300万U尿激酶溶栓治疗急性心肌梗塞231例的临床初步总结The report on thrombolytic therapy using 300 million U urokinase in 231 cases with acute myocardial infarction
张言镇,郭松鹏,蔡跃红,赵新祥,坚永彬,吴玉萍,李秀云,陈立辉
摘要(Abstract)：
目的为观察３００万Ｕ尿激酶（ＵＫ，由广州天普洛欣生物制品厂生产）静脉溶栓治疗急性心肌梗塞（ＡＭＩ）的临床疗效和安全性。方法对６１１例ＡＭＩ患者进行ＵＫ静脉溶栓治疗，Ｂｏｌｕｓ法给药。随机分为Ａ组（３００万Ｕ）、Ｂ组（２５０万Ｕ）和Ｃ组（１５～２００万Ｕ）。对比观察三组患者临床疗效、副作用、５周病死率、左室射血分数（ＥＦ）、再通时间、各种严重并发症发生率和心肌断层显像（ＳＰＥＣＴ）及心肌缺血面积（ＩＭＡ）定量分析。结果按临床判定标准，Ａ组和Ｂ组梗塞相关血管（ＩＲＡ）再通率各为８１．８％和７４．１％，均显著高于Ｃ组（６９．０％，Ｐ＜０．０１，０．０５）。三组５周病死率分别为３．０３％、４．１５％和８．５６％，Ａ组显著降低（Ｐ＜０．０５）。Ａ组和Ｂ组比Ｃ组轻度出血和中重度出血发生率略有增高，但差异无显著性（Ｐ＞０．０５），三组均未发生脑出血。Ａ组和Ｂ组ＥＦ≥５０％者所占比率显著增高Ｃ组。Ａ组各种严重并发症发生率均显著降低（Ｐ＜０．０５或０．０１）。Ａ组和Ｂ组再通时间均显著缩短［（９９．６３±９．２４）ｍｉｎ对（１５２．６１±１０．９２）ｍｉｎ，Ｐ＜０．００１；（１１２．２１±７．２２）ｍｉｎ对（１５２．６１±１０
关键词(KeyWords)： 心肌梗塞; 溶栓疗法; 尿激酶; 大剂量
基金项目(Foundation):
作者(Author): 张言镇,郭松鹏,蔡跃红,赵新祥,坚永彬,吴玉萍,李秀云,陈立辉
参考文献(References)：
- 1丁文惠,张钧华,胡大一,等.不同溶栓药物和剂量治疗急性心肌梗塞239例对比分析.中华心血管病杂志,1997,25:277-279.
- 2中华心血管病杂志编委会.急性心肌梗塞溶栓疗法参考方案.中华心血管病杂志,1992,24;328-329.
- 3 AHA/ACC Task. Force Report. Guidelines for clinicaluse of cardiac radionuclide imaging. Circulation, 1995,91: 1278-1285.
- 4 Sinusas AJ, Trautman KA, Bergin JD, et al. Quantification of area at risk during coronary occlusion and degree of myocardial salvage after reperfusion with ~99mTc Methoxy isobutyl isonitrile. Circulation, 1990, 82: 1324-1328.
- 5 The Gusto investigators. An international randomizedtrial comparing four thrombolytic strategies for acutemyocardial infarction. N Engl J Med, 1993, 329: 673.
- 6 Wall TC, Phillips HR, Stack RS, et al. Results of highdose intravenous urokinase for acute myocardial infarction. Am J Cardiol, 1990, 65: 124-128.
- 7 Braunwald E, Kloner RA. The stunned myocardium:prolonged, post-ischemic ventricular dysfunction. Circulation, 1982, 66: 146.
- 8 Beanlands RSB, Dawood F, Wen WH, et al. Are theKinetics of ~99mTc methoxy isobutyl isonitrile affected bycell metabolism and viability? Circulation, 1990, 82:1802~1807.