纤溶酶原激活剂联合还原型谷胱甘肽治疗急性 ST 段抬高型心肌梗死的疗效观察

The effect of the recombinant tissue plasminogen activator combined with reduced glutathione in the treat-ment of acute ST-elevation myocardial infarction

目的：探讨重组人组织型纤溶酶原激活剂（ rt-PA）联合还原型谷胱甘肽（ RGSH）治疗急性ST段抬高型心肌梗死（ASTEMI）的疗效和安全性。方法110例确诊的ASTEMI患者按治疗方法不同分为对照组和观察组，每组各为55例，对照组每天静脉注射50 mg rt-PA，观察组在对照组基础上注射1200 mg RGSH冻干粉针。比较两组血管再通率，治疗前后心肌酶谱和心室结构和功能参数水平变化及不良反应情况。结果观察组血管再通率达到92．73％与对照组的89．09％差异无统计学意义（P＞0．05）；观察组治疗后CK、AST、cTnT、cTnI和CK-MB水平显著低于对照组水平（P＜0．05）；SOD水平为（134．27±20．19）U／L，显著高于对照组（P＜0.05）；LVEDd、LVESd分别为（52．24±5．83）mm和（39．95±7．06）mm，显著低于对照组（P＜0.05），EF达到（63．25±9．38）％，显著高于对照组（P＜0．05）；总不良反应率为10．91％，显著低于对照组的21.82％（P＜0.05），再梗死率仅为3．63％，显著低于对照组12．73％（P＜0．05）。结论 rt-PA常规溶栓治疗基础上联合RGSH能够提高ASTEMI患者的血管再通率，改善心室结构和功能、不良反应少，综合疗效优于单用rt-PA。

Objective To investigate the effect and safety of the recombinant tissue plasminogen activator （ rt-PA） combined with reduced glutathione （ RGSH ） in the treatment of acute ST-elevation myocardial infarction （ ASTEMI） .Methods 110 cases of ASTEMI were randomly divided into the control group and the observation group,55 cases in each group.The control group was intravenously injected 50mg rt-PA once a day,while the observa-tion group was injected 1200 mg RGSH freeze-dried powder once a day based on the control group .The vascular reca-nalization rate,the changes of myocardial enzymes ,cardiac structure and function parameters before and after treat-ment and adverse reactions in two groups were compared .Results The recanalization rate of the observation group and the control group reached 92.73%and 89.09% respectively,the difference between two groups was not signifi-cant （P〉0.05）.After treatment,the levels of CK,AST,cTnT,cTnI and CK-MB in the observation group were signifi-cantly lower than those of the control group （P〈0.05）,while the level of SOD was significantly higher than the con-trol group（P〈0.05）.The LVEDd and LVESd in the observation group were （52.24 ±5.83）mm and （39.95 ± 7.06）mm respectively,which were significantly lower than those in the control group （P 〈0.05）,while the EF [（63.25 ±9.38）%] was significantly higher than that of the control group （P〈0.05）.The total adverse reaction rate in the observation group was 10.91%,which was significantly lower than 21.82% in the control group （ P〈0.05）.The reinfarction rate in the observation group was 3.63%,which was significantly lower than 12.73% in the control group（P〈0.05）.Conclusion The rt-PA routine thrombolysis therapy combined with RGSH could improve the recanalization rate and left ventricular structure and function of the ASTEMI patients and has less adverse reac -tion.The curative effect is better than single rt-PA.