急诊溶栓治疗急性心肌梗塞的临床观察  

Clinical observation on emergency thrombolytic therapy for acute myocardial infarction

作　　者：黄先勇[1] 李利华[1] 孟庆义[1] 计达[1] 武建军[1] 张志强[1] 

机构地区：[1]解放军总医院

出　　处：《中国危重病急救医学》1997年第8期482-484,共3页Chinese Critical Care Medicine

摘　　要：目的：评估急诊溶栓治疗急性心肌梗塞（ＡＭＩ）的效果。方法：根据入院时间将９２例经尿激酶静脉溶栓治疗的ＡＭＩ患者分为急诊组和院内组，并对其疗效和安全性进行总结分析。结果：急诊组溶栓时间比院内组要早（８４±１４）分钟，其中在发病２小时以内接受溶栓者，急诊组约占２６．５％，而院内组无一例；血管再通率２组分别为４２．９％（２１／４９）和３９．５％（１７／４３，Ｐ＞０．０５）；２组再灌注心律失常的发生率分别为４２．９％（９／２１）和２９．４％（５／１７），无一例死亡；急诊组梗塞后心绞痛的发生率较院内组明显减少（Ｐ＜０．０５）；３０天内病死率分别为１０．４％和１１．６％（Ｐ＞０．０５）。结论：急诊溶栓能较大限度地减少治疗耽搁时间，通过加强对再灌注心律失常的处理，证明是安全可行的，且对预后有显著的益处。Objective:To assess the efficacy and safety of emergency thrombolytic therapy for acute myocardial infarction(AMI).Methods:According to the time before and after admission, 92 patients with AMI treated with urokinase were divided into two groups:the emergency group (n=49) and the hospital group (n=43).The efficacy and safety of emergency thrombolytic therapy were evaluated from clinical data.Results:Patients in the emergency group received thrombolytic therapy had a median of (84±14) minutes earlier than those in the hospital group.In 26 5% of the patients in the emergency group,thrombolytic therapy was administered within 2 hours after angina, but no one in the hospital group.The patency rate was 42 9% in the emergency group and 39 5% in the hospital group ( P >0 05),respectively.It was noted that high incidences of reperfusioninduced arrhythmia were 42 9% in the emergency group and 29 4% in the hospital group.No death occurred in the arrhythmia in both groups.Post infarct angina pectoris was significantly less frequent in the emergency group than that in the hospital group ( P <0 05).However,there was no significant difference in mortality at 30 days between the emergency group and the hospital group (10 4% vs. 11 6%, P >0 05). Conclusions:These results suggest that the emergency thrombolytic therapy may further short the delayed time to treat,and it is both feasible and safe when reperfusioninduced arrhythmia can be treated effectively.The emergency therapy may be of benefit for prognosis of AMI.

关 键 词：心肌梗塞 急诊 溶栓治疗 

分 类 号：R542.220.5[医药卫生—心血管疾病]