瑞替普酶溶栓治疗急性心肌梗死的疗效观察(1)
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【摘要】目的观察国产重组组织型纤溶酶原激活剂(瑞替普酶)治疗急性心肌梗死(AMI)的临床疗效和副作用。方法将106例AMI患者随机分两组，瑞替普酶组57例，先给普通肝素4000U静脉推注，之后给予瑞替普酶10U溶于10 ml 09%氯化钠溶液，5 min静脉推注；尿激酶组49例，予尿激酶150万U溶于100 ml 09%氯化钠溶液，30 min静脉滴注。两组均用皮下肝素，其余治疗也相同。溶栓后2 h行冠脉造影，了解TIMI血流情况。结果瑞替普酶组与尿激酶组的血管总开通率、TIMI3级血流、开通时间分别为689%与563%；496%与387%；(083±054)h与(131±052)h(P<005)。副作用：轻度出血率在瑞替普酶与尿激酶组分别为88%与82%。结论瑞替普酶治疗AMI血管开通率高，开通时间短，副作用小。
【关键词】瑞替普酶；溶栓治疗；开通率
The Clinic Effect of Reteplase in Treating Acute Myocardial InfarctionLIU Qing, YANG Bei.Department of cardiology,the First People’s Hospital of Yunan Province 453400,China
【Abstract】ObjectiveTo observe the clinic and side effects of a domestic recombinant tissuetype plasminogen activatorreteplsae in treating the acute myocardial infarction (AMI) Methods106 patients with AMI were divided into two groups at random Group A (57 cases) accepted reteplsae for intravenous injection with 10U within 5 minutes after being injected with unfractionated heparin Group B (49 cases) accepted urokinase 150U intravenous dropping within 30 minutes After 2 hours, both groups accepted coronary angiography Their TIMI flows were observed ResultsThe revascularization rate, TIMI 3 flow and revascularization time in reteplsae group are 689%, 496% and(083±054)hours respectively while are 563%, 387% and (131±052)hours in urokinase group There are significant differences between two groups The bleeding complication in reteplsae group and urokinase group are 88% and 82% respectivelyConclusionUsing reteplsae to treat AMI has high recanalization rate with short time and fewer side effects than using urokinase.
【Key words】Reteplsae for injection;Thrombolytic therapy;Revascularization rate
静脉溶栓治疗急性心肌梗死是冠状动脉血管恢复再灌注的有效治疗方法之一。本文总结了使用国产组织型纤溶酶原激活剂(瑞替普酶)与尿激酶对106例AMI患者进行溶栓治疗的观察结果。
1资料与方法
11一般资料本科2007年1月至2010年1月收住的106例ST段抬高性AMI患者，期中急性前壁心梗68例(包括前间壁、局限前壁、广泛前壁)，急性下壁38例(包括下壁、正后壁及右室)。胸痛<6 h入院者74例，6~12 h者32例。106例患者的诊断标准、溶栓适应证与禁忌证均符合“急性心梗溶栓治疗参考方案”[1]确定的标准。所有患者随机分为瑞替普酶组与尿激酶组，瑞替普酶组57例，男39例，女18例，年龄38~75岁，平均(543±76)岁；尿激酶组49例，男32例，女17例，年龄35~75岁，平均(517±89)岁。两组年龄和性别差异无统计学意义(P>005)。
12方法入院确诊后两组患者均予负荷量的阿司匹林肠溶片及氯吡格雷各300 mg嚼服，以后每天口服阿司匹林肠溶片100 mg、氯吡格雷75 mg。瑞替普酶组先予4000 U普通肝素静推后再予瑞替普酶10U溶于10 ml 09%氯化钠溶液内5 min内静推；尿激酶组予尿激酶150万U溶于100 ml氯化钠溶液内30 min静脉滴注 ......
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