重组组织型纤溶酶原激活剂治疗心肌梗死的临床观察

Clinical observation of recombinant tissue-type plasminogen activator in the treatment of patients with myocardial infarction

目的探讨重组组织性纤溶酶原激活剂治疗心肌梗死的临床疗效。方法选择2011年3月-2012年8月我院住院AMI患者69例,随机分为重组组织型纤溶酶原激活剂组(γt-p A组)34例与尿激酶组(UK组)35例。分别采用γt-p A及国产尿激酶溶栓治疗。观察比较2组临床效果、病死率及不良反应。结果γt-p A组总再通率67.6%(23/34),优于UK组的48.6%(17/35),差异有统计学意义(P<0.05)。γt-p A组住院4周病死率3例(8.8%)低于UK组的5例(14.3%),但差异无统计学意义(P>0.05)。2组不良反应均为牙龈轻度出血或消化道小量出血,未见脑出血等重大不良反应事件。γt-p A组2例(5.9%);UK组4例(11.4%),2组比较差异无统计学意义(P>0.05)。结论γt-p A治疗AMI再通率高,不良反应少,溶栓疗效优于UK,适合作为基层医院AMI溶栓首选药物。

Objective To explore the clinical effect of recombinant tissue-type plasminogen activator in the treatment of patients with myocardial infarction. Methods 69 cases of patients with AMI in our hospital were selected from March 2011 to August 2012,and randomly divided into recombinant tissue-type plasminogen activator group（ γt-p A group,34 cases） and urokinase group（ UK group）. The 2 groups were given thrombolytic therapy withγt-p A and urokinase respectively. The clinical effect,mortality and adverse reactions of 2 groups were observed. Results The total recanalization rate of inγt-p A group was67. 6%（ 23 /34）,which was higher than 48. 6%（ 17 /35） of UK group,the differences was statistically significant（ P〈0. 05）.The case fatality rate inγt-p A group was 8. 8%,and it was 14. 3% in UK group,the difference was not statistically significant（ P〉0. 05）. The adverse reactions of the 2 groups were mild bleeding gums or slight bleeding of the digestive tract. There were no major adverse events such as cerebral hemorrhage in 2 groups. Theγt-p A group was 2 cases（ 5. 9%）,and the UK group was4 cases（ 11. 4%）,the difference was not statistically significant（ P〉0. 05）. Conclusion The recanalization rate of γt-p A is higher in the treatment of AMI,with less adverse reactions,which is suitable for the first choice to AMI thrombolysis in primary hospital.