在急诊科开展对急性心肌梗死的溶栓治疗——附62例去纤酶溶栓治疗经验

Thrombolytic Therapy to patient with Acute Myocardial Infarction in the Emergency Department—Experience of 62 cases with Defibrinase Therapy.

静脉溶栓在现代急性心肌梗死治疗中占极重要位置。文献已有提出,到诊后半小时为急性心肌梗死溶性治疗的黄金时间。近三年来,我们用去纤酶对62例急性心肌梗死患者进行了静脉溶险。对象为胸痛发作<6小时者,去纤酶首剂0.05～0.075U/kg。出院时死亡率11.29%,死亡率下降31.2%;血管再通率为83.33%;酶峰比对照组提前,P<0.01。溶栓开始>6小时组存活率显著低于<4小时及4～6小时组,P>0.01;血管再通率<4小时组优于4小时以上组,P<0.05。本组来诊至确诊<30分钟者占69.4%,来诊至溶栓≤1小时者占40.32%。作者提出,宜在半至1小时内确诊并在急诊科开始溶栓治疗。去纤酶有较好溶栓及抗凝特性,出血并发症少,值得推广;并提出溶栓前后监测注意事项。在急诊科对急性心肌梗死患者开展溶栓治疗是安全,有益与必要的。

A clinical trial of intravenous thrombolysis with defibrinase in 62 cases with acute myocardial infarction (AMI) yielded a mortality of 11.29%, a reduction rate of 31.2%, a coronary reperfusion rate of 83.33%, and an earlier peak value of serum enzymes (p<0.01)as well.The mortality, of the group beginning thrombolytic therapy<4h & 4—6h after onset of pectoralgia was lower than groups>6h, (p<0.01); the coronary reperfusion rate of beginning the therapy within 4h was evidently better than that of more 4h (p<0.06). from 59.4% patients with AMI were diagnosedwithin 30 minutes; and 40.3% of them received thrombolytic therapy within 1 hour. Every effort should be made to begin thrombolytic therapy to patients with AMI within 0.5h—1h. Defibrinase is a good thrombolytic agent, as a long acting plasminogen activator with less bleeding. Indexes for monitoring defibrinase were mentioned. Intravenous thrombolytic therapy in Emergency Department is safe, beneficial necessary.