基层医院阿替普酶与尿激酶治疗急性ST段抬高型心肌梗死对比研究

Comparative study of alteplase and urokinase in treatment of acute ST-segment elevation myocardial infarction in basic level hospitals

目的:对比研究基层医院应用重组组织型纤溶酶原激活剂(rt-PA)阿替普酶与尿激酶(UK)治疗急性ST段抬高型心肌梗死(STEMI)的疗效及安全性。方法:资料完整的126例STEMI静脉溶栓患者,分为UK对照组(67例)和rt-PA治疗组(59例),对溶栓再通情况和溶栓并发症进行评价,并择期行冠状动脉造影评价梗死相关动脉(IRA)心肌梗死溶栓(TIMI)血流,比较两组30d的主要不良心血管事件(MACE)发生率。结果:溶栓治疗后,与UK组比较,rt-PA组梗死相关血管再通率明显提高(56.7%%比81.4%),左心衰竭(13.4%比5.1%)、心源性休克(7.5%比3.4%)、再缺血胸痛发生率(9.0%比3.4%)明显降低(P<0.01);皮肤穿刺部位轻度出血率升高(7.5%比27.1%,P<0.05);两组均未出现死亡病例,无严重出血及其他严重并发症。结论:使用重组组织型纤溶酶原激活剂溶栓治疗急性ST段抬高型心肌梗死,梗死相关血管再通率显著高于尿激酶,合并症少,安全性好。

Objective： To compare and study curative effect and safety of recombinant tissue type plasminogen activa- tor （rt- PA） alteplase and urokinase （UK） in treatment of acute ST- segment elevation myocardial infarction （STEMI） in basic level hospitals. Methods： A total of 126 STEMI patients undergoing venous thrombolysis with complete data were randomly divided into UK control group （n = 67） and rt- PA treatment group （n = 59）. Thrombolytic recanalization rate and complications were evaluated and thrombolysis in myocardial infarction （TIMI） blood flow grade of infarct- related artery （IRA） was evaluated using selective coronary angiography. Incidence rate of major adverse cardiovascular events （MACE） within 30d was compared between two groups. Results： Compared with UK group after thrombolysis, there were significant increase in recanalization rate of IRA （56.7%% vs. 81.4%） and mild bleeding rate at skin puncture site （7. 5% vs. 27. 1%, P〈0. 05 both）, and significant decrease in incidence rates of left heart failure （13.4% vs. 5.1%）, cardiogenic shock （7.5% vs. 3.4%） and recurrence of is- chemic chest pain （9.0% vs. 3.4%, P〈0.01 all） in rt- PA group; There were no death, severe bleeding and other severe complications in both groups. Conclusion.. Compare with urokinase, recombinant tissue type plasminogen activator may significantly improve recanalization rate of infarct- related artery, decrease complication, and is safe treating acute ST- segment elevation myocardial infarction