早期心肌再梗塞或梗塞延展的静脉溶栓后护理  

Analysis of Clinical Diagnosis and Effect ofIntravenous Urokinase on Early Myocardial Reinfarction or Infarction Extension

作　　者：孔德兰[1] 

机构地区：[1]附属菏泽市立医院,山东菏泽274031

出　　处：《菏泽医学专科学校学报》2001年第2期79-81,共3页Journal of Heze Medical College

摘　　要：目的　探讨早期心肌再梗塞或梗塞延展的早期诊断及不同剂量尿激酶的静脉溶栓后护理。方法　分析 36例早期心肌再梗塞或梗塞延展的临床表现和心电图变化 ,比较AB两组不同剂量尿激酶静脉溶栓疗效、不良反应及四周病死率。结果　 4 86例AMI病人 36例发生早期心肌再梗塞或梗塞延展 (7.4 % )。 31例有胸痛 ,5例无胸痛者中 2例表现为急性左心衰竭 ,2例心源性休克 ,1例室速。 36例心电图ST段均有再抬高 ,常规 12导联检出 32例 ,V7- 9检出 2例 ,V3 R -V5R检出 2例。 36例CPK -MB均有复升 ,再通者峰值前移。A组溶栓治疗组 19例 ,B溶栓治疗组 17例 ,A组与B组的尿激酶用量及再通率分别是 10 0万Iu、2 0 0万Iu和6 3.1%、82 .3% (P >0 .0 5 )。两组不良反应及四周病死率无明显差别。两组病人均在发病后 2小时内进行溶栓治疗。结论　早期心肌再梗塞 /梗塞延展仍为静脉溶栓的适应证 ,密切观察病情变化 ,及时记录 18导联心电图是早期诊断的关键 ,尽早使用足量尿激酶溶栓治疗是提高疗效 ,改善病人预后的重要措施。Objective To approach the early diagnosis andthe nursing of intravenous different dose urokinase on early myocardial reinfartion or infarction extension. Methods The clinical expression and changes of ECG in 36 patients with early myocardial reinfarction or infarction extension were analysed.Effect harmful reaction and 4-week mortality were compared between A and B groups. Results Among 46 patients with AMI, 36 patients suffered from early myocardial reinfarction or infarction extension (7.4%). 31 out of 36 patients had chest pain (86.1%). 2 patients with acute left heart failure were found in 5 patients without chest pain, 2 patients with cardic shock and 1 patient with VT. ST segment on ECG were re-elevated in all 36 patients. 32 cases were found in routine 12 lead ECG, 2 cases in V7-9 and 2 cases in V3R-V5R. CPK-MB was re-elecvated in all 36 patients.Its peak values were advanced. A and B groups with thrombolytic therapy are 19 and 17 cases respectively. The urokinase dose and the recanalization rate for A or B group was not different.All patients of groups were treated with urokinase in 2 hours after onset of the disease. Conclusion Early myocardial reinfarction or infarctionextension is still indication for thrombolytic therapy.Observing seriously the changes of patient's condition and recording timely 18 lead ECG is the key of early diagnosis.Enough dose urokinase thrombolytic theraoy is a vital measure for improving effect and prognosis as soon as the diagnosis is established.

关 键 词：早期心肌再梗塞/诊断 梗塞延长/诊断 早期心肌再梗塞/治疗 梗塞延展/治疗 尿激酶/投药和剂量 尿激酶/治疗应用 

分 类 号：R542.2[医药卫生—心血管疾病] R473.5[医药卫生—内科学]