早期溶栓治疗终止急性心肌梗死的探讨  

Study on early fibrinolytic therapy to avoid acute myocardial infarction

作　　者：刘纪改[1] 姚玉才[1] 徐瑞[1] 徐文伟[1] 张伟[1] 况荣光[1] 高梅[1] 

机构地区：[1]山东省千佛山医院急诊科,济南250014

出　　处：《中华心血管病杂志》2005年第9期782-784,共3页Chinese Journal of Cardiology

摘　　要：目的探讨早期溶栓治疗终止急性心肌梗死(AMI)发生的频率及其临床特点。方法以给栓溶剂后2h内胸痛基本消失,抬高的ST段降低≥50%;肌酸激酶同工酶(CKMB)升高但峰值≤正常高限的2倍,作为终止AMI的定义。将接受溶栓治疗的1120例AMI患者分为真正AMI与终止AMI进行对照分析,观察溶栓开始时间与AMI终止率的关系等临床特点。结果溶栓治疗后血管开通率为80.5%;7.1%达AMI终止标准。起病1h开始溶栓者中AMI终止率为22.0%,明显高于其他各时间段(P<0.01);终止率在尿激酶(UK)组为7.0%,链激酶(SK)组为6.7%,重组组织型纤溶酶原激活剂(rtPA)为7.1%,组间比较无统计学意义(P>0.05);AMI终止组的急性期KillipⅢ/Ⅳ、恶性心律失常、心绞痛发生率、30天病死率分别是3.9%、18.0%、1.3%、0;低于真正AMI组的17.1%、30.0%、8.0%、6.0%(P<0.01)。结论早期溶栓可终止少数AMI发生并改善预后,AMI终止的发生与起病至溶栓开始的时间相关,与溶栓药物的种类无关。Objective To investigate the frequency of aborted AM! and clinical characteristics of the patients received prompt fibrinolytic therapy. Methods 1120 patients with AMI were divided into two groups, true AMI group and aborted AMI group, Aborted AMI was defined as maximal creatine kinase-MB ≤2× upper limit of normal coupled with the presence of resolution of chest pain and 50% of ST-segment deviation within 2 hours after onset of therapy. We compared some characteristic of two groups such as the fibrinolytic time after symptom onset and the frequency of aborted AMI. Results The reopening ratio of infarct was 80. 5%. 7.1% of the patients escaped myocardial necrosis. Aborted AMI was highest frequency within the first hour （22. 0% ） than other time groups（ P 〈 0. 01 ） ;There were no significant differences in the frequency of Aborted AMI in UK group, SK group and rt-PA group （ 7.0%, 6.7 %, 7. 1%, P 〉 0. 05 ） ; The rate of Killip Ⅲ/Ⅳ、major arrhythmias,angina pectoris and mortality at 30 day in aborted AMI patients compared with those who had true AMI was 3. 9% versus 17.1%, 18. 0% versus 30. 0%,1. 3% versus 8.0%, 0 versus 6, 0%, respectively （ P 〈 0. 01）. Conclusion Prompt fibrinolytic therapy improved the likehood of aborted AMI and clinical outcomes. The frequency of aborted AMI has no relationship with fihrinolvtic drug, but closelv related to the starting time of treatment from svmotom onset.

关 键 词：心肌梗塞 血栓溶解疗法 预后 急性心肌梗死(AMI) 早期溶栓治疗 重组组织型纤溶酶原激活剂 溶栓开始时间 肌酸激酶同工酶 恶性心律失常 临床特点 

分 类 号：R542.22[医药卫生—心血管疾病] R541.7[医药卫生—内科学]