国人小剂量与快速常规剂量rt-PA治疗急性心肌梗死的疗效与安全性比较

Comparison between effect and safety treated with low dose and rapid routine dose of rt-PA in Chinese patients with acute myocardial infarction/

目的:评价重组组织型纤溶酶原激活剂(rt-PA)快速给药对国人急性心肌梗死(AMI)溶栓治疗的疗效及安全性,并与小剂量rt-PA的疗效进行对比。方法:快速常规剂量组(R组)75例AMI病人在阿司匹林和肝素治疗后接受20mg rt-PA一次弹丸注射,随后80mg半小时内快速滴入,尽快行急诊冠状动脉造影响术。小剂量治疗组(S组)32例AMI病人在阿斯匹林和肝索治疗基础上接受8mg rt-PA一次弹丸注射,继之42mg在90分钟内滴入,并进行冠状动脉造影。以用药后冠状动脉造影显示梗死相关动脉(IRA)TIMI血流分级作为主要终点评价疗效。结果:107例冠状动脉造影的冠状动脉血流通畅率(TIMⅡ和Ⅲ级):R组显著高于S组(88％、75％,P<0.01),达到TIMI3级血流者R组亦高于S组(62％、47％,P<0.01);左室射血分数:R组明显高于S组(P=0.05);出血发生率:两组差异无显著性。结论:快速常规剂量rt-PA对国人AMI病人是有效和安全的。其冠状动脉再通率明显高于小剂量rt-PA治疗。

Objective:To compare the effect and safety treated with low dose and rapid routine dose of rt-PA in Chinese patients with acute myocardial infarction (AMI). Methods: All patients treated with aspirin and heparin therapy. Rapid routine dose group (R group, 75 cases) accepted intravenous bolus of 20mg rt-PA followed by intravenous infusion of 80 mg rt-PA over 30 minutes. Low dose group (L group, 32 cases) accepted intravenous bolus of 8mg rt-PA followed by intravenous infusion of 42mg rt-PA over 90 minutes. The primary endpoint was patency grade (TIMI flow) of the infarct-related artery (IRA) by coronary angiography at 90 minute after began treatment. Results: Patency rate (TIMI flow of Ⅱ , Ⅲ grade) of IRA was 88% in R group, it was higher than that of S group (75% , P<0. 01). Patient with TIMI Ⅲ grade occupied 62% in R group, it was higher than that of S group (47% , P<0. 01). LVEF of R group was higher than that of S group (P = 0. 05). The overall bleeding incidence was same for two group (P>0. 05). Conclusion: Rapid routine dose of rt-PA is effective and safe for Chinese patients with AMI. Its patency rate of IRA is higher than that of low dose therapy.