急诊应用HUTPA、rt-PA溶栓治疗STEMI临床比较

Comparison of clinical effect of HTUPA and rt-PA in emergency patients with STEMI

目的:观察急诊应用HUTPA和rt-PA治疗急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)的疗效和安全性。方法:对发病在12h内的74例STEMI患者随机分为HUTPA组(n=37)和rt-PA组(n=37),分别一次性静脉推注HUTPA 25mg和静脉注射rt-PA 100mg,在溶栓90min时行冠脉造影检查,评价梗死相关动脉开通率,监测溶栓30d不良事件发生率。结果:在STEMI发病3h内静脉应用HUTPA和rt-PA梗死相关动脉开通率分别为95.65%和81.82%,发病12h内静脉应用HUTPA和rt-PA梗死相关动脉开通率为83.78%和81.08%,差异无统计学意义(P>0.05);在溶栓前、溶栓6h、溶栓12h及溶栓7d血浆纤维蛋白原两组无显著性差异(P>0.05);在30天出血、心律失常、心力衰竭、再梗塞及全因死亡不良事件两组差异无统计学意义(P>0.05)。结论:与rt-PA比较HUPTA治疗STEMI病人同样安全有效,且使用方法简便、易操作。

Objective：To investigate the effect and safety of HTUPA and rt-PA in emergency patients with ST- elevation acute myocardial infarction （STEMI）. Method： 74 STEMI patients within 12 hours after onset were divided randomly into HTUPA group （n=37） and rt-PA group （n=37）. HUPTA were injected 25 rng one and rt-PA was injected and dropped 100 mg. The patency of involved coronary artery was evaluated by selective coronary angiography at 90 minutes after thrombolytic therapy,and the adverse event of all patients were observed in 30 days after thrombolytic therapy. Result：The rates of resumed of obstructed coronary artery were 95.65 % in HTUPA treated patients and 81.82% in rt-PA treated patients within 12 hours after onset,and it was 83.78% in HTUPA treated patients and 81.08% in rt-PA treated patients within 3 hours after onset（P〉O. 05）. There were no significant differences in plasma fibrinogen before thrombolytic,at 6 hours 24 hours and 7 days after thrombolytic between two groups（P〉0.05）. The rates of bleeding,arrhythmia,heart failure;＇recurrent myocardial infarctions and all kind reason death showed no differences between two groups 30 days after thrombolytic（P〉0.05）. Conclusion： HUPTA is effective and safe as same as rt-PA for the patients with STEMI,and it was used easily.