静脉溶栓治疗急性心肌梗死临床分析

Comparison of different intravenous thrombolysis therapies in acute myocardial infarction in prehospital care

目的探讨急性心肌梗死不同院前静脉溶栓方案的安全性与可行性。方法本研究为随机、前瞻性试验,入选病例随机分为尿激酶组和重组组织型纤溶酶原激活剂(rtPA)组,未入选的病例用低分子肝素治疗,比较其疗效和近期并发症。结果3组的年龄、梗死部位、性别等对比差异无统计学意义。冠脉再通率rtPA组(82.1%)明显高于尿激酶组(55.3%),有显著的统计学意义(P<0.05)。4周时室壁瘤形成rtPA组(10.7%)明显低于低分子肝素组(33.3%),有显著的统计学意义(P<0.05),但rtPA组与尿激酶组差异无统计学意义。心衰、死亡、恶性心律失常、出血的发生率3组无统计学差异。4周时左室射血分数(LVEF)3组无统计学差异。心衰、死亡、室壁瘤形成再通组明显低于未通组(P<0.05),而两组恶性心律失常未见明显的统计学意义。结论院前进行急性心肌梗死溶栓治疗快速、安全,可首选rtPA50mg溶栓,若有禁忌证,可选用低分子肝素治疗。

Objective To explore the efficacies and safeties of different intravenous thrombolysis therapies in acute myocardial infarction in prehospital care.Methods In light of a prospective and random way,patients with acute myocardial infarction who met the criteria for intravenous thrombolysis therapy were randomly divided into urokinase group and the reconstructive tissue plasminogen activator(rtPA)group,meanwhile,those who did not match the criteria were treated with low-molecular-weight heparin preparations(LMWH).The effects and complications in all groups were compared.Results The age,sex and infarction region among the three groups were not statistically different.The re-canalization rate of coronary artery in rtPA group(82.1%)was significantly higher than urokinase group(53.3%)(P<0.05).The frequency of ventricular aneurysm in rtPA group was significantly lower than LMWH group(10.7%vs33.3%,P<0.05),but not statistically different between rtPA and urokinase groups at the point of4weeks after treatment.There were not differences about complications of heart failure,death rate,fatal arrythmias,hemorrhage and left ventricular e-jection fraction(LFEF)among the three groups.The rates of heart failure,death and ventricular aneurysm in patients with recanalization of coronary artery were obviously lower than those without recanalization,except fatal arrythmias.Con-clusion The thrombolysis therapy in acute myocardial infarction in prehospital care is safe and reliable.The best choice of medication is rtPA,but if any contraindications to rtPA or urokinase,LMWH should be considered as a candi-date.