尿激酶溶栓与瑞替普酶溶栓治疗急性心肌梗死的效果比较

Comparison of effects of reteplase thrombolysis versus urokinase thrombolysis in the treatment of acute myocardial infarction

目的比较尿激酶溶栓与瑞替普酶溶栓对急性心肌梗死患者的治疗效果。方法选取2016年3月至2019年3月大同煤矿集团有限责任公司三医院收治的急性心肌梗死患者90例,按随机数字表法分为对照组和观察组,每组45例。对照组使用尿激酶溶栓治疗,观察组使用瑞替普酶溶栓治疗,栓溶后,通过心电图、心率变化、心肌酶及临床症状比较两组患者的再通率,并比较两组患者的再通时间及肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)峰值,记录出血并发症及不良心血管事件(MACE)发生情况。结果观察组溶栓后1、6、12 h的再通率[37.78%(17/45)、62.22%(28/45)、84.44%(38/45)]均高于对照组[15.56%(7/45)、37.78%(17/45)、64.44%(29/45)],差异有统计学意义(P<0.05);观察组再通时间[(0.77±0.14)h]短于对照组[(1.36±0.20)h],且CK[(1657.22±334.52)U/L]与CK-MB[(196.65±26.51)U/L]峰值低于对照组[(2756.29±425.71)、(430.78±37.63)U/L],差异有统计学意义(P<0.05);两组患者的出血并发症发生率比较,差异未见统计学意义(P>0.05);两组患者的再梗死、心力衰竭、心绞痛、病死率及总并发症发生率比较,差异均未见统计学意义(P均>0.05)。结论针对急性心肌梗死患者使用瑞替普酶溶栓起效快,安全性高,有利于促进梗死血管再通率,降低患者CK与CK-MB峰值,且出血与MACE发生率较低。

Objective To compare the effects of reteplase thrombolysis and urokinase thrombolysis on patients with acute myocardial infarction.Methods A total of 90 patients with acute myocardial infarction admitted to the No.3 Hospital of Datong Coal Mine Group from March 2016 to March 2019 were selected and divided into control group and observation group according to the random number table method,with 45 patients in each group.The control group was treated with urokinase thrombolysis,while the observation group was treated with reteplase thrombolysis.After thrombolysis,the recanalization rate of the two groups was compared by electrocardiogram,heart rate,myocardial enzymes and clinical symptoms.And the recanalization time,creatine kinase(CK),creatine kinase isoenzyme(CK-MB)peak of the two groups were compared.Moreover,the bleeding complications and adverse cardiovascular events(MACE)were recorded.Results The recanalization rate of the observation group at 1,6 and 12 h after thrombolysis were 37.78%(17/45),62.22%(28/45)and 84.44%(38/45),respectively,higher than the 15.56%(7/45),37.78%(17/45),64.44%(29/45)of the control group,and the difference was statistically significant(P<0.05).The recanalization time of the observation group was(0.77±0.14)h,shorter than the(1.36±0.20)h of the control group,and the peak values of CK and CK-MB of the observation group were(1657.22±334.52)U/L and(196.65±26.51)U/L,respectively,significantly lower than(2756.29±425.71)U/L and(430.78±37.63)U/L of the control group(P<0.05).There was no significant difference in the incidence of bleeding complications between the two groups(P>0.05).There was no statistically significant difference in secondary infarction,heart failure,angina pectoris,case fatality rate or total incidence between the two groups(all P>0.05).Conclusions Reteplase thrombolysis in the treatment of acute myocardial infarction works fast and has high safety,which is conducive to promoting the vascular recanalization rate,reducing the peak values of CK and CK-MB in patients,with low incidence of bleeding and MACE.