阿替普酶与尿激酶溶栓治疗急性心肌梗死的疗效对比分析

Comparative analysis of alteplase and urokinase in the treatment of acute myocardial infarction

目的分析阿替普酶与尿激酶溶栓治疗急性心肌梗死的疗效及并发症。方法选择我院2008年9月至2012年8月急性心肌梗死经溶栓治疗的248例患者。将所选患者因溶栓药物不同分为A组(阿替普酶)和B组(尿激酶),每组124例。观察两组血管总再通率、发病6 h内及6 h后溶栓血管再通率、死亡率、出血等不良反应及并发症。结果发病6 h后溶栓,A、B组分别有28(70.0%)、18(47.4%)例再通;发病6 h内溶栓,A、B组分别有76(90.5%)、68(79.1%)例再通。两组比较差异有统计学意义(P<0.05)。A组死亡2例(1.6%),心力衰竭1例,心源性休克2例,脑出血1例,消化道出血3例,牙龈出血4例;B组死亡5例(4%),心力衰竭1例,心源性休克3例,脑出血4例,消化道出血5例,牙龈出血8例。两组患者均未出现过敏反应,以上各项两组比较差异均无统计学意义(P>0.05)。结论阿替普酶具有血管开通率高、出血等并发症少、安全及使用方便等优点,是一种高效安全的治疗急性心肌梗死的溶栓药物。

Objective To analyze the effect and complications of alteplase and urokinase in the treatment of acute myocardial infarction. Methods 248 patients with acute myocardial infarction in our hospital from September 2008 to August 2012 were randomly divided into 2 groups, 124 cases in each group. Group A was treated with alteplase, group B was treated with urokinase. The incidence of adverse reactions and fatality rate were observed after treatment with thrombolytic recanalization. Results There were 28 cases （70. 0% ） and 18 cases （47.4%） with recanalization in group A and group B when thrombolysis was given after 6 h of onset;there were 76 cases（90. 5% ） and 68 cases （ 79. 1% ） with recanalization in group A and group I3 when thrombolysis was given within 6 h of onset. There were significant differences between the two groups （ P 〈 0. 05 ）. There were 2 cases of death, 1 case of heart failure, 1 case of myocardial infarction,2 cases of cardiogenic shock,3 cases of cerebral hemorrhage,3 cases of hemorrhage in upper digestive tract in group A;while there were 5 cases, 1 case,3 cases,3 cases,4 cases,5 cases in group B respectively. Conclusion Alteplase has patency rates, high safety and convenient administration and other advantages, it is a safe and effective thrombolytic drug for acute myocardial infarction.