阿替普酶联合替罗非班在急性心肌梗死中的溶栓有效性与安全性的临床研究

Clinical Study of Efficacy and Safety of Alteplase Combined with Tirofiban in Treatment of Patients with Acute Myocardial Infarction

目的 探讨阿替普酶联合替罗非班在急性心肌梗死（AMI）中的溶栓有效性与安全性.方法 选取2011年1月～2014年6月在笔者医院心内科住院诊断急性心肌梗死的患者175例,将其随机分为阿替普酶联合替罗非班组（联合组）91例和阿替普酶组（单药组）84例.统计患者基本临床资料、入院24h内实验室检查结果、超声心动图及24h动态心电图检查,并记录住院期间心律失常、心力衰竭、心源性休克、心源性猝死等主要不良反应发生率.分析两组溶栓再通率、住院期间急性期病死率和不良事件发生率.结果 联合组溶栓治疗后30、60、90及120min的总再通率均高于单药组相应时间段的总再通率（P＜0.05）,联合组不良事件发生率低于对照组（P＜0.05）,出血并发症的发生率比较在,差异无统计学意义（P＞0.05）.结论 阿替普酶联合替罗非班在急性心肌梗死治疗中的溶栓再通率高于单用阿替普酶,并能有效降低不良事件发生率,且与单用阿替普酶相比不增加出血并发症的发生率,值得在临床应用和推广.

Objective To investigate the efficacy and safety of alteplase combined with tirofiban in treatment of patients with acute myocardial infarction（AMI）. Methods Totally 175 patients with acute myocardial infarction during January 2011 to June 2014 in our hospital were divided into two groups： aheplase combined with tirofiban group（combining group） （91 cases） and aheplase group （single group） （84 cases）. The Basic clinical data and laboratory results were collected within 24h. The cardiac function tests were performed for all the patients during the period of hospitalization after admission. Their echocardiographic parameters were analyzed, meanwhile the 24h dynamic electrocardiogram detection were performed. The incidence of major adverse cardiovascular events including malignant arrhythmia, heart failure,cardiogenic shock and sudden cardiac death during during the period of hospitalization was also observed and analyzed. Then the total recanalization rate at different times, fatality rate and incidence of complications of two groups were compared. Results The re- canalization rate by clinical Judgment at 30min,60min, 90min and 120min was higher in combining group than in single group,with statis- tically significant difference at the two groups（P 〈 0.05）. The rate of adverse events was lower in combining group than in single group, with statistically significant difference at the two groups（P 〈 0.05）. The incidence of bleeding complications bad no statistical significance between combining group and single group（P 〉 0.05）. Conclusion The thrombolysis effect of alteplase combined with tirofiban in pa- tients with acute myocardial infarction is better,and the safety profile of reperfusion therapy with combination of tirofiban for AMI is similar to that of single use of Aheplase. Aheplase is an effective, reliable and safe thrombolytic agent in the treatment of AMl,so the aheplase combined with tiroflban is worthy of clinical application.