急性心肌梗塞患者溶栓治疗期间纤溶活性和血小板功能的变化及其临床意义  

Changes and clinical significance of fibrinolytic activity and platelet function during thrombolytic therapy in patients with acute myocardial infarction

作　　者：金兰[1] 张抒扬[1] 严晓伟[1] 许澎淮 朱广瑾 方圻[1] 

机构地区：[1]中国医学科学院北京协和医院心内科,中国医学科学院基础所病理生理室

出　　处：《中华心血管病杂志》1995年第4期261-263,共3页Chinese Journal of Cardiology

基　　金：卫生部重点科研基金

摘　　要：观察２０例急性心肌梗塞（ＡＭ１）患者早期溶栓治疗期间纤溶活性及血小板功能的变化，以２２例常规治疗病人为对照。结果显示静注尿激酶（ＵＫ）完毕后即刻血浆组织型纤溶酶原激活物（ｔＰＡ）活性直线上升（Ｐ＜０．００１），纤溶酶原激活物抑制物（ＰＡ１）活性直线下降（Ｐ＜０．００１），但不到２４ｈ血浆ＰＡＩ活性反跳超过静注ＵＫ前水平。血小板功能，因入院后即给阿司匹林治疗而受抑制，但静注ＵＫ完毕后，血小板最大聚集率达峰值。以上的变化说明溶栓治疗期间血栓与溶栓过程并存。了解溶栓治疗期间溶栓与凝血的病理生理过程对提高溶栓治疗的成功率和预防血管再堵的处理有很大意义。Abstract To observe the changes of fibrinolytic activity and platelet function during thrombolytic therapy,20 cases of acute myocardial infarction (AMI) patients recieving urokinase (UK) within 6 hours after onset,and 22 cases with conventional therapy as control were compared. The results displayed the coexistence of thrombolysis and throinbosis.Immediately after completion of UK infusion, the plasma tPA activity increased (P<0.001) and PAI activity, fibrinogen concentration decreased promptly (P<0.001 ),but they returned to the control levels within 24-48 hours.The PAI activity rebounded to levels higher than that of control since the Znd day.Platelet function was suppressed by the use of aspirin, but the maximum platelet aggregation rate arrived at peak level immediately after conipletion of UK infusion. All of these findings indicate that during the use of thrombolytic agent,blood coagulation is enhanced,an understanding of which is very important in increasing the successful rate of thromboiytic therapy and preventing reocclusion by the use of adjunctive drugs,such as aspirin,heparin or hirulog (hirudin),etc.

关 键 词：心肌梗塞 溶栓疗法 纤溶活性 血小板功能试验 

分 类 号：R542.220.5[医药卫生—心血管疾病]