瑞替普酶与尿激酶溶栓治疗急性ST段抬高型心肌梗死的疗效对比研究

Comparison of the therapeutic effect between reteplase and urokinase on the treatment of patients with STsegment elevation myocardial infarction

目的探讨基层医院急性ST段抬高型心肌梗死(STEMI)溶栓疗法中不同溶栓剂的选择和应用。方法 90例STEMI患者随机分为A组和B组各45例,A组采用瑞替普酶治疗,B组采用尿激酶溶栓治疗,比较两组的疗效及安全性。结果与B组比较,A组血管再通率较高(88.9%vs 71.1%,P<0.05),特别是发病时间>6 h者(66.7%vs 12.5%P<0.05);A组出院前左心室射血分数(LVEF)较高,脑钠肽(BNP)较低(P<0.05),心功能较好。两组均无致死性大出血及脑出血。结论瑞替普酶能早期快速开通梗死相关血管,减少心肌损伤,改善心功能和预后,是STEMI患者的更佳选择。

Objective To summarize the thrombolytic therapy for the patients with acute ST-segment eleva- tion myocardial infarction（STEMI） in a primary hospital. Methods Ninety patients with STEMI in our hospital from November 2013 to November 2015 were randomly divided into two groups：group A （n = 45 ） and group B （n = 45 ）. Group A was treated with reteplase and group B received urokinase. The clinical effect and the incidence of adverse reactions were observed and compared between the two groups. Results Compared with group B, group A had a higher revaseularization rate two hours（88.9% vs 71.1%, P 〈0. 05）, or six hours（66. 7% vs 12. 5%, P 〈0. 05） after the thrombolytie therapy. Compared with group B, group A had a higher ejection fration, a lower BNP level and better cardiac function（ P 〈 0. 05 ）. There were no significant differences in the risk of bleeding and death between the two groups. Conclusion Reteplase can recanalize the infarct-ralated arteries, reduce myocardial injury, improve the heart function and prognosis in the patients with early STEMI.