瑞替普酶与尿激酶在急性 ST 段抬高型心肌梗死静脉溶栓治疗中的疗效比较

Comparison of the efficacy of reteplase and urokinase intravenous thrombolysis in treatment of patients with acute ST segment elevation myocardial infarction

目的：对比瑞替普酶与尿激酶在急性 ST 段抬高型心肌梗死溶栓治疗的临床效果。方法选择2013年10月至2015年10月经长治医学院附属和济医院确诊并接收治疗的116例急性 ST 段抬高型心肌梗死患者为研究对象，采用随机、单盲法将其分组两组，每组各58例。对照组患者采取尿激酶溶栓治疗，观察组患者采取瑞替普酶溶栓治疗，对比两组溶栓再通率、不良事件的发生率。结果观察组患者溶栓后0．5 h、1 h、1．5 h、2 h 时临床判断血栓再通率分别为27．59％、60．34％、81．03％、86．21％，均明显高于对照组的15.52％、29．31％、62．07％、70．69％，两组比较差异均有统计学意义（χ2＝3．853、3．907、3．898、3．524，均 P ＜0．05）；溶栓后1．5 h 时行冠状动脉造影结果显示，观察组梗死相关血管再通率为70．69％，完全再通率为60.34％，均明显高于对照组的55．17％和41．37％，两组比较差异均有统计学意义（χ2＝4．032、4．153，均 P ＜0．05）；两组不良事件发生率比较无显著差异（χ2＝0．250，P ＞0．05）。结论瑞替普酶用于急性 ST 段抬高型心肌梗死溶栓治疗效果优于尿激酶，具有较高的血管开通率，且不良事件发生率低，安全性好，值得临床推广和应用。

Objective To explore the curative effect of reteplase and urokinase in treatment of acute ST elevation myocardial infarction.Methods 116 patients with acute ST segment elevation myocardial infarction who were diagnosed and received treatment in our hospital from October 2013 to October 2015,were selected as the study subjects and were randomly divided into two groups with 58 cases in each group according to the single blind method. The control group was treated with urokinase thrombolytic therapy,while the patients in the observation group were treated with reteplase thrombolytic therapy.The thrombolytic recanalization rate,and adverse event incidence were compared in the two groups.Results The clinical judgement thrombosis recanalization rates in the observation group after 0.5h,1h,1.5h,2h of thrombolysis were 27.59%,60.34%,81.03% and 86.21% respectively,which were sig-nificantly higher than 15.52%,29.31%,62.07%,70.69% of the control group,the differences between the two groups were statistically significant（χ2 =3.853,3.907,3.898,3.524,all P 〈0.05）.After 1.5 h of thrombolytic ther-apy,the results of underwent coronary angiography showed that the infarct related artery recanalization rate of the observation group was 70.69%.The complete recanalization rate was 60.34%,which was significantly higher than 55.17% and 41.37% in control group,the differences between the two groups were statistically significant（χ2 =4.032,4.153,all P 〈0.05）.There was no significant difference between the two groups in the incidence of adverse events（χ2 =0.250,P 〉0.05）.Conclusion Reteplase for acute ST segment elevation myocardial infarction thrombo-lytic therapy is better than urokinase,has a high patency rate and low incidence of adverse events,it is safe and worthy of clinical popularization and application.