 %,P< 0.05 ),early postinfarction angina( 8.6 % vs 19.6 %,P< 0.05 ) and infarct extension ( 3.1 % vs 10.9 %,P< 0.05 ).Conclusion:Thrombolytic therapy with intravenous UK can improve the shortterm outcome of elderly patients(including aged>70 years) with AMI.The dosage of UK used should be small.