小剂量rt-PA治疗老年急性心肌梗死的临床研究

Clinical Trial on the Treatment of Acute Myocardial Infarction in Eldly Patients by Low Dose of rt-PA

目的:探讨小剂量(50 mg)重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗老年急性心肌梗死(AMI)的疗效及安全性。方法:老年AMI患者57例,90分钟内静脉注射rt-PA 50mg,依据临床指标判断再通与否。应用超声心动图比较再通组与未通组的心功能。结果:冠脉再通率71.9%(41/57),再通组心功能明显好于未通组(P<0.01),5周病死率再通组2.4%显著低于未通组(12.5%)(P<0.001)。住院期间再梗死率7.0%(4/57),出血发生率14.0%(8/57)。结论:小剂量rt-PA静脉溶栓可获较高冠脉再通率,明显改善心功能,降低病死率、出血并发症及医疗费用。

Objective: The aim of the study was to evaluate the safety and efficacy with intravenous thrombolytic therapy by recombinant tussue-type plasminogen activator( rt-PA) 50 mg in eldly patients with AMI. Methods: The rt-PA was administered by an intravenous bolus of 8 mg followed by infusion of 42 mg over 90 minutes in fifty seven eldly patients of AMI. Heparin was given intravenously to all patients. The coronary reperfusion was determined by the uniform clinical criteria and heart function was compared be-tween the re-opened and non-opened group by echocardiography. Results: The coronary reperfusion rate, reinfarction rate and bleeding incidence were 71. 9%, 7.0% and 14.0% respectively. There were signifi-cant differences of the improved heart function ( P < 0. 01) and the mortality within 5 weeks (2.4% vs 12. 5%, P<0.001) between two groups. Conclusion: The treatment with transvenous low dose of 11111111rt-PA could acquire the higher rate of coronary reperfusion, remarkably improve the heart function and reduce the mortality and bleeding incidrtence.