替奈普酶对急性心肌梗死患者溶栓临床疗效及心功能的影响  

Effect of Tenecteplase on Clinical Efficacy of Thrombolysis and Cardiac Function in Patients with Acute Myocardial Infarction

作　　者：马小茹 闫春芳 史清涛 李志军 李桂青 张同乐[1] 杨晓雪 MA Xiao-ru;YAN Chun-fang;SHI Qing-tao;LI Zhi-jun;LI Gui-qing;ZHANG Tong-le;YANG Xiao-xue(Department of Cardiology,the First Central Hospital of Baoding City,Baoding,Hebei 071000,China;Department of Ultrasound,the Fourth People's Hospital of Hengshui City,Hengshui,Hebei 053000,China;Department of Bone Oncology,Chaoyang Emergency Rescue Center of Integrated Traditional Chinese and Western Medicine,Beijing 100021,China;Department of Cardiology,the First Hospital of Zhangjiakou City,Zhangjiakou,Hebei 075000,China)

机构地区：[1]保定市第一中心医院心内科,河北保定071000 [2]衡水市第四人民医院超声科,河北衡水053000 [3]北京朝阳中西医结合急诊抢救中心骨肿瘤科,北京100021 [4]张家口市第一医院心内科,河北张家口075000

出　　处：《解放军医药杂志》2022年第8期82-86,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省中医药管理局科研计划项目(2019537);保定市科学技术局科研计划项目(2141ZF060)。

摘　　要：目的评估替奈普酶(TNK-tPA)对急性心肌梗死(AMI)患者溶栓临床疗效及心功能的影响。方法选取2016年10月-2021年10月收治的AMI 120例,按治疗方法分为观察组和对照组各60例,2组均给予常规治疗,对照组给予阿替普酶治疗,观察组给予TNK-tPA治疗。比较2组溶栓后6 h内不同时点冠状动脉再通情况,溶栓前后心功能相关指标、血清心肌损伤标志物及其峰值与达峰时间,2组溶栓治疗后观察30 d,统计并记录并发症及病死发生情况。结果观察组溶栓后6 h内不同时点再通率高于对照组(P<0.05)。观察组溶栓后左心室射血分数、心排血量、每搏量高于对照组,心肌型肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、肌红蛋白(MYO)水平低于对照组(P<0.05,P<0.01)。观察组溶栓后CK-MB、cTnI峰值低于对照组,CK-MB、cTnI、MYO达峰时间短于对照组(P<0.01)。观察组并发症总发生率低于对照组(P<0.05);2组病死率比较差异无统计学意义(P>0.05)。结论AMI应用TNK-tPA溶栓治疗可显著提高冠状动脉再通率,改善心功能,并有效缓解心肌损伤,安全性高。Objective To evaluate the effect of Tenecteplase(TNK-tPA)on clinical efficacy of thrombolysis and cardiac function in patients with acute myocardial infarction(AMI).Methods A total of 120 cases of AMI admitted to our hospital from October 2016 to October 2021 were selected and divided into the observation group(n=60)and the control group(n=60)according to treatment methods.Both groups were given conventional treatment,the control group was given Alteplase treatment,and the observation group was given TNK-tPA treatment.Coronary artery recanalization at different time points within 6 h after thrombolytic therapy,cardiac function related indicators before and after thrombolytic therapy,markers of serum myocardial injury and their peak value and time to peak(TTP)were compared between the two groups.Both groups were observed for 30 days after thrombolytic therapy,and complications and death were recorded.Results The recanalization rate of the observation group was higher than that of the control group at different time points within 6 h after thrombolytic therapy(P<0.05).After thrombolytic treatment,left ventricular ejection fraction,cardiac output and stroke volume in the observation group were higher than those in the control group,and the levels of cardiac creatine kinase-MB(CK-MB),cardiac troponin I(cTnI)and myoglobin(MYO)were lower than those in the control group(P<0.05,P<0.01).After thrombolytic treatment,the peak values of CK-MB and cTnI in the observation group were lower than those in the control group,and the TTP of CK-MB,cTnI and MYO was shorter than that in the control group(P<0.01).The total incidence of complications in observation group was lower than that in control group(P<0.05).There was no significant difference in mortality between the two groups(P>0.05).Conclusion TNK-tPA thrombolytic therapy for AMI can significantly improve coronary artery recanalization rate,improve cardiac function,and effectively relieve myocardial injury,with high safety.

关 键 词：急性心肌梗死 替奈普酶 左心室射血分数 肌酸激酶 MB型 肌钙蛋白I 肌红蛋白 

分 类 号：R542.22[医药卫生—心血管疾病]