小剂量尿激酶延迟溶栓与阿斯匹林加肝素钠治疗急性心肌梗死的疗效比较

The Clinical Effect of Delayed Thrombolytic Therapy with Low Dose Urokinase in Acute Myocardial Infarction

为探讨使用小剂量尿激酶延迟溶栓法治疗急性心肌梗死的临床疗效是否优于阿斯匹林加肝素钠 ,根据WHO的诊断标准 ,将 66例距发病时间 1 2～ 2 4h的急性心肌梗死患者随机分为两组 :尿激酶组 30例 ,阿斯匹林加肝素钠组 36例。以一周内心绞痛发生率、4周内病死率 ,心肌梗死并发症作为评定标准。结果发现 ,减少频发心绞痛发生率尿激酶组优于阿斯匹林加肝素钠组 (第一周 2 6 .7%比 36 .1 % ,P <0 .0 5) ,减少心衰竭并发症小剂量尿激酶组亦优于阿斯匹林加肝素钠组 (1 3 .3 %与 33 .3 % ,P <0 .0 5) ,4周病死率 ,两组间无显著差异 (3 .3 %与 2 .8% ,P >0 .0 5)。休克、严重心律失常、出血并发症两组间均无显著差异。此结果提示 ,小剂量尿激酶延迟溶栓治疗发病 1 2～2 4h内急性心肌梗死患者可降低频发心绞痛发生率及心肌梗死后心衰竭发生率。

Aim To evaluate the clinical effect of delayed thrombolytic therapy with low dose urokinase in acute myocardial infarction. Methods 66 cases of acute myocardial infarction with 12 h to 24 h after onset were divided randomly into two groups, low dose UK group (n=30) and aspirin plus heparin group (n=36). In low dose UK group, low dose UK 5 kIU/kg was given per half hour for 5 consecutive days. Results The number of patients with frequent angina was significant decrease in patients treated with low dose UK as compare with patients in aspirin plus heparin group, the differences were significant (first week: 26.7% vs 36.1%, P<0.05). The rate of heart failure was much lower in low dose UK group than aspirin plus heparin group, the differences were significant (13.3% vs 33.3%, P<0.05). There was no statistically significant difference in four week mortality(3.3% vs 2.8%, P>0.05). Frequency of shock, cardiac arrhythmias, adverse bleeding actions had no statistical significance between the two groups. Conclusion The number of patients with frequent angina and the rate of heart failure might be reduced by using low dose UK in acute myocardial infarction with 12 h to 24 h after onset.