不同溶栓药物和剂量治疗急性心肌梗塞239例对比分析  

Results of thrombolysis with different thrombolytic agents for 239 patients with acute myocardial infarction

作　　者：丁文惠[1,2,3] 张钧华[1,2,3] 胡大一[1,2,3] 邵耕 张玉华[1,2,3] 刘梅林 韩改仙 袁德芹[1,2,3] 汪丽蕙 

机构地区：[1]北京医科大学第一医院心内科 [2]山西晋中地区第一人民医院 [3]邯郸市峰峰矿务局二院

出　　处：《中华心血管病杂志》1997年第4期277-279,共3页Chinese Journal of Cardiology

摘　　要：２３９例急性心肌梗塞（ＡＭＩ）患者接受溶栓治疗，其中采用日本尿激酶（ＵＫ）９６万Ｕ３５例，１５０万Ｕ５５例；国产ＵＫ９６万Ｕ１５例，１５０万Ｕ５３例；德国链激酶（ＳＫ）１５０万Ｕ６６例；国产重组链激酶（ｒＳＫ）１５０万Ｕ１５例。对不同剂量及不同溶栓剂的疗效与安全性进行对比分析发现：１９９２年前国产ＵＫ９６万Ｕ比日本进口ＵＫ９６万Ｕ血管再通率低（２０．０％ｖｓ５１．４％Ｐ＜０．０１）。１９９２年后国产ＵＫ剂量增至１５０万Ｕ，血管再通率显著提高（５６．６％ｖｓ２０．０％Ｐ＜０．０１），与进口ＵＫ１５０万Ｕ的疗效与安全性相近（Ｐ＞０．０５）；国产ｒＳＫ１５０万Ｕ与进口ＳＫ１５０万Ｕ的血管再通率相似（７３．３％ｖｓ６５．２％Ｐ＞０．０５）；且比国产ＵＫ１５０万Ｕ的血管再通率明显提高（７３．３％ｖｓ５６．６％Ｐ＜０．０５），虽然ｒＳＫ轻度出血高于ＵＫ（２６．７％ｖｓ９．４％Ｐ＜０．０１），偶有低血压发生，但不影响疗效。国产ｒＳＫ与ＵＫ比进口ＳＫ和ＵＫ价格低２～４倍。因此认为，国产ｒＳＫ和ＵＫ是较为有效、安全、价廉且适合我国国情的溶栓药物。Two hundred and thirty nine patients with acute myocardial infarction (AMI) were treated with different thrombolytic agents and doses. Among them, 35 cases received Japanese UK 960,000 U(group Ⅰ); 55 cases, Japanese UK 1.5 million U (group Ⅱ); 15 cases, Chinese UK 960,000 U produced before 1992 (group Ⅲ); 53 cases, Chinese UK 1.5 million U produced after 1992 (group Ⅳ) ; 66 cases, German SK 1.5 million U (group Ⅴ); 15 cases, Chinese rSK 1.5 million U (group Ⅵ). The results showed that the reperfusion rate was significantly lower (20.0% vs 51.4%, P <0.01) and the mortality rate within 5 weeks was significantly higher (33.3% vs 11.4%, P <0.01) in group Ⅲ than in group Ⅰ. The reperfusion rate was significantly increased (56.6% vs 20.0%, P <0.01) in group Ⅳ than in group Ⅲ and the efficacy and safety of group Ⅳ were similar to group Ⅱ (the reperfusion rates were 56.6% vs 61.8%, P >0.05, the incidence of mild bleeding was 9.4% vs 10.9%, P >0.05). The efficacy and safety of group Ⅵ were also similar to group Ⅴ (the reperfusion rates were 73.3% vs 65.2%, P >0.05; the incidences of mild bleeding were 26.7% vs 18.7%, P >0.05, and hypotension, 6.7% vs 15.2%, P >0.05). The reperfusion rate was significantly higher (73.3% vs 55.6%, P <0.05) in Chinese rSK 1.5 milllion U group than that of Chinese UK 1.5 million U group, though mild hemorrhage and hypotension were more common in the former, they were not severe and did not affect the treatment. The prices of Chinese rSK and UK were two to four times lower than those of imported SK and UK. In conclusion, both Chinese rSK (1.5 million U) and UK (1.5 million U) were effective and safe thrombolytic agents for AMI and could be afforded by most patients in our country.

关 键 词：心肌梗塞 溶栓治疗 尿激酶 链激酶 剂量 

分 类 号：R542.220.5[医药卫生—心血管疾病]