院外静脉溶栓救治急性心肌梗死

Intravenous thrombolytic therapy in the onthespot treatment of acute myocardial infarction

目的 :使急性心肌梗死 (AMI)患者得到良好的临床治疗效果 ,并探讨院外 AMI患者溶栓治疗的可行性、安全性。方法 :连续观察发病≤ 6小时的 12 0例在院外给予静脉溶栓的 AMI患者 ,其中发病≤ 3小时内溶栓者 91例 ,发病 4～ 6小时溶栓者 2 9例 ,对比两者的冠状动脉 (冠脉 )再通率 ;同时与同期住院治疗的 12 0例 AMI患者比较。结果 :再通率 :≤ 3小时溶栓者 6 8.13% ,4～ 6小时溶栓者 5 8.33% ,两者比较差异显著 ,P<0 .0 0 5。确诊为 AMI距接受溶栓时间 :院外组为 (0 .5 4± 0 .5 8)小时 ,院内组为 (2 .74± 1.0 2 )小时 ;2组比较 P<0 .0 0 0 1。院外 AMI诊断准确率达 98.4% ,无一例死亡。结论 :急性心肌梗死院外静脉溶栓能减少不必要的耽搁时间 ,溶栓时间越早 ,冠脉再通率越高 ;院外溶栓治疗安全。

Objective:To verify the safety and practicability of intravenous thrombolytic therapy in the onthespot treatment of the patients suffering from acute myocardial infarction (AMI) so as to shorten the time between the onset of the disease and the treatment,thus improving the therapeutic effects of AMI.Methods:One hundred and twenty AMI patients receiving onthespot intravenous thrombolytic therapy were included in the study (group A).Ninetyone patients received the treatment within 3 hours after AMI,and the other 29 patients received the treatment between 46 hours after AMI.One hundred and twenty AMI patients received the treatment in hospital were included in the study as control.Results:The rates of reopening of coronary blood vessel were 68 13% and 58 33% respectively in patients who received thrombolytic therapy within 3 hours and 46 hours after AMI,and the difference was very significant ( P <0 005).The time for the patients to receive intravenous thrombolytic therapy was (0 54±0 58) hours in group A and (2 74±1 02) hours in control.The difference was also very significant ( P <0 000 1).The accurate rate of diagnosis for AMI was 98 4%,and no patients died in group A.Conclusions:Onthespot intravenous thrombolytic therapy can shorten the time interval between the onset of AMI and the treatment,significantly increase the reopening rate of coronary artery.Thus it is safe and practical.