小剂量尿激酶治疗非ST段抬高急性冠脉综合征76例临床观察  

Clinical effect observation in patients with non-ST-segment elevation acute coronary syndrome after thrombolytic therapy by low dose urokinase

作　　者：武效宏[1] 陈士良[1] 王小冬[1] 杨杰[1] 刘晓靖[1] 张金萍[1] 

机构地区：[1]解放军第305医院心内科,北京100017

出　　处：《陕西医学杂志》2010年第5期576-579,共4页Shaanxi Medical Journal

摘　　要：目的:观察小剂量尿激酶溶栓治疗非ST段抬高急性冠脉综合征(NSTE-ACS)的疗效和安全性。方法:选择NSTE-ACS患者76例(男43例,女34例),随机分为溶栓组和对照组。治疗组应用尿激酶30万U/d,共7～10d,对照组未使用尿激酶,其他治疗方法与溶栓组完全一致。观察两组患者治疗前后心绞痛发作频率、心电图变化、出血并发症及心血管意外等情况,同时监测血小板计数(Plt)、凝血酶原时间(PT)、激活的部分凝血活酶时间(APTT)、纤维蛋白原(FIB)。结果:1溶栓组患者总有效率及显效率明显高于对照组,两组出血并发症发生率无显著性差异;对照组有1例发生急性心肌梗死,溶栓组未出现急性心脏事件。2溶栓组FIB在治疗后明显下降(P<0.01),对照组FIB无明显变化,溶栓前后Plt、PT、APTT无明显变化。结论:1NSTE-ACS患者进行小剂量尿激酶溶栓治疗可以改善临床症状,且不增加出血并发症和心脏恶性事件发生率。2在应用低分子肝素的基础上,使用小剂量尿激酶溶栓治疗未发生凝血功能异常,且出现纤溶亢进,提示小剂量溶栓治疗是安全的。Objective：To observe clinical curative effect and security in certain subgroup patients with non-ST-segment elevation acute coronary syndrome after thrombolytic therapy by low dose urokinase.Methodes：76 patients（male 43 and female 34）with non-ST-segment elevation acute coronary syndrome were chosen and subdivided randomly into thrombolytic therapy group and control group.Except the injection of urokinase,the same procedure was done in the two groups.Before and after the therapy,angina recurrence rates,ECG changes,bleeding complications and cardia events were observed.At the same time,PLT、PT、APTT、FIB were determined.Results：①The excellent effective rate and total effective rate in thrombolysis group were significantly higher than that in control group,while no statistics difference was found in the bleeding complications Between the two groups.There was 1 patient with acute myocardial infarction in control group,while no cardia events were found in therapy group.②In the thrombolytic therapy group,FIB decreased significantly（P0.01）after thrombolysis,while no significantly change was found in control group.Between the two groups,there were no differences were found in PLT,PT and APTT after thetherapy.Conclusion：①The alterations of clinical out come after thrombolysis suggests that suitable thrombolytic therapy by low dose urokinase can be good to patients with NSTE-ACS,and increase in bleeding complications and cardia events did not be observed.②Thrombolytic therapy with the low dose of UK combined with low molecule heparin calcium can enhance endogenous fibrinolytic system,but coagulative system was not affected.

关 键 词：心绞痛 不稳定型/药物疗法 心肌梗塞/药物疗法 尿纤溶酶原激活物/治疗应用 

分 类 号：R541.1[医药卫生—心血管疾病]