急性心肌梗死药物溶栓治疗的新进展

New Progress of Thrombolytic Treatment in Acute Myocardial Infarction

急性心肌梗死(AMI)属于严重的心血管事件,发病急,死亡率高,且发病率逐年增高,是目前急救医学中最常见的危重症。其死亡率的高低和缺血心肌改善与早期再灌注治疗密切相关。急诊经皮冠状动脉介入治疗(PCI)在目前急性心肌梗死患者的血管重建上有着显著优势,但基层医院因受各种因素影响,开展PCI比较困难,所以药物溶栓治疗仍然是当下基层医院治疗心肌梗死的重要措施。溶栓药物包括尿激酶,重组织型纤溶酶原激活剂(rt-PA),瑞替普酶等。近年来的研究发现,瑞替普酶作为第三代溶栓药物是一种新型的非糖基化纤溶酶原激活物,具有很强的纤维蛋白选择性。与其他溶栓药相比,瑞替普酶具有给药方便,易于掌握,血管开通时间提前,能尽早和更大限度地挽救濒死心肌等优点。

Acute myocardial infarction（AMI） is a kind of severe cardiovascular disease,manifested by acute onset and high mortality,and its morbidity has been rising year by year in our country. AMI is one of the most common heart diseasea mong critically ill patients. The mortality and improving heart function are directly related to earlier reperfusion treatment. Urgent percutaneous coronary intervention（PCI）had obvious advantage in blood vessel reconstruction,but carrying out PCI in grassroots hospital is difficult for various kinds of factors,so thrombolysis is still one of the important measures in the treatment of myocardial infarction in these hospitals. Urokinase（UK）,Tissue plasminogen activator（t-PA） and Reteplase all can be used as thrombolytic drugs clinically. In recent years,the research discovered that,as the third generation thrombolytic drug,Reteplase is a new kind of Plasminogen Activator with nonenzymatic glycosylation and has quite strong selectivity upon fibrous protein. As compared with other thrombolytic drugs,Reteplase has a lot of advantages,such as convenient administration,easy to grasp,earlier recanalization,saving ischemic myocardium to a greater extent,and so on.