重组组织型纤溶酶原激活剂与尿激酶治疗急性ST段抬高型心肌梗死的疗效对比

Recombinant tissue-type plasminogen activator and urokinase treatment for patients with ST-segment elevation myocardial infraction

目的对重组人组织型纤溶酶原激活剂突变体-瑞替普酶(rt-PA)和尿激酶(UK)在急性ST段抬高型心肌梗死患者溶栓疗效的比较。方法选取2011年11月至2013年5月于岳阳市二人民医院心内科就诊的急性ST段抬高型心肌梗死患者63例,随机分为2组,分别给予rt-PA和UK进行溶栓治疗,即分为rt-PA组和UK组,比较2组溶栓再通率、并发症发生、心肌酶学指标、心电图、心功能预后等情况。结果 rt-PA组12 h内溶栓成功率为78.8%,UK组12 h内溶栓成功率为56.7%,前组显著高于后组(P<0.05),左心衰竭、心源性休克并发症的发生率rt-PA组比UK组更小,2组比较差异有统计学意义(P<0.05)。治疗3 h后,ST段回降情况rt-PA组优于UK组,且cTn-T峰值水平前者低于后者(P<0.05),血管再通时间前者短于后者(P<0.05)。治疗30 d后,rt-PA组的心功能恢复情况显著优于UK组(P<0.05)。结论 rt-PA组在溶栓成功率及安全性方面均优于UK组。

Objective To compare the therapeutic effect of recombinant tissue-type plasminogen activator（rt-PA） and urokinase（UK） for ST-segment elevation in the Department of Cardiology,Second People＇s Hospital of Yueyang.Methods A total of 63 patients with ST-segment elevation myocardial infraction from November 2011 to May 2013 were randomly divided into an rt-PA group and a UK group.Thrombolytic recanalization rate,complications,myocardial enzyme,electrocardiogram and cardiac function were observed.Results The thrombolytic recanalization rate in the rt-PA group at 12 h was 78.8%,significantly higher than that in the UK group（56.7%）（P 〈0.05）.The incidence of left heart failure and cardiogenic shock in the rt-PA group was lower than that in the UK group（P 〈0.05）.About 3 h after the treatment,the reduction of ST-segment in rt-PA group was more than that in the UK group,and the maximum of cTn-T in the rt-PA group was lower than that in the UK group（P 〈0.05）.The duration of recanalization was shorter in the rt-PA group than that in the UK group（P 〈0.05）.Thirty days after the treatment,the heart function in the rt-PA group was better than that in the UK group（P 〈0.05）.Conclusion The thrombolytic recanalization rate in the rt-PA group is higher than that in the UK group and the incidence of complications in the rt-PA group is lower than that in the UK group.