老年急性心肌梗死溶栓治疗的效果与危险

The effects and risks of thrombolytic therapy for elderly patients with acute myocardial infarction

目的 观察老年急性心肌梗死溶栓治疗的有效性与安全性。方法 全组 65岁以上患者共 88例 ,分为溶栓治疗组 41例和常规治疗对照组 47例。治疗组采用尿激酶 10 0万～ 15 0万u静脉滴注 ,3 0分钟滴完 ,同时给予肝素抗凝治疗。结果 梗死相关动脉的再通率溶栓组 65 9%显著高于对照组 10 6% (P =0 .0 0 0 ) ;发病 4wk内病死率 ,溶栓治疗组 12 2 % ,显著低于对照组 3 4 0 % (P =0 .0 46) ,再通者病死率 3 7% ,显著低于未通者 2 8 6% (P =0 0 47)。全组无 1例发生严重出血并发症。

Objective The aims of the study were to observe the efficacy and safety of thrombolytic therapy in the elderly patients wit acute myocardial infarction. Methods There were 88 cases (age 65 or above) to be divided into two group:urokinase troup (41 cases ,age 70.8±5 3 years) and routine therapy group (47 cases,age 72.3±6.5 years).Ln urokinase group,the patients were treated with intravenous urokinase group,the patients were treated with intravenous urokinase 1000000 to 1500000 IU over 30 minutes. Results The reperfusion rate in the infarct-related artery (IRA) was significantly higher in urokinase group than in control group (65.9% VS 10.6%,P=0.000).The mortality during 4 weeks was significantly lower in urokinase group than in control group (12.2% VS 34.0% ,P=0.046).The mortality of the patients whose IRA was reperfused was significantly lower than the patients whose IRA was non-reperfused (3.7% VS 28.6% P=0.047).There was no major bleeding in the study. Conclusion In the absence of contraindication,administration of intravenous urokinase to elderly patients with acute myocardial infarction is effective and safe.