瑞替普酶院前静脉溶栓治疗急性ST段抬高型心肌梗死87例的疗效及安全性

Efficacy and safety of reteplase pre-hospital intravenous thrombolysis in the treatment of 87 cases of acute ST-segment elevation myocardial infarction

目的分析瑞替普酶院前溶栓治疗急性ST段抬高型心肌梗死(STEMI)的疗效及安全性。方法选取147例在我院进行院前静脉溶栓STEMI患者,按照治疗方法分为瑞替普酶(r-PA)组87例、尿激酶(UK)组60例。r-PA组首次给予r-PA 18mg+0.9%氯化钠10mL静推,30 min后重复给药1次,每次给药在2~3 min内缓慢静推;UK组给予UK 70万U+0.9%氯化钠20mL静推,5 min后给予UK 80万U+0.9%氯化钠100mL,0.5h内静滴完。比较两组患者的临床疗效。结果发病后2h内溶栓、2~6h内溶栓,r-PA组再通率及总再通率高于UK组(P<0.05);r-PA组血管再通时间和不良反应总发生率优于UK组(P<0.05)。结论应用r-PA院前溶栓治疗STEMI,给药方便,再通率高,副作用少。

Objective To analyze the curative effect and security of reteplase pre-hospital thrombolysis on ST-segment elevation myocardial infarction （STEMI）. Methods One hundred and forty-seven cases of patients with STEMI admitted in our hospital were divided into reteplase （r-PA） group （n=87） and urokinase （UK） group （n=60） according to treatment mets. R-PA group was given r-PA 18 mg＋0.9% sodium chloride 10 mL for the first time, after 30 minutes, the administration repeated once, with slow intravenous push in 2-3 minutes each time; UK group was given UK 70 million U＋0.9% sodium chloride 20 mL static push, and given UK 80 million U＋0.9% sodium chloride 100 mL 5 minutes later, with intravenous dripping in 0.5 hour. The clinical effects were compared between the two groups. Results Within 2 hours after onset and at 2-6 hours after onset, the recanalization rate and total recanalization rate of r-PA group were higher than those of UK group （P〈0.05）. The time of reeanalization and total incidence rate of adverse reactions in r-PA group was significantly su- perior to those in UK group （P〈0.05）. Conclusion R-PA pre-thrombolytic therapy applied on STEMI has advantages of convenient administration, high recanalization rate and less side effects.