溶栓疗法在初发急性心肌梗死中的应用

Use of thrombolytic therapy for first acute myocardial infarction

目的 :调查初发急性心肌梗死 (AMI)溶栓疗法的应用现状及近期疗效。方法 :总结我院 1996 - 0 1～ 1999- 0 8期间所有确诊初发 AMI患者的临床资料 ,发病超过 2 4h入院、外院转来、心内膜下心梗、再梗患者除外。结果 :2 0 2例初发 AMI患者中 ,148例 (73.3% )符合溶栓适应证 ,132例 (6 5 .3% )应用溶栓疗法 ,36例 (2 4.3% )未溶栓 (16例 )或溶栓药物剂量不足 (2 0例 )。 70例未溶栓患者中 ,发病—入院 >12 h、符合适应证而未予溶栓、溶栓禁忌、入院心电图不能确诊 AMI的比例分别为 6 0 .0 % ,2 2 .8% ,8.6 %和 8.6 %。溶栓组住院期间病死率显著低于未溶栓组(6 .1% vs15 .7% ,P<0 .0 5 ) ,其中再通组病死率显著低于未通组 (2 .3% vs2 0 .8% ,P<0 .0 1)。结论 :尽管溶栓疗法改善了 AMI的近期预后 ,但合理应用溶栓疗法的比例仍有待提高 ,患者入院过迟、溶栓治疗不积极是溶栓疗法应用偏低的主要原因。

AIM: To survey the use of thrombolytic therapy (TT) for first acute myocardial infarction (AMI) in recent years. METHODS Data from patients with confirmed first AMI were collected in a single center during 1996 through 1999. The exclusion criteria include: the interval from symptom onset to presentation >24 h, transferred from other hospitals, subendocardial MI, and reinfarction. RESULTS:Among 202 patients enrolled , 132(65.3%) of 148(73.3%) patients eligible for TT received TT, 36(24.3%) received insufficient dosage of thrombolytic agents (20) or even no TT (16). Among 70 untreated patients, the elapsed time from symptom onset to presentation >12 h, eligible but withholding from TT, contraindications, undiagnostic ECG were found in 22.8%, 60.0%, 8.6% and 8.6%, respectively. The inhospital mortality of patients treated with TT was significantly lower than in counterpart patients (6.1% vs 15.7%, P <0.05) . Of patients treated with TT, the mortality in the reperfusion subgroup was lower than in the counterpart subgroup(2.3% vs 20.8%, P <0.01) . CONCLUSION:Although TT improve the short term prognosis for first AMI, it was still underused in recent years. The late arrival of the patients and unaggressive attitude of attending physicians toward TT mainly explain this status.