院前、院内小剂量重组组织型纤溶酶原激活剂静脉溶栓治疗急性心肌梗死的临床研究

A Clinical Study on Prehospital Versus In-hospital Intravenous Thrombolytic Therapy With Low Dose Recombinant Tissue-Type Plasminogen Activator in Acute Myocardial Infarction Patients

目的 :评价静脉小剂量重组组织型纤溶酶原激活剂 (rt PA)院前救治急性心肌梗死的临床疗效 ,及其安全性和可行性。 方法 :所有确诊为急性心肌梗死的患者 ,院前给予小剂量rt PA (5 0mg)进行静脉溶栓治疗 (院前组 ,n =60 ) ,与院内应用小剂量rt PA (5 0mg)进行静脉溶栓的患者 (院内组 ,n =5 7)进行比较 ,观察发病—溶栓时间延迟对rt PA静脉溶栓疗效的影响。 结果 :院前组的冠状动脉总再通率为 91 7% ,明显高于院内组的 80 7% (P <0 0 5 ) ;病死率两组相比无显著性差异 (3 3 %vs 3 5 % ,P >0 0 5 ) ;两组患者均无需要输血的严重出血并发症 ;两组轻度出血的发生率 ,分别占病例总数的3 3 %和 3 5 % ,无显著性差异。 结论 :院前小剂量rt PA (5 0mg)静脉溶栓治疗急性心肌梗死 ,只要适应证选择适当 ,能争取最大限度地挽救濒危的心肌组织 ,方法快速、简单、安全、有效 ,是可行的 ,并可能提高再通率。

Objective: To determine the clinic therapeutic effect of prehospital intravenous thrombolytic therapy with low dose of recombinant tissue-type plasminogen activator(rt-PA) in acute myocardial infarction(AMI) patients, and to verify the safety and feasibility of prehospital intravenous thrombolytic therapy. Methods: The trial enrolled 117 AMI patients presenting with ST-segment elevation, Among them, 60 AMI patients receiving prehospital intravenous thrombolytic therapy with low dose rt-PA (50*!mg) were included in the study as the prehospital group,the other 57 AMI patients received the same therapy during the hospital syay as the in-hospital group. The effect of the time from AMI attack to the delayed thrombolytic therapy on the terapeutic resulis of intravenous thrombolytic therapy with rt-PA was evaluated in AMI patients. Results: The total reopening rate of coronary blood vessel was 91.7% in prehospital group, and in contrast to 80.7% in in-hospital group (p<0.05). The mortality rate was similar between the two groups (3.3% vs 3.5%, p>0.05). There was no sever complicated hemorrhagia in both groups. The occurrence of mild bleeding was 3.3% in prehospital group and 3.5% in in-hospital group(p>0.05). Conclusion: Prehospital intravenous thrombolytic therapy with rt-PA in AMI patients can save the dying heart muscle cells.This method is rapid, easy, safe, and practical.