22例疑似急性心肌梗死猝死患者心肺复苏中r-PA溶栓治疗分析  

Analysis of using recombinant tissue plasminogen activator thrombolytic therapy during cardiopulmonary resuscitation for treatment of 22 patients with suspected acute myocardial infarction sudden death

作　　者：张亮[1] 李海林[1] 袁玉霞 杨峥 Zhang Liang;Li Hailin;Yuan Yuxia;Yang Zheng(Department of Emergency,Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China)

机构地区：[1]浙江省立同德医院急诊医学科,浙江杭州310012

出　　处：《中国中西医结合急救杂志》2022年第4期417-420,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省卫生医药卫生科技计划项目(2020KY087)。

摘　　要：目的探索疑似急性心肌梗死(AMI)猝死患者心肺复苏(CPR)中应用重组组织型纤溶酶原激活剂(r-PA)溶栓的临床应用效果。方法统计分析2019年1月至2021年9月浙江省立同德医院急诊医学科收治的22例疑似AMI猝死患者CPR中使用r-PA的临床资料,记录并分析患者溶栓时间、CPR时长、并发症及转归等。结果22例患者平均年龄57(44,72)岁,男性18例(81.82%);其中7例(31.82%)患者发生心室颤动(室颤)。22例患者心搏骤停(CA)到入抢救室中位时间为26(0~60)min,CA至CPR中位时间为10(0~96)min,CA至第1剂溶栓中位时间为68(14~175)min,CPR至第1剂溶栓中位时间为51(14~150)min;溶栓治疗后10例(45.45%)患者实现了自主呼吸循环恢复(ROSC),4例(18.18%)患者存活出院,神经功能恢复良好〔格拉斯哥-匹兹堡脑功能分级(CPC)1~2级〕。10例ROSC患者中有5例出现呼吸道、消化道、泌尿道出血;4例存活患者随访1年,大脑功能CPC 1~2级。结论在CPR抢救疑似心源性猝死患者过程中联合r-PA溶栓治疗可增加患者的存活机会。Objective To explore the clinical effect of intravenous recombinant tissue plasminogen activator(r-PA)thrombolysis in cardiopulmonary resuscitation(CPR)for treatment of patients with suspected acute myocardial infarction(AMI)sudden death.Methods The clinical data of 22 patients with suspected AMI sudden death admitted in the department of emergency of Tongde Hospital of Zhejiang Province from January 2019 to September 2021 and treated by using r-PA during CPR were statistically analyzed.The thrombolytic time,duration of CPR,complications,outcomes,etc.were recorded.Results The average age of the 22 patients was 57(44,72)years old,there were 18(81.82%)males;and 7(31.82%)cases presented ventricular fibrillation.The median time of 22 patients with cardiac arrest(CA)from their CA to emergency room was 26(0-60)minutes,their median times from CA to CPR,from CA to the first use of thrombolysis,from CPR to the first use of thrombolysis were 10(0-96)minutes,68(14-175)minutes and 51(14-150)minutes,respectively.After thrombolytic therapy,10 patients(45.45%)achieved return of spontaneous circulation(ROSC),and 4(18.18%)survived and were discharged with good neurological function recovery[Glasgow-Pittsburgh cerebral performance category(CPC)grades 1-2].In the 10 patients with ROSC,there were 5 patients presented respiratory,elementary and urinary tract hemorrhages,and after follow-up for one year,4 patients survived and their cerebral function CPC were grades 1-2.Conclusion In the process of CPR rescuing patients with suspected AMI sudden death,combination with r-PA thrombolysis can increase the patients'survival chance.

关 键 词：急性心肌梗死猝死 心肺复苏 溶栓 重组组织型纤溶酶原激活剂 

分 类 号：R542.22[医药卫生—心血管疾病]