急性心肌梗死院前和院内溶栓的安全性和有效性比较

Comparison of the Effectiveness and Safety on Thrombolysis with Patient of AMI between in-hospital and out-hospital Groups

目的:观察对急性心肌梗死(AMI)病人院前及院内尿激酶静脉溶栓的有效性及安全性。方法:人选AMI病人120例,按发病时间至开始静脉溶栓给药的时间,两组均为≤12小时。入选者立即嚼服阿司匹林300mg,给予尿激酶100万U入20ml生理盐水10分钟内静注,再用150万U入100ml生理盐水中60分钟内滴注。结果:院前溶栓比院内溶栓时间平均提前1.4小时。临床开通率,院前组76％,院内组63％。随访5周观察:反复心绞痛发作、重度心律失常和心源性死亡,院前组明显优于院内组;心功能不全、心肌再梗死、多巴酚丁胺心脏负荷试验存活心肌和室壁瘤发生的比率、出血并发症两组无明显差异。结论:为了提高梗塞相关血管的开通率和降低急性期病死率,除提早溶栓时间外,早期识别高危病人及时有效的稳定血液动力学是非常重要的。

Objective: In this study we used Urokinase to observe effectiveness and safely of patients of AMI between in-hospital and out-hospital groups.Methods: Our study included 120 acute myocardial infarction patients. The patients were in two groups whose time from onset to thrombolysis less or mean than twelve. All the patients received 300 mg of Aspirin when they were selected, then we manage high-risk patients, stabilizing their blood pressure and cardiac rhythm, After these, we used 1 million unit of Urokinase intravenously in ten minutes, then gave the other 1.5 million unit in the following 60 minutes. 6 hours later, we monitored the APTT times to decide whether to give low-molecule heparin.Resuts: Time from onset to thrombolysis was earlier 1.4 hours in the out-hospital group than the in-hospital group. Recanalization rate: The out-hospital group was 76% and the in-hospital group was 63%. 90 minutes coronary arteriography results show the recanalization rate of infarct-related arteries: The out-hospital group was 71% and the in-hospital group was 53%.The incidence rate of severe angina , severe arrhythmin and cardiac death in the five week was lower in the out-hospital group than in the in-hospital group. There was on marked difference in heart failure, dobutamie stress test viable myocardium, cardiac a-neuryssm and the bleeding complication rates.Conclusion: To raise the recanalization rate and lower the mortality rate, It is very important to give the thromoblytic drugs earlier and give the patients general hospital management in time to stablish the blood pressures and heart rates.