瑞替普酶治疗急性心肌梗死108例临床观察(1)
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[摘要] 目的 探讨瑞替普酶(r-PA)治疗急性心肌梗死(AMI)的临床疗效及安全性。方法 符合入选标准的206例患者随机分为研究组和对照组，研究组108例给予瑞替普酶10mU+10mU静脉溶栓治疗方案；对照组98例给予尿激酶150万U静脉溶栓治疗方案。观察临床症状、心电图变化、心肌酶，比较两组再通率、4周内死亡率及不良反应发生率等。结果 研究组较对照组再通率高(P<0.05)，4周内死亡率及不良反应发生率均较对照组低(P<0.05)。结论 瑞替普酶是治疗急性心肌梗死高效、安全的静脉溶栓药物。
[关键词] 心肌梗死；静脉溶栓 ；瑞替普酶
[中图分类号] R542.2 [文献标识码] B [文章编号]1673-9701(2011)24-87-02
Effect of Reteplase in Treatment of Patients with Acute Myocardial Infarction： A Clinical Observations of 108 Cases
GU Sanming CUI Yan
Linyi Municipal Lanshan District People’s Hospital，Linyi 276000，China
[Abstract] Objective To explore the curative effect and safety of Reteplase(r-PA) in the treatment of Patients with acute myocardial infarction(AMI). Methods Two hundreds and six patients comply with the standards were randomly divided into research group of 108 cases accepted reteplase 10mU+10mU intravenous thrombolytic therapy and control group of 98 cases accepted urokinase 1.5 million units intravenous thrombolytic therapy. The clinical symptoms，ECG changes， myocardial enzymes were observe. The reperfusion rate ，the mortality rate within 4 weeks and the incidence of adverse reactions of the two groups were compared. Results The reperfusion rate in the research group was higher then in the control group(P<0.05)，The research group had less mortality rate within 4 weeks and slight side effects than the control group(P<0.05). Conclusion Reteplase is an ideal intravenous thrombolytic medicine having notable curative effect， higher safety in the treatment of AMI.
[Key words] Myocardial infarction；Intravenous thrombolytic therapy；Reteplase
急性心肌梗死是冠心病的危重类型，发病急、病死率高。及早再通闭塞的冠状动脉，使心肌得到再灌注，挽救濒死心肌和缩小心肌梗死的范围是治疗AMI的关键。早期静脉溶栓和经皮冠状动脉介入(PCI)治疗是心肌再灌注的有效措施。基层医院因条件限制无法实施PCI治疗，静脉溶栓治疗成为AMI再灌注常规疗法。我院采用瑞替普酶静脉溶栓治疗AMI 108例，并与同期使用尿激酶治疗的98例对照，现报道如下。
1 资料与方法
1.1 入选标准
①持续性胸痛超过30min，含服硝酸甘油片症状不能缓解；②相邻两个或更多导联ST段抬高>0.2mV；③发病6h以内，若超过6h，患者仍有胸痛并且ST段抬高导联有R波者；④年龄在70岁以下者[1]；⑤无溶栓禁忌证；⑥患者家属同意并签字。
1.2 排除标准
①2周内有活动性出血，做过外科手术，活体组织检查，心肺复苏术后，不能实施压迫的血管穿刺，以及外伤史者；②高血压病患者血压>180/110mmHg，或不能排除主动脉夹层分离者；③有出血性脑血管病史，或半年内有缺血性脑血管病史者；④对扩容和升压药无反应的休克；⑤妊娠、感染性心内膜炎、二尖瓣病变合并房颤且高度怀疑左心房内有血栓者 ；⑥糖尿病合并视网膜病变者；⑦出血性疾病或有出血性倾向者 ......
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