尿激酶加速给药方法的探讨

Evaluation of an accelerated regimen of urokinase

目的 探讨急性心肌梗死 (AMI)尿激酶静脉溶栓加速给药方法的临床疗效和安全性。方法 ① 4 5例AMI患者 ,均用尿激酶 2 0 0万U静脉溶栓治疗 ,其中 2 5例先静脉推注尿激酶 10 0万U ,余 10 0万U 30min静脉点滴 (A组 ) ;另 2 1例为全量 30min匀速静脉点滴 (B组 )。②在完成上述 4 5例对比观察后 ,连续按A组的方法治疗 10 2例 (C组 )。观察内容 :临床再通指标、溶栓并发症和溶栓前后的血液纤溶活性检测。结果 ①A组在溶栓 15min血液PAI活性被明显抑制 (已降到最低点 ) ,B组在 15min血液PAI活性的降低仅约 5 0 % (P <0 0 0 1) ,30min时两组PAI活性均降到最低点 ;②A组出现临床再通迹象 (ST段迅速回落 ;再灌注心律失常 )的时间比B组提前 ;③A组临床评价再通率高于B组 (76 %比 6 1 9% ,P >0 0 5 ) ;④C组临床观察结果与A组相似 ,临床再通率 78 4 %。 3组均未出现严重溶栓并发症。结论 尿激酶加速给药可加快对血液PAI活性的的抑制 ,从而使临床再通指标的出现提前 ,2h临床评价再通可能高于以往常用的方法 ,此方法安全可靠 ,操作简便 ,值得进一步推广和验证。

Objective To evaluate the clinical efficacy and safety of thrombolytic therapy with accelerated intravenous urokinase.Methods Firstly,we studied 46 patients with acute myocardial infarction.All the patients received thrombolytic therapy with 2 millions units of urokinase intravenously,25 of them with accelerated method,a front-loaded bolus with 1 million units followed by 1 million stable speed infusion(group A);21 with 2 million stable speed infusion(group B).Secondly,102 patients with a method same to the group A(group C).We observed the clinical reperfusion markers and the occurring time,changes of the activity of serum plasminogen activator inhibitor(PAI-1) and thrombolysis complications.Result Clinical reperfusion markers such as ST segment rapid resolution≥50% and reperfusion arrhythmia occurred in group A earlier and more than group B,the activity of serum PAI-1 decreased to a lowest level at 15 minutes after beginning of thrombolysis in group A and partly decreased in group B at the same time(P<0 001),no major bleeding and other complication occurred in all of the patients.Conclusion Accelerated intravenous urokinase speeds up the inhibition of PAI-1,and therefore make earlier and more occurrence of reperfusion markers than that of stable infusion method.It showed that the method is effective and safety,and worth to spread and further verification