再灌注治疗急性心肌梗塞的临床评价(摘要)
作者：骆秉铨 王人彭 吴良金 王彦炯 傅强 张义勤
单位：江苏省，徐州市心血管病研究所(221009) 骆秉铨 王人彭 吴良金；江苏省，徐州市第四人民医院 王彦炯 傅 强 张义勤
关键词：
中国循环杂志99zk81 目的：比较急性心肌梗塞(AMI)的尿激酶溶栓、尿激酶加肝素和经皮冠状动脉腔内成形术(PTCA)3种再灌注治疗方法的临床效果及其应用价值，将为AMI现代治疗提供经验。
方法：选择缺血性胸痛开始7小时内或12小时内仍有胸痛的AMI病人483例，进行再灌注治疗，分为3个亚组：尿激酶组(100～150万U)143例，尿激酶加肝素组(750 U/h×48 d)254例，急诊PTCA组(直接14例，补救7例)21例，另设常规治疗对照组65例。以梗塞相关动脉再通、再梗塞、心功能不全、死亡和出血并发症5项指标评价疗效。
, http://www.100md.com
结果及结论：①尿激酶溶栓治疗组：与对照组比较，提高梗塞相关冠状动脉再通率(63.6%对16.9%)，减少心力衰竭(16.8%对23.1%)，降低死亡率(5.5%对10.7%)，但有出血并发症(5.5%对0)。②尿激酶加肝素组：有利于防治再梗塞(7.1%对17.5%)，减少心功能不全(8.2%对16.8%)，在ACT监测下使用，并不增加出血(6.7%对5.5%)。③PTCA治疗组明显提高梗塞血管再通率(90.4%对69.2%)，避免出血并发症(0%对6.7%)，并有利于改善AMI后左心室重构(左心室内径缩小)。④AMI伴左主干病变，早期溶栓加择期冠状动脉旁路移植术(CABG)效果满意。⑤70岁以上AMI病人尿激酶减量(50～100万U)溶栓治疗，得益于早期再灌注，降低病死率(9.3%对18.7%)。⑥溶栓疗法的限制：43%的病人未达到完全灌流(心肌梗塞溶栓治疗临床试验3级)；62%的病人存在中重度残留狭窄；39%的病人失去再灌注时机。
Clinical Assessment of Reperfusion Therapy in 483 Patients with Acute Myocardial Infarction (Abstract)
, 百拇医药
Xuzhou Institute of Cardiovascular Disease, Xuzhou (221009), Jiangsu
Luo Bingquan, Wang Yanjiong, Wang Renpeng, et al.
Objective: To assess the clinical efficacy and value of three different reperfusion therapy, including intravenous urokinase (UK), UK combined heparin, and percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI).
Methods: Four hundred and eighty three of patients with AMI were devided into three groups, of them 143 were treated with UK, 254 with UK combined heparin, and 21 with PTCA, other 65 with usual treatment as controls. Five indexes were observed.
, http://www.100md.com
Results and Conclusions: ① Compared with controls, the patency rate of IRA elevated (63.6% vs. 16.9%), the heart failure reduced (16.8% vs. 23.1%) and the mortality declined (5.5% vs. 10.7%), but bleeding complications were higher (5.5% vs. 0) in thrombolytic therapy with UK. ② Therapy with UK combined heparin was beneficial to prevent anid treat reinfarction (7.1% vs. 17.5%), lower heart failure (8.2% vs. 16.8%), and the hemorrhage is not increased (6.7% vs. 5.5%) during ACT monitoring. ③ PTCA groups could increase patency rate of IRA (90.4% vs. 69.2%), reduce hemorrhage complications and improve left ventricular remodeling after AMI. ④ Primary early effective thrombolysis combined with elective CABG had good efficacy in AMI with left main lesions. ⑤ Aged over 70 years old with UK should reduce dosages, early reperfusion could lower mrtality. ⑥ Limitations of thrombolytic therapy: 43% patients could not restored complete onward flow (TIMI 3), 62% left residual narrow (moderate or severe degree) 39% losed the chance of reperfusion., 百拇医药
单位：江苏省，徐州市心血管病研究所(221009) 骆秉铨 王人彭 吴良金；江苏省，徐州市第四人民医院 王彦炯 傅 强 张义勤
关键词：
中国循环杂志99zk81 目的：比较急性心肌梗塞(AMI)的尿激酶溶栓、尿激酶加肝素和经皮冠状动脉腔内成形术(PTCA)3种再灌注治疗方法的临床效果及其应用价值，将为AMI现代治疗提供经验。
方法：选择缺血性胸痛开始7小时内或12小时内仍有胸痛的AMI病人483例，进行再灌注治疗，分为3个亚组：尿激酶组(100～150万U)143例，尿激酶加肝素组(750 U/h×48 d)254例，急诊PTCA组(直接14例，补救7例)21例，另设常规治疗对照组65例。以梗塞相关动脉再通、再梗塞、心功能不全、死亡和出血并发症5项指标评价疗效。
, http://www.100md.com
结果及结论：①尿激酶溶栓治疗组：与对照组比较，提高梗塞相关冠状动脉再通率(63.6%对16.9%)，减少心力衰竭(16.8%对23.1%)，降低死亡率(5.5%对10.7%)，但有出血并发症(5.5%对0)。②尿激酶加肝素组：有利于防治再梗塞(7.1%对17.5%)，减少心功能不全(8.2%对16.8%)，在ACT监测下使用，并不增加出血(6.7%对5.5%)。③PTCA治疗组明显提高梗塞血管再通率(90.4%对69.2%)，避免出血并发症(0%对6.7%)，并有利于改善AMI后左心室重构(左心室内径缩小)。④AMI伴左主干病变，早期溶栓加择期冠状动脉旁路移植术(CABG)效果满意。⑤70岁以上AMI病人尿激酶减量(50～100万U)溶栓治疗，得益于早期再灌注，降低病死率(9.3%对18.7%)。⑥溶栓疗法的限制：43%的病人未达到完全灌流(心肌梗塞溶栓治疗临床试验3级)；62%的病人存在中重度残留狭窄；39%的病人失去再灌注时机。
Clinical Assessment of Reperfusion Therapy in 483 Patients with Acute Myocardial Infarction (Abstract)
, 百拇医药
Xuzhou Institute of Cardiovascular Disease, Xuzhou (221009), Jiangsu
Luo Bingquan, Wang Yanjiong, Wang Renpeng, et al.
Objective: To assess the clinical efficacy and value of three different reperfusion therapy, including intravenous urokinase (UK), UK combined heparin, and percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI).
Methods: Four hundred and eighty three of patients with AMI were devided into three groups, of them 143 were treated with UK, 254 with UK combined heparin, and 21 with PTCA, other 65 with usual treatment as controls. Five indexes were observed.
, http://www.100md.com
Results and Conclusions: ① Compared with controls, the patency rate of IRA elevated (63.6% vs. 16.9%), the heart failure reduced (16.8% vs. 23.1%) and the mortality declined (5.5% vs. 10.7%), but bleeding complications were higher (5.5% vs. 0) in thrombolytic therapy with UK. ② Therapy with UK combined heparin was beneficial to prevent anid treat reinfarction (7.1% vs. 17.5%), lower heart failure (8.2% vs. 16.8%), and the hemorrhage is not increased (6.7% vs. 5.5%) during ACT monitoring. ③ PTCA groups could increase patency rate of IRA (90.4% vs. 69.2%), reduce hemorrhage complications and improve left ventricular remodeling after AMI. ④ Primary early effective thrombolysis combined with elective CABG had good efficacy in AMI with left main lesions. ⑤ Aged over 70 years old with UK should reduce dosages, early reperfusion could lower mrtality. ⑥ Limitations of thrombolytic therapy: 43% patients could not restored complete onward flow (TIMI 3), 62% left residual narrow (moderate or severe degree) 39% losed the chance of reperfusion., 百拇医药