急性心肌梗死不同时期及剂量尿激酶静脉溶栓治疗的临床观察

The Clinical Efficacy of Thrombolytic Therapy in Different Starting Time of Treating Acute Myocardial Infarction with Different Doses of Urokinase

目的:探讨急性心肌梗死发病不同时期、不同剂量尿激酶静脉溶栓治疗的疗效及安全性。方法:对173例采用尿激酶溶栓治疗的急性心肌梗死病人的临床资料作回顾性分析,比较发病不同时期、不同剂量尿激酶静脉溶栓治疗的疗效及安全性。结果:使用50万u、75～100万u、120～150万u尿激酶静脉溶栓治疗的再通率在起病3小时内组分别为64.3%、78.9%、77.8%(三者无显著性差异,P>0.05);在起病3～6小时组分别为16.7%、25.0%、70%(后者与前二者比较,差异有显著性,P<0.05);在起病>6～12小时组分别为0、11.1%、15,8%(三者无显著性差异,P>0.05)。使用50万u、75～100万u、120～150万u尿激酶静脉溶栓治疗病人的出血发生率分别为2.1%、10.4%、12.5%(前者较后两者低,P<0.05)。结论:急性心肌梗死起病3小时内,予尿激酶50万u可达到有效的溶栓目的,且可减少出血并发症。而起病3～6小时者,则宜予尿激酶120～150万u方可达到有效的溶栓目的。

Objective: To investigate the effects of thrombolytic therapy in different starting time of treating acute myocardial infarction with different doses of urokinase(UK). Methods; 173 patients with AMI who were treated by intravenous UK were reviewed, the clinical efficacy and safety of different start-ing time of treatment and different doses were compared. Results: The results showed that when doses of UK was 0. 5 million u、 0. 75 ~ 1. 0 million u、1. 2 ~ 1. 5 million u, the recanalization rate was 64. 3 %, 78.9%, 77.8% in 3 hours after onset of symptoms(the differences were no statistically significant, P> 0.05). The recanalization rate was 16. 7%, 25.0%, 70.0% in 3~6 hours after onset(the recanalization rate in the third group was significantly higher than that in the first two groups, P<0.05). The recanal-ization rate was 0, 11.1%, 15.8% in 6~12 hours after the onset(the differences were no statistically sig-nificant, P>0.05). The incidence of bleeding were 2.1%, 10.4%, 12.5% when doses of UK was 0. 5 million N 0.75~ 1.0 million 、 1.2~1.5 million(the bleeding rate of the first group was significantly lower than the later group, P<0.05). Conclusion: Within 3 hours after the onset of AMI, UK of 0.5 million are effective in thrombolytic therapy, and the incidence of bleeding is lower than others. But within 3~6 hours, UK doses of 1.2~1.5 million are just effective in thrombolytic therapy.