小剂量栓体舒冠脉根部注射溶栓治疗急性早期心肌梗死的临床应用与研究  

Clinical application and research about small amount of rt-PA injected in the root of coronary artery thrombolytic therapy for early stage acute myocardial infarction

作　　者：闫农[1] 张树新[1] 张琳[1] 刘淑媛[1] 宋守忠[1] 李博[1] 

机构地区：[1]解放军第309医院急诊科,北京100091

出　　处：《中国急救医学》2000年第8期462-463,共2页Chinese Journal of Critical Care Medicine

摘　　要：目的　观察比较小剂量栓体舒 (rt-PA)导管介入冠脉根部给药溶栓治疗急性心肌梗死 (AMI)的临床疗效。方法　将发病 12小时内的AMI患者 88例随机分为 4组 ,A组 :导管介入冠脉根部注射rt-PA组 2 0例 (rt-PA用量为 5 0mg) ;B组 :外周静脉应用rt-PA组 2 2例 (rt-PA用量为 10 0mg) ;C组 :导管介入冠脉根部注射尿激酶 (UK)组 2 3例 (UK用量为 5 0万～ 75万U) ;D组 :外周静脉应用尿激酶组 2 3例 (UK用量为 15 0万U)。分别观察冠脉再通率及药物副作用。结果　冠脉再通率 :A组 (85 0 % ) >B组 (72 7% ) >C组 (6 0 9% ) >D组 (5 6 5 % )。应用导管介入冠脉根部注射rt-PA组的患者冠脉再通率最高 ;应用rt-PA的患者冠脉总再通率 (90 48% )明显优于应用UK组 (6 3 0 4% ) (P <0 0 5 )。内脏出血并发症比较 :A组 (0 0 0 )<B <(4 5 5 % ) <C组 (13 0 4% ) <D组 (2 1 74% )。应用导管介入冠脉根部注射rt-PA组的患者未发现内脏出血并发症 ;应用rt-PA的患者总内脏出血并发症 (2 38% )明显低于应用UK组 (14 2 8% ) (P <0 0 5 )。结论　rt-PA的临床疗效优于UK。小剂量栓体舒导管介入冠脉根部给药溶栓治疗急性心肌梗死的临床疗效优于尿激酶及大剂量栓体舒静脉给药。Objective To observe clinical curative effect of small amount of rt-PA injected in the root of coronary artery through intervened conduit for early stage acute myocardial infarction (AMI).Methods The 88 patients that less than 12 hours from symptom onset were divided into 4 groups randomly:The 20 patents in group A that treated with 50 mg of rt-PA injected in the root of coronary artery through intervened conduit.The 22 patients in group B that treated with intravenous thrombolytic therapy with 100 mg of rt-PA.The 23 patients in group C treated with 0.5～0.75 million units of urokinase injected in the root of coronary artery through intervened conduit.The 23 patients in group D treated with intravenous thrombolytic therapy with.5 million units of urokinase.Then observe reperfusion rate and side effect of the two drugs of patients in 4 groups respectively.Results Reperfusion rate of coronary artery:Group A (85 0%)>Group B (72 7%)>Group C (60 9%)>Group D (56.5%).The reperfusion rate of the group that treated with 50 mg of rt-PA injected in the root of coronary artery through intervened conduit is the highest.The total reperfusion rate of treating with rt-PA is 90 48% which significantly higher than that of treating with urokinase (63 04%) ( P <0 05).Bleeding complication of viscera:Group A (0 00)<Group B (4.55%)<Group C (13 04%)<Group D (21 74%).The patients who treated with 50 mg of rt-PA injected in the root of coronary artery through intervened conduit hadn't found bleeding complication of viscera.The rate of total visceral bleeding complication of patients who treated with rt-PA (2 38%) is lower than patients who treated with urokinase (14 28%) ( P <0 05).Conclusion The clinical efficiency of rt-PA is superior to the UK.Small amount of rt-PA injected in the root of coronary artery thrombolytic therapy for AMI is better than that treated with intravenous thrombolytic therapy with urokinase and large dose of rt-PA. [

关 键 词：急性心肌梗死 冠脉根部 溶栓疗法 栓体舒 

分 类 号：R542.22[医药卫生—心血管疾病]