阿替普酶溶栓后介入治疗对急性心肌梗死的临床研究

Clinical trial of interventional therapy after thrombolysis with alteplase on acute myocardial infarction

目的观察小剂量阿替普酶溶栓后介入治疗对急性心肌梗死的临床研究。方法将62例急性心肌梗死患者随机分为对照组和试验组,每组31例。对照组用直接介入治疗,术后皮下注射低分子肝素2~5 d,每次5000 U,每12 h给药1次,长期服用氯吡格雷,每次75 mg,每天1次,阿司匹林,每次100 mg,每天1次。试验组在对照组基础上用小剂量阿替普酶溶栓后介入治疗,先静脉推注阿替普酶8 mg,再将阿替普酶42 mg溶于生理盐水100 m L,用静脉泵缓慢泵入,时间90 min。比较2组患者心功能、手术情况、肌酸激酶同工酶(CK-MB)峰值和药物不良反应发生情况。结果术后3,30,90 d,2组左心室舒张末期容积指数(LVEDV1)、左心室收缩末期容积指数(LVESV1)和左心室射血分数(LVEF)差异均无统计学意义(均P>0.05)。治疗后,试验组和对照组的CK-MB峰值分别为(271.82±115.62),(445.27±179.74)U·L^-1,差异有统计学意义(P<0.05)。试验组术后血流TIMIⅡ~Ⅲ级占96.77%(30例/31例),药物不良反应发生率为12.90%(4例/31例);对照组分别为100.00%(31例/31例),3.23%(1例/31例),差异无统计学意义(P>0.05)。试验组慢血流或无复流者占3.23%(1例/31例),对照组为22.58%(7例/31例),差异有统计学意义(P<0.05)。结论小剂量阿替普酶溶栓后介入治疗能改善心功能,安全性较好,能够减少术中无复流和慢复流现象。

Objective To explore the clinical value on acute myocardial infarction using interventional therapy after thrombolysis with low-dose of alteplase.Methods Sixty-two patients with acute myocardial infarction were randomly divided into control group and treatment group,with 31 cases in each group.The control group was treated with direct interventional therapy,subcutaneous injection of low molecular weight heparin 2-5 d,5000 U,12 h a time,long-term administration of clopidogrel,75 mg a time,once a day,aspirin 100 mg,once a day.While the treatment group was treated with interventional therapy after thrombolysis with low-dose of alteplase,alteplase 8 mg was injected intravenously,then alteplase 42 mg was dissolved into normal saline 100 mL,and then pumped slowly by venous pump for 90 min.The levels of cardiac function,operation status,creatine kinase isoenzyme(CK-MB)peak and adverse drug reactions were compared between the two groups.Results There was no significant difference in left ventricular end diastolic volume index(LVEDV1),left ventricular end systolic volume index(LVESV1)and left ventricular ejection fraction(LVEF)between the two groups at 3,30 and 90 after operation(all P>0.05).The levels of CK-MB peak in treatment group and control group were(271.82±115.62),(445.27±179.74)U·L^-1,with significant difference(P<0.05).After operation,blood flow between TIMIⅡ-Ⅲgrade accounted for 96.77%(30 cases/31 cases),and the incidence of adverse drug reactions was 12.90%(4 cases/31 cases)in treatment group,while those in control group were 100.00%(31 cases/31 cases)and 3.23%(4 cases/31 cases).There was no significant difference between the two groups(P>0.05).Slow blood flow or no reflow during PCI occurred in treatment group and control group were 3.23%(1 case/31 cases),22.58%(7 cases/31 cases),with statistical difference(P<0.05).Conclusion Interventional therapy after thrombolysis with low-dose of alteplase can gradually improve cardiac function,with good safety.Moreover,interventional therapy with low-dose of alteplase can reduce slow blood flow or no reflow during operation.