瑞替普酶联合依诺肝素治疗急性ST段抬高型心肌梗死的疗效观察

Clinical effect of reteplase combined with enoxaparin in treatment of acute ST-segment elevation myocardial infarction

目的观察瑞替普酶联合依诺肝素治疗急性ST段抬高型心肌梗死(ASTEMI)的临床效果。方法选择2014-01~2016-01该院收治的ASTEMI患者90例,采用随机数字表法将其分为对照组和研究组,各45例。两组均采取常规治疗,在此基础上,对照组应用尿激酶与依诺肝素治疗,研究组应用瑞替普酶与依诺肝素治疗。观察两组治疗后30、60、90 min时梗死动脉的再通率,并发症发生率及1年后病死率。结果研究组治疗后30、60、90 min时梗死动脉的再通率为44.44%、51.11%、57.78%,分别高于对照组的22.22%、28.89%、35.56%(P<0.05)。研究组出血的发生率为4.44%,低于对照组的17.78%(P<0.05);随访1年,研究组病死率为4.44%,低于对照组的17.78%(P<0.05)。结论瑞替普酶联合依诺肝素治疗ASTEMI疗效满意,可以有效促使梗死动脉再通,降低出血率与病死率,适合临床推广。

Objective To investigate the clinical effect of reteplase combined with enoxaparin in the treatment of acute ST-elevation myocardial infarction(ASTEMI).Methods A total of 90 patients with ASTEMI were enrolled in our hospital from January 2014 to January 2016,and were randomly divided into the control group(n=45)and the study group(n=45).Both groups were treated with conventional therapy.Besides the conventional therapy,the control group was treated with urokinase plus enoxaparin,and the study group was treated with reteplase plus enoxaparin.The recanalization rate of infarcted arteries,and the incidence rates of complications and mortality were observed at 30 min,60 min and 90 min after the treatment.Results The recanalization rates of infarcted arteries in the study group were 44.44%,51.11%and 57.78%at 30 min,60 min and 90 min after the treatment respectively,and the corresponding indicators mentioned above in the control group were 22.22%,28.89%and 35.56%,with significant differences between the two groups(P<0.05).The incidence of bleeding in the study group(4.44%)was significantly lower than that in the control group(17.78%),P<0.05.After one year of follow-up,the mortality rate of the study group(4.44%)was significanthy lower than that of the control group(17.78%)(P<0.05).Conclusion Reteplase combined with enoxaparin has satisfactory curative effect on ASTEMI.It can effectively improve the recanalization rate of the infarcted artery,and reduce the rates of bleeding and mortality.