尿激酶联用硫酸镁治疗急性心肌梗塞的研究

Study of urokinase combined with magnesium sulfate in the treatment of early acute myocardial infarction

目的评价尿激酶(UK)联用硫酸镁(MS)治疗急性心肌梗塞(AMI)的临床疗效及安全性。方法151例AMI住院患者随机分为UK +MS组(UM组 ,76例)和UK组(75例) ,除UM组在静滴UK前15min开始加用MS外 ,余相同。结果UM组的再通率有高于UK组趋势 ,而5周病死率、心力衰竭、梗塞后心绞痛、再梗塞及梗塞延展的发生率均明显低于UK组(P均<0.01)。结论UK联用MS治疗AMI优于UK疗法 ,MS可作为一种安全有效的溶栓治疗辅助剂。

Aim To evaluate the efficacy and safety of urokinase (UK) combined with magnesium sulfate (MS) in the treatment of early acute myocardial infarction (AMI). Methods One hundred and fifty_one patients with AMI admitted to hospitals from December 1991 to May 1998 were randomly divided into two groups, 76 cases in UK plus MS (UM) group and 75 cases in UK group. In UM group, MS begen to be used 15 minites before intravenous drip of UK. Dose of UK in both groups was equivalent . The patency of infarct _related coronary artery within three hours (including delayed patency )was assessed by uniform clinical criteria. Results The recanalization rate was higher in UM group than in UK group, but there was no statistical significance (73.7% vs 65.3%,P>0.05). five_week mortality was 1.3% and 9.3% respectively. The difference was abvious (P<0.05). Incidence of reperfusion arrhythmias was dramatically decreased (64.3 vs 87.8%, P<0.01) in UM group. Moreover, frequency of severe arrhythmias after thrombolysis was much lower in UM group than that in UK group (10.5% vs 28.0%, P<0.01).In comparison with UK group, incidences of left heart failure (11.8% vs 25.3%), early postinfarction angina (3.9% vs 13.3%)reinfarction and infarct extension (2.6% vs 10.7%) were significantly reduced (all P<0.05) in UM group, and frequency of cardiogenic shock (3.9% vs 8.0%) was lower, but it was not significant (P>0.05). Conolusions The efficacy of UK combined with is was superior to that of UK alone, for AMI and MS might be an effective and safe adjunct for thrombolytic therapy.